Since March 2020, TCTMD reporters and editors have been keeping tabs on breaking research and policy news--our COVID-19 Dispatch is now updated three days a week. If you have something to share, tell us. Our in-depth coverage of COVID-19 and the heart can be found on our COVID-19 Hub.
June 6, 2022
A new COVID-19 vaccine may be coming, with the US Food and Drug Administration (FDA) expected to make a decision about authorizing the shot from Novavax within weeks, the Associated Press reports. “The Novavax vaccine already is used in parts of Europe and multiple other countries, but FDA clearance is a key hurdle. And health experts are closely watching to see if a new tool offers advantages, either in enticing vaccine holdouts or maybe even offering somewhat broader immunity.” Agency advisors are set to discuss the vaccine on Tuesday, and documents released ahead of the meeting indicate that rare cases of myocarditis—which have been linked to the mRNA vaccines—will be a topic of discussion for this shot, too (CIDRAP News).
Tens of millions of COVID-19 vaccine doses, representing about 11% of those distributed by the US government, have been wasted, NBC News reports. Between December 2020 and the middle of May 2022, fully 82.1 million doses were discarded. “The overall amount of waste is in line with World Health Organization estimates for large vaccination campaigns,” the story notes. “But public health experts said the waste is still alarming at a time when less than half of fully vaccinated Americans have a booster shot—which is critical to fight newer, more contagious virus strains—and when many poorer countries continue to struggle with vaccine supply.”
The proportion of people around the world with substantial levels of antibodies against SARS-CoV-2—either from infection or vaccination—reached 67% in October 2021, up from just 16% in February 2021, according to an update released by the World Health Organization (WHO) last week: “Due to a steep rise in the number of infections in many countries following the emergence of Omicron and increasing vaccine coverage, both vaccine- and infection-induced population seroprevalence levels are expected to have increased substantially since October 2021, albeit with sustained regional and subpopulation variations.”
The number of COVID-19 cases in the United States fell for the first time since late March, according to the latest numbers from the Centers for Disease Control and Prevention (CDC) released last week. As of June 1, Becker’s Hospital Review notes, the 7-day case average was 100,684, down 8.5% from the week before. On average, hospitalizations increased 4.7% and deaths dropped 23.1%.
Booster COVID-19 vaccination during the Omicron wave was associated with a 57% lower risk of any SARS-CoV-2 infection and a 61% lower risk of symptomatic infection among the highly vaccinated population of NBA players, researchers report in JAMA. CIDRAP News gives more details.
A preprint study, detailed by Reuters, indicates that Pfizer’s Paxlovid reduces COVID-19-related hospitalizations and deaths in both vaccinated and unvaccinated patients age 65 and older during a period of rising Omicron variant prevalence. But the data, from Clalit Health Services in Israel, suggest that the antiviral treatment does not prevent severe outcomes in younger individuals. Another study, also out of Israel and published in Clinical Infectious Diseases, shows that Paxlovid reduces severe COVID-19 or mortality in the Omicron era, but that it appears more effective in older patients and those who are immunosuppressed or have underlying neurological or cardiovascular disease.
Compared with white individuals living in Alaska, American Indians or Alaska Natives in the state have greater risks of COVID-19 and associated hospitalization and death, according to data in Morbidity and Mortality Weekly Report. That mirrors other studies conducted during the COVID-19 era and during the influenza A (H1N1) pandemic of 2009.
More evidence points to the ability of specially trained dogs to sniff out SARS-CoV-2 infections. A study in PLOS One shows that compared with nasopharyngeal RT-PCR testing, dogs detected the virus in nasopharyngeal, saliva, and sweat samples with 97% sensitivity and 91% specificity (reaching 100% and 94%, respectively, in asymptomatic individuals). Use of dogs could be an alternative to standard testing “when it is necessary to obtain a result very quickly according to the same indications as antigenic tests in the context of mass screening,” the authors say. CIDRAP News has more.
