Daily Archives: February 29, 2024

February 28 marks four years since COVID-19 was first reported in Aotearoa New Zealand. Many of us are probably surprised this virus is still causing a pandemic.

The World Health Organization refers to COVID-19 as a continuing pandemic. As Scientific American put it recently, it has been the elephant in every room sometimes confronted and sometimes ignored but always present.

It wasnt meant to be like this. The main wave of the 1918 influenza pandemic swept through New Zealand in eight weeks, killing 9,000 people almost 1% of the population. Then it was largely gone, returning as a new seasonal flu virus.

In doing so, it defined how pandemics were expected to behave. This model was written into pandemic plans and collective thinking across the globe.

But COVID is still circulating four years after New Zealand reported its first case, and more than two years after the Omicron variant arrived and infection became widespread.

Constantly present, it is also occurring in waves. Unexpectedly, the current fifth wave was larger than the fourth, suggesting we cant rely on the comforting assumption that COVID will get less severe over time.

These waves are driven by the interaction of the organism (SARS CoV-2 virus), the host (human characteristics such as immunity and behaviour), and environmental factors (such as indoor ventilation).

Continuing viral evolution is a major contributor to the changing dynamic. The virus has demonstrated an ability for large, unpredictable evolutionary shifts that dramatically alter its genome and spike protein.

The result is an enhanced ability to evade prior immunity and infect more people. This jump was seen with the highly mutated BA.2.86 subvariant in mid-2023.

Its offspring, JN.1, has acquired additional changes and is causing such a wave of new infections it could potentially be the next variant of concern, with its own Greek letter. It is now driving epidemic increases across the globe, including in New Zealand. This dominance by a single subvariant takes us back to the first year of Omicron in 2022.

Read more: I have COVID. How likely am I to get long COVID?

The pandemic continues to have a large, visible health impact. It is a leading cause of serious illness and death, mainly in older populations and those with existing long-term health conditions.

In 2023, it caused more than 12,000 hospitalisations and 1,000 deaths in New Zealand.

But COVID-19 also has an important and largely unmeasured burden of disease as the cause of long COVID, which may become its biggest health impact. A growing number of studies are describing an estimated incidence of long COVID of 5% to 15% of all infections.

For example, a recent large study of almost 200,000 Scottish adults reported that, after adjustment for factors that might confuse the results, long COVID prevalence following an infection was 6.6% at six months, 6.5% at 12 months, and 10.4% at 18 months.

These findings illustrate an important feature of long COVID: recovery can take two years or more, with symptoms that fluctuate over time.

New Zealand now needs a strong, integrated response to COVID-19 and other respiratory infections.

The major pandemic interventions have not changed: vaccination, public health and social measures to prevent infection, and antivirals for more vulnerable groups. The evidence has firmed up that long COVID risk is reduced by vaccination, but research is less certain for antivirals.

Read more: Vaccination, testing, clean air: COVID hasn't gone away here's where Australia needs to do better

But growing pandemic complacency from political leaders and the public has changed things. Some of this apparent indifference can be put down to understandable fatigue with response measures. But it remains dangerous in the face of a continuing pandemic.

One way to keep a focus on prevention and control would be to include these measures in an integrated respiratory infectious disease strategy. This would combine COVID-19 control measures with those used to protect against influenza, respiratory syncytial virus (RSV), and other respiratory infections.

Measles could be added to the list, given the rising threat to New Zealand from a global resurgence of the disease.

This integrated strategy would include vaccination, promoting testing and self-isolation when sick, and measures to reduce transmission in critical indoor environments such as healthcare, public transport and education settings.

Read more: Long COVID stemmed from mild cases of COVID-19 in most people, according to a new multicountry study

Such a programme would need to be supported with community engagement, education, surveillance and research.

Structural inequalities mean Mori, Pacific peoples, and those living in relative deprivation, are less vaccinated, less protected from infection, less tested and less likely to have antivirals.

Consequently, they are more likely to be hospitalised and die from COVID-19. These inequities are currently not being systematically tracked and acted on.

