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)