Cases are falling here in the U.S., although there are still about 55,000 new cases of SARS-CoV-2 daily. Mask mandates have been dropped in many places including in California businesses and restaurants because fewer people are hospitalized with COVID now although the CDPH still "strongly recommends" wearing masks indoors. Schools in California, Oregon and Washington state have stopped masking mandates. The San Francisco Unified School District will still require masks for now. Masks will still be required for public transportation (trains, planes, buses, Ubers), hospitals and healthcare facilities and long term care facilities.
A study in New York posted this week showed that children aged 5 to 11 had a large reduction in vaccine effectiveness (VE) from 68% VE against infection in December down to 12% VE against infection at the end of January. This is not too surprising since this age group is not yet eligible for boosters and we have seen in adults that boosters are needed to protect against the Omicron variant. Children aged 5 to 11 years old were also only given a 10 ug dose of the Pfizer mRNA vaccine. The article states that in the 5 to 11 year old age group, VE against hospitalizations decreased from 100% down to 48% but there were very few kids hospitalized and the 95% Confidence Intervals were all over the place making this data less reliable.
The new National Pandemic Preparedness Plan was revealed by President Biden this week including a "Test to Treat" plan where a person could go to a local pharmacy, get tested and be prescribed Paxlovid (the Pfizer antiviral pill) immediately. While this is an excellent idea, there are a lot of logistics to be worked out and pharmacists are concerned that they are already short staffed.
Hong Kong is going through their Omicron wave now and has a very high death rate which may be related to low vaccination rates in the elderly and the fact that many people live together in a densely populated city. New Zealand is also going through their Omicron wave, but in contrast New Zealand has very few deaths because their population is both vaccinated and boosted in high numbers.
3/4/22 STAT news: White House holds off on buying millions of courses of Paxlovid due to budget constraints. https://buff.ly/3vH1LbU
US Covid-19 response money has nearly run out and it needs $22.5 Billion more, or it won’t be able to secure future treatments, vaccines and tests.
3/4/22 3/4/22 ACS: Mucins Inhibit Coronavirus Infection in a Glycan-Dependent Manner https://buff.ly/3MlfECu
Mucins are sugar-coated proteins covering wet mucosal surfaces in the body that viruses attach to for host-cell entry.
Certain mucins inhibit CoV infection depending on their glycans.
Certain mucins in mucous may protect against fomite transmission of coronavirus on common touch surface materials (plastic, steel, glass).
3/4/22 Denmark
If most people in Denmark are vaccinated, and vaccinated have about half the risk of Long COVID, then
18% x 1/2 = 9%
Potentially 9% of Danes could get Long COVID 6+ months after the huge Danish Omicron surge if Omicron causes Long COVID as often.
Potentially fewer could get Long COVID if boosters make a difference in future Long COVID risk.
2/28/22 MedRxiV (Denmark): Post-acute symptoms (PASC or Long COVID), new onset diagnoses and health problems 6 to 12 months after SARS-CoV-2 infection: a nationwide questionnaire study in the adult Danish population https://buff.ly/3vFOwbB
This is the Danish long covid study. 6-12 months post test, report:
Physical symptoms: 29.6% + vs 13.0%
New dx health prob: 7.2% + vs 3.3%
New problems: 53.1% + vs 11.5%
3/4/22 MedRxiV (France): Evidence of co-infection during Delta and Omicron variants of concern co-circulation, weeks 49-2021 to 02-2022, France https://buff.ly/3MnzbCl
Report of 7 immunocompetent and unrelated patients were co-infected with Delta and Omicron at the same time.
3/3/22 Neurology: Peripheral Neuropathy Evaluations of Patients With Prolonged Long COVIDhttps://buff.ly/3tw33nc
Prolonged, often disabling, small-fiber neuropathy in long COVID may be caused by a defective immune response.
17 people with long COVID (16 of whom had mild cases of SARS-CoV-2 infection) had been referred for neuropathy:
≥10 received small-fiber neuropathy diagnoses.
One patient had critical illness axonal neuropathy.
One had multifocal demyelinating neuropathy 3 weeks after mild COVID.
For treatment, 65% (11/17) received immunotherapies (corticosteroids and/or IV immunoglobulins).
Longitudinal improvement averaged 52%, although none reported complete resolution.
3/3/22 MedRxiV (Switzerland): Severe Neuro-COVID is associated with peripheral immune signatures, autoimmunity and signs of neurodegeneration: a prospective cross-sectional study https://buff.ly/3HHkNRZ
Neuro-COVID class III patients had strong, peripheral immune response resulting in:
Blood-brain barrier (BBB) impairment
Autoantibodies
Microglia activation and neuronal damage signatures.
Decreased regional brain volumes were present in COVID-19 patients and associated with specific CSF and plasma parameters.
Our data point towards several potentially actionable targets.
3/3/22 NY Times: As Cases Skyrocket, New Zealand Finally Faces Its Covid Reckoning https://buff.ly/3HGVuzt
New Zealand has managed the pandemic extremely well with high vaccination and booster rates, there have only been 56 COVID deaths total over 2 years among 4.9 million people.
3/3/22 Science: Arthritis drug reduces mortality in severe COVID-19, huge clinical trial finds https://buff.ly/35qV56U
In 8000+ patients with severe COVID, adding Baricitinib to other medications reduces mortality by 13% in randomized control trial.
Olumiant or baricitinib, a JAK inhibitor, is an oral drug that dampens an overactive immune system in rheumatoid arthritis.
3/3/22 Senator Tim Kaine describes '24/7' tingling sensation from long COVIDhttps://buff.ly/35wLzPH
Tim Kaine, Tammy Duckworth and Ed Markey introduced a bill, called the CARE for Long COVID Act, which would centralize information, increase public awareness of the condition as well as treatments.