June 2, 2022
COVID-19 cases among Americans emerging from the Memorial Day holiday earlier this week were six times higher than this time last year, according to ABC News, noting that millions of Americans traveled for the long weekend at levels not seen since before the onset of the pandemic. That’s based on official case counts from the US Centers for Disease Control and Prevention (CDC), but real numbers are likely far higher, given the widespread availability of at-home testing.
More broadly, COVID-19 cases are up 9% in the Americas, with pediatric cases doubling over the last 2 weeks in the US, even as global cases fell by 11% and deaths by 3%, CIDRAP News summarizes. A lack of transparency from North Korea, however, is making it difficult to factor in new cases there, which potentially number in the millions, according to frustrated World Health Organization (WHO) officials quoted in the story.
In South Africa, new COVID-19 infections have surged in recent months, despite studies suggesting that 98% of the population has antibodies from prior infection, vaccination, or both, the New York Times reports. A new study, “released Thursday but not yet peer-reviewed, analyzed the prevalence of two types of antibodies in 3,395 blood donors collected mid-March across the country in order to estimate prevalence at the national level,” the story explains. “About 11% had antibodies that, according to the study’s authors, suggest that a person had been vaccinated but not recently infected.”
Elsewhere on the continent, an analysis of 47 countries making up the WHO African region published in the Lancet Global Health estimates that the number of SARS-CoV-2 infections between January 2020 and December 2021 was more than 505 million, but infers that just 1.4% of infections (one out of 71) were reported. “Deaths are estimated at 439,500,” authors say, “with 35.3% (one in three) of these reported as COVID-19-related deaths.” Those numbers, they write, confirm other studies suggesting that the African region has had a similar number of COVID-19 infections compared with other parts of the world, but fewer deaths.
There’s more evidence that an mRNA booster can ratchet up the efficacy of Johnson & Johnson’s single-dose Janssen (Ad26.COV2.S) vaccine against the Omicron variant of COVID-19. Writing in a letter to the editor in the New England Journal of Medicine, authors calculated the vaccine effectiveness of four different homologous and heterologous vaccine doses, concluding that, regardless of original vaccine course, “all the regimens that included a booster dose, as compared with no vaccination, offered protection against symptomatic Omicron infection, although vaccine effectiveness was highest for the regimens that included a booster dose of an mRNA vaccine and was lowest for the homologous Ad26.COV2.S/Ad26.COV2.S regimen.”
Also in the NEJM, Israeli investigators tracked the immunity protection afforded by SARS-CoV-2 infection as compared with that conferred by vaccination, and how these wane with time. The upshot: people previously infected with SARS-CoV-2, regardless of whether they had received any dose of vaccine before or after infection, saw their protection against reinfection decrease with time, but the level of protection maintained over this interval appeared higher than that conferred by a second vaccine dose in someone who was previously uninfected. Notably, write the authors, “a single dose of vaccine after infection reinforced protection against reinfection.”
The US National Institutes of Health-funded HEROS study has some intriguing new epidemiological insights, among them the observation that people with food allergies are less likely to catch COVID-19, and—as other studies have documented—that obesity and high body mass index are associated with a higher risk of SARS-CoV-2 infection. Asthma, however, did not increase risks. Additional observations are in the paper published this week in the Journal of Allergy and Clinical Immunology. One theory for the lower risk in people with food allergies, a press release notes, is that “type 2 inflammation, a characteristic of allergic conditions, may reduce levels of a protein called the ACE2 receptor on the surface of airway cells. SARS-CoV-2 uses this receptor to enter cells, so its scarcity could limit the virus’s ability to infect them.”
COVID-19 has had “substantial global collateral CV damage” when it comes to the delivery of cardiovascular services around the world, particularly in low- and middle-income countries that were already lagging behind their higher-income counterparts, a systematic review and meta-analysis published this week in the European Heart Journal makes clear. Declines in services were seen across the globe, although countries outside of Europe and North America experienced steeper reductions in hospitalizations and primary PCIs for STEMI and worse short-term outcomes for certain conditions.
