HCFI Dr KK Aggarwal Research Fund

With inputs from Dr Monica Vasudev

Capillary leakage syndrome, a new side effect of AstraZeneca Covid-19 vaccine

Capillary leak syndrome has been identified as a new side effect of the AstraZeneca vaccine The Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA). The committee reviewed 6 such cases in people who had received the AstraZeneca vaccine. Most of these cases were in women and occurred within 4 days of vaccination. Three patients had a history of capillary leak syndrome and one of them subsequently died.

The safety committee has cautioned against using this vaccine in people with known history of capillary leak syndrome and concluded that capillary leak syndrome should be added to the product information as a new side effect of the vaccine, together with a warning to raise awareness among healthcare professionals and patients of this risk.

Capillary leak syndrome is a very rare, serious condition that causes fluid leakage from capillaries resulting in swelling mainly in the arms and legs, low blood pressure, thickening of the blood and low serum albumin. Immediate medical attention should be sought if there is rapid swelling of the arms and legs or sudden weight gain in the days following vaccination, along with feeling faint.

(Source: EMA, 11/06/2021)

Improved outcomes with mavrilimumab in patients with severe COVID-19 pneumonia

A phase 2 study (LB0001) presented at the annual European Congress of Rheumatology has shown that mavrilimumab improves outcomes in non-mechanically-ventilated patients with severe covid-19 pneumonia and systemic hyperinflammation.  A single infusion of mavrilimumab reduced progression to mechanical ventilation and improved survival. All patients received the local standard of care (steroids, remdesivir).

No differences in outcomes were observed between the two doses (10 mg/kg and 6 mg/kg). Mavrilimumab is an inhibitor of granulocyte/macrophage–colony stimulating factor (GM-CSF), a cytokine which is vital to lung homeostasis and also important in regulating inflammation and autoimmunity.

• At day 29, the proportion of patients alive and free of mechanical ventilation was 12.3 percentage points higher with mavrilimumab (86.7%) vs placebo (74.4%). 
• Mavrilimumab recipients experienced a 65% reduction in the risk of mechanical ventilation or death through Day 29 (Hazard Ratio (HR) = 0.35; p=0.0175). 
• Day 29 mortality was 12.5 percentage points lower with mavrilimumab (8%) vs placebo (20.5%).
• Mavrilimumab recipients had a 61% reduction in risk of death through Day 29 (HR= 0.39; p=0.0726). 
• Fewer adverse events (including secondary infections and thrombotic events) were reported in mavrilimumab-treated patients. Thrombotic events occurred only in the placebo group (5/40 [12.5%]).

(Pupim L, et al. Annals of Rheumatic Diseases, 2021)

New “game-changing” antibody tests to detect exposure to new COVID-19 variants 

New antibody tests to detect antibody responses to infection by new variants of SARS-CoV-2 virus has been developed by scientists at the University of Aberdeen, in collaboration with biotechnology group Vertebrate Antibodies Ltd and NHS Grampian. The test accuracy is more than 98% and specificity is 100%. The currently available tests have an accuracy of around 60-93% and they also cannot detect the new variants. The new tests can be used 

• To estimate the prevalence of circulating variant strains in the community, including the Alpha and Delta variants. 
• To evaluate the long-term immunity of the person and whether immunity is vaccine-induced or is a result of previous infection.

Professor Mirela Delibegovic from the University of Aberdeen and academic lead on the project explains: "Accurate antibody tests will become increasingly important in the management of the pandemic and this is a truly game-changing technology with the potential to dramatically change the trajectory of global recovery from the pandemic."

(Source: Medical Express.com)

HCFI Dr KK Aggarwal Research Fund

Coronavirus Updates 

With inputs from Dr Monica Vasudev 

The emerging Delta plus variant

Around 40 cases of the “Delta plus” coronavirus variant have been reported in India. This new variant is a sub-lineage of the Delta variant first detected in India and has acquired the spike protein K417N mutation. “The mutation K417N has been of interest as it is present in the Beta variant (B.1.351 lineage), which was reported to have immune evasion property,” Indias health ministry said in a statement.

In India, Maharashtra reported the first case of delta plus variant in the country. Madhya Pradesh, Kerala, Karnataka, Tamil Nadu and J&K are the other states that have reported this new variant. On Thursday (June 24), Madhya Pradesh also reported the first Delta Plus death. ICMR is examining the efficacy of the vaccines available in the country against the Delta plus variant.  Indias health ministry has cautioned that regions where it has been found "may need to enhance their public health response by focusing on surveillance, enhanced testing, quick contact-tracing and priority vaccination."

As of June 16, the delta plus variant has been reported in 11 countries, as of June 1 - Britain (36), Canada (1), India (8), Japan (15), Nepal (3), Poland (9), Portugal (22), Russia (1), Switzerland (18), Turkey (1), and the United States (83).

“WHO is tracking this variant as part of the Delta variant, as we are doing for other Variants of Concern with additional. For the moment, this variant does not seem to be common, currently accounting for only a small fraction of the Delta sequences ... Delta and other circulating Variants of Concern remain a higher public health risk as they have demonstrated increases in transmission,” said the WHO in a statement to Reuters. (Source: Reuters, HT, TOI, June 23-24, 2021)

 Delta Covid variant is fast becoming the predominant global variant

 “The Delta variant is well on its way to becoming the dominant variant globally because of its increased transmissibility,” said Dr SoumyaSwaminathan at a news conference. Britain has reported a steep rise in infections with the Delta variant, while Germanys top public health official predicted it would rapidly become the dominant variant there despite rising vaccination rates. Record new infections in Moscow are also mostly with the new Delta variant, fanning fears of a third wave.

Recent research from the UK suggests the Delta variant may be up to 60% more transmissible than the Alpha variant, which originally emerged in the UK in 2020 and has since become dominant in the U.S. and many other countries. (Source: Medscape)

Older IBD patients with Covid-19 at higher risk of VTE

Older men with inflammatory bowel disease (IBD) are at an 8-fold higher risk of developing venous thromboembolism (VTE) after developing COVID-19 (OR 8.15, 95% CI 4.34-15.30, P<0.001).

A case crossover study examined data on IBD patients (n=428, average age 69 years) from the VA healthcare system who reported a VTE event from April 1, 2020 to March 30, 2021. 54% had a diagnosis of ulcerative colitis, while 46% had been diagnosed with Crohns disease. Half of the patients were taking 5-aminosalicylic acid.  Hypertension (58%), diabetes mellitus (31%) and arrhythmia (20%) were the most common pre-existing conditions; 31% patients reported chronic anticoagulant use.

The percentage of participants who developed Covid-19 was 13.6%. Out of these, 21 patients acquired the infection within 30 days before experiencing VTE. The risk of VTE was found to be considerably higher in patients who were not taking anticoagulant medications prior to COVID-19 infection (OR 14.31, 95% CI 6.90-29.66, P<0.001). These patients were therefore likely to benefit from prophylaxis. (Source: Medscape)

US FDA will add warning about myocarditis risk following mRNA Covid vaccination

The US FDA will add a warning statement about the risk of myocarditis or pericarditis following mRNA Covid vaccination that states "these events have occurred in some recipients following dose 2, onset of symptoms was several days to a week" and based on limited follow-up, "most cases had a resolution of symptoms."

This action follows on the reported cases of myocarditis in young people, aged 12 to 39 years, who received mRNA COVID-19 vaccines. Rates were highest among boys and younger men. The side effect was rare, but when it occurred, it was typically within a week of vaccination. The estimated rate is 12.6 cases per million within 3 weeks of a second dose of either Pfizers or Modernas mRNA vaccine

(Source: Medpage Today)

HCFI Dr KK Aggarwal Research Fund

With inputs from Dr Monica Vasudev

Delta variant spreads by cell-to-cell fusion

Compared to the spike protein on earlier versions of the coronavirus, the spike on the Delta variant is better able to break into lung cells and fuse them together, according to a preprint posted on BioRxiv.

Spread by cell-to-cell fusion allows the virus to spread faster in infected people and partially hide from the immune system. And by spreading via cell-to-cell fusion, the virus reduces its risk of encountering immune system cells that might attack and inactivate it, said Markus Hoffman of Georg-August-University Göttingen in Germany, co-author of the study. These "skills" might make the Delta variant more transmissible, and the resulting illness more severe. It was also found that although the Delta variant can evade antibodies, it is not completely resistant (Source: Medscape).

Germany strongly recommends mixing of Covid-19 vaccines

Germany has become one of the first countries to make a strong recommendation for the mixing of Covid-19 vaccines on the basis of efficacy. On Thursday, the German Standing Committee on Vaccination (STIKO) said that people who receive a first dose of the Oxford-AstraZeneca vaccine “should get an mRNA vaccine as their second dose, regardless of their age.” STIKO said that "current study results" show that the immune response generated after a mixed dose vaccination "is clearly superior." (Source: CNN)

Sickle cell disease patients with history of pain are at risk of severe Covid-19

Patients with sickle cell disease (SCD) who have a history of disease-related comorbidities were found to be at greater risk for worse COVID-19 outcomes. A new study published in the journal Blood Advances has shown that children were more likely to require hospital admission for Covid19, if they had frequent prior acute care visits for pain (relative risk [RR] 2.15, P<0.0001), as well as sickle cell disease-related heart and lung comorbidities (RR 1.61, P=0.0001).

• Prior acute care visits for pain were the most common sickle cell disease-related comorbidity among both children (55.5%) and adults (78.5%).
• History of pain was also found to be a risk factor for hospitalization in adults (RR 1.78, P=0.002).
• Children with a history of pain (RR 3.09, P=0.009), SCD-related heart and lung comorbidities (RR 1.76, P=0.03), and SCD-related renal comorbidities (RR 3.67, P<0.0001) were at a higher risk of developing serious Covid illness.

The researchers said, “SCD is a chronic inflammatory disease. An infection like COVID-19 that targets the lungs can lead to decreased oxygenation and blood hypoxia, which promotes sickling, vaso-occlusive episodes and pain.” Patients at high risk should consider vaccination (Source: Medpage Today, July 1, 2021)

Repurposing hepatitis C antiviral drugs as possible treatment of Covid-19

An antiviral combination Sofosbuvir/ledipasvir used to treat hepatitis C infection and an antiprotozoal drug nitazoxanide may eliminate SARS-CoV-2, according to preliminary results presented at the International Liver Congress 2021. Sofosbuvir/ledipasvir was particularly efficacious. Molecular docking studies, which use computation to find ligands that bind to proteins, suggested that both sofosbuvir/ledipasvir and nitazoxanide might block key proteins in SARS-CoV-2.

The study grouped 190 patients with mild and moderate COVID-19 infections into three groups. One group was given sofosbuvir/ledipasvir, another group also received nitazoxanide. All the three groups received also standard care. The effect of sofosbuvir/ledipasvir appeared within 5 days and viral clearance was achieved in most patients within 2 weeks. Nitazoxanide had a weaker effect but still appeared to achieve a benefit. No serious adverse events or mortality was recorded (Source: Medscape)

With inputs from Dr Monica Vasudev

Tokyo Olympics to be held sans spectators due to surge in delta variant cases

The Tokyo Olympics will be held as scheduled. However, the Games will take place without spectators, according to the organisers, following declaration of a state of emergency in the city in the wake of the rapidly spreading delta variant of Covid-19, which will continue throughout the Games. People will also be asked not to gather for events on public roads, such as the triathlon, though officials said some venues outside the greater Tokyo metropolitan area would allow small numbers of spectators. The Games are due to start on July 23 and will end on August 8 (Source: Medscape).

Fitbit and other wearable devices can assess prolonged physiological changes post-Covid-19

Fitbit detected lasting physiologic effects in Covid-19 patients following their recovery from the infection, according to early data from the ongoing DETECT (Digital Engagement and Tracking for Early Control and Treatment) study that is evaluating the use of Fitbit and other wearable devices to assess prolonged physiological and behavioral changes associated with Covid-19. The study was published online July 7 in JAMA Network Open. The study found “a prolonged physiological impact of COVID-19 infection, lasting approximately 2 to 3 months, on average, but with substantial intraindividual variability, which may reflect various levels of autonomic nervous system dysfunction or potentially ongoing inflammation”.

Individuals with COVID-19 took longer to return to their resting heart rate (RHR), sleep and activity baselines vs symptomatic individuals who were Covid-19 negative. This difference was most marked for RHR, with COVID-19–positive individuals initially experiencing a transient bradycardia followed by a prolonged relative tachycardia that did not return to baseline, on average, until 79 days after symptom onset. Step count and sleep quantity returned to baseline sooner than RHR at 32 and 24 days, respectively (Source: Fitbit stats show lingering physiologic hit after COVID-19 - Medscape - Jul 08, 2021; JAMA Netw Open. 2021;4(7):e2115959)

IL-6 inhibitors reduce mortality in patients with severe or critical Covid-19

Findings from a prospective meta-analysis of 27 randomized trials included almost 11,000 patients show that administration of IL-6 antagonists, compared with usual care or placebo, was associated with lower 28-day all-cause mortality in patients hospitalized for COVID-19. According to the WHO analysis, the risk of dying within 28 days for patients getting one of the arthritis drugs with corticosteroids such as dexamethasone is 21%, compared with an assumed 25% risk among those who got standard care. For every 100 such patients, four more will survive, the WHO said. Moreover, the risk of progressing to mechanical ventilation or death was 26% for those getting the drugs and corticosteroids, compared with 33% in those getting standard care.

On Tuesday (July 6), the WHO has made a strong recommendation to use IL-6 receptor blockers (tocilizumab or sarilumab) in patients with severe or critical COVID-19.

Asymptomatic or mild Covid-19 generate effective and durable neutralising antibody response in children and adolescents

Children and adolescents with asymptomatic or mild symptomatic SARS‑CoV‑2 infection mount “broad, effective, and durable” antibody responses that exhibit “robust” viral neutralising activity for at least 4 months after acute infection. The study published in JCI Insight evaluated humoral immune responses in 69 children and adolescents with asymptomatic or mild symptomatic SARS-CoV-2 infection.

• These antibody responses were associated with virus neutralizing activity that was still detectable 4 months after acute infection in 94% of children.
• Antibody responses and neutralizing activity in sera from children and adolescents were comparable or superior to those observed in sera from 24 adults with mild symptomatic infection

“Our findings suggest that children and adolescents develop effective humoral immune responses irrespective of illness severity that are likely to contribute to protection against reinfection, thereby contributing to the establishment of herd immunity,” said the authors (DG Alerts, July 7, 2021).

With inputs from Dr Monica Vasudev

Covid cluster in hotel for Olympic players as cases surge in Tokyo

A cluster of Covid-19 cases has been identified at a hotel where the Brazilian Olympic team is staying. Also, Tokyo recorded 1149 new Covid-19 cases on Wednesday, the highest number of daily cases in six months. Seven staff at the hotel in Hamamatsu city, southwest of Tokyo, had tested positive for the coronavirus. These infections point out the risk of hosting the Olympics during the pandemic, even if is held without spectators. The Russian womens rugby team were also in isolation after their masseur tested positive for COVID-19, as was part of the South African mens rugby team after a case on their inbound flight. A state of emergency has been imposed in Tokyo till 8th August, when the Olympic Games will come to a close (Medscape, July 15, 2021)

US FDA cautions about increased risk of Guillain-Barré Syndrome with J&J Covid-19 Vaccine

The US FDA has revised the Janssen COVID-19 vaccine fact sheet for healthcare providers administering vaccine (vaccination providers) and for recipients and caregivers to include a warning about increased risk of Guillain-Barré Syndrome following vaccination.

The Fact Sheet for Recipients and Caregivers notes that vaccine recipients should seek medical attention right away if they develop any of the following symptoms after receiving the Janssen COVID-19 Vaccine: weakness or tingling sensations, especially in the legs or arms, that’s worsening and spreading to other parts of the body; difficulty walking; difficulty with facial movements, including speaking, chewing or swallowing; double vision or inability to move eyes; or difficulty with bladder control or bowel function... (Source: US FDA, July 13, 2021)

Beta variant may also be more transmissible

The second wave of Covid-19 in South Africa, primarily driven by the Beta variant (B.1.351) recorded a dramatic increase in the number of cases compared to the first wave (240.4 per 100,000 people vs 136 per 100,000, respectively), hospital admissions (27.9 per 100,000 vs 16.1 per 100,000) and deaths (8.3 per 100,000 vs 3.6 per 100,000), as per a study in The Lancet Global Health.. A multivariable analysis of the second wave showed a 31% increased risk of in-hospital death (adjusted OR 1.31, 95% CI 1.28-1.35). Mortality was particularly high when the hospitals were stretched to their capacity. According to the authors, the beta variant binds more strongly to the ACE2 receptors thereby increasing the risk of transmission (Medpage Today, July 12, 2021).

Joint CDC and FDA Statement on Vaccine Boosters

In a joint statement, the CDC and the US FDA have said that “Americans who have been fully vaccinated do not need a booster shot at this time. FDA, CDC, and NIH are engaged in a science-based, rigorous process to consider whether or when a booster might be necessary. This process takes into account laboratory data, clinical trial data, and cohort data – which can include data from specific pharmaceutical companies, but does not rely on those data exclusively. We continue to review any new data as it becomes available and will keep the public informed. We are prepared for booster doses if and when the science demonstrates that they are needed” (Source: CDC).

With inputs from Dr Monica Vasudev

Do not ignore atypical symptoms in older adults with severe Covid-19

A study reported in the Journals of Gerontology: Series A, over a third of older adults who were hospitalized with COVID-19 during the early months of the pandemic had an atypical presentation, with a mix of typical and atypical symptoms. Almost a quarter of patients ages 65 and older presented with functional decline, while 11.3% presented with altered mental status and around 9% had gastrointestinal symptom. Among those with an atypical presentation, 49% presented with atypical symptoms only. But, patients with typical symptoms were 1.39 times more likely to be admitted to the ICU than those with atypical symptoms.

Study author, Allison Marziliano, PhD, from the Feinstein Institutes for Medical Research in Manhasset, New York said, “While we found that atypical presentation in older adults does not necessitate the same need for ICU-level care as typical presentation (often characterized by respiratory distress), it must not be dismissed, as those presenting atypically have just as poor short-term outcomes of hospital length of stay, 30-day readmission and hospital mortality as those older adults presenting typically”... (MedPage Today July 22, 2021)

Sequential contralateral facial nerve palsies in the same patient after Covid vaccine

BMJ Case Reports has described the case of a 61-year-old man, who developed two discrete contralateral facial palsies after each dose of the Pfizer-BioNTech vaccine. The patient initially developed right-sided facial weakness 5 hours after taking the first dose of the Pfizer-BioNTech vaccine. The second episode occurred 2 days after the second dose and the patient developed more severe left-sided facial nerve palsy. On both occasions, the patient was diagnosed with Bells palsy.

“The occurrence of the episodes immediately after each vaccine dose strongly suggests that the Bells palsy was attributed to the Pfizer-BioNTech vaccine, although a causal relationship cannot be established,” the researchers wrote ... (MedPage Today July 19, 2021)

Some countries are adopting the mix-and-match Covid vaccines strategy

While the data remain preliminary, some countries are moving ahead with mixing and matching mRNA and adenoviral vector COVID-19 vaccines, often driven by supply challenges. Germany has recently made an official recommendation to mix-and-match, encouraging citizens to follow their AstraZeneca shots with a dose of an mRNA vaccine. Chancellor Angela Merkel led the way by following her initial AstraZeneca dose with a shot of Moderna in June. Other countries like Canada and Thailand have started administering vaccines on a heterologous schedule.

The European Medicines Agency (EMA) and the European Centre for Disease Prevention and Control (ECDC) have not issued any specific recommendations, but say in a press release that the approach "may allow populations to be protected more quickly and make better use of available vaccine supplies." Neither the World Health Organization (WHO) nor the CDC endorse the approach.

Journal retracts study on masks in children

JAMA Pediatrics has retracted a research letter “Experimental assessment of carbon dioxide content in inhaled air with or without face masks in healthy children: a randomized clinical trial” published online June 30, 2021, which suggested that children should not be forced to wear face masks as masks may harm children by exposing them to high carbon dioxide levels. The research letter had reported unacceptably high levels of carbon dioxide by German standards in air inside masks worn by children in a laboratory environment. In the retraction notice, the journal editors cited "numerous scientific issues," that also included questions over the applicability of the CO2 measurement device and the validity of the study conclusions.