Read more: COVID: there's a strong current of pandemic revisionism in the mainstream media, and it's dangerous

As we enter the fifth pandemic year, we need a change in thinking about COVID-19. This infection has pathological features in common with the other severe coronaviruses (SARS and MERS).

It is wishful thinking to imagine it will suddenly transform into a common cold coronavirus. As a recent review article concluded:

Transition from a pandemic to future endemic existence of SARS-CoV-2 is likely to be long and erratic [] endemic SARS-CoV-2 is by far not a synonym for safe infections, mild COVID-19 or a low population mortality and morbidity burden.

In the face of this continuing pandemic threat, we need a response that is evidence-informed rather than evidence-ignored.

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A pandemic that won't go away as COVID enters its 5th year, NZ needs a realistic strategy - The Conversation

NEW YORK Older U.S. adults should roll up their sleeves for another covid-19 shot, even if they got a booster in the fall, an influential government advisory panel said Wednesday.

The panel voted 11-1 to say Americans 65 and older should get another dose of the updated vaccine that became available in September if at least four months has passed since their last shot. The committee advises the head of the Centers for Disease Control and Prevention, who will decide whether to sign off on the recommendation.

The panels decision came after a lengthy discussion about whether to say older people may get the shots or if they should do so. That reflects a debate among experts about how necessary another booster is and whether yet another recommendation will add to the publics growing vaccine fatigue.

Some doctors say most older adults are adequately protected by the fall shot, which built on immunity derived from earlier vaccinations and exposure to the virus itself. And preliminary studies so far have shown no substantial waning in vaccine effectiveness over six months.

However, the bodys vaccine-induced defenses tend to fade over time, and that happens faster in seniors than in other adults. The committee had recommended covid-19 booster doses for older adults in 2022 and 2023.

Covid-19 remains a danger, especially to older people. There are still more than 20,000 hospitalizations and more than 2,000 deaths each week due to the coronavirus, according to the CDC. And people 65 and older have the highest hospitalization and death rates.

Some members of the advisory panel said a should recommendation is meant to more clearly prod doctors and pharmacists to offer the shots.

Most people are coming in either wanting the vaccine or not, said Dr. Jamie Loehr, a committee member and family doctor in Ithaca, New York. I am trying to make it easier for providers to say, Yes, we recommend this.

In September, the government recommended a new covid-19 shot recipe built against a version of the coronavirus called XBB.1.5. That single-target vaccine replaced combination shots that had been targeting both the original coronavirus strain and a much earlier omicron version.

The CDC recommended the new shots for everyone 6 months and older, and allowed that people with weak immune systems could get a second dose as early as two months after the first.

Most Americans havent listened. According to the latest CDC data, 13% of U.S. children have gotten the shots and about 22% of U.S. adults have. The vaccination rate is higher for adults 65 and older, at nearly 42%.

In each successive vaccine, the uptake has gone down, said Dr. David Canaday, a Case Western Reserve University infectious diseases expert who studies covid-19 in older people.

People are tired of getting all these shots all the time, said Canaday, who does not serve on the committee. We have to be careful about over-recommending the vaccine.

But there is subset of Americans those at higher danger of severe illness and death who have been asking if a another dose is permissible, said Dr. William Schaffner, a Vanderbilt University vaccines expert who serves on a committee workgroup that has been debating the booster question.

Indeed, CDC survey data suggests that groups biggest worry about the vaccine is whether its effective enough.

Agency officials say that among those who got the latest version of the covid-19 vaccine, 50% fewer will get sick after they come into contact with the virus compared with those who didnt get the fall shot.

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Older U.S. adults should get another covid-19 shot, advisers say - TribLIVE

Participant characteristics

A total of 271 participants (meanSD, 61years12) were assessed, and 113 participants were women (41.7%). The baseline and clinical characteristics are summarized in Table 1. Of the 271 participants, the median body mass index was 21.8kg/m2 (IQR, 17.129.1), and 80 (29.5%) were smokers. 148 participants (54.6%) had different types of comorbidities and common comorbidities included hypertension (82 participants, 30.3%), type II diabetes mellitus (80 participants, 29.5%), ischemic heart disease (61 participants, 22.5%), chronic obstructive pulmonary disease (18 participants, 6.6%) and previous venous thromboembolism (10 participants, 3.7%). The median hospital stay was 12days (IQR, 420days), with 68 participants (25.1%) requiring the highest level of ventilatory support in the form of invasive ventilation or noninvasive positive pressure ventilation. Participants are treated with medications mainly including paxlovid (183 participants, 67.5%), azvudine (60 participants, 22.1%) and glucocorticoid (69 participants, 25.5%).