A review of all live births in Norway between September 2021 and February 2022, published in JAMA Internal Medicine, found that babies born to women who received a second or third dose of COVID-19 vaccine during the last two trimesters of pregnancy had a lower incidence of SARS-CoV-2 infection during their first months of life as compared with infants born to unvaccinated women. “The findings of this study provide early evidence to suggest that infants benefit from passive protection from SARS-CoV-2 infection following maternal COVID-19 vaccination during pregnancy,” the authors conclude, noting that similar protection has been documented with studies of pertussis and influenza vaccination during pregnancy.
Patients hospitalized with COVID-19 have objective evidence of damage, including cardiovascular damage, to multiple organ systems up to 2 months after discharge, and these abnormalities have a relationship to long COVID symptoms, according to a prospective study published last week in Nature Medicine. As TCTMD’s Todd Neale reports, imaging, ECG, and biomarker tests performed 28 to 60 days after patients left the hospital revealed injuries to the heart, lung, and kidney that were typically not seen in contemporary controls without COVID-19. As senior author Colin Berry, MBChB, PhD, told TCTMD, the study lends support to the belief that “long COVID does have a pathological basis to it.”
***THE DISPATCH WILL RETURN AFTER MEMORIAL DAY***
May 26, 2022
Though some parts of the world continue to deal with rising COVID-19 numbers, including the Americas and the Western Pacific region, cases have again started to decline from a global perspective after a week of stabilization, according to the latest update from the World Health Organization (WHO). New cases fell 3% from the prior week, with an 11% reduction in new deaths. CIDRAP News has more.
Earlier this week, the US Centers for Disease Control and Prevention (CDC) issued an alert regarding the potential for “COVID-19 rebound” after treatment with Pfizer’s oral antiviral therapy Paxlovid. The agency maintains its recommendation to use the therapy for patients with mild-to-moderate COVID-19 who are at risk for progression to severe disease, but newly advises patients with a rebound to re-isolate for at least 5 days and wear a mask for 10 days after the start of rebound symptoms. A STAT story discusses the efforts going into uncovering the reasons for the rebound phenomenon.
Taiwan, which managed to limit the number of locally transmitted COVID-19 cases to less than 15,000 for all of 2021, is now seeing about 80,000 cases each day as it eases restrictions with an eye on living with the virus, a Reuters article notes. “Unlike some countries where new case spikes overwhelmed medical systems and disrupted everyday life, Taiwan hospital beds earmarked for COVID patients are at 56% occupancy. Shops, restaurants, and gyms remain open, and gatherings continue, with mandatory mask-wearing.”
Full vaccination is associated with less secondary transmission of COVID-19 and a shorter duration of viable viral shedding compared with partial or no vaccination, according to a study in JAMA Network Open. That provides “important evidence that despite the possibility of breakthrough infections, COVID-19 vaccinations remain critically useful for controlling the spread of SARS-CoV-2,” the authors say. A commentary delves into the implications.
Sweden is recommending a fifth COVID-19 shot for people older than 65 and others deemed to be at risk for serious illness, including pregnant women, those who are immunocompromised, and patients with heart and lung disease, the Associated Press reports. The policy takes effect September 1.
Some studies have suggested that COVID-19 vaccination not only protects against severe outcomes from acute SARS-CoV-2 infection, but also limits long COVID symptoms months later. A new study in Nature Medicine, however, indicates that protection against long COVID is not absolute—vaccinated people with breakthrough infections still had an elevated risk of postacute sequelae, though it was lower than that seen in unvaccinated individuals. “Altogether, the findings suggest that vaccination before infection confers only partial protection in the postacute phase of the disease; hence, reliance on it as a sole mitigation strategy may not optimally reduce long-term health consequences of SARS-CoV-2 infection,” the researchers write. The findings are disappointing, the lead author told the Washington Post.
A study from CDC researchers, published in Morbidity and Mortality Weekly Report, provides some insights into the occurrence of post-COVID conditions up to a year after the initial infection, showing that about one in five people ages 18 to 64 and one in four people 65 and older had at least one condition that could be linked to COVID-19. The greatest risks were seen for acute pulmonary embolism and respiratory signs or symptoms. Here’s more from the New York Times.