CDC does not list any known risk to children from wearing face masks, and in fact, recently recommended that unvaccinated children wear masks when school reopens in the fall... (Medpage Today, July 16, 2021)

A different approach to reach the unvaccinated

Ozarks Healthcare, based in the city of West Plains, Missouri in the United States adopted a unique approach to encourage people to come forward to take the vaccine. They recently issued an impassioned plea for people to get vaccinated, even if it means doing so in secret. They offered to answer any questions about the vaccine and help with scheduling in a recent statement, addressing the local community. Notably, the health system added: “If you are afraid of walking into a public area where you might be seen getting your vaccine, we will work to accommodate even more of a private setting for you to receive your vaccine.”

With misinformation rampant and vaccination status largely divided by political lines, the concept of making a public appeal to offer the COVID vaccine in private seems to be a unique approach... (Medpage Today, July 16, 2021)

Israel approves a third dose of Pfizer vaccine for older adults

Israel has approved a third shot of Pfizers COVID-19 vaccine for citizens over 60 years of age, reports the Times of Israel (July 29, 2021). Booster doses of the vaccine will be given starting next week to those over age 60 who are more than five months after their second shot.

 EMA approves use of the COVID-19 vaccine Spikevax for children aged 12 to 17

The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has recommended granting an extension of indication for the COVID-19 vaccine Spikevax (previously COVID-19 Vaccine Moderna) to include use in children aged 12 to 17 years. The vaccine is already authorised for use in people aged ≥ 18years... (Source: EMA)

The case for a vaccine booster in kidney transplant patients

A JAMA research letter (published online July 23, 2021. doi:10.1001/jama.2021.12339) has suggested that a third dose of vaccine may be considered in kidney transplant recipients who show minimal serologic response to two doses of the Moderna (mRNA-1273) vaccine.

• The third dose generated a serologic response in 49% of kidney transplant recipients who did not respond after 2 doses of the vaccine.
• Patients who had a weak response after the second dose, were more likely to develop an antibody response after the third dose vs those did not have antibody response (81.3% vs 27.4%, respectively.
• Patients on tacrolimus, mycophenolate and steroids were 35% less likely to develop antibodies vis à vis other treatment regimens.

Delta variant as contagious as chickenpox

Internal Centers for Disease Control and Prevention (CDC) documents support the high transmission rate of the Delta variant and put the risk in easier to understand terms. A new MMWR report also shows high prevalence of delta variant and that Delta variant likely causes more severe COVID-19 illness. In July 2021, following multiple large public events in a Barnstable County, Massachusetts, town, 469 COVID-19 cases were identified among Massachusetts residents who had traveled to the town during July 3–17; 346 (74%) occurred in fully vaccinated persons. Testing identified the Delta variant in 90% of specimens from 133 patients (Source: Medscape, MMWR Morb Mortal Wkly Rep. ePub: 30 July 2021)

Safety of vaccine in pregnancy

As per a pre-proof in the Journal of Allergy and Clinical Immunology, over 128,306 pregnant patients have received the vaccine (Pfizer and Moderna) and registered with the CDC V-safe program. In 827 completed pregnancies, there were no adverse outcomes miscarriage, preterm birth, small for gestational age and neonatal death when compared to data prior to the COVID-19 pandemic. The benefits of these vaccines may outweigh the risks of COVID-19 disease in pregnancy and in the postpartum period (Source:  Journal of Allergy and Clinical Immunology (2021), doi: https://doi.org/10.1016/j.jaci.2021.07.013)

CanSinoBIOs Inhaled Covid vaccine produces similar immune response as the injectable vaccine

The Lancet Infectious Disease reports that an inhaled version of CanSino Biologics (CanSinoBIO) Covid-19 vaccine triggered immune responses without serious side effects. Two inhaled doses of the Ad5-nCoV vaccine, given 28 days apart, induced a similar level of antibodies to those of a single injection, but lower titers of neutralizing antibodies at day 28. This vaccine requires lower dosages than the injected version and could help CanSinoBIO boost its production capacity... (Source: Reuters, July 28, 2021)

(With inputs from Dr Monica Vasudev)

Dr Veena Aggarwal

Consultant Womens’ Health

MD and Chairperson, IJCP Group & Medtalks

Trustee, Dr KK’s Heart Care Foundation of India

COVID-19 is a risk factor for acute cardiovascular events

A Lancet study has suggested COVID-19 as an independent risk factor for acute myocardial infarction (MI) and ischemic stroke. A significant increase in the incidence of acute cardiovascular events was observed in the first week after onset of Covid-19. When Day 0 (day of exposure) was included, the risk of acute MI was found to increase eight times, while the risk of ischemic stroke increased six times in. A 3-fold rise in the incidence of acute MI and stroke was still observed even when Day 0 was excluded. The study analysed 86,742 patients in Sweden diagnosed with COVID-19 between February 1 and September 14, 2020. More than 300,000 matched control individuals were also included in the analysis.… (Source: Medscape, August 2, 2021)

Children too get long COVID

Most school-going children with Covid-19 have only mild disease and recover in around 6 days from their illness, with more than 98% recovering in 8 weeks. But, the symptoms like fatigue, headache, or loss of smell persisted in a small percentage of children pointing out the need for continuous care of children even post-Covid. These results from a large study of smartphone data from the UK has been published in The Lancet Child & Adolescent Health… (Medscape, August 6, 2021)

Antibody response to Covid-19 quickly declines in IBD patients

In a serosurveillance study from Canada published in the journal Gut, the antibody responses to COVID-19 in patients with inflammatory bowel disease were found to quickly decline in due course of time. This decrease was particularly notable more than 90 days after the infection. Up to 90 days after the diagnosis, 80.8% of IBD patients tested positive for nucleocapsid antibodies, but after 90 days, antibodies decreased to 21.7%. Seropositivity in IBD patients was 1% compared to 1.8% in the general population during the same time suggesting that the serological response postinfection was not as robust as the general population

Gilaad G. Kaplan, MD, from the University of Calgary in Canada said, “Many individuals with IBD are immunocompromised by their medical treatments. Moreover, immunosuppression may reduce the formation of antibodies to viruses such as SARS-CoV-2.” The study also emphasizes on the importance of vaccination in these patients.... (Source: Medpage Today, August 4, 2021)

Post-vaccine disease flares are rare in patients with rheumatic diseases

Patients with rheumatic and musculoskeletal diseases who had taken the Covid-19 vaccine rarely reported post-vaccine disease flares, in a prospective observational study reported in Arthritis & Rheumatology.

Around 11% of 1377 patients who were given two doses of mRNA vaccine while on immunomodulatory therapy reported disease flare that required treatment, but none of the flares were severe. Among the 151 patients who had a flare following vaccination, it was after the second dose in 60%. Worsening of pre-existing symptoms was reported by 91% and new-onset symptoms by 72%.The local and systemic reactions to the vaccine were common and expected.... (Source: Medpage Today, August 4, 2021)

Potential protective effects of Flu vaccine against SARS-CoV-2

A retrospective cohort analysis of 74,754 patients in PLoS One has shown that the influenza vaccine may provide vital protection against adverse outcomes caused by SARS-CoV-2. The analysis showed that the patients who received the influenza vaccine experienced decreased sepsis, fewer ICU admissions, fewer deep vein thrombosis (DVT) 60–120 days after positive test and fewer emergency department (ED) visits 90–120 days post SARS-CoV-2-positive diagnosis. These observations suggest a potential protective effect of influenza vaccination in SARS-CoV-2-positive patients against adverse outcomes... (PLoS One. 2021 Aug 3;16(8):e025554)

(With inputs from Dr Monica Vasudev)

Dr Veena Aggarwal

Consultant Womens’ Health

Trustee, Dr KK’s Heart Care Foundation of India

CMD and Editor-in-Chief, IJCP Group & Medtalks

Are two COVID vaccine doses necessary for all?

A research letter in JAMA Research published August 6, 2021 has suggested that one dose of vaccine may be adequate for people who have recovered from COVID-19. The small study of 59 people found that those with previous COVID-19 infection had higher antibody levels after one dose of Pfizer vaccine compared with infection-naive individuals after two doses. SARS-CoV-2 spike IgG levels did not increase after the second dose among those previously infected compared with the first dose.

CDC now recommends booster shot of mRNA vaccine for the immunocompromised

Following FDA’s authorisation for a booster shot for immunocompromised persons, the CDC now recommends that people whose immune systems are compromised moderately to severely should receive an additional dose of mRNA COVID-19 vaccine after the initial 2 doses. The additional dose should be the same vaccine as the initial series and administered at least 4 weeks after completing a primary mRNA COVID-19 vaccine series. The list includes people who have

• Been receiving active cancer treatment for tumors or cancers of the blood
• Received an organ transplant and are taking medicine to suppress the immune system
• Received a stem cell transplant within the last 2 years or are taking medicine to suppress the immune system
• Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
• Advanced or untreated HIV infection
• Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response

However, the CDC advises to follow all preventive measures wearing a mask, distancing of 6 feet from others and avoiding crowds and poorly ventilated indoor spaces to protect themselves.

Diagnostic features of vaccine-induced immune thrombocytopenia and thrombosis

A new UK prospective study of 220 confirmed cases of vaccine-induced immune thrombocytopenia and thrombosis (VITT) after having the first dose of the Oxford-AstraZeneca vaccine published in the New England Journal of Medicine, August 11, 2021 has identified five diagnostic criteria that are indicative of definite VITT.

• Time of presentation post-vaccination (5-30 days and not before, or ≤42 days in patients with isolated deep-vein thrombosis or pulmonary embolism)
• Low platelets (<150,000 per cu mm)
• Documented thrombosis
• Very raised D-dimers
• Presence of anti-platelet factor 4 antibodies

If all these criteria are met, it is a definite case of VITT. If one is not met, then the diagnosis is probable, if two are not met, then the diagnosis is possible and if ≥3 are not met than it is unlikely to be VITT and there could an alternative diagnosis. While the overall mortality was 23%, in patients with very low platelet counts (<30,000 per cu mm) and intracranial hemorrhage following thrombosis, the mortality increased to 73%... (NEJM, Medscape).

Continuing microscopic lung damage may explain the persistent breathing problems in long-COVID

A medRxiv preprint study has demonstrated that microscopic damage to the lungs many continue in long COVID, even several months after the initial infection and discharge from hospital. This may explain why some patients continue to have breathing problems for many months.

Examination of bronchoalveolar fluid from 38 patients who continued to experience breathing problems at least three months after they were discharged from hospital showed increase in cytotoxic lymphocytes (especially tissue resident CD8+ T cells), lactate dehydrogenase and albumin (biomarkers of cell death and barrier integrity) in COVID-19 survivors compared to healthy volunteers. These persistent abnormalities in the airway immune-proteome in the post-COVID19 airways correlate with ongoing epithelial damage … (medRxiv, posted August 10, 2021).

With inputs from Dr Monica Vasudev

With inputs from Dr Monica Vasudev

Unvaccinated Delta variant cases more likely to be hospitalized than alpha variant cases

Results of a study from the UK published in The Lancet Infectious Diseases show that COVID-19 patients infected with the Delta variant (B.1.617.2) had 2-folds greater risk of being hospitalized within 2 weeks of infection compared to patients who were infected with the Alpha variant (B.1.1.7). Nearly 6% of patients with the Delta variant required emergency care or were hospitalized within 14 days compared with 4.2% of patients with the Alpha variant. Almost three-quarters of patients requiring hospitalization were unvaccinated or had taken their first dose of vaccine in less than 21 days. However, the risk for hospitalization and the need for emergency care or hospitalization in the vaccinated persons were comparable between the two groups of the patients … (Source: Medpage Today, August 27, 2021)

CDC study shows COVID-19 vaccines less  effective against delta variant 

According to a new CDC study published earlier this week, the effectiveness of COVID-19 vaccine declined from more than 91% to 66% in the fully vaccinated as the delta variant became the predominant strain in the US indicating the highly contagious nature of the Delta variant. Between December 2020 and April 2021, the vaccines were about 90% effective in preventing symptomatic and asymptomatic infections. From April onwards to August, when delta variant became dominant, there were 19 infections among the 488 unvaccinated individuals, while there were 24 infections among 2352 fully vaccinated people …(Source: Medscape, August 25, 2021)

How long is long COVID? A new study says one year

A Lancet single-center study from Wuhan, China has shown that about 50% of patients hospitalized with COVID-19 had at least one symptom that persisted for a year after the infection. Although the percentage of patients who had at least one symptom decreased from 68% at 6 months to 49% at one year. The most common symptom was fatigue or muscle weakness. Anxiety or depression and dyspnea were also common symptoms at one year. The authors say, “To our knowledge, this is the largest longitudinal cohort study of hospital survivors with COVID-19 to describe the dynamic recovery of health consequences within 12 months after symptom onset.” (The Lancet, published August 28, 2021)

A new study to understand the responses to COVID-19 vaccine 

The UK Health Security Agency (UKHSA) will conduct a study to find out why some people get reinfections or infections after vaccination while others do not. It will also assess how long immunity from vaccinations lasts, how the timeline differs between the different vaccines and how changes in the SARS-CoV-2 virus’ genetic make-up might evade the immune response. The Public Health England (PHE) landmark SARS-CoV-2 immunity and reinfection evaluation (SIREN) study, together with a number of other research cohorts and partners including the Protective Immunity from T-Cells in Healthcare workers (PITCH) study, the Humoral Immune Correlates of COVID-19 (HICC), the Genotype to Phenotype (G2P) Consortium, GenOMICC and the Francis Crick Institute will assess participants’ detailed immune system response to COVID-19 infections and vaccinations… (Public Health England, August 26, 2021)

Inputs from Dr Monica Vasudev

Israel data supports booster doses, says Dr Anthony Fauci

“COVID booster shots are showing good efficacy in Israel,” said Anthony Fauci, MD, chief medical advisor to President Biden, said Thursday at a briefing held by the White House COVID-19 Response Team. The impact of the third dose has been published as a preprint study in medRxiv, which demonstrated the effectiveness of a third vaccine dose in both reducing transmission and severe disease. An 11.4-fold decline in the relative risk of confirmed infection, and a >10-fold reduction in the relative risk of severe illness was noted after 12 days of the booster dose. This study also indicates the great potential of curbing the resurgence of Delta variant by administering booster shots.

Israel has approved a booster dose for adults aged 60 years and older. A total of 1.1 million people were given the booster dose between July 30 and August 22… (Medpage Today, Sept. 2, 2021; medRxiv, August 31, 2021)

Fibro-COVID, a new post-Covid entity

RMD Open: Rheumatic & Musculoskeletal Diseases has reported fibromyalgia as a new symptom of post-acute COVID-19 or long COVID. Results from a web-based survey study from Italy show that 189 (30.7%) patients met the ACR survey criteria for a diagnosis of fibromyalgia at 6 months after Covid-19. Male gender and obesity were the strongest predictors of affect the risk of developing post-COVID-19 fibromyalgia. The authors write, “It is reasonable to expect that rheumatologists will soon face up with a sharp rise of cases of this new entity that we defined ‘FibroCOVID’…(Source: RMD Open 2021;7:e001735)

CDC Expert Panel unanimously recommends Pfizer vaccine for 16 years and older

A CDC expert panel has unanimously voted to recommend Pfizer-BioNTech COVID-19 vaccine for all US citizens aged 16 and older. The vaccine had been granted full approval by the US Food and Drug Administration (FDA) last week. However, the vaccine is still authorised for emergency use in the age group 12 to 15 years… (Source: Medscape, Aug. 30, 2021)

Delta variant increases risk of hospitalisation

As per a recent study from the UK published in The Lancet Infectious Diseases, people infected with the delta variant of SARS-CoV-2 double their risk of hospitalization when compared to patients with the alpha variant. 196 (2·3%) of patients with the delta variant were hospitalized versus 764 (2·2%) patients with the alpha variant within 14 days of test; 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days. Most infections in both groups were in individuals who had not taken the vaccine…(Source: The Lancet Infectious Diseases, Aug. 27, 2021).

With inputs from Dr Monica Vasudev

Masks prevent Covid-19 transmission

Universal masking and fewer encounters in close proximity to persons with Covid-19 can limit the spread of SARS-CoV-2 in university settings, according to a new CDC Morbidity and Mortality Weekly Report published September 10, 2021. Among nearly 400 close contacts of students who tested positive for SARS-CoV-2, the likelihood of a positive test result was more than five times higher in situations where at least one of the two individuals was unmasked versus situations where both were masked. Each additional exposure was associated with a 40% increase in odds of a positive test for SARS-CoV-2 (Source: MMWR, Medpage Today)

Chronic fatigue is the most persistent symptom in long Covid patients

Fatigue is the most common symptom of long Covid-19 and is the most persistent symptom in most patients, according to a study presented at the European Respiratory Society (ERS)s virtual annual meeting. Among 239 individuals belonging to online support groups for "long Covid," 178 (85%) said they had severe fatigue when surveyed 11 weeks after symptom onset. At week 24, 79% reported suffering from severe fatigue, with 15 of the 35 who said they had mild or no fatigue at week 11 now saying it was severe. By this time most had consulted at least one medical professional as well as one or more allied specialists such as physiotherapists, psychologists, or dietitians but derived no benefit…. (Medscape)

Some cancer drugs may have anti-SARS-CoV-2 activity

A study in JAMA Oncology has suggested that some cancer drugs such as TOR/PI3K inhibitors (everolimus, temsirolimus and alpelisib), antimetabolites (decitabine and gemcitabine), mitotic inhibitors (cabazitaxel), and other kinase inhibitors (dasatinib and crizotinib) may potentially be protective against SARS-CoV-2 infection by reducing the levels of angiotensin-converting enzyme 2 (ACE2). The study of 1701 cancer patients at the Memorial Sloane Kettering Center (MSKCC), New York City who underwent treatment with the abovementioned drugs were significantly less likely to test positive SARS-CoV-2 tests compared to patients who were taking other drugs (7% vs 12.9%). The authors suggest that these particular compounds may impair specific signaling pathways that SARS-CoV-2 needs to replicate, though further research is needed to explore and better understand these pathways…. (Source: Medscape)

COVID-19 vaccines positively impact mental health

A study in PLoS One reports that people who had taken just the first dose of the Covid-19 vaccine reported decrease in their mental stress. An analysis of survey data from 8,003 US adults collected between March 2020 and March 2021 showed similar levels of mental distress among the “ever vaccinated” and the “never vaccinated” groups until the vaccines started becoming available in December 2020. A reduction in 1 percentage point (4% reduction from the baseline level) in the probability of being at least mildly depressed, and of 0.7 percentage points (15% reduction from the baseline level) in the probability of being severely depressed was seen after the first dose of COVID-19 vaccine… (PLoS One, Medscape)

Mild Covid-19 protects from reinfection

A study published in Microbiology Spectrum has concluded that persons who have mild COVID-19 illnesses are protected from reinfection for up to 6 months after the infection. About 90% of the study participants had persistent spike, nucleocapsid, and virus-neutralizing antibodies that were stable for up to 6 months. None of the initially seropositive participants experienced a subsequent COVID-19 infection during follow-up when compared to 15 initially seronegative subjects who developed the infection… (Source: Microbiology Spectrum, September 1, 2021)

COVID-19 patients with new-onset myocarditis and pericarditis at higher risk of adverse outcomes

A new retrospective study of 718,365 COVID-19 patients published in the European Journal of Clinical Investigation suggests that COVID-19 patients with new-onset myocarditis and pericarditis are at greater risk of all-cause mortality, rehospitalization and acute myocardial infarction. Of the two, the association of major adverse events and new-onset cardiovascular sequelae was far stronger for patients with pericarditis. 

