COVID news 2/18/22
COVID news 2/18/22
Hi All,
Last week, a large study on Long COVID from the Veterans Administration hospitals showed that there was a significantly increased risk of 20 different cardiovascular diseases including heart attack, pulmonary embolism and stroke one year after a COVID-19 infection. This week, the same population of more than 150,000 V.A. patients was studied for mental health issues. They reported that people who survive the acute phase of COVID-19 are at increased risk of new mental health disorders and cognitive disorders. One year after the acute COVID infection, these patients were 80% more likely to develop cognitive problems like brain fog, confusion and forgetfulness than those who didn’t have Covid. Inflammation can disrupt the ability of the brain to function in many ways, including the ability of the brain to make serotonin, which is fundamental for both mood and sleep.
Denmark has lifted all COVID restrictions despite rising cases and hospitalizations. Denmark has a high vaccination and booster rate, but they also have the highest number of new COVID cases in the world right now. There is a big debate on Twitter whether published Danish government COVID statistics show such high numbers of deaths because they are including both people who died "with" COVID as a secondary diagnosis and those who died "of COVID". We may have to wait to see excess mortality figures to understand more.
Here in the U.S., new case numbers have fallen a lot which is a relief, but we are still at about 100,000 new COVID cases each day. To quote Katie Mack, "Case rates are going down" is not the same as "case rates are low" and the former should never determine policy when the latter condition is not met.
Regarding vaccines and immunity, with 2 doses of vaccine against COVID, immunity tends to wane over 4 to 6 months. However, a new study shows that a prior COVID infection (natural immunity) plus 1 dose of mRNA vaccine helps fight COVID for 1 year.
The data is a little less clear about a 4th dose booster. A small study in Israel showed that in 274 healthcare workers, the fourth dose of mRNA vaccine restored antibody titers to peak post-third dose titers including neutralizing titers but had low efficacy in preventing mild or asymptomatic Omicron breakthrough infections. But a much larger study of over 1 million people over age 60 or high risk for another reason showed that people who got a 4th dose of an mRNA vaccine had a 2x lower Omicron infection rate and a 4.3x lower rate of severe illness.
Have a great long weekend,
Ruth Ann
---
Ruth Ann Crystal MD
Twitter: https://twitter.com/CatchTheBaby
This week I am including a story from CNN's Good Stuff Newsletter about my neighbor Elise Martin who just turned 107 years old. Mama Elise is a wonderful person.
From CNN’s Good Stuff Newsletter 2/12/22:
Photo credit: Ruth Ann Crystal
107 and thriving
Happy Birthday, Mama Elise! At 107, Elise Jones Martin has led quite a life. The South Carolina native survived the 1918 flu pandemic, owned several beauty shops and was the first African American to own a business on downtown Columbia's Main Street when she opened a boutique there in 1969. A strong proponent of voting rights, Martin spent decades as a poll worker during a time when segregation and Jim Crow made the work especially dangerous -- and especially necessary. She was also a longtime member of several civic groups and charities. Martin is now a beloved member of her Palo Alto, California neighborhood, and to mark her recent birthday, people lined up to drive by in a celebratory parade.
Photo credit: Ruth Ann Crystal
Martin looked on from her front yard as the cars passed; a queen in a rocking chair with her little dog, Vanity Fair, on her lap. When asked the secret to a long, successful life, Martin replied: "Just trust in God. Be good to people. And love the best you can."
Thank you to Ruth Ann C. for recommending this story!
COVID News:
World
United States
U.S.
New cases: 103,294 per day
7 day average cases: 116,193 (-9,234) which is the lowest level since December 2
Test positivity rate is 7.35%.
In hospital: 68,185 (-3,668)
In ICU: 13,485 (-607)
New deaths: 3,238 includes a backlog from TN. The seven-day average is 2,345 deaths per day.
Total U.S. deaths reported is 933,779.
64% fully vaccinated (2 doses)
2/17/22 UKHSA: The effectiveness of vaccination against Long COVID; a review of the literature https://buff.ly/33sID5E
Vaccinated people who are subsequently infected with COVID-19 are less likely to get long COVID than unvaccinated people.
This is in addition to any benefit of vaccination in preventing COVID-19 infection.
Unvaccinated people with long COVID who were subsequently vaccinated had, on average, reduced long COVID symptoms (though some people reported worsened symptoms after vaccination).
2/17/22 NY Times: Covid Patients May Have Increased Risk of Developing Mental Health Problems https://buff.ly/33wk6Ne
A new, large study (see below) found that in the year after getting Covid (Long COVID), people were significantly more likely to be diagnosed with psychiatric disorders they hadn’t had than people who didn’t get infected.