Another study, this one in the Annals of Clinical and Translational Neurology, indicates that a subset of patients who were not hospitalized for COVID-19 can have neurologic symptoms, fatigue, and compromised quality of life that lasts more than a year after the initial infection. At a median follow-up of 14.8 months, a range of symptoms that included “brain fog,” numbness/tingling, headache, dizziness, blurred vision, tinnitus, and fatigue remained prevalent. Vaccination did not have an impact on cognitive function or fatigue.
Though a fourth dose of the Pfizer/BioNTech vaccine gives added protection against SARS-CoV-2 infection and severe COVID-19 compared with three doses in people 60 and older, its effects fade faster than those seen with a third dose, researchers report in the BMJ. Effectiveness against infection peaked 3 weeks after administration of the fourth dose (at 65.1%), falling to just 22.0% by 10 weeks.
Long-term exposure to air pollution, particularly ground-level ozone, is associated with greater risks of hospitalization, ICU admission, and death among patients with COVID-19, according to a study in CMAJ. “However,” the authors say, “uncertainty still remains in the mechanisms of how long-term air pollution might affect COVID-19 severity, which calls for future research.”
May 23, 2022
According to the latest numbers from the US Centers for Disease Control and Prevention (CDC), released late last week, most Americans live in areas with low levels of COVID-19, although many parts of the country have moved into medium and high levels. The 7-day average of new cases increased by 18.8% compared with the prior period, with hospitalizations up 24.2%. The average of new deaths declined slightly, by 1.2%.
Pfizer and BioNTech said Monday that a third, 3-µg dose of their COVID-19 vaccine elicited “a strong immune response, with a favorable safety profile” in children ages 6 months to under 5 years in a phase II/III trial. Vaccine efficacy, a secondary endpoint, was 80.3% at a time when the Omicron variant was dominant. “These top-line safety, immunogenicity, and efficacy data are encouraging, and we look forward to soon completing our submissions to regulators globally with the hope of making this vaccine available to younger children as quickly as possible, subject to regulatory authorization,” said Albert Bourla, Pfizer’s chairman and CEO. US Food and Drug Administration (FDA) advisors will meet June 14 and 15 to discuss the use of this vaccine and the one from Moderna in young children (Reuters).
Excess mortality related to COVID-19 in Massachusetts was actually higher when Omicron was the dominant variant than when Delta was widely circulating, despite reports that Omicron presents less risk, researchers report in JAMA. “The present findings indicate that a highly contagious (although relatively milder) SARS-CoV-2 variant can quickly confer substantial excess mortality, even in a highly vaccinated and increasingly immune population,” they say.
Over the course of the pandemic, COVID-19-related mortality has continued to fall among older individuals, with particularly large declines in death rates in those 80 and older, according to a study in JAMA Network Open. In contrast, mortality increased over time among younger adults. “Possible factors underpinning these changing patterns are higher vaccination prevalence and less exposure to infection among older individuals,” the authors suggest. “This advantage may have increased over time as younger individuals returned to work and other activities and the Delta variant emerged.”
The COVID-19 pandemic did not drive up medical debt among Americans, an analysis of credit reports in JAMA Health Forum suggests. “We found no evidence of a net association between the COVID-19 pandemic and medical debt, overall or across areas with different incomes and pandemic severity. These results are consistent with any increase in medical debt being offset by decreases in elective medical procedures and new healthcare-related governmental policies,” the authors write.
Over the weekend, the New York Times released a story delving into what’s known about long COVID, or postacute sequelae of COVID-19 (PASC), including discussions around diagnosis, risk factors, the impact of vaccination, and medical care. Studies estimate that 10% to 30% of people report medical issues months after the initial infection. “Such lingering medical issues are so varied that one study by a patient-led research group evaluated 203 symptoms that may fluctuate or even appear out of the blue after people seem to have recovered,” the article notes.
People with low body weight have less waning of COVID-19 vaccine immunity 6 months after receipt of two doses of the Pfizer/BioNTech shot, according to a study in JAMA Network Open. The researchers conclude: “A booster shot . . . may be given later than 6 months after the second dose in young and middle-aged healthy persons with low body weight.” CIDRAP News has more.