Compared of baseline and clinical characteristics, age (mean, 58years11 vs 65years12, P<0.001), smoker (42 participants [24.3%] vs 38 participants [38.8%], P=0.04), heart rate (mean, 83 times per minute14 vs 92 times per minute16, P=0.02), respiratory rate (mean, 20 times per minute7 vs 24 times per minute9, P=0.03), oxygen saturation on room air (SaO2, 96%, IQR, 8899% vs 92%, IQR, 8098%, P=0.001), chronic obstructive pulmonary disease (COPD, 10 participants [5.8%] vs 8 participants [8.1%], P=0.02), length of hospital stay (11days, IQR, 414days vs 16days, IQR, 1027days, P<0.001), invasive ventilation (2 participants [1.6%] vs 15 participants [15.3%], P<0.001) and using paxlovid (147 participants [85.0%] vs 36 participants [36.7%], P<0.001) demonstrated a statistically significant difference between participants with normal and abnormal chest CT at 6-month follow-up.

All participants underwent a 6-month follow-up chest CT at a median of 177days (IQR, 155203days) after hospital admission and pulmonary residual abnormalities were found in 98 participants (36.2%). Compared to the initial CT (Table 2), participants with GGO decreased from 270 (99.6%) to 66 (24.4%) and consolidation decreased from 111 (41.0%) to 20 (7.4%) (Fig.2). Meanwhile, participants with reticulation increased from 19 (7.0%) to 57 (21.0%). The ARDS pattern in three participants (1.1%) and crazy paving pattern in two participants (0.7%) at initial CT had disappeared at 6-month follow-up CT. Participants with organizing pneumonia pattern increased from four (1.5%) to seven (2.6%). Among CT evidence of fibrotic-like changes, participants with linear atelectasis increased from four (1.5%) to seven (2.6%) (Fig.3), participants with bronchiectasis and parenchymal bands increased from six (2.2%) to 31 (11.4%) (Fig.4) and 14 (5.2%) (Fig.5) respectively. There was no change in the three participants (1.1%) with honeycombing. In summary, 39 participants (14.4%) demonstrated new suspicious fibrotic-like changes at 6-month follow-up CT.

Serial chest CT scans in a 45-year-old man with severe coronavirus disease 2019 pneumonia. (A, B) Initial CT scans obtained on day 5 after the onset of symptoms showed extensive ground-glass opacities (GGO) with some areas of consolidation bilaterally. (C, D) CT scans obtained on day 9 showed extensive consolidation with few GGOs bilaterally. (E, F) CT scans obtained on day 179 showed almost absorption of the abnormalities with mild GGOs and interstitial thickening remaining.

Serial chest CT scans in a 61-year-old man with coronavirus disease 2019 pneumonia. (A, B) Initial CT scans obtained on day 4 after the onset of symptoms showed multiple ground-glass opacities and consolidation bilaterally. (C) CT scans obtained on day 22 showed moderate consolidation and reticulation in the lower lung lobes bilaterally. (D) CT scans obtained on day 191 showed obviously absorption of the abnormalities with subtle reticulation and linear atelectasis (arrow) in the lower lung lobes.

Serial chest CT scans in a 60-year-old man with coronavirus disease 2019 pneumonia. (A, B) Initial CT scans obtained on day 8 after the onset of symptoms showed multiple ground-glass opacities and interstitial thickening bilaterally. (C, D) CT scans obtained on day 180 showed traction bronchiectasis (white arrow) and interlobar pleural traction (black arrow) in the upper lobe of right lung.

Serial chest CT scans in a 54-year-old man with coronavirus disease 2019 pneumonia. (A) Initial CT scans obtained on day 9 after the onset of symptoms showed multiple ground-glass opacities and interstitial thickening bilaterally. (B)CT scans obtained on day 169 showed traction bronchiectasis (white arrow) and parenchymal bands (black arrow) in the lower lung lobes.