The all-cause mortality was 3.9% in patients with COVID-19 and new-onset myocarditis versus 15.2% in patients with COVID-19 and new-onset pericarditis. The odds of rehospitalisation (OR 1.90 vs OR 2.77) and acute myocardial infarction (OR 1.37 vs OR 2.22) were also higher among patients with new-onset pericarditis compared to new-onset myocarditis…. (Source: European Journal of Clinical Investigation, published Sept. 13, 2021)

Preterm delivery and hypertension are the most common complications in pregnant women with Covid-19

An ICMR study has shown preterm delivery (16.3%) and hypertensive disorders in pregnancy (10%) to be the most common complications in pregnant women with Covid-19. In addition, Almost 4% women were hospitalized in the ICU; of which, 96% were  due to COVID-19 related complications. The study analysed data of 4203 pregnant women from the PregCovid registry during the first wave of the pandemic in various districts of Maharashtra, from March 2020 to January 2021. The overall case fatality rate in pregnant and post-partum women with COVID-19 was less than one percent… (Source: Indian Journal of Medical Research, DOI: 10.4103/ijmr.ijmr_1938_21)

NIH Treatment Guidelines Panel recommends bamlanivimab + etesevimab for non-hospitalized COVID-19 patients 

With bamlanivimab + etesevimab now available in the US, the NIH COVID-19 Treatment Guidelines Panel has updated its recommendations and advises use of  anti-SARS-CoV-2 monoclonal antibodies (mAb) regimens to treat nonhospitalized patients with mild to moderate COVID-19 who are at high risk of clinical progression. The mAb regimens include  Bamlanivimab 700 mg + etesevimab 1400 mg IV infusion or Casirivimab 600 mg + imdevimab 600 mg IV infusion / subcutaneous injection or Sotrovimab 500 mg IV infusion… (Source: NIH Covid-19 treatment guidelines, Sept. 15, 2021)

Memory T cell immunity in children and adults with mild COVID-19

A preprint study has suggested that children and adults with mild COVID-19 symptoms develop memory T cell immunity to SARS-CoV-2, which could protect against re-infection. Results showed that S-SARS-CoV-2-specific IFN-ɣ T cell responses in most infected children (83%) and all adults (100%) that were absent in unexposed controls. Frequencies of SARS-CoV-2-specific T cells were higher in infected adults, especially in those with moderate symptoms, compared to infected children. The S-SARS-CoV-2 IFN-ɣ T cell response correlated with S1-SARS-CoV-2-specific serum IgM, IgG, and IgA antibody concentrations. Predominantly, effector memory CD4+ T cells of a Th1 phenotype were activated upon exposure to SARS-CoV-2 antigens, which persisted for 4-8 weeks after symptom onset... (Source: medRxiv, posted September 15, 2021) 

With inputs from Dr Monica Vasudev

CDC updates its recommendations for booster dose of COVID-19 vaccine

The CDC Director Rochelle P. Walensky has endorsed the CDC Advisory Committee on Immunization Practices’ (ACIP) recommendation for a booster shot of the Pfizer-BioNTech COVID-19 vaccine in certain populations and also recommended a booster dose for those in high risk occupational and institutional settings. CDC now recommends:

• people 65 years and older and residents in long-term care settings shouldreceive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
• people aged 50–64 years with underlying medical conditions shouldreceive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
• people aged 18–49 years with underlying medical conditions mayreceive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks, and
• people aged 18-64 years who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting mayreceive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.

(Source: CDC, Sept. 24, 2021)

A new COVID variant detected in the US

The SARS-CoV-2 R.1 Lineage Variant, first reported in Japan has now been reported in the US at a nursing home in Kentucky, where 26 residents and 20 workers tested positive for COVID-19. Whole genome sequencing showed the virus to have "mutations aligning with the R.1 lineage". About 90% of the facilitys residents and 52% of the staff had been fully vaccinated with two doses of Covid-19 vaccine, which protected 86.5% residents and 87.1% employees against symptomatic illness. R.1 has not yet been categorised as a variant of concern by the CDC. However, it says that the strain has "several mutations of importance" and "demonstrates evidence of increasing virus transmissibility." (Source: Medscape)

WHO reclassifies the Variants of Interest

The Eta (B.1.525), Iota (B.1.526) and Kappa (B.1.617.1), earlier categorised as VOIs by the WHO have now been downgraded to “Variants Under Monitoring”. While all three variants carry mutations with suspected and/or established phenotypic impacts, the number of reported detections of these variants have decreased over time at the global, regional and country levels. The revised list of current VOIs now includes Lambda and Mu variants, both circulating in Latin America, where the Delta variant has begun to circulate but has not yet become dominant… (Source: WHO COVID-19 Weekly Epidemiological Update, Sept. 21, 2021)

COVID-19 vaccines antibodies can cross placenta

A new study reported in the American Journal of Obstetrics & Gynecology MFM says that women who receive COVID-19 vaccines during pregnancy pass antibodies to their babies, which could protect newborns from the disease. The study included pregnant women who had received at least one dose of an mRNA COVID-19 vaccine (Pfizer/BioNTech or Moderna). All neonates were found to have high titers of spike protein antibodies; no nucleocapsid antibodies were detected suggesting that the spike protein antibodies were produced due to the vaccine and not from a previous Covid infection.

Second J&J vaccine dose offers enhanced protection against moderate to severe COVID-19

A second dose of the J&J vaccine was 94% effective in protecting against moderate to severe COVID-19. However, the confidence interval was wide, with one case in the vaccine arm and 14 in the placebo arm (95% CI 58%-100%). The second dose also was 100% protective against severe or critical cases of COVID-19 at least 14 days after the second shot, though with an even wider confidence interval (95% CI 33%-100%). Data from the ENSEMBLE 2 study showed that the two-dose regime had 75% efficacy against moderate to severe disease (95% CI 55%-87%), with 14 cases in the vaccine arm and 52 in the placebo arm … (Source: Medpage Today)

With inputs from Dr Monica Vasudev

WHO clinical case definition of post COVID-19 condition

The World Health Organization (WHO) has developed the first version of a clinical case definition of post COVID-19 condition as follows: “Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others which generally have an impact on everyday functioning. Symptoms may be new onset, following initial recovery from an acute COVID19 episode, or persist from the initial illness. Symptoms may also fluctuate or relapse over time. A separate definition may be applicable for children”. This definition may change as new evidence emerges, says the WHO... (Source: WHO)

Pfizer seeks authorization for its COVID vaccine for children aged 5-11 years

Pfizer asked the FDA on Thursday to expand emergency use authorization of its COVID-19 vaccine to children ages 5 to 11. The company has submitted clinical trial data to the FDA on Sept. 28, which showed the vaccine was safe and produced a robust immune response. Children in the trial were administered 10µg, which is lower than the routinely administered dose. Pfizer has been fully approved by the FDA for persons aged 16 years and above. It is still authorised for emergency use for children aged 12- to 15-year-old and individuals eligible for booster dose… (Source: Medscape, Oct. 7, 2021)

Increase in anti-thyroid antibody titers with Interferon treatment for COVID-19

A new study from Hong Kong presented at the virtual 90th Annual Meeting of the American Thyroid Association (ATA) has suggested that even short-term treatment of COVID-19 patients (no known history of previous thyroid disorders) with interferon beta-1b is associated with potentially important adverse effects on thyroid function. A significant rise in anti-thyroid antibodies including anti-thyroglobulin (anti-Tg) and anti-thyroid peroxidase (anti-TPO) was seen at 3 months compared to patients not treated with interferon … (Source: Medscape, Oct. 7, 2021)

Orphaned children, the hidden US COVID-19 pandemic 

One US child loses a parent or caregiver for every four COVID-19-associated deaths, a new modeling study published in Pediatrics reveals.  The findings illustrate orphanhood as a hidden and ongoing secondary tragedy caused by the COVID-19 pandemic and emphasizes that identifying and caring for these children throughout their development is a necessary and urgent part of the pandemic response – both for as long as the pandemic continues, as well as in the post-pandemic era. From April 1, 2020 through June 30, 2021, data suggest that more than 140,000 children under age 18 in the United States lost a parent, custodial grandparent, or grandparent caregiver who provided the child’s home and basic needs, including love, security, and daily care… (CDC, Oct. 7, 2021)

Myocarditis and mRNA Covid-19 vaccines

In a large study from Israel of patients in an Israeli health care system who had received at least one dose of the BNT162b2 mRNA vaccine, the estimated incidence of myocarditis was 2.13 cases per 100,000 persons; the highest incidence was among male patients between the ages of 16 and 29 years. Most cases of myocarditis were mild or moderate in severity… (Source: NEJM, Oct. 6, 2021)

With inputs from Dr Monica Vasudev

Now Finland stops Moderna Covid-19 vaccine for men younger than 30

Finland has discontinued Moderna’s Covid-19 vaccine for younger males after a study showed that men below the age of 30 years were more at risk of myocarditis. Earlier this week, Sweden and Denmark had stopped using Moderna vaccine for all young adults and children. Norway recommends Pfizer vaccine for men under the age of 30 years. The study involved participants from Finland, Sweden, Norway and Denmark is yet to be published; however, preliminary data has been sent to the EMA for evaluation … (Medscape)

HEPA filters may reduce hospital-acquired SARS-CoV-2 infection

A preprint study suggests that high-efficiency particulate air (HEPA) filters and UV light sterilization effectively remove SARS-CoV-2 particles from the air. “Airborne SARS-CoV-2 was detected in the ward on all five days before activation of air/UV filtration, but on none of the five days when the air/UV filter was operational; SARS-CoV-2 was again detected on four out of five days when the filter was off. Airborne SARS-CoV-2 was infrequently detected in the ICU.” Not just SARS-CoV-2, other microbial bioaerosols were also significantly reduced in both the ward and ICU… (Source: medRxiv)

A long-acting monoclonal antibody combination to prevent and treat Covid-19

Results of the phase III international multicenter trial TACKLE trial show that compared to placebo, AZD7442, the long-acting combination of two monoclonal antibodies (tixagevimab and cilgavimab) reduced risk of severe COVID-19 and all-cause mortality by 50% in non-hospitalized adults with mild to moderate COVID-19 within 7 days of onset of symptoms. Out of a total of 822 participants, there were 18 events in the monoclonal antibody group compared to 37 in the placebo group; 4.4% vs 9.9%, respectively…. (Source: Medpage Today)

WHO constitutes a new expert group to examine the origin of Covid-19

The World Health Organization (WHO) on Wednesday launched an expert group of 26 scientists that will examine the origins of new pathogens, including SARS-CoV-2, the coronavirus that causes COVID-19. The proposed members of the WHO Scientific Advisory Group for the Origins of Novel Pathogens (SAGO) were selected for their expertise in areas such as epidemiology, animal health, clinical medicine, virology and genomics.  “SAGO will advise WHO on the development of a global framework to define and guide studies into the origins of emerging and re-emerging pathogens with epidemic and pandemic potential, including SARS-CoV-2,” said WHO chief Tedros Adhanom Ghebreyesus … (Source: UN News)

With inputs from Dr Monica Vasudev

AY.4.2: A new delta subvariant

A new mutation of the Delta variant of SARS-CoV-2, called AY.4.2, has been recently detected in England. It has been also called the “new delta plus” variant by some. AY.4.2 was first identified in July 2021 and has been detected in around 6% of  cases that were tested for genomically sequenced in the last week of September. This subvariant has two S gene mutations (A222V and Y145H) and may be potentially 10% more transmissible, though probably not as much transmissible as the delta and alpha variants, experts say. Sporadic cases of AY.4.2 have also been detected in the US, Israel, Russia. Although it is being monitored, this subvariant is not yet considered a variant of concern (VOC), or a variant under investigation (VOI).

Some multiple myeloma patients do not show T cell response after Covid-19 vaccination 

A study reports in Cancer cell that 25 out of 26 seropositive multiple myeloma patients after Covid-19 patients showed a CD4+ T-cell response, whereas only 6 of the 17 seronegative patients had a T cell response. Spike-reactive B cells were detected in almost all seropositive patients, including all 12 of the healthy individuals without myeloma in comparison to only 40% of the seronegative myeloma patients, who also had lower B-cell numbers in their peripheral blood compared with the seropositive group… (Medpage Today,  October 21, 2021)

CDC eligibility criteria for COVID-19 Booster Shots

For individuals who received a Pfizer-BioNTech or Moderna COVID-19 vaccine, the following groups are eligible for a booster shot ≥6 months after their initial series:

• ≥65 years 
• Age 18+ who live in long-term care settings
• Age 18+ who have underlying medical conditions
• Age 18+ who work or live in high-risk settings

For those who got the Johnson & Johnson COVID-19 vaccine, booster shots are also recommended for persons ≥18 years and who were vaccinated ≥2 months ago… (Source: CDC, October 21, 2021)

US will relax its international travel policy from November 8

From November 8, the United States will allow fully vaccinated people from foreign countries, including the European Union and the United Kingdom. “CDC has already informed airlines that all FDA approved and authorized vaccines, as well as all vaccines that have an Emergency Use Listing (EUL) from the WHO will be accepted for air travel. We anticipate the same will be true at the land border…” (Medscape, Oct. 15, 2021)

CDC now reports COVID data by vaccination status

The CDC is now reporting weekly rates of Covid-19 cases and deaths among fully vaccinated and unvaccinated people. Data is now available for overall cases and deaths by vaccination status and the vaccine product as well. Data shows that the unvaccinated individuals are at greater risk of developing Covid-19. Mortality is also higher in the unvaccinated group. You can follow the data at CDC COVID Data Tracker (Source: CDC & Medpage Today,  October 19, 2021)

With inputs from Dr Monica Vasudev

Declining post-vaccine declining immunity in Israel

A study from Israel, published in the New England Journal of Medicine, has shown declining immunity against the delta variant of SARS-CoV-2 in all age groups a few months after the second dose of the Pfizer vaccine. Among persons ≥60 years, the infection rate in July was higher among persons who became fully vaccinated in January 2021 (when they were first eligible) compared to those who took both doses in March 2021 (rate ratio 1.6). Individuals aged 40-59 vaccinated in February had higher infection rates vs those vaccinated in April (RR 1.7); similarly, those aged 16-39 years vaccinated in March had higher rates compared to those vaccinated in May (RR 1.6)…(Source: NEJM)

Covid-19 vaccines also lower non-Covid-related mortality risk

People who have taken the Covid-19 vaccine not only have lower Covid-19-related mortality rates, they also have lower non-Covid-19 mortality rates than those who have not taken the vaccine, suggests a study of 11 million people conducted between December 2020 to July 2021 and published in the CDCs Morbidity and Mortality Weekly Report. Non-Covid-19 related mortality risk reduced 34% in those who had taken both doses of Pfizer vaccine, 31% in those who received two doses of the Moderna vaccine and 54% in those who had taken the J&J vaccine… (Source: Medpage Today)

Ukraine facing a deadly third wave

Ukraine is currently among the top three countries with the highest number of daily new cases. The country is in the midst of a deadly third wave. The number of daily new infections has surpassed 25,000 new infections with more than 600 daily deaths. The vaccination rate in Ukraine is the lowest among European countries. Only less than 18% of the population (25% in Kiev) has been vaccinated… (Source: Medscape)

Scientists identify ADAM9 gene that facilitates replication of coronavirus in healthy young adults

Scientists have identified a gene that helps the coronavirus to replicate and lead to severe and critical illness in healthy young people. Five genes were found to be upregulated and the most commonly occurring gene was ADAM9.The study of 72 hospitalized COVID-19 patients under age 50, including 47 who were critically ill and 25 with non-critical illness is reported in Science Translational Medicine. None of the patients included in the study had an underlying medical condition that could predispose to severe disease. Lab studies showed that blocking ADAM9 gene could prevent viral replication… (Source: Medscape) 

Patients with mood disorders now eligible for Covid booster shot

CDC has added mood disorders including depression, and schizophrenia spectrum disorders to its list of persons eligible for Covid-19 booster shots. Studies have shown an association between mood disorders and the high risk of hospitalization and death.

With inputs from Dr Monica Vasudev

LZTFL1 gene predisposes South Asians to high risk of severe Covid-19 

Researchers from Oxford University have identified a gene “leucine zipper transcription factor-like 1 (LZTFL1)” leads to a two-folds increase in the risk of respiratory failure and death from COVID-19. The high-risk form of this gene is present in 60% of South Asians, 15% of Europeans and just 2% of persons with African-Caribbean ancestry and 1.8% of people of East Asian descent. This gene does not affect the immune system, but affects the lungs. The study published in the journal Nature Genetics attempts to explain why some ethnic groups are at higher risk from Covid… (Source: Medscape, November 5, 2021) 

More than 28 million excess years of life lost in 2020 during pandemic

A BMJ study has reported that more than 28 million excess years of life were lost in 2020 in 31 countries, with a higher rate in men than women (except New Zealand, Taiwan, and Norway, where there was a gain in life expectancy in 2020). Excess years of life lost associated with the Covid-19 pandemic in 2020 were more than five times higher than those associated with the seasonal influenza epidemic in 2015. The study evaluated the changes in life expectancy and years of life lost in 2020 associated with the Covid-19 pandemic in 37 upper-middle and high-income countries. The highest reduction in life expectancy was observed in Russia, the United States, Bulgaria, Lithuania, Chile and Spain…(Source: BMJ, November 3, 2021)

Single dose J&J Covid-19 is 74% effective in preventing Covid-19

A retrospective analysis of electronic health records of nearly 9000 adults from the multistate Mayo Clinic Health System who received the single dose J&J shot during the first five months of its authorization reported in JAMA Network Open showed an actual effectiveness of 74%, which is in accordance with the 66.9% effectiveness reported in the phase 3 clinical trial of the vaccine. Covid-19 cases declined by 3.73 folds after the vaccination. The vaccinated group had 60 cases of Covid-19 compared to 2236 cases in the unvaccinated group … (Source: Medscape, November 2, 2021)

“When to Test”: A free online tool from NIH to decide if you need a Covid test 

The National Institutes of Health (NIH)’s Rapid Acceleration of Diagnostics (RADx) initiative has launched the “When To Test Calculator for Individuals”, a companion to the version for organizations introduced last winter. It is available at https://whentotest.org/. The new individual impact calculator helps to decide when should a person get tested for Covid-19—now or soon. It was developed and tested by computer modelers to help people determine if they are at risk of getting or transmitting Covid-19 based on just a few variables, such as vaccination status, transmission rates in the geographic area, and mitigation behaviors … (Source: NIH, November 3, 2021)

With inputs from Dr Monica Vasudev

Interim results show 77.8% effectiveness of Covaxin against symptomatic Covid

Interim results from a phase III trial show that Covaxin (BBV152) was highly effective against laboratory-confirmed symptomatic COVID-19 disease in adults. In the final per-protocol analysis, measured 14 days after the second dose, the overall vaccine efficacy was 77·8% against symptomatic COVID-19 disease and a higher efficacy against severe COVID-19 of 93·4%. It was well tolerated with no safety concerns. Covaxin is an inactivated whole virus vaccine formulated with a novel adjuvant and has a two-dose regime given at a gap of 28 days… (Source: The Lancet, Nov. 11, 2021)

France recommends against Moderna vaccine for people younger than 30 years

The Haute Autorite de Sante (HAS) or the French National Authority for Health has recommended that people younger than 30 years should be given the Pfizer Covid-19 vaccine in place of the Moderna vaccine citing "very rare" risks linked to myocarditis with the Moderna vaccine. According to HAS, this risk appears to be around five times lesser with Pfizers Comirnaty jab compared to Modernas Spikevax jab... (Source: Reuters, Nov. 9, 2021)

ECG findings in Covid-19 patients

A review of the ECG findings in Covid-19 patients reported in the journal Cardiac Electrophysiology Clinics has described QRS axis changes, conduction abnormalities, arrhythmias (most commonly atrial fibrillation) and ST segment and T wave changes. The study authors write, “Clinicians should be cognizant of some of the reported ECG changes, such as abnormal QRS axis in nearly 20% of patients, conduction abnormalities in approximately 20%, atrioventricular block in about 2.5%, and premature beats in nearly 10% of patients.” ST and T wave changes can be due to myocardial infarction or myocardial injury secondary to myocarditis, or microthrombi and so should be clinically correlated… (Source: Cardiac Electrophysiology Clinics, Oct.30, 2021).