A study out of Israel, published in JAMA, indicates that the severity of multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection was reduced when Omicron was circulating. “Possible explanations include the Omicron variant itself, previous infection with SARS-CoV-2, vaccination against SARS-CoV-2, and improvement in treatment over time,” its authors note.
A study published last week in Psychological Medicine shows that depression, worry about COVID-19, and loneliness prior to SARS-CoV-2 infection are associated with a greater risk of hospitalization for COVID-19. “Assessment of psychological distress may identify patients at greater risk of hospitalization,” the researchers say. “Future work should examine whether addressing distress improves physical health outcomes.”
May 20, 2022
The estimated number of COVID-19 cases in North Korea is approaching 2 million just a week after the country—which has an unvaccinated population—admitted it had an outbreak, the Associated Press reports. The story notes that “the outbreak could be worse than officially reported since the country lacks virus tests and other healthcare resources and may be underreporting deaths to soften the political impact on authoritarian leader Kim Jong Un.”
Shanghai, China, continues to emerge from its latest round of lockdowns, with plans to reopen four of its 20 subway lines on Sunday (Associated Press). Also restarting will be 273 bus lines that connect major urban centers, airports, train stations, and hospitals. “The lockdown of China’s largest city”—done as part of a “zero COVID” strategy—“has dealt a blow to the economy and frustrated residents, particularly as many countries elsewhere in the world move away from such harsh measures as they try to live with the virus.”
COVID-19 cases are rising in several parts of the world, with a weekly update from the World Health Organization (WHO) showing increasing infections in the Eastern Mediterranean, Western Pacific, Americas, and African regions (CIDRAP News). WHO officials are warning health systems in the Americas to prepare for surges (New York Times). An official said there are over 27% more cases in the region, driven by increases in the US. On Wednesday, federal officials said one-third of Americans live in areas where spread of the virus is so high that they should consider wearing a mask indoors.
As COVID-19 numbers continue to rise across the United States, the Centers for Disease Control and Prevention (CDC), decided yesterday to recommend booster doses of the Pfizer/BioNTech vaccine in children ages 5 to 11 (New York Times). The US Food and Drug Administration (FDA) authorized that use earlier in the week.
On Monday, the FDA declined to authorize fluvoxamine, a generic antidepressant, as a treatment for COVID-19, STAT reports. In a two-page summary, the agency said a group of doctors that has been advocating for use of the drug failed to prove that it was effective. FDA reviewers note that in one particular trial, “the treatment benefit of fluvoxamine was not persuasive when focusing on clinically meaningful outcomes such as proportion of patients experiencing hospitalizations or hospitalizations and deaths.”
Children and teens with congenital and acquired cardiovascular conditions are particularly susceptible to severe COVID-19 outcomes, according to a study in JAMA Network Open. Cardiac arrest, cardiogenic shock, heart surgery, cardiopulmonary disease, heart failure, hypotension, nontraumatic cerebral hemorrhage, pericarditis, and biventricular defects all were associated with increased COVID-19 severity. CIDRAP News provides more details.
More than three-quarters of patients with long COVID were not hospitalized for the initial infection, according to a report from FAIR Health based on private insurance claims. “The new study adds to a growing body of evidence that, while patients who have been hospitalized are at greater risk for long COVID, people with mild or moderate initial coronavirus infections—who make up the vast majority of coronavirus patients—can still experience debilitating post-COVID symptoms including breathing problems, extreme fatigue, and cognitive and memory issues,” a story in the New York Times notes.
A UK study published in the BMJ suggests that receipt of a COVID-19 vaccine after testing positive for SARS-CoV-2 may prevent long COVID symptoms, with sustained improvement after a second dose, although the researchers say longer follow-up is necessary. And an accompanying editorial notes that “a clear explanation for how vaccines might reduce the multisystem manifestations of long COVID is still lacking.” Here’s more from STAT.