In the Chest CT scores (Table 3), a significantly decrease was found for any abnormality (P<0.001), GGO (P<0.001), and consolidation (P<0.001), whereas a significantly increase for fibrotic-like abnormalities (P<0.001) compared with the initial CT scans. Meanwhile, reticulation showed insignificantly change between two CT scans (P=0.33).

In the univariate analysis, paxlovid (odd ratio [OR]: 0.08; 95% CI 0.03, 0.21; P<0.001), invasive ventilation (OR 9.3; 95% CI 2.8, 29; P<0.001), age>60years (OR 6.5; 95% CI 2.7, 17; P<0.001), SaO2 less than 93% at admission (OR 4.5; 95% CI 1.4, 14; P<0.001), hospitalization more than 15days (OR 3.8; 95% CI 1.3, 11; P=0.002), and respiratory rate more than 23 times per minute at admission (OR 3.3; 95% CI 1.3, 8.7; P=0.004) were associated with pulmonary residual abnormalities at 6-month follow-up CT. In the multivariate analysis, the predictive factors were invasive ventilation (OR 13.6; 95% CI 1.9, 45; P<0.001), age>60years (OR 9.1; 95% CI 2.3, 39; P=0.01), paxlovid (OR 0.11; 95% CI 0.04, 0.48; P=0.01), hospitalization more than 15days (OR 6.1; 95% CI 1.2, 26; P=0.002), heart rate greater than 100 times per minute (OR 5.9; 95% CI 1.1, 27; P=0.03), and SaO2 less than 93% at admission (OR 5.6; 95% CI 1.4, 13; P=0.02) (Table 4).

In the univariate analysis, paxlovid (OR 0.11; 95% CI 0.04, 0.32; P<0.001), invasive ventilation (OR 8.8; 95% CI 2.1, 26; P<0.001), smoker (OR 7.4; 95% CI 3.0, 16; P<0.001), SaO2 less than 93% at admission (OR 4.5; 95% CI 1.2, 16; P=0.002) and age>60years (OR 4.2; 95% CI 1.3, 11; P=0.002) were associated with pulmonary fibrotic-like changes at 6-month follow-up CT. In the multivariate analysis, the predictive factors were invasive ventilation (OR 10.3; 95% CI 2.9, 33; P=0.002), smoker (OR 9.9; 95% CI 2.4, 31; P=0.01), paxlovid (OR 0.1; 95% CI 0.03, 0.48; P=0.01), SaO2 less than 93% at admission (OR 7.8; 95% CI 1.5, 19; P=0.02), age>60years (OR 6.1; 95% CI 2.3, 22; P=0.03) and heart rate greater than 100 times per minute (OR 4.9; 95% CI 1.7, 11; P=0.04) (Table 5).

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CT-based Assessment at 6-Month Follow-up of COVID-19 Pneumonia patients in China | Scientific Reports - Nature.com

February 27, 2024

Most COVID-19 cases are mild, but many still lead to life-threatening complications. Severe cases feature an overactive immune response that causes dangerous inflammation. This inflammation affects many different tissues and cell types, including uninfected ones, and resembles that seen in some autoimmune diseases. Its not clear why SARS-CoV-2 can cause such inflammation while other coronaviruses responsible for common colds dont.

One way the immune system fights viruses is by breaking down the viral proteins into small fragments called peptides. An NIH-funded research teamled by Dr. Gerard Wong at the University of California, Los Angeles, in collaboration with Richard L. Gallo at the University of California, San Diegoinvestigated whether these peptides could continue to activate the immune system. Their results were published in Proceedings of the National Academy of Sciences on February 6, 2024.

The team used machine learning to search SARS-CoV-2 proteins for fragments that resemble molecules called antimicrobial peptides (AMPs). The body makes these molecules as part of its defense against infections. Certain AMPs can bind to double-stranded RNA (dsRNA), which is produced during some viral infections. The resulting AMP-dsRNA complexes have been shown to trigger inflammation and have been implicated in autoimmune conditions such as lupus, rheumatoid arthritis, and psoriasis. Among the SARS-CoV-2 AMP-like fragments, the team looked for those that carried a strong positive electric charge. This would allow them to bind dsRNA, which is negatively charged.