Unvaccinated persons have 20 times higher mortality risk 

A study from Texas Department of State Health Services, US has concluded that compared to fully vaccinated people, unvaccinated persons were 13 times more likely to become infected with COVID-19 than fully vaccinated people. They were also 20 times more likely to die from Covid-19-related complications. The risk of death was 23 times higher in unvaccinated people in their 30s and 55 times higher for unvaccinated people in their 40s…(Source: Texas Department of State Health Services, Nov. 9, 2021)

Covid-19 generates 8 million tons of plastic waste

Covid-19 has resulted in over 8 million tons of mismanaged plastic waste globally as of August reports the Proceedings of the National Academy of Sciences. And, more than 25,000 tons has entered the global ocean. Nearly 90% of the excess plastic waste generated during the pandemic were the medical waste from hospitals; individual PPE (personal protective equipment) contributed to just 7.6% of the plastic waste, while 4.7% came from packaging. Almost half of all the mismanaged plastic waste was produced in Asia…(Source: PNAS, Nov. 23, 2021)

EMA adds transverse myelitis as a side effect of J&J vaccine

The European Medicines Agency (EMA), the drug regulating agency in Europe, has recommended adding transverse myelitis as a side-effect of Johnson & Johnsons single-dose Covid-19 vaccine.

With inputs from Dr Monica Vasudev

FDA approves Covid-19 vaccine booster dose for all adults

All adults (≥18 years) in the United States can now take a single booster dose after completion of primary vaccination with any FDA-authorized or approved COVID-19 vaccine following the amendment of the emergency use authorizations (EUA) for both the Moderna and Pfizer-BioNTech COVID-19 vaccines by the US Food and Drug Administration (FDA). All those who received their primary vaccination at least six months before are eligible for the booster… (Source: US FDA, November 19, 2021).

Eye manifestations of Covid-19

Several eye manifestations have been linked to Covid-19, according to findings presented at the annual meeting of the American Academy of Ophthalmology (AAO). These include conjunctivitis, photophobia, retinal hemorrhage, optic neuritis. Rhino-orbital-cerebral mucormycosis (ROCM) is more likely in patients with diabetes and those on steroids. Some eye manifestations are related to sequelae of COVID-19 such as meningitis, ptosis, eye muscle movements, eye fatigue. Corneal verticillata may develop in Covid patients who develop arrhythmia and are put on amiodarone… (Source: Medpage Today, November 16, 2021)

Monoclonal antibodies reduce hospitalization in patients with breakthrough Covid-19

In a study of 1395 fully vaccinated patients with breakthrough Covid-19, early treatment with anti-spike monoclonal antibody treatment significantly reduced the risk of hospitalization (Odds Ratio 0.227) by reducing disease severity, according to a study published in the Journal of Infectious Diseases.  The degree of medical comorbidity was assessed using Monoclonal Antibody Screening Score (MASS), clinical criteria for risk of severe COVID-19 outcomes ... MASS assigned points to characteristics and comorbidity that made a person eligible for monoclonal antibody, according to the initial Food and Drug Administration (FDA)… (Source: Journal of Infectious Diseases, Nov. 18, 2021)

Low mortality risk in Covid patients on SSRIs

According to a retrospective multicenter study reported in JAMA Network Open, Covid-19 patients prescribed selective serotonin reuptake inhibitor (SSRI) had a modest but significant 8% reduced risk of death. Overall, 14.6% of patients on an SSRI died from Covid-19 compared to 16.6% of patients who had never taken an SSRI. Specifically, the risk was lower in Covid-19 patients on fluoxetine; 9.8% vs 13.3%, respectively… (Source: JAMA Network Open, Nov. 15, 2021)

Effectiveness of public health measures in reducing Covid-19

Reiterating the effectiveness of public health measures, a new systematic review and meta-analysis from Monash University in Australia has shown 53% reduction in the incidence of Covid-19 with mask wearing and a 25% reduction with physical distancing and recommends that Covid-19 protocols such as handwashing, mask wearing, and physical distancing should be continued together with vaccination… (Source: BMJ, Nov. 18, 2021)

Omicron: The latest SARS-CoV-2 variant of concern 

The new variant of SARS-CoV-2 (B.1.1.529) has been designated as a variant of concern (VOC) on 26^th November by the World Health Organization (WHO). First identified from Botswana, it has been detected in South Africa, Hong Kong, Israel and Hong Kong. There could be suspected cases in Australia, Germany, Czech Republic and The Netherlands. The new variant has more than 50 mutations, with 32 alone in the spike protein. Compared to other VOCs, there is an increased risk of reinfection with this variant.

As per the WHO, one of the three target genes is not detected (called S gene dropout or S gene target failure) in cases of infection with this variant. This test can therefore be used as marker for this variant, pending sequencing confirmation. Countries have sounded the alarm and many have imposed travel restrictions for South Africa and many other southern African countries.

WHO updates its guidelines on management of children with COVID-19 associated MIS-C 

The World Health Organization (WHO) has updated its guidelines on the management of multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C). The two new recommendations include: 

• Conditional recommendation to use corticosteroids + supportive care (rather than either IVIG plus supportive care, or supportive care alone), for hospitalized children aged 0-18 years who meet a standard case definition for MIS-C.
• Conditional recommendation to use corticosteroids + standard of care for hospitalized children aged 0-18 years who meet both a standard case definition for MIS-C and diagnostic criteria for Kawasaki disease.

(Source: WHO, Nov. 23, 2021)

Antibodies from mild Covid-19 may not protect against new emerging variants

A preprint study from Australia involving 43 patients with mild Covid-19 has concluded that while 90% still had antibodies one year after recovery, but neutralizing antibodies against the original virus were detected in only 51.2%; the levels declined to 44.2% against the Alpha variant, 11.6% against Gamma and against 4.6% against Beta. Only 16.2% showed neutralizing antibodies against the delta variant. These findings suggest that the antibodies may not be protective against the new emerging variants… (Source: medRxiv, Nov. 11,2021)

A vendor in Wuhan market is probably the first Case of COVID

A vendor at an animal market in Wuhan, China, was probably the first person to contract COVID-19, with onset of illness on Dec.11, 2019 suggests a study reported in the journal Science discounting the earlier notion that the first person thought to have contracted COVID-19 was a male accountant in Wuhan who lived miles from the market, did not visit the market, and reported COVID symptoms around Dec. 16, 2019. “Hospital records and a scientific paper that reports his COVID-19 onset date as 16 December and date of hospitalization as 22 December indicate that he was infected through community transmission after the virus had begun spreading from Huanan Market.” … (Source: Medscape, Nov. 19, 2021)

Study shows direct effect of SARS-CoV-2 on blood clotting

Covid-19 is characterized by a hypercoagulable state, which has been attributed to the hyperinflammatory response induced by the virus. A new study reported in the International Journal of Biological Macromolecules has now shown that the virus itself also has a direct effect on blood clotting and coagulation. The SARS-CoV-2 spike protein competitively binds to heparan resulting in an abnormal increase in activity of thrombin thereby causing blood clotting and coagulation… (Source: International Journal of Biological Macromolecules, Oct. 29, 2021)

Prioritize genomic sequencing of immunocompromised positive Covid cases to detect omicron

In addition to vaccination, prioritizing genomic sequencing of positive cases, particularly the immunocompromised persons should be undertaken immediately, suggested experts at a media briefing by the Infectious Diseases Society of America (IDSA) as it is these patients that the virus continues to mutate. “We also need to be more concerned about our immunosuppressed patients because immunosuppressed patients may be where the virus continues to mutate," said Carlos del Rio, president-elect of the IDSA board of directors and professor of global health and epidemiology at the Rollins School of Public Health of Emory University in Atlanta, Georgia. (Source: Medscape, Dec. 2, 2021)

Sotrovimab may be effective against the Omicron variant

Preliminary results from lab studies, which tested sotrovimab against individual mutations in omicron, show that sotrovimab may be effective against the variant. Two mutations in omicron overlap with the drugs target site. And researchers believe that the mutations will not have hamper the ability of the drug to bind to the spike protein. These findings are yet to be peer-reviewed and further studies are needed to test sotrovimab against the whole spike protein on the virus to verify these results… (Source: Medscape, Dec. 2, 2021)

Follow all precautions as safeguard against Omicron 

According to Dr Anthony S. Fauci, MD, it is too soon to say how the omicron variant compares against the delta variant, even though it appears to be highly contagious and show more ability to evade vaccines than other variants. He said at a White House COVID-19 briefing that this variant has a “very unusual constellation of changes. This mutational profile is very different from other variants of interest and concern, and although some mutations are also found in Delta, this is not Delta.” Although initial observations show that omicron causes mild disease, it is too soon to know how the picture evolves over the weeks. Everyone needs to take their vaccinations and booster, wear masks, hand wash and avoided crowded indoor spaces, he recommended…(Source: Medscape, Dec. 2, 2021)

Molnupiravir narrowly wins emergency use authorization for COVID-19

A US Food and Drug Administration (FDA) advisory panel has recommended emergency use authorization for Merck’s antiviral oral drug molnupiravir to treat COVID-19, though this was a narrow vote 13 to 10. Earlier results had shown that molnupiravir reduced the risk of hospitalization or death in patients at high risk for severe disease by about 50%. However, later results showed that this protective effect had declined to around 30%...(Source: Medscape) 

Children with poorly-controlled asthma at risk of severe COVID-19

Children with poorly-controlled asthma are at least six times more likely to be hospitalized for Covid-19 than children who did not have asthma, suggests a retrospective study of 750,000 children aged 5 to 17 years from Scotland reported in The Lancet Respiratory Medicine. Children who received two or more courses of oral steroids in the past couple of years were at a significantly higher risk for hospitalization. These children should receive the vaccination on priority… (The Lancet Respiratory Medicine, Nov. 30, 2021) 

With inputs from Dr Monica Vasudev

With inputs from Dr Monica Vasudev

Study shows Omicron variant is four times more transmissible than Delta A study from Japan has found that the omicron SARS-CoV-2 variant is 4.2 times more transmissible in its early stage than the delta variant, currently the dominant strain globally. This affirms apprehensions about the infectiousness of the new variant. This inference is based on analysis of genome data from Gauteng province in South Africa by Hiroshi Nishiura, a professor of health and environmental sciences at Kyoto University whose area of specialization is in mathematical modeling of infectious diseases. He said, “The omicron variant transmits more, and escapes immunity built naturally and through vaccines more.” …. (Source: Bloomberg, Dec. 9, 2021)

CDC expands its Covid-19 booster recommendations to include adolescents aged 16-and-17-years

The CDC has expanded its recommendations for Covid-19 booster vaccine. Now everyone aged 16 years and older can get a booster shot after six months of the second dose of the Pfizer vaccine. “Although we don’t have all the answers on the Omicron variant, initial data suggests that COVID-19 boosters help broaden and strengthen the protection against Omicron and other variants,” said Dr. Rochelle Walensky, Director CDC. At present, only the Pfizer-BioNTech Covid-19 vaccine is authorized and recommended for adolescents aged 16 and 17 years…(CDC, Dec. 9, 2021)

Study shows that coronavirus directly infects human adipose tissue

A study posted on the preprint server, bioRxiv, has suggested that the SARS-CoV-2 can directly infect human adipose tissue in a possible explanation as to why the obese are more prone to develop severe Covid-19. The study found that mature adipocytes and adipose tissue macrophages are the two cellular targets of SARS-CoV-2 infection. Infection of adipose tissue macrophage is mostly limited to highly inflammatory macrophages, present at baseline, which are further activated following SARS-CoV-2 infection. Preadipocytes, while not infected, adopt a proinflammatory phenotype…(Source: bioRxiv, Oct. 25, 2021)

Omicron detected in wastewater in Houston

The Omicron (B.1.1.529) variant has been detected in waste water in Houston, according to the Houston Health Department as an indication that the new variant is already prevalent in the community. Wastewater samples collected on November 29-30 showed Omicron at eight of the city’s 39 wastewater treatment plants (Source: (Houston Health Department, Dec. 6, 2021) Since then at least 9 cases have been reported in the city.

FDA grants EUA to use of monoclonal antibodies in young children

The US FDA has granted emergency use authorization (EUA) for AstraZeneca’s Evusheld (tixagevimab co-packaged with cilgavimab and coadministered) for the pre-exposure prophylaxis of Covid-19 in children aged 12 years and older weighing at least 40 kg. It is indicated for use only in individuals who are not currently infected with the SARS-CoV-2 virus and who have not recently been exposed to an individual infected with SARS-CoV-2… (Source: US FDA, Dec. 8, 2021)

With inputs from Dr Monica Vasudev

WHO approves Covovax Covid-19 vaccine for emergency use

The World Health Organization (WHO) has issued an emergency use listing (EUL) for Covovax “NVX-CoV2373” produced by the Serum Institute of India under licence from Novavax. Covovax requires two doses and is produced by creating an engineered baculovirus containing a gene for a modified SARS-CoV-2 spike protein. It is a subunit of the vaccine developed by Novavax and the Coalition for Epidemic Preparedness Innovations (CEPI) … (Source: WHO, December 17, 2021)

More than 5 times higher risk of reinfection with Omicron than Delta

New research from the Imperial College London has found that Omicron was associated with a 5.41-fold higher risk of reinfection compared with Delta suggesting that immunity accorded by previous infection is as low as 19%. Persons who had taken their second vaccine dose two or more weeks before and were two or more weeks past their booster dose were at an increased risk of developing a symptomatic Omicron case compared to Delta … (Source: Imperial College, Report 49, December 16, 2021)

Omicron may become the dominant strain in Europe early next year 

The European Centre for Disease Prevention and Control (ECDC) has stated that the “Omicron variant of concern (VOC) was likely to overtake Delta within the first two months of 2022”. There is a very high risk of it becoming the dominant strain in Europe because of its high transmissibility, although data is inadequate at this point of time to actually determine the severity of the infection caused by Omicron variant. Stella Kyriakides European Health Commissioner has expressed concern about the slow vaccination rates in countries like Bulgaria, Romania and Slovakia, where less than 50% of the population has been immunised….(Medscape, December 16, 2021)

The next-generation SARS-CoV-2 vaccine 

The US Army has developed a spike ferritin nanoparticle vaccine, which is expected to protect from other respiratory viruses and not just SARS-CoV-2. The vaccine uses ferritin as a soccer ball-shaped “platform”. It has 24 “faces” to which are attached the replicas of the spike proteins through which the virus enters the cells. The vaccine would not require special storage as it is stable at varying temperatures. The first trial of the vaccine in humans has been completed and results are being evaluated. According to Gordon Joyce of the Walter Reed Army Institute of Research in Silver Spring, Maryland, the study lead author said, “Presenting multiple copies of spike in an ordered fashion may be the key to inducing a potent and broad immune response.” (Source: Medscape, 

Risk of myocarditis after adenovirus-based Covid-19 vaccine

Nature Medicine has probably published the first report of risk of acute myocarditis with an adenovirus-vector vaccine. The incidence rate ratios (IRRs) for myocarditis 1 to 7 days after the first AstraZeneca, Pfizer, and Moderna injections were 1.76, 1.45, and 8.38, respectively, and 23.1 after the second dose of the Moderna vaccine…(Source: Medscape, December 16, 2021)

Compulsory vaccination for healthcare workers in Germany

Healthcare workers at hospitals, doctors offices and nursing homes in Germany are now required by law to get the Covid-19 vaccine. They must prove that they are vaccinated or have recovered from COVID-19 by mid-March as part of new legislation passed by the parliament on Friday. The new legislation allows closure of bars and restaurants and banning of large gathering events. Health Minister Karl Lauterbach, “Its absolutely unacceptable that in establishments where people live, who put their trust in us to protect them, that people are unnecessarily dying because unvaccinated work there." … (Medscape, December 13, 2021)

With inputs from Dr Monica Vasudev

Molnupiravir gets FDA nod for emergency use in Covid-19 treatment

The US Food and Drug Administration (FDA) has issued emergency use authorization for the antiviral drug, molnupiravir for “the treatment of mild-to-moderate coronavirus disease (COVID-19) in adults with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by the FDA are not accessible or clinically appropriate”. It is not authorized for use in children younger than 18 years. Treatment has to be started at the earliest after diagnosis of COVID-19 and within 5 days of symptom onset. Molnupiravir is available by prescription only… (Source: US FDA, December 23, 2021)

Israel expert panel recommends fourth Covid-19 vaccine dose

A Health Ministry expert panel has recommended a fourth Covid-19 vaccine dose for persons older than 60 years, those with immunocompromised status and for health workers in view of the swiftly spreading Omicron variant. It also recommended reducing the gap between the second and third doses to be decreased to three months from the current five months. The panel stated, “Such measures would be "part of the preparation for the fifth wave" of the pandemic” … (Source: Reuters, December 23, 2021)

Covid-19 vaccines mandatory for most persons aged 5 years and older in Ecuador 

Ecuador has made Covid-19 vaccine compulsory for most citizens aged five years and older. But persons with pre-existing medical conditions will be exempted from the mandate. According to a health ministry statement, “The decision was made due to an increase in new coronavirus cases, including the Omicron variant”. Ecuador requires vaccination certificates for public places such as restaurants, cinemas, theatres and shopping centres … (Source: CNN & BBC, December 24, 2021)

CDC updated guidance for isolation and quarantine for healthcare workers

In its updated guidance for isolation and quarantine for healthcare workers, the CDC has reduced their isolation time following infection with Covid-19. It has stressed that the new guidelines are not applicable to the general public and only meant for health care workers.

• “Healthcare workers with COVID-19 who are asymptomatic can return to work after 7 days with a negative test, and that isolation time can be cut further if there are staffing shortages.
• Healthcare workers who have received all recommended COVID-19 vaccine doses, including a booster, do not need to quarantine at home following high-risk exposures.”

(Source: CDC, December 23, 2021)

Achieving 70% coverage with Covid-19 vaccines by Mid-2022

As per the Independent Allocation of Vaccines Group (IAVG), only 730 million of the estimated 8 billion doses of vaccine have been administered globally, which is less than 10%. It has expressed concern that the primary priority use of available vaccines is not consistent with the goals outlined in the Strategy to Achieve Global COVID-19 Vaccination by Mid-2022 and emphasizes the critical need to high levels of immunization coverage in all countries in view of the rapid emergence of the Omicron variant. Towards this end, IAVG has made the following recommendations:

• Achievement of 70% coverage with COVID-19 vaccines in all countries as a global imperative. 
• All countries to work with COVAX with considerable urgency to optimize the strategic use of the growing vaccine supply. 
• All countries to have a steady, predictable supply of COVID-19 vaccines, which meet the unique needs of each country. Attention must be paid to addressing prohibitive absorptive challenges in countries that request support. 

(Source: WHO, December 23, 2021)

With inputs from Dr Monica Vasudev

Florona, first case of double infection of Covid-19 and influenza

A case of “florona”, a double infection of Covid-19 and influenza at the same time has been reported in a pregnant woman who delivered a child at a hospital in Israel this week, in the 38th week of her pregnancy. This is the first such case in the world. According to reports, the woman was unvaccinated and has mild symptoms. Israel has recently approved the fourth booster dose for the vulnerable population in view of the Omicron cases... (Source: Wion, Dec. 31, 2021)

J&J Covid-19 booster dose improves protection against hospitalization

Preliminary results of the Sisonke 2 Study in South African health care workers show that a booster dose of the J&J Covid-19 vaccine, given 6-9 months after the initial single vaccination increased vaccine effectiveness against hospitalization from 63% to 84% and then 85%, 0-13 days, 14-27 days, and 1-2 months after the booster dose. The trial was conducted in November and December but participants were enrolled before the advent of the current Omicron wave in South Africa. The yet to be peer reviewed study is published on the preprint server medRxiv… (Source: medRxiv, Dec. 29, 2021)

SARS-CoV-2 can remain in the body for months

According to a preprint study (currently under review for publication in the journal Nature) by the National Institutes of Health, SARS-CoV-2 causes systemic infection as it is found to be is extensively distributed in the body, even among patients who died with asymptomatic to mild infection. Autopsies done on 44 Covid-19 patients showed viral RNA in multiple anatomic sites, including the heart and brain, for up to 230 days following the onset of symptoms… (Source: In Review, Dec. 20, 2021)

CDC reduces quarantine and isolation duration 

The CDC has reduced the isolation and quarantine duration for the public. People with Cvido-19 should isolate for 5 days and if they are asymptomatic or their symptoms are resolving (without fever for 24 hours), follow that by 5 days of wearing a mask when around others to minimize the risk of infecting people they encounter.