The study included only patients who had no mental health diagnoses or treatment for at least two years before becoming infected with the coronavirus.
Most Covid patients will not develop new mental health symptoms.
Only between 4.4% and 5.6% of those in the study received diagnoses of depression, anxiety or stress and adjustment disorders.
But people who had COVID were 35-40% more likely than people who did not have COVID to be diagnosed with one of these psychiatric disorders.
Researchers also found that Covid patients were 80% more likely to develop cognitive problems like brain fog, confusion and forgetfulness than those who didn’t have Covid.
2/17/22 BMJ: Risks of mental health outcomes in people with COVID-19: cohort study https://buff.ly/3Busrxq
Significant mental health complications of Long COVID (PASC) at 1 year at the Veterans Administration:
153,760 people with COVID-19
5,637,647 contemporary controls
5,859,411 historical controls
The COVID group had increased risk of:
Anxiety disorders, depressive disorders, stress and adjustment disorders, and use of antidepressants and benzodiazepines.
Opioid (34% more) and non-opioid (alcohol 20%) use disorders.
Neurocognitive decline and sleep disorders.
Patients hospitalized for Covid were more likely to be diagnosed with mental health issues than those with less serious coronavirus infections.
But people with mild initial infections were still at greater risk than people without Covid.
Mental and cognitive illness was higher in the COVID-19 group for:
Non-hospitalized COVID patients versus Non-hospitalized seasonal influenza patients,
Hospitalized COVID patients versus hospitalized influenza patients,
Hospitalized COVID patients versus patients hospitalized for any other cause.
3 studies showing Protection from Prior COVID infection + 1 dose of vaccine:
2/17/22 NEJM (UK): Protection against SARS-CoV-2 after Covid-19 Vaccination and Previous Infection https://buff.ly/3HYu6gZ
N = 35,768 participants, 27% (9488) had a previous SARS-CoV-2 infection.
Two doses of BNT162b2 vaccine were associated with high short-term protection against SARS-CoV-2 infection; this protection waned considerably after 6 months.
Infection-acquired immunity boosted with vaccination remained high more than 1 year after infection.
2/17/22 NEJM (Israel): Effectiveness of the BNT162b2 Vaccine after Recovery from Covid-19 https://buff.ly/352Yd8A
n = 149,000, Data from the Delta wave and before Omicron.
In people with history of prior COVID infection, giving 1 dose of Pfizer vaccine:
82% reduced reinfections for people aged 16-64
60% reduced reinfections for people age 65+
No added benefit for 2 doses in those previously infected.
2/15/22 MedRxiV: Coronavirus Disease 2019 (COVID-19) Vaccine Boosting in Persons Already Protected by Natural or Vaccine-Induced Immunity
Among 39,766 Cleveland Clinic employees already protected by prior COVID infection or vaccination, vaccine boosting after 6 months was associated with significantly lower risk of Omicron infection.
In previously infected people, there was no benefit to administering more than one dose of vaccine in protecting against Omicron.
2/17/22 MedRxiV (Israel): 4th Dose COVID mRNA Vaccines’ Immunogenicity & Efficacy Against Omicron VOC https://buff.ly/3gRZSAH
Of 1050 eligible HCW, 154 and 120 were enrolled to receive BNT162b2 and mRNA1273, respectively, and compared to 426 age-matched controls.
The fourth dose of mRNA vaccine restored antibody titers to peak post-third dose titers including neutralizing titers but had low efficacy in preventing mild or asymptomatic Omicron breakthrough infections in 274 healthcare workers.
Compare to this very large in higher risk people study from 2/1/22 MedRxiV:
Protection by 4th dose of BNT162b2 against Omicron in Israel https://buff.ly/3Lbz7oJ
Omicron-dominated period January 15 through January 27, 2022, from the Israeli Ministry of Health database regarding 1,138,681 persons aged over 60 years and high risk people eligible for the fourth dose.
12 or more days after their fourth dose:
2x lower infection rate
4.3x lower rate of severe illness
Demark Debate:
2/17/22 Kristian Andersen’s thread on Denmark and why he finds the situation and Denmark’s decision to lift all COVID-19 restrictions concerning
High number of cases and high positivity now in Denmark.
COVID hospitalizations and deaths are increasing in Denmark, although ICU admissions are not.
The debate of deaths “with” COVID vs. deaths “from” COVID.
One of the main issues of having 'rampant' cases starts to become a big issue - an (entirely predictable) shift in age groups.
We're now seeing that effect in Denmark - starts in the young, then moves to the elderly. We have seen this in *every* wave.