In an explainer video, STAT’s Helen Branswell explores why there isn’t a nasal vaccine for COVID-19 yet. “If we want to prevent mild COVID infections, we’re going to need vaccines that protect us where infections start: in the mucus membranes of the nose, mouth, and throat. And for that, we’re likely going to need intranasal vaccines,” Branswell says, noting that “the development process is tricky.”
New data published this week in BMJ Public Health affirm that specially trained dogs can accurately sniff out COVID-19 among travelers passing through an airport. “One of our findings highlights the importance of continuous retraining as new variants emerge,” the researchers say, adding that “using scent dogs may present a valuable approach for high-throughput, rapid screening of large numbers of people.” CIDRAP News provides more details.
May 16, 2022
New Zealand Prime Minister Jacinda Ardern has tested positive for COVID-19, joining other members of her family, the Associated Press reported late last week. Ardern, who is fully vaccinated, said she still plans to travel to the United States later this month to discuss trade and give a commencement address at Harvard University.
Authorities in Shanghai, China, says its lockdown meant to stem a recent outbreak of SARS-CoV-2 will start easing, the Associated Press reports. Fewer than 1 million people in the city of more than 26 million remain under strict lockdown, and the vice mayor said 15 of 16 districts in Shanghai had eliminated virus transmission.
Readmission after a prior hospitalization for severe COVID-19 is common, investigators write in the CMAJ. Relatively little attention has been paid to readmission rates, the authors say, and while these appear similar to those following discharge for other medication conditions, more research is needed to understand postacute COVID symptoms and outcomes.
In a randomized trial, prone positioning did not significantly boost outcomes over usual care among adults with COVID-19 and acute hypoxemia. There were no differences between groups in terms of endotracheal intubation within 30 days (primary outcome), mortality at 60 days, or other events, although the researchers note in JAMA that “the effect size for the primary study outcome was imprecise and does not exclude a clinically important benefit.”
Among immunosuppressed patients, two doses of the COVID-19 vaccine from Moderna result in stronger seroresponses than two doses of the Pfizer/BioNTech shot, according to a study in JAMA Network Open. “These findings suggest that choice of mRNA vaccine platform is important in optimizing immune responses to SARS-CoV-2 vaccination and can help inform strategies for booster doses in high-risk, immunosuppressed populations,” the researchers write.
With help from the government, US hospitals fared well financially during the first year of the pandemic, according to an analysis in JAMA Health Forum. Though operating margins were substantially reduced, overall profit margins were similar to those in prior years, with government, rural, and smaller hospitals having even higher profit margins. The findings suggest “that the COVID-19 relief fund effectively offset the financial losses for hospitals during the COVID-19 pandemic.” CIDRAP News has more.
Two other studies in JAMA focus on the pediatric population. One shows that during a period of dominance for the Omicron variant, estimated vaccine effectiveness for two doses of the Pfizer/BioNTech shot was “modest and decreased rapidly,” although a booster dose increased it. The other demonstrates that unvaccinated children and teens had greater risks of infection and hospitalization compared with their vaccinated peers, with declining risk as Omicron became more prevalent. “The encouraging message should be that although vaccine protection for children and adolescents was lower in the Omicron era than with previous variants and that such protection wanes rapidly, vaccine effectiveness against hospitalization remains high and booster doses confer additional protection,” an editorial states.
The Omicron variant is more likely than prior strains to cause croup in children, researchers report in Pediatrics. Of the 75 children admitted to Boston Children’s Hospital with COVID-associated croup through the middle of January 2022, 81% were during the period of Omicron dominance. Most were male (72%) and discharged from the emergency department (88%). The “preliminary findings lend compelling evidence to the hypothesis that the Omicron variant causes laryngotracheobronchitis,” the authors say. CIDRAP News has more details.
Asthma + Lung UK reports a doubling in the number of people looking for help with long COVID symptoms over the last 6 months, with about 500,000 visiting its website or calling its helpline over that span, according to Bloomberg. The charity’s chief executive said: “As we near the grim milestone of 2 million people living with long COVID, there is still a dismal lack of treatments for this disabling condition, which is leaving people fighting for breath and devastating every aspect of their life, health, work, and relationships.”