Unvaccinated persons or those who received their second mRNA dose six months back (or more than 2 months after the J&J vaccine) and are not yet boosted, should quarantine for 5 days followed by strict mask use for an additional 5 days. Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. Those who are boosted don’t need to quarantine after an exposure, but should wear a mask for 10 days after the exposure … (Source: CDC, Dec. 27, 2021)

T cell-mediated immunity may protect from Omicron

Results of a preprint study demonstrate that regardless of the large number of mutations in the new Omicron variant and its immune escape from neutralizing antibodies, the majority of T cell response, induced by vaccination or natural infection, cross-recognises the variant. Researchers examined unvaccinated convalescent COVID-19 patients including persons who had taken the Pfizer-BioNTech and the Johnson and Johnson vaccines. They concluded that “well-preserved T cell immunity to Omicron is likely to contribute to protection from severe Covid-19”…(Source: medRxiv, Dec. 28, 2021).

British data shows that booster protection may decline in 10 weeks

Data from Britain shows that booster protection against symptomatic Covid-19 due to the Omicron variant may decrease within 10 weeks. Among persons who received AstraZeneca as the primary vaccination, the Pfizer booster was 35% effective after 10 weeks, while the effectiveness of Moderna was 45%. Persons who had taken Pfizer vaccine initially followed by Pfizer booster saw a decline in vaccine effectiveness to 45% from 70%, after 10 weeks. Those who received an initial two-dose series of the Pfizer vaccine and then a Moderna booster seemed to have 75% effectiveness up to 9 weeks … (Source: Medscape, Dec. 27, 2021)

Hospitalization rates for children rising, says CDC

New data from the CDC suggests that the hospitalization rates for children in the US aged 0-4 years are at the highest since the pandemic started. This age group is not yet eligible for Covid-19 vaccination. The hospitalization rate for children under 5 years is 4 in 100,000, and about 1 in 100,000 in children 5-17 years. At present, just over 50% of children aged 12 to 17 years are fully vaccinated, and only 16% of those five to 11 years are fully vaccinated….(Source: CDC, Jan. 7, 2022)  

Post-Covid executive dysfunction in young 

Persons with history of previous Covid-19 infection reported more cognitive dysfunction particularly executive dysfunction compared to persons who did not have the infection, according to a new medRxiv study of 1958 young and middle-aged adults. Compared to persons with asymptomatic infection, those who had had moderate and very/extremely severe disease experienced greater dysfunction. This effect was stronger for men than for women, and for younger compared to older adults. Researchers used four “self-restraint” subscale items from the Deficits in Executive Functioning Scale, short form (BDEFS-SF) to assess executive dysfunction ….(Source: medRxiv, Jan. 2, 2022)

Adolescents aged 12-17 Years now eligible for booster, says CDC

The CDC has recommended booster doses for adolescents aged 12 to 17 years old. They are now eligible to receive a booster shot 5 months after the initial vaccination with two doses of Pfizer-BioNTech Covid-19 vaccine. At present, only the Pfizer-BioNTech COVID-19 vaccine is authorized and recommended for adolescents aged 12-17 years. CDC also recommends that moderately or severely immunocompromised 5–11-year-olds should get an additional primary dose of vaccine 28 days after their second dose.... (Source: CDC, Jan. 4 & 5, 2022)

Atypical manifestations of Covid-19

Researchers have reported the case of a 34-year-old man who presented with a new onset of hallucination and a 5-day history of anxiety. The patient had no past history of any medical condition or any complaints of headache, visual changes, seizures, or body weakness. He was a nonsmoker and did not consume alcohol/drugs. He was tested for Covid-19 with nasopharyngeal RT PCR in the ED due to a history of contact with sick patients in his family, which was positive. This case reports highlights the need that physicians should be aware about atypical manifestations of Covid-19. Any new symptom must be carefully considered keeping in view the local epidemiology… (Source: Case Reports in Psychiatry. 2021 Dec 30.)

CoronaVac two doses + Pfizer booster less effective against Omicron

A preprint study conducted in vaccinated volunteers from Dominican Republic, two doses of the inactivated CoronaVac Covid-19 vaccine followed by Pfizer booster generated comparable antibody response against ancestral virus and Delta variant to that seen after two doses of mRNA vaccines, while the neutralization titers against Omicron were significantly lower. Antibody levels against Omicron declined 6.3-fold when compared with the ancestral variant and 2.7-fold lower when compared with the Delta variant. None of the participants who had taken just the two doses of CoronaVac showed neutralizing antibodies against Omicron…(Source: medRxiv, Dec. 29, 2021)

With inputs from Dr Monica Vasudev

WHO recommends two new drugs for Covid-19

The World Health Organization (WHO) has added two new drugs in the treatment armamentarium of Covid-19, baricitinib and sotrovimab in its eighth update of WHO’s living guidelines on therapeutics and COVID-19,. Baricitinib, a Janus kinase (JAK) inhibitor, is strongly recommended for patients with severe disease or those who are critically ill with Covid-19. It is recommended to be given with corticosteroids. The second drug, sotrovimab is a monoclonal antibody indicated for mild or moderate Covid-19 patients at high risk of hospitalization such as patients who are older, immunocompromised or with comorbid conditions such as diabetes, hypertension, and obesity and those who have not taken the vaccine...(Source: WHO, Jan. 14, 2022) 

Some US states are allowing asymptomatic and mildly infected healthcare workers to continue working 

The surge in Omicron cases has overwhelmed hospitals and resources in the US. Many hospitals are facing severe shortage of hospital staff as many of them are now infected with SARS-CoV-2. Taking this into consideration, states like California, Arizona, Rhode Island are permitting those hospital staff, infected with coronavirus, to continue working if they are either asymptomatic or have mild symptoms. Last month, in its guidance for healthcare workers, the CDC had said that “Healthcare workers with COVID-19 who are asymptomatic can return to work after 7 days with a negative test, and that isolation time can be cut further if there are staffing shortage”… (Source: Medscape, January 11, 2022)

Immune escape of Omicron variant

A Nature study has demonstrated considerable escape of SARS-CoV-2 Omicron to neutralization by antibodies. The sensitivity of the Omicron virus was tested against nine monoclonal antibodies (mAbs) and antibodies present in 115 sera from either convalescent patients or those who had been vaccinated from the Orleans Cohort. Omicron was found to be completely or at least partially resistant to neutralization by all monoclonal antibodies tested in this study as well as vaccine induced antibodies. However, Omicron was susceptible to the booster dose of Pfizer vaccine, though with 6- to 23-fold lower against Omicron compared to against Delta… (Source: Nature, Dec. 23, 2021)

Omicron variant remains a “dangerous virus” particularly for the unvaccinated, says Dr Tedros

WHO Director General Dr Tedros Ghebreyesus has cautioned that the Omicron variant remains a “dangerous virus” even though it has so far caused milder disease than the delta variant. The unvaccinated persons are particularly at risk of severe disease from Omicron. He further said at a news briefing that more than 90 countries were yet to meet the target of vaccinating 40% of their populations and more than 85% of people in Africa were yet to receive a single dose …(Source: Medscape, Jan. 13, 2022)

Last ICU bed should be given to patient with best chances of survival, reveals survey

Results of a new survey conducted between 28th August and 4th September, 2020 reported in the Emergency Medicine Journal show that the respondents were in favor of giving the last available ICU bed available to the patient who had the highest odds of surviving Covid-19. Age of the patient did not influence the decision of the people surveyed. Younger respondents (under 30 years of age) were more likely to choose young and old patients, and were less likely to select patients aged 40–60 years old. Conversely, as the age of the patient declined, the preference for saving the patient showed a modest decline for respondents aged 30 to 49 years… (Source: Emergency Medicine Journal, Jan. 3, 2022)

Need to update Covid-19 vaccines, says WHO Technical Advisory Group

The Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC), a WHO Technical Group has said that “the composition of current COVID-19 vaccines may need to be updated, to ensure that COVID-19 vaccines continue to provide WHO-recommended levels of protection against infection and disease by VOCs, including Omicron and future variants”. According to the expert group, vaccines that not only protect against severe disease but also prevent infection are needed. The vaccine could be a multivalent vaccine or monovalent vaccine against the predominantly circulating variant… (Source: WHO, Jan. 11, 2022)

Myocardial inflammation in patients recovered from mild Covid-19

A recent study reports that some patients recently recovered from Covid-19 can have myocardial inflammation, which can present without any cardiac symptoms. In this single center study, eight out of the 47 patients enrolled, showed focal fluorodeoxyglucose (FDG) uptake on PET consistent with myocardial inflammation. They also had high levels of inflammatory blood markers including interleukin 6, interleukin 8, and high-sensitivity C-reactive protein (hsCRP). These findings were seen to improve on follow up… (Source: JAMA Cardiology, Jan.12, 2022)

With inputs from Dr Monica Vasudev

Physician burnout increased during Covid, reveals Medscape survey 

The Covid-19 pandemic has augmented the problem of physician burnout. According to the Medscapes National Burnout and Depression Report 2022, 47% physicians reported feeling burnout compared to 42% last year. The survey included more than 13,000 physicians from 29 specialties. Expectedly, emergency physicians topped the list at 60% followed by Critical care specialists at 56%, ob/gyn at 53% and infectious disease and family medicine at 51% each. Women physicians reported more burnout than men physicians (56% vs 41%, respectively)…(Source: Medscape, Jan. 21, 2022)

Genetic factor associated with loss of smell and taste in Covid patients

A new study published in Nature Genetics has suggested that the loss of smell and taste during Covid-19 may be due to a genetic risk factor. Results of a multi-ancestry genome-wide association study show that a locus near the UGT2A1 and UGT2A2 genes, expressed in the olfactory epithelium, is associated with the loss of smell and taste. Presence of this genetic risk factor increases the chances of loss of smell and taste after Covid infection by 11%. This symptom was more commonly reported by women than men (72% vs 61%, respectively) and more than 70% of patients having this symptom were aged 26 to 35 years …(Source: Nature Genetics, Jan. 17, 2022)

Fourth dose of Covid-19 vaccine less protective against Omicron 

Preliminary results from an Israeli study show that though a fourth dose of the Covid-19 vaccine led to a small increase in the levels of antibodies, these levels were inadequate in terms of protecting from Omicron infection. In this study,  274 medical workers at Sheba Medical Center were administered the fourth vaccine dose (either Pfizer or Moderna) in December after vaccination with three doses of Pfizer vaccine… (Source: Medscape, Jan. 18, 2022)

Long COVID and Metabolic Liver Disease

A single center analysis of patients from Canada has found an association of postacute COVID syndrome (PACS) or long Covid with increased risk of metabolic-associated fatty liver disease (MAFLD), also known as nonalcoholic fatty liver disease (NAFLD). MAFLD was defined as presence of liver steatosis plus overweight/obesity or type 2 diabetes. Published in the Open Forum Infectious Diseases, this retrospective analysis of Covid-19 patients found that 50% (103/235) patients had features of MAFLD at the time of admission for acute Covid-19, while 48% had MAFLD at the time of discharge. At follow-up for long Covid, 71% were diagnosed with MAFLD…(Source: Medscape, Jan. 21, 2022)

Women with Covid-19 more fatigued than men, finds survey

In a poll conducted by WebMD from 23rd December to 4th January among 489 readers, more women (40%) than men (34%) reported experiencing fatigue or feeling frustrated or fed up every day. Similarly, more women than men reported these symptoms few times in a week; 25% vs 18%, respectively. However, 34% of men and 23% of women did not report experiencing these symptoms. Younger participants (<45 years) reported daily fatigue vs older participants (>45 years); 46% vs 31%, respectively… (Source: Medscape, Jan. 20, 2022)

Scrub typhus coinfection in Covid patients 

Two cases of scrub typhus coinfection in Covid-19 patients has been reported in the journal Future Microbiology highlighting the need for a high index of suspicion for seasonal tropical infections in COVID-19 patients, particularly in endemic areas. The first patient was hypertensive and had lymphopenia and raised IL-6, while the second patient had leukocytosis and increased liver enzymes. Both patients had hypoalbuminemia and needed intensive care. Early diagnosis is imperative for timely management and better patient outcomes… (Source: Future Microbiology. Jan. 19, 2022).

Adverse events among placebo recipients in Covid-19 vaccine trials

A systematic review and meta-analysis of 12 clinical trials published in JAMA Network Open has found that while persons who received the Covid-19 vaccine reported much more adverse events vis-à-vis the placebo recipients, the adverse events in the placebo group were still significant. After the first dose, 46.3% of the vaccine recipients reported systemic adverse events, while 66.7% AEs after the second vaccine dose. Among the placebo recipients, 35.2% reported at least one systemic AE after the first dose and 31.8% reported an AE after the second dose. Headache and fatigue were the most commonly reported systemic AEs in the placebo group… (Source: JAMA Network Open, Jan. 18, 2022)

With inputs from Dr Monica Vasudev

Trial of Omicron-specific vaccine commences

Trial of an Omicron-specific Covid-19 vaccine developed by Pfizer Inc and BioNTech has begun in 1420 adults. This vaccine would be tested as a three-dose series, administered in doses of 30 µg, in the unvaccinated persons and as a booster dose in persons who have been vaccinated with two doses of primary vaccination with the current Pfizer vaccine. The trial will also test a fourth dose of the current vaccine against a fourth dose of the Omicron-specific vaccine in people who have received three doses of the Pfizer vaccine 3 to 6 months before the start of the trial… (Source: Medscape, Jan. 26, 2022)

Requirement of mechanical ventilation reduces in hospitalized Covid-19 patients treated with remdesivir: CATCO trial

Findings from the Canadian Treatments for COVID-19 (CATCO) trial show that addition of remdesivir (200 mg IV on day 0, followed by 100 mg IV daily) to standard of care reduced the need for mechanical ventilation among 1282 hospitalized Covid-19 patients compared with standard of care alone (8% vs 15%, respectively). There were also more oxygen-free and ventilator-free days in remdesivir treated patients (15.9 and 21.4 days vs 14.2 and 19.5 days, respectively). The CATCO trial is a substudy of the Solidarity conducted by the WHO… (Source: CMAJ, Jan. 19, 2022)

Trial to test molnupiravir in hospitalized patients with Covid-19

Trial investigating the possibility of using molnupiravir, the oral antiviral pill, as treatment for patients hospitalised with Covid-19 will soon start in the UK. The drug would be tested as stand-alone treatment and also in combination with other Covid-19 therapies. It would be administered twice daily for five days in 800 mg dose. At present, molnupiravir is approved for use in patients with mild to moderate Covid-19 infection… (Source: Medscape, Jan. 25, 2022)

Under-60 individuals with comorbidities now eligible for the fourth dose in Israel

Israel has expanded the coverage of the fourth dose of Pfizer/BioNTech Covid-19 vaccine to also include persons under 60 years of age with underlying medical conditions and their caregivers four months after the third dose. At-risk individuals older than 18 years are also now eligible for the fourth dose. Prior to this, the fourth dose had been approved only for persons older than 60 years after a gap of 5 months from the third dose (Source: Medscape, Jan. 27, 2022)

Third dose Covid-19 mRNA vaccine boosts protection against hospitalization

In a study conducted across multiple states in the US during the delta wave and reported in CDC’s latest MMWR, administration of the third dose of Covid-19 mRNA vaccine enhanced the vaccine effectiveness against Covid-related hospitalization from 82% (in 2-dose recipients) to 97% among immunocompetent adults. The third dose was also seen to increase the vaccine effectiveness against hospitalization from 69% (in two-dose recipients) to 88% among immunocompromised persons…(Source: Morbidity and Mortality Weekly Report (MMWR) Jan. 28, 2022)

Researchers from South Africa to examine association between HIV and Covid-19 

Accumulating evidence shows that the HIV and Covid-19 pandemics could be producing new coronavirus variants. Coronavirus can linger on for months in immunocompromised persons such as those with untreated HIV and mutate. Some mutations may be advantageous to the virus. Now, researchers at the Network for Genomic Surveillance in South Africa (NGS-SA) will investigate the impact of the two pandemics acting in concert with each other. Research would study how the immune systems of patients with HIV would react to Covid-19 and whether this would lead to emergence of new variants…. (Source: Medscape, Feb. 2, 2022)

COVID-19 wastewater surveillance as an early warning system

For the first time, the CDC will include data from wastewater Covid-19 surveillance in its online COVID Data Tracker to study the spread of infection in a community. Shedding of the virus in the feces begins very early in the infection. “Because increases in wastewater generally occur before corresponding increases in clinical cases, wastewater surveillance serves as an early warning system for the emergence of COVID-19 in a community”, said Dr Amy Kirby, team lead for the National Wastewater Surveillance System, which collects data from more than 400 testing sites across the US … (CDC, Feb. 4, 2022)

Gut dysbiosis in long Covid patients

Findings from a study published in Gut has for the first time shown altered gut microbiome at 6 months in patients with long Covid or post-acute COVID-19 syndrome (PACS), whereas patients who did not have PACS showed recovered gut microbiome. The bacterial diversity and richness was much lower in patients with PACS vs those without PACS. Gut microbiome of long Covid patients had higher levels of Ruminococcus gnavus, Bacteroides vulgatus and lower levels of Faecalibacterium prausnitzii. An association between opportunistic gut pathogens and continued respiratory symptoms was seen. Similarly, a correlation between neuropsychiatric symptoms and fatigue with nosocomial gut pathogens was also observed… (Source: Gut, Jan. 26, 2022)

Novavax files application for EUA of its COVID Vaccine

Novavax has applied for emergency use authorization (EUA) of its Covid-19 vaccine, NVX-CoV2373, for persons aged ≥18 years on the basis of results from clinical trials which demonstrated around 90% efficacy and a “reassuring safety profile”. These trials, however, were conducted before the Omicron variant replaced the delta variant to become the dominant strain in the US. The two-dose vaccine is administered at a gap of 21 days… (Source: Medscape, Feb. 1, 2022)

Pfizer seeks approval of its vaccine for under-5 children 

Pfizer and BioNTech have also applied to the US FDA to expand the EUA for their Covid-19 vaccine to include children aged 6 months to 4 years. Currently, approval has initially been sought for two doses of 3µg each. Permission for the third dose will be filed in the coming months, say Pfizer and BioNTech. The Vaccines and Related Biological Products Advisory Committee of the FDA will meet on Feb. 15 to review the application. Currently, the Pfizer-BioNTech vaccine is approved for use in children 5-11 years of age; a single booster dose has also been approved for children aged 12-15 years … (Source: Medscape, Feb. 1, 2022)

Omicron BA.2 sublineage is more transmissible than BA.1

The BA.2 sublineage of the Omicron variant is more infectious than the BA.1 variant and causes more infections in households. According to a preprint study from Denmark, BA.2 was associated with an increased risk for infection for unvaccinated individuals (Odds Ratio (OR) 2.19), fully vaccinated individuals (OR 2.45) and booster-vaccinated individuals (OR 2.99) compared to BA.1. The unvaccinated persons with BA.2 infection were 2-times (OR 2.62) more likely to transmit the virus among the household compared to those with BA.1... (Source: medRxiv, Jan. 30, 2022)

Unvaccinated persons at 23 times higher risk of hospital admission due to Omicron 

The chances of hospitalization are 23 times higher for unvaccinated adults during the Omicron wave and they are also four times more likely to contract the infection compared to the boosted adults, according to a CDC report. The unvaccinated persons were at 5 times higher risk of hospital admission and 2 times more at risk of getting infected compared to the fully vaccinated, but non-boosted individuals. They were also more likely to need intensive care or mechanical ventilation. Their mortality was also higher …(Source: Medpage Today, Feb. 1, 2022)

With input from Dr Monica Vasudev

Famotidine in mild to moderate Covid-19 

Results of a phase II trial reported in the journal Gut have shown that in patients with mild to moderate COVID-19 there was early resolution of symptoms and inflammation after treatment with famotidine without and decrease in anti-SARS-CoV-2 immunity. Fourteen of 16 symptoms evaluated such as loss of smell and taste, shortness of breath and abdominal pain recovered. Fifty percent relief in symptoms was noted in 8.2 days in the famotidine-treated patients compared to 11.4 days in the placebo group. Very few patients on famotidine showed detectable plasma levels of interferon alpha … (Source: Gut, Feb. 10, 2022)

Ivermectin does not stop progression of mild to moderate Covid-19 to severe disease

The Malaysian Ivermectin Treatment Efficacy in Covid-19 High Risk Patients (I-TECH) study reported in JAMA Internal Medicine has not shown favorable results with ivermectin for mild to moderate Covid-19. The study was conducted between May 31 and October 25, 2021. In these patients, ivermectin did not stop disease progression to severe disease (21.6% vs 17.3%, respectively with relative risk of 1.25). Patients treated with ivermectin also required mechanical ventilation (1.7% vs 4.0%) and intensive care (2.4% vs 3.2%, respectively)… (Source: Medscape, Feb. 18, 2022) 

Mental health outcomes in Covid patients

Covid survivors were at a 60% higher risk of being diagnosed with a new mental health condition up to one year compared with those who were never infected, according to a BMJ study. They were 1.35 times at higher risk of developing anxiety disorder and 1.39 times the risk for depressive disorder. Stress, both acute and PTSD, adjustment disorders and sleep disorders were also prevalent in them. Mental health-related drug prescriptions, also increased by 86% and they were more likely to be prescribed an antidepressant, Selective serotonin reuptake inhibitors (SSRIs), benzodiazepenes, Serotonin–norepinephrine reuptake inhibitors (SNRIs) …(Source: Medpage Today, Feb. 16, 2022)

WHO recommends reducing quarantine period in places with huge number of cases

The World Health Organization (WHO) has recommended reducing the quarantine period in countries with high number of cases that are overwhelming the resources in its interim guidance. It suggests shortening the quarantine period from 14 days to 10 days without a test and to 7 days with a negative test, if the person should not develop any symptoms. If testing is not possible, then absence of symptoms could be used as a marker in place of testing…(Source: Medscape, Feb. 18, 2022)

Booster effectiveness decreases after 4 months

CDC’s latest Morbidity and Mortality Weekly Report (MMWR) reports that the effectiveness of the booster dose against COVID-19–associated emergency department/urgent care visits and hospitalizations was higher after the third dose than after the second dose but the effectiveness declined after some time. During the Omicron-predominant period, the vaccine effectiveness against COVID-19–associated ED/UC visits was 87% during the first two months after the booster but declined to 66% after the fourth month. Similarly, vaccine effectiveness against hospitalizations, which was 91% initially decreased to 78% by the fourth month after a third dose. These findings call for being up to date with the recommended vaccination program in respective countries…(Source: MMWR, Feb. 18, 2022).