The researchers studied three SARS-CoV-2 fragments that both resembled AMPs and had a large positive charge. These fragments were also found in the airways of patients with severe COVID-19. The scientists dubbed these AMP-like peptides xenoAMPs. Notably, SARS-CoV-2 contained more potential xenoAMPs than common cold coronaviruses. SARS-CoV-2 xenoAMPs also mimicked real AMPs more closely than those from common cold coronaviruses.

XenoAMPs bound to dsRNA and caused it to form liquid crystalline structures like those formed when AMPs bind to dsRNA. These structures were the optimal size and shape for binding to certain receptors that control the innate immune response. When tested in various types of human cells, the xenoAMP-dsRNA complexes enhanced inflammatory responses. They also triggered gene activity changes resembling those triggered by SARS-CoV-2 infection. Corresponding peptides from a common cold coronavirus did not bind and form such structures with dsRNA. They also did not enhance inflammation in the cells.

The researchers injected one of the xenoAMP-dsRNA complexes into the bloodstream of mice. After they did, the mice had higher levels of proinflammatory molecules in the blood, similar to those seen in people with COVID-19. They also had higher levels of various immune cells.

These findings could lead to new strategies for treating severe cases of COVID-19. They also suggest a way to determine whether future coronaviruses could cause similar inflammation. More generally, they show how viruses can continue to affect the host even after theyre destroyed by the immune system.

The textbooks tell us that after the virus is destroyed, the sick host wins, and different pieces of virus can be used to train the immune system for future recognition. COVID-19 reminds us that its not this simple, Wong explains. For comparison, if one were to assume that after food gets digested into its molecular components, then its effects on the body are over, it would be very liberating. I wouldnt have to worry about the half-dozen jelly donuts I just ate. However, this simple picture is not correct.

by Brian Doctrow, Ph.D.

References:Viralafterlife: SARS-CoV-2 as a reservoir of immunomimetic peptides that reassemble into proinflammatory supramolecular complexes. Zhang Y, Bharathi V, Dokoshi T, de Anda J, Ursery LT, Kulkarni NN, Nakamura Y, Chen J, Luo EWC, Wang L, Xu H, Coady A, Zurich R, Lee MW, Matsui T, Lee H, Chan LC, Schepmoes AA, Lipton MS, Zhao R, Adkins JN, Clair GC, Thurlow LR, Schisler JC, Wolfgang MC, Hagan RS, Yeaman MR, Weiss TM, Chen X, Li MMH, Nizet V, Antoniak S, Mackman N, Gallo RL, Wong GCL. Proc Natl Acad Sci U S A. 2024 Feb 6;121(6):e2300644120. doi: 10.1073/pnas.2300644120. Epub 2024 Feb 2. PMID:38306481.

Funding:NIHs National Institute of Allergy and Infectious Diseases (NIAID), National Heart, Lung, and Blood Institute (NHLBI), National Cancer Institute (NCI), National Institute of General Medical Sciences (NIGMS), and Office of the Director (OD); National Science Foundation; W. M. Keck Foundation; Rapidly Emerging Antiviral Drug Development Initiative.

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SARS-CoV-2 fragments may cause problems after infection - National Institutes of Health (NIH) (.gov)

Since the beginning of the COVID-19 pandemic, the focus of research has primarily been on COVID-19 symptoms and vaccinations. Despite the widespread administration of millions of vaccine doses worldwide, concerns about the safety and efficacy of vaccinations continue to be raised. To address this, our study aimed to investigate the adverse events (AEs) associated with different types and doses of COVID-19 vaccines across six Arabic countries during the fourth wave of the pandemic.

The variation in the number of vaccinated participants among the studied Arab countries reflects differences in vaccine availability and compulsory vaccine regulations. For example, Saudi Arabia initiated vaccination for children aged 12 and older in July 2021 and mandated that all citizens and residents receive a booster dose by February 2022. In contrast, compulsory vaccination policies and booster doses had not been implemented in the remaining five countries at the time of data collection46,47,48.