3/3/22 3/3/22 AP: New Biden pandemic plan: Closer to normal for the nation https://buff.ly/3KdNpE2
“Test to Treat” plan to provide free antiviral pills at pharmacies to people who test positive for the virus. Pharmacists worry about having enough staff to do this.
140 million Americans, or 43% have now had COVID, according to the CDC.
That estimate comes from 72,000 blood samples sent to commercial labs from late December to late January. Samples were checked for antibodies from infection, and were distinguishable from antibodies that came from vaccination.
The administration believes that it is safe to resume normal activities because of the increasing availability of antiviral pill Paxlovid which reduces hospitalization from COVID-19 by 90%.
By the end of the month, 1 million pills will be available, with double that ready for use in April.
Paxlovid interacts with many other medications.
Starting next week, the administration would make available four more free tests to U.S. households through COVIDTests.gov.
3/2/22 BioRxiV: An immunoPET probe to SARS-CoV-2 reveals early infection of the male genital tract in rhesus macaques https://buff.ly/3HyKiEP
4 tissues in male genital tract of rhesus macaques (penis, prostate, pampiniform plexus and testis) help explain erectile dysfunction and male infertility issues from COVID infection.
3/2/22 CDC MMWR: Effectiveness of COVID-19 Pfizer-BioNTech BNT162b2 mRNA Vaccination in Preventing COVID Emergency Department and Urgent Care Visits and Hospitalizations Among Children and Adolescents Aged 5–17 Years, April 2021–January 2022 https://buff.ly/3hybfxT
Two doses protect against COVID-19–associated emergency department and urgent care encounters among children and adolescents.
However, vaccine effectiveness (VE) was lower during Omicron predominance and decreased with time since vaccination.
A booster dose restored VE to 81% among adolescents aged 16–17 years.
Overall (both Omicron and Delta), 2-dose VE against COVID-19–associated hospitalization was 73%–94%.
Excellent protection (73% to 94%) against hospitalizations for children and teens, ages 5-17, by vaccinations and booster, vs Omicron and Delta.
3/2/22 Annals of Internal Medicine: Prescribing Nirmatrelvir–Ritonavir: How to Recognize and Manage Drug–Drug Interactions (DDI) https://buff.ly/3tpTJBm
The use of ritonavir to boost plasma concentrations of nirmatrelvir through inhibition of cytochrome P450 (CYP) 3A4 confers a high potential for clinically significant drug–drug interactions (DDIs).
Avoiding the drug-drug interactions (DDIs) when prescribing Paxlovid (Nirmatrelvir-Ritonavir) for Covid
Common drugs like statins can be paused, other DDIs can be avoided by switching (e.g clopidogrel) or withdrawn.
3/1/22 Reuters: 2 doses of Pfizer/BioNTech COVID vaccine less effective in ages 5-11 -New York study https://buff.ly/35IX0DS
Vaccine effectiveness (VE) against infection with 2 doses:
5 to 11 year olds: 68% in mid-December down to 12% by end of January.
12 to 17 year olds: 66% down to 51%
VE against hospitalization with 2 doses:
5 to 11 year olds: 100% decreased to 48% (but confidence intervals are wide)
12 to 17 year olds: 85% down to 73%
Younger children receive a lower 10-microgram dose of the vaccine.
12- to 17-year-olds receive the same 30-microgram dose as adults and are eligible for a third booster shot.
In adults, a 3rd booster shot helped to protect against Omicron as well.
2/28/22 MedRxiV: Effectiveness of the BNT162b2 vaccine among children 5-11 and 12-17 years in New York after the Emergence of the Omicron Variant https://buff.ly/3HGBEEe
In the Omicron era, the effectiveness against cases of BNT162b2 declined rapidly for children, particularly those 5-11 years.
However, vaccination of children 5-11 years is protective against severe disease and is recommended.
h/t @erictopol:
A lot written today about a vaccine not working well for ages 5-11. That was vs Omicron infections, which is not at all surprising.
We still don't know about severe disease, hospitalizations since the events were so few and 95% CI are all over the place.
3/1/22 AP: California, Oregon, Washington to drop school mask mandates https://buff.ly/3vudvyr
It is strongly recommended but no longer requiredthat all persons, regardless of vaccine status, continue indoor masking.
Universal masking shall remain required in specified high-risk settings.
On public transit (examples: airplanes, ships, ferries, trains, subways, buses, taxis, and ride-shares) and in transportation hubs (examples: airport, bus terminal, marina, train station, seaport or other port, subway station, or any other area that provides transportation)
K-12 and Childcare mask requirement will end March 11.
CDPH strongly recommends that individuals in these settings continue to mask in indoor settings when the universal masking requirement lifts.
San Francisco School District to continue masks.
3/1/22 Santa Clara County Public Health Department announced that it is transitioning the county’s indoor masking requirement to a “strong recommendation,” effective March 2. https://buff.ly/35nUZwX
2/27/22 BioRxiV (Canada): Highly divergent SARS-CoV-2 in white-tailed deer with potential deer-to-human transmission https://buff.ly/3tgy3I0
Discovery of a highly divergent lineage of SARS-CoV-2 (76 mutations, 23 not previously reported) in white-tailed deer and one case of probable deer-to-human transmission.
2/27/22 MedRxiV (Paris): SARS-CoV-2 Exposures of Healthcare Workers from Primary Care, Long-Term Care Facilities and Hospitals: A Nationwide Matched Case-Control Study https://buff.ly/3vpDdnF
April to July 2021
Predictors of COVID-19 in HCWs:
exposure to an infected person outside work (adjusted odds ratio, 19.9)
infected colleague (2.26)
COVID-19 patients (2.37)
Partial or complete immunization was protective, as were using eye protection and wearing a gown.