Study finds vagus nerve dysfunction as the cause of post-COVID symptoms 

Research from Spain has suggested that many symptoms of long Covid could be due to the effect of SARS-CoV-2 on the vagus nerve, which performs several functions in the body. Nearly 66% of the 348 patients had at least one symptom suggesting dysfunction of the vagus nerve such as diarrhea, low BP, tachycardia, dizziness, dysphagia and voice problems. Six patients showed vagus nerve thickening and increased echogenicity on ultrasound indicative of inflammation. Many of these patients had “structural and/or  functional alterations in their vagus nerve, including nerve thickening, trouble swallowing, and symptoms of impaired breathing” which point to “vagus nerve dysfunction as a central pathophysiological feature of long COVID”, state the authors… (Source: Medscape, Feb. 15, 2022).

Deltacron cases reported in the UK

Cases of deltacron variant have been reported in the UK. A hybrid of the Omicron and Delta variants (BA.1 + B.1.617.2), deltacron is currently being monitored, according to the UK’s health security agency (UKSHA). It was first discovered by researchers at the University of Cyprus, who said that the hybrid strain has Omicron-like genetic signatures within the Delta genome. Its origin was earlier  attributed to sample contamination. According to reported, it is believed to have evolved in a patient who caught both variants at the same time… (Source: Dailymail UK, Feb. 11, 2022)

With inputs from Dr Monica Vasudev

CDC relaxes the Covid-19 indoor mask guidelines 

The US Centers for Disease Control and Prevention (CDC) has eased the COVID-19 guidelines for mask wearing, including in schools. The new guidelines shift the emphasis from the rate of transmission of Covid-19 to monitoring hospitalizations, hospital capacity and infection rates. Under the new policy, counties have been segregated into three categories - low, medium and high risk – on the basis of hospital capacity and cases. People in medium-risk communities who are at increased risk of complications, such as those who are immunocompromised, are advised to consult their doctors if they should wear a mask. Only schools in high-risk areas should continue with universal masking, says the CDC … (Reuters, February 26, 2022)

FDA revises EUA to increase dose of Evusheld for pre-exposure prophylaxis of Covid-19

The US FDA has revised the dose of Evusheld (tixagevimab co-packaged with cilgavimab) used as pre-exposure prophylaxis of COVID-19 so that it is more activity against Omicron. The dose has now been increased to 300 mg of tixagevimab and 300 mg of cilgavimab from the earlier authorised dose of 150 mg of tixagevimab and 150 mg of cilgavimab administered as two separate consecutive intramuscular injections. Eusheld is authorized for use in adults and pediatric patients who are immunocompromised or who cannot take the vaccine due to history of severe adverse reaction. It is indicated for use only in persons who are not currently infected with SARS-CoV-2 and who have not had a known recent exposure to someone infected with SARS-CoV-2… (Source: US FDA, Feb 24, 2022)

Covid-19 vaccines protect against reinfection

Two studies reported in the New England Journal of Medicine have demonstrated strong protection with Covid-19 vaccines against reinfection. In one study from Israel by Hammerman et al, persons who recovered from Covid-19 and received at least one dose of the Pfizer-BioNTech vaccine were at a significantly lower risk of recurrent infection. Vaccine effectiveness was 82% for 16-64 age group and 60% for ≥65 age group. In the second study from the UK, vaccine effectiveness was greater than 90% for those who were vaccinated (Pfizer or AstraZeneca vaccine) after infection including in persons who had been infected more than a year back…(Medscape, Feb. 22, 2022)

CDC recommends longer interval between the two-vaccine doses 

In its updated guidance, the CDC has said that an 8-week gap between the first and second doses of the Pfizer/BioNTech and Moderna COVID vaccines may be more advantageous for individuals aged 12 years and older, especially for males. According to the CDC, this would reduce the risk of myocarditis. The earlier recommended interval of 3 weeks for Pfizer and 4 weeks for Moderna remains for persons aged ≥65 years, the immunocompromised or those at risk of severe infection. For children, the second dose should be taken 3 weeks after the first dose of Pfizer…(Source: Medscape, Feb. 24, 2022)

FDA restricts scope of sotrovimab monoclonal antibody

In a revised EUA letter issued to GlaxoSmithKline on Wednesday, the US FDA has said that “sotrovimab is not authorized for treatment of mild to moderate COVID-19 in geographic regions where infection is likely to have been caused by a non-susceptible SARS-CoV-2 variant, based on available information including variant susceptibility to this drug and regional variant frequency.” Sotrovimab is the only monoclonal antibody to retain some neutralizing activity against the Omicron variant. It has to be administered in a healthcare setting…(Source: US FDA, Feb. 23. 2022)

Mental health toll of the pandemic in adolescent females 

According to a new CDC study, more adolescent females (aged 12–17 years) visited the emergency department for mental health conditions during the pandemic than before. The number of ER visits for eating disorders increased 2-folds, while visits for tic disorders increased 3-folds. There were also more visits for anxiety,  trauma and stressor-related visits, including obsessive-compulsive disorders … (Source: MMWR, Feb. 25, 2022)

With inputs from Dr Monica Vasudev

Covid-19 pandemic led to 25% rise in global prevalence of anxiety and depression

According to a World Health Organization (WHO) scientific brief, prevalence of anxiety and depression worldwide rose by 25% during the first year of the pandemic. Multiple stress factors have been implicated such as social isolation, loneliness, fear of infection, bereavement and financial worries. Exhaustion has been cited as the principal factor responsible for suicidal ideation among healthcare workers. Young people and women are among the worst affected… (Source: WHO, March 2, 2022)

Addition of baricitinib reduces mortality in hospitalized patients with severe Covid-19 

Results from the UK RECOVERY trial show that the addition of baricitinib (4mg once daily x 10 days) to standard care reduced deaths in hospitalized patients with severe Covid-19 by 13% compared to standard care alone. Baricitinib-treated patients were more likely to be discharged alive within 28 days (80% vs 78%). Progression to invasive mechanical ventilation or death reduced from 17% to 16% among patients who were not on invasive mechanical ventilation … (Source: Medscape, March 4, 2022)

Raised liver enzymes plus comorbidity increase mortality in Covid-19 patients 

Results of a retrospective study published in the Journal of Clinical and Translational Hepatology suggest that raised liver enzymes at the time of hospitalization coupled with presence of comorbidity increased mortality risk 5-folds in patients with Covid-19. These patients were more likely to be older and have severe symptoms and also required intensive care … (Source: Journal of Clinical and Translational Hepatology, February 28, 2022)

Fewer Covid-19 patients survive in-hospital cardiac arrest

According to a JAMA Network Open study, which reviewed data from the American Heart Association Get With the Guidelines–Resuscitation registry, compared to patients without Covid-19, those who had Covid-19 had lower chances of surviving an in-hospital cardiac arrest; 23.5% vs ~12%, respectively. Defibrillation was more likely to be delayed in Covid patients (30%). Return of spontaneous circulation was 53.7% and 63.6%, for infected and noninfected patients, respectively…(Source: Medscape,  March 3, 2022)

Molnupiravir can be used in high-risk patients with non-severe Covid-19

A World Health Organization (WHO) panel has recommended the use of molnupiravir for patients with non-severe Covid-19 disease who are at high risk of hospitalization, such as patients with chronic diseases or those who are immunocompromised or unvaccinated including older patients. Owing to lack of data for patients with severe or critical disease, molnupiravir has not been recommended for these groups of patients. Molnupiravir should not be administered to young and healthy patients, including children, and pregnant or breastfeeding women … (Source: Medscape, March 4, 2022)

With inputs from Dr Monica Vasudev

Deltamicron: Could this be a new variant of concern? 

A preprint study has reported “Deltamicron” a recombinant hybrid form of coronavirus, which has genes from both Delta and Omicron variants “Delta 21J/AY.4-Omicron 21K/BA.1 in three patients in southern France. Similar hybrid version of the virus have also been reported in 15 samples from Europe and two from United States. According to the Philippe Colson, the lead author of the study, it is too early to state if the recombinant virus would be infectious or cause severe disease... (Source: medRxiv, March 8, 2022)

Sniffer dogs to detect SARS-CoV-2 infection

Dogs can screen crowds to detect persons infected with the coronavirus, suggests a new preprint study from France. 335 volunteers scheduled for RT PCR also gave sweat samples at two community screening centers in Paris. Of these, 78 symptomatic and 31 asymptomatic were positive on RT PCR. When dogs were asked to smell the sweat samples, they could detect infected cases with 97% accuracy in symptomatic cases and also in asymptomatic patient with 100% accuracy. They could also exclude the infection in persons without symptoms with 94% accuracy … The sensitivity of canine detection was higher than that of nasopharyngeal antigen testing (97% vs 84%), but the specificity was lower (90% vs 97%) … (Source: medRxiv, March 8, 2022)

Patients with congenital heart defects at 2-folds higher risk of severe COVID-19 

A new study in the journal Circulation reports that patients with congenital heart defects who were hospitalized with COVID-19 double their risk of severe disease or mortality versus those who do not have such heart defects. They were also more likely to need intensive care or mechanical ventilation. Those who also had a comorbid condition, in addition to congenital heart defects, were at higher risk of severe COVID-19. Hence, people with heart defects must get vaccinated and also continue with protective measures like face masks, physical distancing …. (Source: Circulation, March 7, 2022)

Total IgE, a new prognostic marker for COVID-19?

In a single-center study reported in the Internal Medicine Journal, the serum total IgE levels were considerable raised in Covid-19 patients whose condition deteriorated clinically compared to stable patients; 172.90 vs 38.70; respectively. They also had lower levels of serum eosinophils (0.015 vs 0.040; respectively). The optimal cut-off for predicting clinical worsening was 105.2 ng/L; with 61% sensitivity, 82% specificity, 46.3% positive predictive value and 89.2% negative predictive value … (Source: Internal Medicine Journal, March 7, 2022)

With inputs from Dr Monica Vasudev

BCG vaccine enhances immune protect against SARS-CoV-2 

A preprint study in hamsters has shown that the BCG vaccine reduced the SARS-CoV-2 viral load in the lungs as well as bronchopneumonia. The vaccine led to an increase in alveolar macrophages in the lungs, reduced interstitial macrophage leading to decreased IFN-associated gene expression and recruitment of higher levels of Th1, Th17, Treg, CTLs, and Tmem cells. The authors concluded that combining the BCG vaccine with the currently available COVID-19 vaccines “may offer synergistic protection” though studies are needed to confirm this… (Source: bioRxiv, March 15, 2022)

Pfizer and Moderna seek approval for second booster doses

Pfizer-BioNTech have applied for authorization for second booster shot, but only for persons older than 65 years who have been vaccinated. Moderna has also sought emergency authorization for a booster shot of its Covid-19 vaccine for all adults ≥ 18 years who have completed their primary vaccination. However, the age groups would be at the discretion of the CDC… (Source: Medscape, March 18, 2022).

Long-term adverse mental health symptoms in patients with severe COVID-19

Analysis of data from Denmark, Estonia, Iceland, Norway, Sweden and the UK between March 27, 2020, and August 13, 2021 shows that 22% patients with COVID-19 who had been confined to bed on account of their illness for ≥7 days, which was 16 months in this multicohort study, were at a greater risk of suffering long-term depression with a prevalence ratio of 1.61) and anxiety (PR 1.43) versus those who had COVID-19 but were not bedridden (PR 0.83 and PR 0.77, respectively)… (Source: The Lancet Public Health, March 14, 2022)

Low efficacy of fourth booster dose against Omicron 

A NEJM study involving healthy young healthcare workers in Israel, which analysed the effectiveness of fourth dose of mRNA Covid-19 vaccine (Pfizer-BioNTech or Moderna) found them to be only marginally effective against Omicron even though both vaccines induced IgG antibodies and increased the titers of neutralizing antibodies. The fourth dose can restore the antibody levels generated after the third vaccine dose. However, people at high risk of severe disease could benefit from the fourth dose, according to the authors”… (Source: New England Journal of Medicine, March 16, 2022)

With inputs from Dr Monica Vasudev

Use of Covid donor organs

Data regarding organ donation from donors who currently had Covid-19 or had the infection in the past will be presented at the European Congress of Clinical Microbiology & Infectious Diseases meeting to be held next month in Lisbon, Portugal. Experimental protocols for the use of these organs may be presented. Lungs or intestines should only be used if the donor last tested positive for the virus ≥20 days before, while other organs can be transplanted safely if the donor did not die due to Covid-19 or had excessive blood clotting … (Source: Medscape, March 24, 2022)

Moderna seeks EUA for Covid vaccine for children aged 6 months

Moderna has applied for emergency use authorization of its mRNA vaccine for use in children aged 6 months to 6 years based on data from the KidCOVE study. Moderna is also seeking approval of two doses of the vaccine in children six to 12 years old. According to the study, the vaccine induced similar levels of antibodies as in adults with a higher dose. The vaccine efficacy in protecting children aged six months to two years from Omicron was nearly 44% and that in children aged two to six years was 37.5%. Moderna vaccine is at present authorized for use only in adults aged ≥18 years … (Source: Times, March 23, 2022)

Common symptoms of long Covid 

More than 20% of the young and middle-aged adults, who had mild Covid-19, continue to experience post-acute symptoms of fatigue, difficulty in concentration, memory problems, dyspnea and rapid physical exhaustion 6-12 months after the mild acute infection, according to the EPILOC (Epidemiology of Long Covid) study. These symptoms greatly affected their general health and working capacity … (Source: medRxiv, March 15 2022)

Higher risk of diabetes in Covid-19 patients

A study reported in The Lancet Diabetes & Endocrinology suggests that patients with Covid-19 are at a 40% higher risk of developing diabetes at one year. They also had an increased risk for incident use of antihyperglycemic drugs, according to analysis of data from 181,280 individuals in the US Department of Veterans Affairs healthcare database with diagnosis of COVID-19. While those with severe infection were at a higher risk of diabetes, even patients with mild Covid-19 had a high risk of diabetes. Hence, Covid patients should be regularly screened for diabetes…. (Source: Medscape, March 23, 2022)

Third dose of Pfizer vaccine is safe and effective

New data gives credence to the safety and efficacy of the third booster dose of the Pfizer–BioNTech COVID-19 vaccine in persons aged ≥ 16 years. The third dose of the vaccine administered a median of 10.8 months after the second dose provided 95.3% efficacy against Covid-19 as compared with two doses of the BNT162b2 vaccine during a median follow-up of 2.5 months. Covid-19 with onset at least 7 days after dose 3 was observed in 6 participants in the vaccine group and in 123 participants in the placebo group… (Source: NEJM, March 23, 2022)

With inputs from Dr Monica Vasudev

Reduced risk of hospitalization in adolescents following Pfizer Covid vaccine

The Pfizer BioNTech Covid vaccine decreased hospitalization during the Omicron in children aged 5-11 years by 68% in a US study. Among adolescents, the omicron-related hospitalization reduced by nearly 40%. But against the delta variant, the vaccine effectiveness in preventing hospitalization among adolescents was around 93%. Despite lower protection against Omicron hospitalizations, vaccination prevented critical illness caused by either variant… (Source: New England Journal of Medicine, March 30, 2022)

Second booster dose for 50+ and immunocompromised persons

The US Food and Drug Administration (FDA) has authorized a second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 vaccines for people aged 50 years and older at least 4 months after taking the first booster dose. Immunocompromised persons  such as those with solid organ transplant are also eligible to receive a second booster dose of the vaccines; 12 years and older for Pfizer and 18 years and older for Moderna at least 4 months after the first booster dose… (Source: US FDA, March 29, 2022)

WHO sounds a note of caution about the “XE” Omicron variant 

The WHO has cautioned about a new variant of Omicron. The XE variant of Omicron is 10% more transmissible than the BA.2 subvariant. It is a recombinant strain and hybrid of the BA.1 and BA.2 sublineages of the Omicron variant. According to the WHO, “The XE recombinant (BA.1-BA.2), was first detected in the UK on January 19 and less than 600 sequences have been reported and confirmed since.” There are currently three recombinant or hybrid variants XD, XE, XF. XD is a delta and BA.1 recombinant detected in France, Denmark and Belgium and XF is the recombinant of Delta and BA.1 detected in Britain… (Source: Express.co.uk, April 1, 2022)

Hearing loss and Covid-19 vaccines 

Cases of hearing loss and other auditory disturbances like tinnitus, though rare, have been reported among Covid-19 vaccinated people. The World Health Organization is reviewing this association. According to a WHO newsletter, globally 164 cases of hearing loss and 367 cases of tinnitus have been reported among Covid-19 vaccinated people. Majority of the tinnitus cases were reported after the Pfizer vaccine… (Source: Medscape, March 31, 2022)

With inputs from Dr Monica Vasudev

The XE recombinant variant

A new recombinant strain of the Omicron variant, called XE, has been detected in the United Kingdom. It combines the BA.1 and the BA.2 lineage of the Omicron variant. About 763 samples of XE have been identified in the UK (as of March 22); few cases have been also reported in China and Thailand. According to the WHO, it was first detected in the UK on 19th January. XE has a community growth rate advantage of ~10% as compared to BA.2. The UK Health Security Agency (UKHSA) is examining three recombinant variants, XF, XE and XD. 38 cases of XF (recombinants of Delta and Omicron BA.1)  have been identified in the UK; XD is not yet detected in the UK… (Source: Medscape, April 5, 2022)

FDA rescinds authorization of sotrovimab for BA.2 Omicron cases

The monoclonal antibody, sotrovimab is not authorized now to treat Covid-19 cases caused by the Omicron BA.2 subvariant citing its lack of effectiveness against the BA.2 subvariant, stated the FDA in an update to the emergency use authorization since BA.2 is becoming the dominant strain in the US…(Source: US FDA,  April 5, 2022)

Unvaccinated ambulatory Covid patients at high risk of venous thromboembolism 

Ambulatory patients with mild Covid-19 are at 20-times higher risk of developing incident venous thromboembolism (VTE) within 30 days of their confirmatory RT PCR test. Unvaccinated persons were at considerably higher risk than the fully vaccinated persons. Older age, male sex, and obesity were the other risk factors for Covid-related VTE. Compared with noncarriers, carriers of inherited thrombophilia were at a 2-folds higher risk of VTE… (Source: Medscape, April 7, 2022)

Myriad presentations of Covid-19

The journal BMC Endocrine Disorders has described the case of a 13-year-old boy, weighing 69 kg, with Covid-19 with multisystemic involvement, including the endocrine, renal, pulmonary, gastrointestinal and nervous systems, due to the infection managed by a multidisciplinary team of doctors. The child had had no such problems earlier but developed them after he acquired Covid-19. In this patient, Covid-19 was associated with new-onset diabetes mellitus, severe diabetic ketoacidosis, acute renal failure, nausea-vomiting and upper gastrointestinal bleeding, resistant hypertension and reduced level of consciousness. The authors say, “practitioners should be more careful in order to avoid missing the chimeric features of COVID-19 infection.” (Source: BMC Endocrine Disorders, April 5, 2022)

Eye, a possible route of Covid-19 transmission? 