This effect is important when we consider "from" vs "with" COVID-19, because we see that most of the "with" group is driven by younger people and the "from" group by the elderly.
2/17/22 Thomas Baekdal’s thread on Denmark’s reporting of hospitalizations and deaths and saying that statistics reflect both people hospitalized “with” COVID versus “because of” COVID.
30-40% who of patients in Denmark were hospitalized because of other reasons
2/13/22 Reports show that COVID deaths are increasing in Denmark
But, the Danes report that they are including elderly who have a positive COVID test, but who have died from another cause and the COVID + test is incidental.
Mortality in Denmark from COVID is actually decreasing and their ICUs are not full.
Dødeligheden i Danmark falder https://buff.ly/3uJyUmV
2/17/22 Nature: Pandemics disable people — the history lesson that policymakers ignore https://buff.ly/3BFEIPT
Spanish influenza, polio and more have shown that infections can change lives even decades later. Why the complacency over possible long-term effects of COVID-19?
Disability is likely to account for the lion’s share of COVID-19’s burden, and might disproportionately affect women, especially those who were infected young.
2/16/22 Reuters: Hong Kong "overwhelmed" as COVID infections hit record https://buff.ly/3s4o8pH
Leader Carrie Lam says the city is overwhelmed, hospitals almost full.
Paxlovid News:
2/16/22 NEJM: Oral Nirmatrelvir/Ritonavir (Paxlovid) for High-Risk, Nonhospitalized Adults with Covid-19 https://buff.ly/3oX1rSi
n = 1120 Paxlovid and 1126 Placebo
Phase 2–3 double-blind, randomized, controlled trial
Symptomatic, unvaccinated, non hospitalized adults at high risk for progression to severe Covid-19.
Treatment of symptomatic Covid-19 with nirmatrelvir plus ritonavir resulted in a risk of progression to severe Covid-19 that was 89% lower than the risk with placebo, without evident safety concerns.
Hospitalization/death decreased from 6.45% down to 0.72% with Paxlovid.
2/16/22 Nature: The oral protease inhibitor Paxlovid (PF-07321332) protects Syrian hamsters against infection with SARS-CoV-2 variants of concern https://buff.ly/3uS7ZFj
Hamsters pretreated w/Paxlovid (oral anti-viral) prevented them from being infected with Beta and Delta and prevented transmission to other hamsters.
Hamsters pre-treated with Paxlovid and then were given Beta and Delta SARS-CoV-2 virus intranasally. The Paxlovid prevented infection in the hamsters.
Moreover, treatment of Delta SARS-CoV-2 infected animals with PF-332 completely prevented transmission to untreated co-housed hamsters.
2/16/22 Lancet: Response to additional COVID-19 vaccine doses in people who are immunocompromised: a rapid review https://buff.ly/3Jx6n81
Seroconversion rates after two COVID-19 vaccine doses:
99% for people who are not immunocompromised
92% for patients with solid cancer
78% for patients with immune-mediated inflammatory disorders
64% for patients with hematological cancer
27% for recipients of transplants
Immunocompromised have reduced protection against symptomatic and severe COVID-19 and make up greater than 40% of hospitalized breakthrough cases despite representing a much smaller proportion of the general population.
2/16/22 John Burn-Murdoch of FT https://twitter.com/jburnmurdoch
Covid’s infection fatality rate (IFR) has now crossed below the "2x flu" line mostly because of the immunity wall from vaccinations.
2/16/22 BioRxiV: Increased Potency and Breadth of SARS-CoV-2 Neutralizing Antibodies After a Third mRNA Booster Vaccine Dose https://buff.ly/3GVbYn7
3 doses of an mRNA vaccine encoding Wuhan-Hu-1, have a diverse memory B cell repertoire that can respond rapidly and produce antibodies capable of clearing even diversified variants such as Omicron.
This is because of expansion of memory B cell clones that were present after the 2nd vaccine dose as well as the emergence of new B cell clones.
The antibodies encoded by these cells showed significantly increased potency and breadth when compared to antibodies obtained after the 2nd vaccine dose.
2/16/22 Nature: Communicate hope to motivate the public during the COVID-19 pandemic https://buff.ly/3HSny3v
Public health messaging- Give them hope!
A hope-oriented visual communication aid, depicting the competing effects on the epidemic curve of (1) a more infectious variant and (2) vaccinations, motivates public action more effectively than a fear-oriented visual communication, focusing exclusively on the threat of the new variant.