The pattern of AEs after each dose aligns with previous reports49. This may be attributed to the cumulative immunological effect of the second dose rather than a direct immunological response50. We observed a lower frequency of AEs after the second dose with many types of vaccines compared to the first dose. However, we reported an increase in the frequency of AEs after the Sputnik V vaccine, local AEs after the Sinopharm vaccine, systemic AEs after the Pfizer-BioNTech vaccine, and serious AEs after the Johnson & Johnson (J&J) vaccine. Previous studies have shown different trends, with higher local and systemic AEs reported after the second dose of Pfizer-BioNTech and AstraZeneca vaccines26,50,51,52.

In our study, the most prevalent local AEs, such as pain, redness, and swelling at the injection site, were reported after the Pfizer-BioNTech, AstraZeneca, and Sinopharm vaccines. Previous studies conducted in the reported varying percentages were reported after the first and second doses20,26,53. The most commonly reported general AEs were fatigue, body aches, fever, headache, and myalgia, which is in line with published studies20,49.

Headache was reported in more than 50% of participants after the AstraZeneca vaccine54,55,56. There are no details about the pathophysiologic mechanisms, whether the intracellularly synthesized spike protein is produced by using mRNA vaccines, or the protein triggers the immune response from activated anti-inflammatory mediators such as prostaglandins, nitric oxide, and cytokines. Headache is the leading symptom of cerebrovascular thrombosis (CVT), including vaccine-induced ones. So, it's important to distinguish between vaccine-induced headaches and those caused by cerebrovascular thrombosis54,55,56.

Visual disturbances were reported by a small number of participants. There are reported cases of transient loss in the visual field due to possible acute vasospasm of the artery in the postchiasmatic visual pathway, triggered by the COVID-19 vaccine that resolved after two hours57. In other cases, macular detachment and severe choroidal thickening were detected causing visual loss and suggesting a potential inflammatory or autoimmune response to the vaccine58,59,60.

Elevations in blood pressure were observed among some vaccinated participants, which is consistent with reports of blood pressure surges after mRNA vaccines and an increase in home blood pressure after the first mRNA vaccine dose. Some patients required modification of anti-hypertensive drugs. This may be attributed to nervousness or white-coat hypertension. However there was no baseline data, and BP follow-up over a long period after vaccination is very important56,61.

Menstrual changes were reported among vaccinated females and it is noteworthy that by September 2, 2021, over 30,000 COVID-19-vaccinated females had reported menstrual changes to the United Kingdoms Medicines and Healthcare Products Regulatory Agency (MHRA) Yellow Card surveillance system12,62. This might be a result of immunological effects on the hormones that regulate the menstrual cycle or biological effects of immune cells on the uterus lining, which contribute to the tissue's cyclical building and breaking down12,63.

Rheumatological symptoms such as bone pain, myalgia, body aches, and weariness were reported in our study, similar to some studies conducted in Italy, Libya, Iran, China, and Turkey61,63,64,65,66,67. These symptoms might be attributed to the immune response triggered by the vaccine, leading to transient inflammation and musculoskeletal discomfort26,68. It is important to note that these symptoms are generally self-limiting and resolve within a few days after vaccination. The association between COVID-19 vaccination and the occurrence of certain symptoms remains uncertain when compared to other vaccines. The hyper-inflammatory response triggered by the COVID-19 vaccine raises concerns about its potential as a risk factor for inflammatory musculoskeletal disorders. This cytokine activation can be attributed to the SARS-CoV-2 spike protein, other components of the vaccine, or the adenoviral vector used67,68.

New-onset autoimmune manifestations, including Guillain-Barr syndrome (GBS), rheumatoid arthritis, and systemic lupus erythematosus, have been reported in eleven cases following COVID-19 vaccination, particularly after the first dose. The precise nature of the link between the COVID-19 vaccine and autoimmune symptoms is still unclear, whether it is coincidental or causal. Molecular mimicry, the generation of specific autoantibodies, and the influence of specific vaccination adjuvants are all thought to play a role in the development of autoimmune diseases63,69. For instance, we documented one case of GBS, a rare autoimmune neurological disorder that affects the peripheral nerves and nerve roots. GBS has been associated with other vaccines such as rabies, hepatitis A and B, influenza, and more recently, the COVID-19 vaccine70,71.