A survey of more than 55,000 volunteers of the Virus Watch cohort study in England and Wales on the use of glasses and contact lenses has shown a 15% reduction in the risk of Covid-19 among those who always wore glasses compared to those who never wore glasses. Nearly 23% of those who never used glasses had COVID-19 versus 15.6% of those who always wore glasses. But this protective effect of glasses was reduced in those who said that glasses interfered with use of face masks. No such protective effect was seen in people who used contact lenses… (Source: medRxiv, April 4, 2022)

With inputs from Dr Monica Vasudev

First Covid-19 diagnostic test using breath samples gets FDA nod

InspectIR COVID-19 Breathalyzer, the first COVID-19 diagnostic test that rapidly detects five volatile organic compounds (VOCs) associated with SARS-CoV-2 infection in exhaled breath has been granted emergency use authorization (EUA) status by the US FDA. A presumptive positive result needs to be confirmed with a molecular test. However, a negative result does not rule out Covid-19 and has to be viewed in context of the history of exposure and compatible signs and symptoms…(US FDA, April 14, 2022)

BA.4 and BA.5: The new sublineages of Omicron variant

Two new sublineages of the omicron coronavirus variant, named BA.4 and BA.5 have been discovered, which are now being monitored by the World Health Organization (WHO) in addition to the BA.1, BA.2, BA.3 sublineages. BA.4 has been found in South Africa, Denmark, Botswana, Scotland and England, while BA.5 has been detected in South Africa and Botswana. As per the 87^th Edition of the WHO Weekly Epidemiological Update, BA.4 and BA.5 have additional mutations in the Spike region (S:L452R, S:F486V) and unique mutations outside of Spike. The S:L452R and S:F486V mutations have potential immune escape. Most BA.4 and BA.5 sequences have the 69-70 deletion leading to S gene target failure …(Source: Medscape & WHO, April 12, 2022).

Pfizer Covid-19 booster safe and effective in children aged 5-11 years

Pfizer-BioNTech have said that a booster dose of their Covid-19 vaccine was safe and elicited an immune response in children aged 5 to 11 years. Based on these findings, Pfizer-BioNTech will apply for  the emergency use authorization (EUA) of their vaccine in this age group. A 36-fold rise in the neutralizing antibodies against the Omicron variant was observed following the third dose in a subgroup analysis of 30 children in the phase II/III clinical trial. A six-fold increase in neutralizing antibodies was seen 1 month after the booster vs immune response seen one month after the second dose  in the phase II/III trial of 140 children… (Source: Medpage Today, April 14, 2022)

Fourth dose of Pfizer vaccine effectively decreases risks of Covid-related outcomes

In a study from Israel, the fourth dose of the Pfizer-BioNTech vaccine was 74% effective against Covid-19-related death within four weeks after the administration of the third dose. The vaccine effectiveness against PCR confirmed SARS-CoV-2 infection was 45% against symptomatic Covid-19 it was 55% and against Covid-19–related hospitalization it was 68%... (Source: New England Journal of Medicine, April 13, 2022)

CDC recommends tracking of new coronavirus variants in animals

Emphasizing the “One Health” approach, the CDC has now recommended regular tracking of the spread of the coronavirus in animals and watching for new variants that could mutate in wildlife and spread back to humans in an update to its earlier recommendation of avoiding routine animal testing. The CDC has said that now the state public health veterinarians, state animal health officials, and wildlife health specialists could test pets, livestock, zoo animals, or wild animals "as part of an epidemiologic investigation" of the coronavirus. It stays, “veterinarians should use their clinical judgement, including considering other common causes of illness, when deciding whether to test animals for SARS-CoV-2” … (Source: Medscape, April 12, 2022)

With inputs from Dr Monica Vasudev

Omicron BA.2 is the dominant variant in the US

According to CDC data, the prevalence of BA.2 sublineage of the Omicron SARS-CoV-2 variant in the US is around 93.4%. Genomic analysis in the week from April 10 to April 16, 2022 also showed that about 19% of these samples are of BA.2.12.1 sublineage of BA.2, 6.1% are BA.1.1, while the B.1.1.529 constitutes just 0.5%…(Source: CDC, April 20, 2022)

“The deadliest lung lobe in COVID-19” 

The involvement of the right middle lung lobe on chest x-ray is an independent predictor of in-hospital mortality in patients hospitalized with Covid-19, says a retrospective study of elderly patients reported the journal Postgraduate Medicine. The relative risk for in-hospital mortality with right middle lung lobe involvement was 1.8 vis a vis relative risk of 1.6 with involvement of the left lower lobe. In cases where the right middle lobe was the only lobe involved, the relative risk for in-hospital mortality was 2.6. The relative risk for persistent organ failure was 1.7 with the involvement of right middle lobe; 1.7 for respiratory failure and 1.5 for acute kidney injury…Source: Postgraduate Medicine, April 20, 2022)

Gender difference in long Covid symptoms

A study published in The Journal of Womens Health suggests that women are more likely to report persistent symptoms such as dyspnea, fatigue, chest pain, and palpitations after recovery from Covid-19. They were also more symptomatic than men during the acute phase of the infection. No such difference was noted for symptoms of myalgia, cough, and sleep disturbance. Hence, follow up of Covid patients should also take into consideration this gender difference and initiate timely preventive and individualized strategies (Source: Journal of Womens Health, March 25, 2022)

Pulmonary embolism in children with Covid-19

A retrospective review of nine cases of Covid-19-associated pulmonary embolism during the B.1617.2 delta wave emphasizes on the need to have a high index of suspicion for PE in children with Covid-19. These adolescents were mostly unvaccinated and also obese. They were all seriously ill and two also required catheter-directed thrombolysis plus anticoagulation. … (Source: Pediatric Blood & Cancer, April 19, 2022)

Peripheral muscle fatigue limits exercise capacity Covid recovered patients

According to a study from Brazil, exercise limitations on cardiopulmonary exercise testing in patients who have recovered from Covid-19 were most commonly due to fatigue of peripheral muscles (92%); limitations due to cardiovascular factors were seen in 2%, while pulmonary factors accounted for 6% cases. Post-recovery treatment should also address fatigue and include rehabilitation program including aerobic and muscle strengthening components, adequate hydration and sleep … (Source: MDedge, April 20, 2022)

With inputs from Dr Monica Vasudev

Rising incidence of BA.2.12.1 subvariant in the US

New York and other parts in the North east part of the United States are witnessing a rise in cases of BA.2.12.1 Omicron subvariant since it was first detected in February. More than 75% cases (as on April 20) in Central New York were BA.2.12.1. In the country as a whole, BA.2.12.1 has increased from 3.5% of cases a little more than a month ago to nearly 30% of cases last week… (Source: Medpage Today, April 28, 2022)

Impending fifth wave in South Africa

There is an uptick in cases in South Africa, largely driven by the BA.4 and BA.5 variants raising concerns of a fifth wave in the country. The cases are showing an exponential rise. Gauteng province, which was the epicenter of the Omicron wave in the country, is again the epicenter of the current surge in cases with 3145 daily new cases and a 7-day average of more than 2000. The test positivity increased from ~12% a week back to 20.2%.... (Source: MedPage Today, April 27, 2022)

Moderna seeks EUA for its Covid-19 vaccine in young children

Moderna has applied for emergency use authorization (EUA) for its Covid-19 vaccine (mRNA-1273) for children aged 6 months to below 6 years. The vaccine will be administered in two doses of 25 μg each. The company is seeking approval based on preliminary results from the Phase 2/3 KidCOVE study which showed that the vaccine induced a strong neutralizing antibody response in this age group with a favorable safety profile. The vaccine was 43.7% effective in preventing COVID-19 with symptoms among those 6 months to 2 years old and 37.5% effective in the 2- to under 6-year age group … (Source: Moderna, April 28, 2022)

Denmark temporarily puts its Covid vaccination program on hold

Denmark will pause its Covid vaccination program from May 15, though people will be able to complete their vaccination course. Vaccination may restart in the Fall, according to the Danish Health Authority, which said, “Spring has arrived, vaccine coverage in the Danish population is high, and the epidemic has reversed.” The country has vaccinated 4.8 million people and more than 3.6 million have taken their booster dose…(Source: CNBC, April 28, 2022)

79% rise in global measles cases

Globally, measles cases increased by 79% in January and February this year compared to the same period last year, according to the WHO and UNICEF. The number increased from 9665 in 2021 to 17,338 in 2022. The Covid pandemic has hampered routine child vaccination programs across the world increasing the risk of vaccine-preventable diseases raising possibility of outbreaks. “In 2020, 23 million children missed out on basic childhood vaccines through routine health services, the highest number since 2009 and 3.7 million more than in 2019.” (Source: WHO, April 27, 2022)

NCCN recommends fifth Covid-19 dose for patients with cancer

Immunocompromised persons, including those with cancer should take a fifth COVID-19 mRNA dose (second booster), recommends the National Comprehensive Cancer Network (NCCN) in its updated vaccine guidelines for patients with cancer. Moderna and Pfizer shots can be used interchangeably for boosters. The primary vaccination series for immunocompromised persons involves three doses of mRNA vaccine…(Source: Medscape, April 27, 2022)

With inputs from Dr Monica Vasudev

WHO finds 14.9 million excess deaths during the pandemic in 2020-21

There were around 14.9 million excess deaths associated with Covid-19 pandemic from January 1, 2020 to December 31, 2021 and ranged between 13.3 million and 16.6 million, says the World Health Organization. 81% of these deaths occurred in middle-income countries and 15% deaths were in the  high-income countries. Low-income countries reported just 4% of these excess deaths. Deaths directly due to the disease or indirectly due to the impact of the pandemic on society and healthcare systems comprise excess mortality. Majority of excess mortality has occurred in Europe, the Americas and South-East Asia… (Source: WHO, May 5, 2022)

CDC reiterates its recommendations for masking during travel

The CDC continues to recommend that all individuals aged 2 years and older including the staff should wear well-fitting face masks during travel in public transport such as trains, airplanes etc. including transportation hubs such as train stations, airports, etc. not only to protect themselves but also protect their fellow travelers and others. This reiteration from the CDC comes in the wake of a ruling by a Federal judge in Florida who ruled against a national mask mandate on public transportation and the Transportation Security Administration (TSA) said that it would not impose mandatory mask wearing … (Source: CDC & NPR, May 3, 2022)

Increase in new infections among TSA staff after lifting of mask mandate

There has been a 50% rise in Covid-19 among the staff of Transportation Security Administration after the federal mask mandate was rescinded by a Florida judge on 18th April. From 359 infections on April 18, the number of infections among the employees has climbed up to 542 on Monday (2nd May) suggesting 50% rise in infections… (Source: Medscape, May 5, 2022)

FDA restricts use of J&J Covid-19 vaccine due to the risk for thrombosis

Because of the risk of thrombosis with thrombocytopenia syndrome (TTS), a potentially fatal condition, which occurs 1-2 weeks after the administration of J&J Covid-19 vaccine, the US FDA on Thursday has allowed use of the vaccine in specific people only. Now “persons 18 years of age and older for whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate, and to individuals 18 years of age and older who elect to receive the Janssen COVID-19 Vaccine because they would otherwise not receive a COVID-19 vaccine”… (Source: US FDA, May 5, 2022)

Airplane wastewater tests positive for SARS-CoV-2 despite mandatory pre-flight test and vaccine pass

Having a vaccination pass and a negative RT PCR before boarding an international flight did not prevent the import of the Omicron variant in Europe, suggests a study posted on the preprint server medRxiv. Testing of the wastewater of the airplane between landing and custom clearance found the SARS-CoV-2 RNA in the wastewater. Eleven passengers (20%) tested positive for SARS-CoV-2 with identification of the Omicron BA.1 subvariant … (Source: medRxiv, April 22, 2022)

With inputs from Dr Monica Vasudev

Masks no longer required during air travel in Europe

Earlier this week, the European Union Aviation Safety Agency (EASA) and European Centre for Disease Prevention and Control (ECDC) said that from 16^th May wearing masks would no longer be mandatory in Europe, both in-flight and also in the airports. Several European countries like France, Italy, Bulgaria have relaxed all Covid-related curbs and restrictions…(Medscape, May 12, 2022).

North Korea confirms first Covid outbreak in the country

A national emergency along with a nation-wide lockdown has been declared in North Korea after it confirmed its first Covid-19 outbreak this week since the onset of the pandemic. There has been at least one confirmed Covid death in the country. As per the official KCNA news agency, there are around 350,000 cases of fever of unknown origin; 18,000 new cases were reported on Thursday. About 187,800 are being managed in isolation. North Korea has no Covid-19 vaccination program …(Reuters, May 13, 2022).

More than half of Covid survivors have symptoms 2 years after the initial infection

According to a study from China reported in The Lancet Respiratory Medicine, 55% patients who survived Covid-19 at a minimum of one symptom two years after their initial hospitalization for Covid-19. Fatigue or muscle weakness were the most commonly reported symptoms, though 12% of patients also reported depression or anxiety. Researchers analyzed data of 1192 patients discharged from a hospital in Wuhan between January 7 and May 29, 2020… (MedPage Today, May 11, 2022)

A new indication for baricitinib 

The US FDA has approved the use of baricitinib in hospitalized adult Covid-19 patients who need oxygen supplementation, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). This makes it the first immunomodulatory drug to be approved for treatment of Covid-19. In 2020, baricitinib was authorized for use in combination with remdesivir, which was later revised in 2021 for authorization as a standalone treatment… (Source: US FDA, May 10, 2022)

IDSA guideline for managing drug interactions with Paxlovid

The Infectious Diseases Society of America (IDSA) has issued guidelines for managing drug interactions with Paxlovid, combination of nirmatrelvir and ritonavir. IDSA advises clinicians to obtain a list of all medications that the patient is taking, including OTC drugs and herbal supplements. Discontinue a drug if the patient is not taking it. Check to see if any of the current medications are contraindicated with Paxlovid. All potential drug interactions between Paxlovid and the current medications should be examined carefully. Specifically, coadministration of Paxlovid should be avoided with two drugs, rivaroxaban and salmeterol, because of severe interactions, says IDSA... (IDSA, May 9, 2022)

With inputs from Dr Monica Vasudev

Daily new cases increasing but deaths decreasing, says WHO

As per the latest WHO Epidemiological Update #92, global deaths saw a decline of 21% in the last week, but the daily new cases continued to increase in many parts of the world. The Eastern Mediterranean Region saw a rise of 63% in new weekly infections, while in the Americas new weekly cases increased by 26%. Cases are declining in South East Asia and Europe. The weekly cases also increased in Africa and the Western Pacific region. Africa registered a 48% increase in new weekly deaths… (Source: WHO, May 18, 2022)

Children aged 5-11 now eligible for Pfizer booster dose

Children aged 5-11 years are now eligible for a booster dose of the Pfizer vaccine after a gap of 5 months from the second dose of the Pfizer vaccine. Earlier this year in January, a single booster dose of vaccine was authorized by the FDA for use in children aged 12-15 years of age following the primary vaccination with the Pfizer vaccine … (Source: US FDA, May 17, 2022).

Fluvoxamine fails to pass muster as Covid-19 treatment

Fluvoxamine, a selective serotonin reuptake inhibitor used as an antidepressant has failed to get the FDA’s nod as outpatient treatment for patients with Covid-19 aged ≥24 years to prevent progression of the disease to severe stage, necessitating hospital admission. The FDA said that the data regarding the effectiveness of the drug was inadequate… (Source: Medscape, May 18, 2022).

Covid test for domestic travel in the US

The CDC advises all domestic travelers in the United States, including those who are fully vaccinated and boosted, to get tested as close to the day of travel. Travelers who have been in crowded places, without masks, should get themselves tested at the end of the trip. The CDC further recommends all domestic travelers to be aware of the rules and regulations of the destination they are traveling to…(Source: CDC, May 16, 2022).

Vaccination reduces probability of long Covid

A BMJ study involving more than 28,000 participants from the UK has found that Covid-19 vaccination reduced the chances of long Covid. The first vaccine dose reduced the probability of long Covid by 12.8%, while the second vaccine dose reduced the odds of post-Covid syndrome by nearly 9%. The risk reduced by 0.8% every week after the second dose… (Source: BMJ, May 18, 2022).

Formation of viral aggregates may have caused high transmissibility of delta variant

New research published in Viruses has shed some light on why infection with the delta variant was highly transmissible and had high viral load. Uniquely, the pseudotyped Delta particles formed large aggregates of viral particles enabling further spread of the virus. Also, this leads to larger number of viral particles coming in contact with the host cell. No such aggregation was observed with other SARS-CoV-2 variants… (Source: NIH, May 11, 2022)

With inputs from Dr Monica Vasudev

Covid-19 weekly cases continue to fall globally

New weekly cases continue to decrease worldwide following a peak in January this year. According to WHO’s latest weekly epidemiological update on Covid-19, more than 3.7 million cases were recorded in the week from 16^th May to 22^nd May, which is a 3% decline from the preceding week. Weekly deaths also showed a decline of 11% from the previous week. Among the six WHO regions, new weekly cases increased by 13% in the Region of the Americas; the Western Pacific Region saw a rise of 6%, whereas cases decreased in all the other four regions… (Source: WHO, May 25, 2022)

CDC still advises Paxlovid despite reports of Covid-19 rebound 

Even as it alerted physicians about cases of “COVID-19 rebound” following treatment with Paxlovid, the Centers for Disease Control and Prevention (CDC) still advises Paxlovid (nirmatrelvir/ritonavir) for treatment of mild to moderate Covid-19 in patients at high risk of developing severe disease. Covid-19 rebound reportedly occurs 2-8 days after the patient has recovered. It is marked by either recurrence of symptoms or a positive test after a negative test. The CDC says that this “return of symptoms may be part of the natural history of SARS-CoV-2”. Such persons should isolate themselves again for minimum of 5 days and wear a mask for 10 days after onset of rebound illness… (Source: CDC, May 24, 2022)

BA.2.12.1 is the new dominant Covid-19 variant in the US

As per CDC data, the dominant Covid-19 strain in the United States now is BA.2.12.1, a sublineage of the BA.2 omicron “stealth” subvariant. In the week from 15^th May to 21^st May, nearly 58% of total cases were due to BA.2.12.1. The BA.2 contributed 39% cases, while the share of original B.1.1.529 Omicron variant was less than 3%. The BA.2.12.1 variant is highly infectious, more than the BA.2 variant...(Source: CDC, May 24, 2022)

Mammography should not be delayed post-Covid-19 vaccine

New research says that screening mammography should not be delayed following vaccination with Covid-19 mRNA vaccine. As reported in the American Journal of Roentgenology, the lymph nodes did not resolve till 127 days after the first dose of the vaccine and 97 days after the first ultrasound. In some women, axillary lymph node enlargement has been detected post-vaccine and may be misdiagnosed as breast cancer. Mammography was earlier recommended to be scheduled before the first dose of the vaccine or at least 4 to 6 weeks after the second dose…(Source: American Journal of Roentgenology, May 18, 2022)

Air pollution increases risk of severe COVID-19 outcomes

Long-term exposure to air pollutants, in particular ozone, increases the risk of severe disease with ensuing adverse outcomes in patients with Covid-19. For every 5.14ppb rise in IQR, exposure to ozone increased the risk of hospitalization, ICU admission and mortality with odds ratios of 1.15, 1.30 and 1.18, respectively. The study of more than 150,000 patients examined the association of fine particulate matter (PM2.5), nitrogen dioxide (NO2) and ground-level ozone (O3) with Covid-related outcomes… (Source: Canadian Medical Association Journal, May 24, 2022)

With inputs from Dr Monica Vasudev

Prevalence of BA.4 and BA.5 Omicron subvariants rising in the US

The prevalence of BA.4 and BA.5 sublineages of the Omicron SARS-CoV-2 variant is increasing in the United States. Together the two strains now constitute 13% of new infections compared to 7.5% in the previous week, as per latest CDC data. 7.6% are BA.5 and 5.4% are BA.4 cases. BA.2.12.1 is the predominant circulating strain at 62.2%, while BA.2 accounts for 24.8% of cases… (Source: Medscape, June 9, 2022).