2/15/22 CDC MMWR: Protection of Infants Aged <6 months From Hospitalization After Maternal Vaccination with mRNA Vaccine During Pregnancy, July 2021–January 2022 https://buff.ly/3uTtd5G
mRNA Vaccination in pregnancy:
61% VE against infant hospitalization overall
32% VE against infant hospitalization if vaccinated in first 20 weeks of pregnancy
80% VE against infant hospitalization if vaccinated 21 to 38 weeks of pregnancy
2/15/22 CDC MMWR: Hospitalizations of Children and Adolescents with COVID-19, July 2021–January 2022 https://buff.ly/3HWi3kp
During the Omicron wave, COVID-19 associated hospitalization rates among children and adolescents aged 0–17 years increased rapidly in late December 2021, especially for children aged 0–4 years who are not yet eligible for vaccination.
Kids under 5 saw the largest increase, with hospitalization rates that were more than 5x higher during Omicron than during Delta.”
For age 12-17 during Delta and Omicron predominance, unvaccinated accounted for 90% of hospitalizations.
2/15/22 Nature: Omicron-targeted vaccines do no better than original jabs in early tests https://buff.ly/3BmWTcT
Four different studies in animals (monkeys, mice) show that boosters customized for the fast-spreading COVID variant offer little advantage over standard jabs.
2/15/22 MedRxiV (Australia): Co-infection with Both SARS-COV-2 Omicron and Delta Variants Revealed by Genomic Surveillance In 2 People with Chronic Kidney Disease https://buff.ly/3gOTiuC
2/14/11 STAT news: Why Covid-19 vaccines are a freaking miracle https://buff.ly/33mOPfC
Helen Branswell reviews the history of vaccines and why the COVID mRNA vaccines are a miracle.
At least 55% of the people inhabiting this planet have been fully vaccinated against Covid-19.
Colombia, Morocco, Sri Lanka, El Salvador, Mongolia, and Tonga have fully vaccinated about the same proportion of their populations — roughly 64% — as has the United States.
According to modeling conducted by the Commonwealth Fund, without these vaccines, 1.1 million additional Americans would have died from Covid — and that estimate was made based on data from before the massive Omicron wave that has swept across the country in the past two months.
The fact that there were no coronavirus vaccines in production forced manufacturers to innovate, to move to new platforms. There wouldn’t have been the same innovation pressure with a new flu virus.
2/14/22 Ground Truths on Prior Covid https://buff.ly/3HQaNGF
Eric Topol MD discusses the data on how much immunity a person gets from a prior COVID infection.
2/14/22 International Journal of Impotence Research:
Tip of the iceberg: Erectile Dysfunction and COVID-19 https://buff.ly/3HPUAS1
Androgen receptors have been implicated to mediate SARS-CoV-2 viral cell entry and infection.
Endothelial dysfunction, direct testicular damage, and the psychological burden of COVID-19 that are of the pathways of Erectile Dysfunction.
2/14/22 Reuters: U.S. COVID vaccine for children under 5 delayed by at least 2 months https://buff.ly/3oNnz1r
"If something does not meet that standard, we can't proceed forward."
2/13/22 Cell: Summary of Antiviral agents for the treatment of COVID-19: progress and challenges https://buff.ly/3GMAree
FYI- From 10/2021 Lancet: Effect of early treatment with fluvoxamine (Luvox) on risk of emergency care and hospitalization among patients with COVID-19: the TOGETHER randomized, platform clinical trial https://buff.ly/2ZuLR6X
Treatment with fluvoxamine (100 mg twice daily for 10 days) among high-risk outpatients with early diagnosed COVID-19 reduced the need for hospitalization with Relative Risk 0.68 for fluvoxamine.
11% hospitalization for fluvoxamine and 16% for placebo
Many people stopped the fluvoxamine because of side effects.
2/13/22 NY Times: F.D.A. Clears Covid Drug From Eli Lilly That Shows Promise Against Omicron https://buff.ly/3HScnrG
Lilly monoclonal antibody Bebtelovimab has activity against Omicron in the lab but studies have not yet been done in humans to see if it stops severe disease.
The company tested the drug in laboratory experiments that found that it remained highly potent against Omicron.
“If the national strategy is every time there’s a new variant, we need to do clinical trials for that variant, we’ll never have the drugs in time,” he said. “We’ll always be one variant behind.” said Dr. Daniel Skovronsky, Eli Lilly’s chief scientific officer.
The F.D.A. said it should not be a preferred product and instead should be used only when alternative treatments are not “accessible or clinically appropriate.”
Federal health officials have given a similar designation to a Covid pill from Merck and the Covid vaccine from Johnson & Johnson.
2/11/22 Hannah Davis thread on Long COVID