Higher immune evading properties of  BA.4, and BA.5

The BA.4 and BA.5 Omicron subvariants show 4.2 times higher immune escape potential in persons who are fully vaccinated and also boosted vis-à-vis BA.2,  thereby increasing the chances of breakthrough infections. The immune escape potential was less with BA.2.12.1 (1.8-fold). Bebtelovimab was the only monoclonal antibody with robust activity against BA.4 and BA.5 and also BA.2.12.1… (Source: bioRxiv, May 26, 2022) 

Intrauterine exposure to SARS-CoV-2 increase risk of neurodevelopmental deficits in Infants

Babies born to Covid-positive mothers are at risk of neurodevelopmental deficits, according to preliminary results of a small study presented at the virtual meeting of the European Psychiatric Association (EPA) 2022 Congress. At 6 weeks of age, the infants showed significantly low scores on the social interactive dimension of the Brazelton Neonatal Behavioural Assessment Scale (NBAS) if the mother became infected before 20 weeks of gestation…(Source: Medscape, June 8, 2022).

Covid-19 vaccine protect against severe outcomes in heart failure patients

Heart failure patients who are fully vaccinated and boosted as well are at lower risk of all-cause mortality with hazard ratio of 0.33 compared to those who were fully vaccinated but had not taken the booster dose (HR 0.36) and those who were unvaccinated. They also had a lower probability of hospitalization (incidence rate ratio 0.68) including ICU admission (IRR 0.63) than those who are partially vaccinated or unvaccinated … (Source: Journal of Cardiac Failure, June 9, 2022).

With inputs from Dr Monica Vasudev

Covid-19-related deaths rise again, says WHO

The number of weekly new Covid cases continues to show a decline, but the weekly deaths have again risen by 4% following five weeks of decreasing trend, says the WHO in its latest COVID-19 Weekly Epidemiological Update. The new weekly deaths in the Regions of Americas were up by 21% and in the Western Pacific region by 17%, while the new weekly deaths decrease in the other four regions… (Source: WHO, June 15, 2022)

Covid-19 vaccines for children below 5 years in the US may start soon

An FDA Panel has unanimously recommended the Pfizer-BioNTech and Moderna Covid-19 vaccines for use in children younger than 5 years beginning from six months of age stating that their benefits outweigh the risks in this age group…(Source: Medscape, June 15, 2022

A negative Covid-19 test no longer mandatory to enter the US

The CDC has revoked the mandatory requirement of a negative Covid-19 test just prior to traveling or a documentation stating recovery from Covid for international travelers. This will come into effect from June 12, 2022. However, the CDC still recommends travelers to test themselves for Covid nearer to their traveling date and desist from traveling if positive … (Source: CDC, June 10, 2022)

Dr Fauci becomes Covid-19-positive

Dr Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) and also the chief medical advisor to the President of the United States, has tested positive for Covid-19 on a rapid antigen test. However, according to the NIH, Dr Fauci has mild symptoms. He is fully vaccinated and has taken two booster doses as well… (Source: NIH, June 15, 2022).

Protective efficacy of Covaxin against delta and omicron variants of concern

Results of preclinical study conducted on Syrian hamster model show that Covaxin booster dose enhanced the protective efficacy of the vaccine against delta variant and was also protective against the BA.1.1 and BA.2 subvariants of the Omicron. The viral load in the lungs diminished subsequent to the booster vaccination…(Source: bioRxiv, June 14, 2022)

With inputs from Dr Monica Vasudev

Covid-19 vaccines prevented 20 million Covid-19 deaths from 2020-2021

A mathematical modeling study from the Imperial College London published in the Lancet Infectious Diseases has described the impact of the Covid-19 vaccines in curbing the onslaught of the pandemic. During the first year of their availability, between December 8, 2020, and December 8, 2021, vaccines prevented 14.4 million deaths from Covid-19 in 185 countries. Addition of excess deaths increased this estimate to nearly 20 million. During the first year, an estimated 60% of people globally had received at least one dose of the vaccine…. (Source: Medscape, June 23, 2022)

Surge in BA.4 and BA.5 cases in Europe

There has been an upsurge of new Covid-19 infections in Europe driven by the BA.4 and BA.5 Omicron subvariants. On Wednesday, France recorded more than 95,000 daily new cases. Cases are also rising in other European countries such as Portugal. These new subvariants, which are more infectious but less virulent, are likely to become the dominant strains in Europe, says the European Centre for Disease Prevention and Control …(Source: Reuters, June 23, 2022)

Moderna says its combination Covid-19 booster vaccine is effectiveness against Omicron

Moderna says that its combination Covid-19 booster vaccine candidate mRNA-1273.214 induced 8-fold increase in the neutralizing antibody titers among seronegative study subjects against the omicron variant than the original mRNA-1273 vaccine after one month of administration. It was also well-tolerated with a side effect profile similar to the mRNA-1273 vaccine. The vaccine candidate contains the original mRNA-1273 vaccine along with a vaccine candidate targeting the omicron variant…(Source: Moderna, June 8, 2022).

Women are more likely to develop long Covid than men 

Women are more likely to develop long Covid than men with odds ratio of 1.22, according to a recently published review in Current Medical Research and Opinion. The likelihood of ENT (OR 2.28), GI (OR 1.60), mood/psychiatric (OR 1.58), neurological (OR 1.30), dermatological (OR 1.29) sequelae were higher among women, while men were more likely have renal (OR 0.74) and endocrine (OR 0.75) disorders…(Source: Current Medical Research and Opinion, June 20, 2022)

Second Pfizer booster dose 72% protective against Covid-related deaths during Omicron wave

In a study from Israel involving more than 24,000 residents of long-term care facilities, a fourth vaccine dose of the Pfizer-BioNTech vaccine was highly protective against COVID-19 hospitalizations and deaths. It provided 34% protection against infection, 64-67% against hospitalizations and 72% against deaths during the omicron wave. The study was conducted between January 10 through to March 2022…(Source: JAMA Internal Medicine, June 23, 2022)

With inputs from Dr Monica Vasudev

Global new Covid-19 cases continue to show a rise

The number of weekly Covid-19 cases has increased again for the third successive week following a declining trend from the last peak in March, as per the latest WHO Weekly epidemiological update on COVID-19. More than 4.1 million new cases were reported from 20^th to 26^th June, 2022 showing a rise of 18% vis-à-vis the preceding week. With more than 8500 deaths reported, the number of deaths continue to be the same… (Source: WHO, June 29, 2022)

Nearly 33% increase in Covid deaths in South America, says PAHO

Pan American Health Organization (PAHO) has said that North and South America have documented a rise of nearly 14% in infections in the previous week, with 1.3 million new cases showing a 24.6% increase versus the earlier week. There were 4158 new deaths. South America reported nearly a 33% rise in deaths. Bolivia had highest number of new cases followed by Peru. Cases in North American saw a rise of 7.7%. Severe and persistent fatigue was the most common symptom; the other symptoms were loss of taste and smell and dyspnea... (Source: Medscape, June 30, 2022)

FDA recommends updation of Covid-19 vaccine booster dose

The US FDA has recommended formulation of a new bivalent booster vaccine by incorporating the omicron BA.4/5 spike protein component in the current Covid-19 vaccines to provide cover against the new circulating SARS-CoV-2 variants. The modified vaccines may be potentially introduced by October this year. However, the FDA has not recommended any alteration in the vaccine for the primary vaccination…(Source: US FDA, June 30, 2022)

South Korea approves its home-grown Covid-19 vaccine

South Korea has developed a Covid-19 vaccine, which has been approved by the Ministry of Food and Drug Safety for use in adults aged ≥18 years. The SKYCovione vaccine manufactured by SK bioscience Co Ltd, is a two-dose vaccine to be administered in a gap of 4 weeks. The vaccine generated neutralizing antibodies against the ancestral strain in phase III clinical trials. But its effectiveness against Omicron and other SARS-CoV-2 variants is still unknown…(Source: Reuters, June 29, 2022).

Frances advises its citizens to mask up again

France is facing a new wave of Covid-19 driven by the new Omicron variants. Although mask wearing has not been made mandatory, the Health Ministry has urged citizens to wear masks in public areas, especially in public transport and also in closed spaces such as shops. There has been a steady rise in cases since May end and on Wednesday, there were 17, 601 new infections, which is the highest number recorded since mid-April…(Source: Reuters, June 28, 2022)

Weekly new Covid cases continue to increase globally

The weekly new Covid cases are continually increasing for the fourth successive week. Nearly 5 million cases were recorded in the week from 27th June to 3rd  July 2022, according to the latest weekly epidemiological update on Covid-19. However, new deaths per week registered a fall of 12% in comparison to the previous week. The Eastern Mediterranean Region showed a rise of 29% in the new weekly cases; in South-East Asia Region new weekly cases were up by 20% and by 15% in the European Region. However, the African Region and the Region of the Americas recorded a decline in new weekly cases of -33% and -18%, respectively…(Source: WHO, July 6, 2022)

Omicron variant is still the dominant strain globally

The currently dominant SARS-CoV-2 strain globally remains the Omicron variant. In June 2022, it accounted for 92% of cases. The delta variant and the recombinant strains constituted the rest of the cases. Eighty-three countries have reported the BA.5 subvariant of Omicron, which increased from 37% to 52% in the week from June 19 to June 25. The BA.4 has now been detected from 73 countries and has increased from 11% to 12%. On the other hand, the BA.2 has declined from 16% to 9% as did the BA.2.12.1, which decreased from 19% to 11%...(Source: WHO, July 6, 2022)

A new sublineage of Omicron in India

BA.2.75, a new subvariant of the Omicron, called “Centaurus” has emerged in India and other countries such as Australia, Canada, Germany, Japan, New Zealand, the UK and US. It is being closely monitored, says the World Health Organization (WHO). It was first detected in May this year. Two more new sublineages of the BA.2 variant namely, BA.2.74 and BA.2.76 have also been detected. It is presumed that these new variants may be driving the recent surge in cases in the country…(Source: ANI, July 7, Medscape, July 7 & & ET Healthworld July 4, 2022)

US Pharmacists can now prescribe Paxlovid directly to Covid-19 patients

Authorized state-licensed pharmacists can now prescribe Paxlovid (nirmatrelvir and ritonavir) directly to eligible patients with Covid-19. This prescribed authority follows the amendment of the EUA for Paxlovid by the US FDA earlier this week. Before seeking a prescription from the pharmacist, patients have to provide all health records within one year, whether digital or printed, plus the latest lab test reports for review by the pharmacist to detect any liver or kidney disorder. This information can also be acquired via the treating physician. A complete list of medications being consumed is also required. If such information is not available, then the pharmacist should refer the patient to a physician…(Source: July 6, 2022)

Sabizabulin, a new antiviral drug for Covid-19 shows encouraging results

A phase III clinical trial published in NEJM Evidence has documented the beneficial effects of oral sabizabulin 9 mg in patients who have been hospitalized with moderate to severe Covid-19 and were at high risk of acute respiratory distress syndrome and mortality. Mortality decreased by nearly 25% vs placebo. The length of ICU admission or mechanical ventilation or hospital stay was also reduced by 43%, 49% and 26%, respectively. According to the study, it had “an acceptable side-effect and safety profile”. Sabizabulin disrupts the microtubule to exert dual antiviral and anti-inflammatory actions… (Source: NEJM Evidence, July 6, 2022).

With inputs from Dr Monica Vasudev

BA.5 fast becoming the globally dominant strain

The dominant circulating SARS-CoV-2 strain across the world continues to be the Omicron variant with 84% of samples testing positive for Omicron in the last one month, according to the latest weekly epidemiological update on Covid-19. While the BA.2 and BA.2.12.1 are declining, the incidence of BA.4 and BA.5 are fast increasing. BA.4 increased from 11% to 14% and BA.5 rose from 42% to 50%…(Source: WHO, July 13, 2022)

US FDA grants EUA to Novavax vaccine

Earlier this week, the US FDA authorized the Novavax Covid-19 vaccine, adjuvanted for emergency use for persons aged 18 years and older. The vaccine components are the SARS-CoV-2 spike protein and Matrix-M adjuvant. The vaccine is given in two doses in a gap of 3 weeks. The adjuvant contains saponin extracts obtained from the bark of the Soapbark tree…(Source: US FDA, July 13, 2022)

The pandemic is not over yet: WHO 

Even in its third year, the Covid-19 continues to be a global health emergency, says the WHO. The recent rise in the cases worldwide, continuous and unpredictable emergence of new and highly transmissible variants of SARS-CoV-2 pose challenges. Whether the already overwhelmed health services are ready to meet the challenges of another future Covid-19 pandemic remains ambiguous. Highlighting a disconnect in COVID-19 risk perception between scientific communities, political leaders and the general public, Dr Tedros A Ghebreyesus, Director General WHO said that the pandemic is “nowhere near over”…(Source: UN, July 12, 2022).

WHO recommends against use of fluvoxamine and colchicine in mild to moderate Covid-19

In its latest “Therapeutics and COVID-19: living guideline”, the WHO has advised against the use of fluvoxamine, an antidepressant drug, in patients with mild or moderate Covid-19. The guideline also strongly recommends against the use of colchicine in non-severe Covid-19…(Source: WHO, July 14, 2022).

Study links persisting gut antigen to post-Covid-19 in IBD patients

Persistence of the SARS-CoV-2  antigen in the GI tract of patients with IBD is associated with postacute Covid-19, according to findings of an endoscopy study of IBD patients with confirmed Covid-19 published in the journal Gastroenterology. The viral RNA continued to be detected in the gut mucosa up to 7 months after a mild Covid-19 infection in in 32 of 46 patients. The N protein was detected in gut mucosa and CD8+ T cells in 24 of the 46 study subjects…(Source: Medscape, July 11, 2022) 

Global new weekly Covid-19 cases stabilizing, says WHO

The number of new weekly cases globally are now settling down after showing a rising trend for more than a month, according to the latest WHO’s weekly epidemiological update on Covid-19. The number of new cases were just below 6.3 million in the week from 11^th to 17^th July 2022. The Western Pacific Region showed a rise of 37% in new weekly cases, while the Americas and the South East Asia Regions recorded a rise of 9% and 5%, respectively. However, the cases declined in Europe and Africa by 5% and 27%, respectively…(Source: WHO, July 20, 2022).

Omicron BA.5 is the dominant strain in the US 

The dominant SARS-CoV-2 strain in the United States is now the BA.5 sublineage of the Omicron variant and accounts for nearly 80% of the circulating variants, according to data for the week from July 11-16. The remaining ~13% are the BA.4 sublineage of the Omicron…(Source: Medscape, July 20, 2022)

CDC recommends Novavax Covid vaccine for persons aged ≥18 years

The CDC has recommended the Novavax Covid-19 vaccine for primary vaccination for adults aged 18 years and above. The two-dose vaccine will soon be available in the US. Novavax is a protein subunit vaccine and also contains an adjuvant... (Source: CDC, July 19, 2022).

Covid infection late in pregnancy increases risk of preterm birth

The risk of preterm birth is increased seven-folds in pregnant women who develop Covid-19 after 34 weeks of gestation. The odds ratio was 7.10. The study published in the journal PLoS One further states that infection in the third trimester was associated with almost thrice the risk of preterm birth with OR 2.76. Presence of symptoms quadrupled this risk with OR 4.28. However, this association was not significant for infection acquired during the first and second trimesters …(Source: Medscape, July 21, 2022).

Increased risk of systemic reactions after simultaneous Covid booster and flu vaccine

A study in JAMA Network Open has found that coadministration of mRNA Covid booster dose (Pfizer or Moderna) and the flu vaccine upped the risk of systemic reactions such as fever, muscle aches compared to administration of the mRNA booster dose alone within the first week after the vaccination. However, these reactions were usually mild…(Source: JAMA Network Open, July 15, 2022).

With inputs from Dr Monica Vasudev

Omicron BA.5 remains the dominant circulating SARS-CoV-2 strain in US

The prevalence of BA.5 Omicron subvariant is rising and it continues to be the dominant circulating SARS-CoV-2 strain in the United States. Nearly 82% of the strains were BA.5 in the week from July 18-23, notes the CDC, a rise from the earlier 76% prevalence. The BA.4 constitutes around 13% of the circulating variants…(Source: Medscape, July 27, 2022)

Pfizer-BioNTech initiate trial of a next generation bivalent vaccine

Pfizer-BioNTech have initiated a randomized, active-controlled, observer-blind, Phase 2 study of a next generation Covid-19 vaccine, which contains the ancestral strain and the BA.2 Omicron subvariant. This vaccine candidate is based on an enhanced spike protein design…(Source: Medscape, July 28, 2022)

Covid-19 and hair loss 

A retrospective case series in the Journal of Drugs and Dermatology has found that patients with Covid-19 commonly experience significant hair loss. Sixty-two patients in the survey sample reported experiencing hair loss after they recovered from Covid. Of these, 38 were females and 24 were males. The most common type of hair loss was telogen effluvium seen in 48 of the 62 patients, while 12 had androgenetic alopecia and two had alopecia areata…(Source: Journal of Drugs and Dermatology, July 22).

Loss of smell and taste may persist for at least 6 months

New onset of loss of smell and/or taste is a characteristic symptom of Covid-19. A BMJ study has found that loss of smell may persist for up to 6 months or beyond in 5.6% of patients and may never be regained in 4.4%. Only 74% recovered their sense of smell at one month after the infection, while 79% could regain their sense of taste. The probability of regaining the loss of smell and taste was less likely in women. Recovery of sense of smell was poor in patients with nasal congestion or those in whom this symptom was greater in severity… (Source: BMJ, July 27, 2022)

WHO updates its global COVID-19 vaccination strategy 

In view of the rising prevalence of the Omicron subvariant, the WHO has updated its global Covid-19 vaccination strategy and has increased the vaccination target from 70% vaccination coverage to 100% coverage of health care workers and the at-risk population, on priority, with the primary vaccination including the booster dose. As per WHO, only 28% of older people and 37% of health care workers in low-income countries have taken two doses of the vaccine and majority have not taken the booster dose…(Source: WHO, July 22, 2022).

With inputs from Dr Monica Vasudev

Rebound symptoms in Covid-19

A new medRxiv preprint study has found that rebound symptoms occurred in about 27% of patients Covid-19 after their symptoms improved and in 10% patients after their symptoms had resolved. These patients had not received any antiviral drug. 12% tested positive again after earlier negative tests indicating a viral rebound. Women were more likely to experience rebound of symptoms, while the probability of viral rebound was higher in older patients. But the two were unlikely to occur together and was seen in 1-2% of patients…(Source: medRxiv, August 3, 2022).

Anosmia severity a better predictor of cognitive impairment

Severity of anosmia in Covid-19 is more predictive of cognitive impairment than the severity of the disease itself, suggests a study from Argentina presented at the recently concluded Alzheimers Association International Conference 2022. Olfactory dysfunction was present in 40%. Around 11.7% of the study subjects had memory-only impairment, 8% had impaired attention and executive function but no memory impairment, while nearly 11.6% had multiple domain impairment. Participants who had severe cognitive impairment also had anosmia…(Source: Medscape, July 31, 2022).

COVID Patients May Be Infectious Beyond 5 Days

— Small study found half of those with positive antigen test on day 6 had culturable virus

A JAMA Network Open study says that Covid-19 patients with a positive rapid antigen test after 5 days of the illness may remain infectious. On day 6, 75% had positive RAT and the virus could be cultured in 35% of them. All patients who had a negative RAT on day 6 also yielded a negative viral culture. Such patients with residual symptoms may be potential sources of infection. These observations highlight the necessity of masking up to the tenth day of the infection….(Source: JAMA Network Open, August 3, 2022).

EU says Novavax COVID shot must carry heart side-effect warning

The European Medicines Agency (EMA) has asked the manufacturers of Novavax Covid-19 vaccine to carry a warning about the risks of myocarditis and pericarditis in the product information…(Source: Reuters,  August 3, 2022).