In this study, we documented the occurrence of symptoms suggesting vaccine-induced myocarditis and pericarditis, including chest pain (88 cases), shortness of breath (103 cases), and sensations of a fast-beating, fluttering, or pounding heart (34 cases). These presentations align with the CDC report on these conditions72. Our findings are consistent with previous research indicating that COVID-19 vaccine-related myocarditis primarily affects young men and is more commonly associated with mRNA vaccines such as those developed by Pfizer-BioNTech and Moderna73.

We observed a statistically significant difference in the occurrence of serious adverse events (AEs) among different vaccine types. We identified 10 cases of VITT out of 3,239 vaccine doses, which is a rare syndrome involving venous or arterial thrombosis at unusual sites such as cerebral venous thrombosis (CVT) and splenic thrombosis. Additionally, we found 10 cases of thrombosis out of 3,239 vaccine doses, a comparable rate to reports from the US (17 cases of VITT, 14 cases of thrombosis out of 7,000 participants after the J&J vaccine) and lower than the European Medicines Agency (EMA) (222 cases of thrombosis out of 35 million participants after the AstraZeneca vaccine)74,75. VITT occurs when DNA leaks from the imperfect adenoviral vector used in AstraZeneca and J&J vaccines, infects cells, binds to platelet factor 4 (PF4), and triggers the production of anti-PF4 autoantibodies76.

We also discovered a significant increase in post-vaccination COVID-19 cases among individuals previously infected with COVID-19. Such findings may raise the issue of the benefit of vaccines for people who were previously infected with SARS-CoV-2. It is noteworthy that a study conducted in Kentucky (MayJune 2021), reported an odds ratio of 2.34 (95% CI 1.583.47) of re-infection among unvaccinated participants compared to those who were fully vaccinated, suggesting that full vaccinations after a past SARS-CoV-2 infection provide additional protection by decreasing its transmissibility by shortening the duration of infectivity and so decrease the transmissibility77. Therefore, vaccination should be offered to all eligible individuals regardless of their previous infection status. While there is limited epidemiological evidence supporting the benefits of vaccination for previously infected individuals, our study supports the notion.

Regarding the frequency of post-vaccination COVID-19 in relation to the number of doses, the interpretation of the increase in infections after the second dose is still uncertain. Cumulatively, they were part of the sample that received the first dose, resulting in a significantly lower difference. Notably, the second dose can cause up to a tenfold increase in antibody levels, a stronger T-cell response, as well as more changes in the immune cells. Moreover, multiple variants of SARS-CoV-2 have emerged, primarily focused on the spike protein, a crucial element for developing vaccine candidates. Diverse vaccinations are currently undergoing clinical trials and demonstrating remarkable outcomes, however, their effectiveness still requires evaluation in various SARS-CoV-2 variants4,20.

We carried out a multicenter study in six Arab countries that included the assessment of AEs associated with eight different vaccine types. We were able to identify several associated factors with post-vaccination AEs, which can aid in monitoring and follow-up efforts during and after vaccination campaigns. Additionally, our study included patients from a previous wave of COVID-19, allowing us to track AEs across different vaccine doses. However, it is important to acknowledge the limitations of our study. Firstly, being an observational study, it is susceptible to bias and confounding issues. Secondly, the use of an online self-administered survey introduces limitations such as data accuracy concerns due to recall bias, sampling bias (as more than 80% of participants were well-educated), and availability bias (excluding individuals who couldn't access or use the Internet, and those who were illiterate or deceased). Thus, our study population may not represent the entire population. Furthermore, assessing SARS-CoV-2 infection rates after vaccination is complicated by the presence of the delta variant and other variants of concern, especially as the immunity from previous vaccinations may be waning. The timing between the first and second doses is relatively close together, but the interval between the second and third doses can vary widely across countries. The availability of COVID-19 confirmatory testing in the studied countries also affects the diagnosis of infection rates, potentially missing asymptomatic cases. Another limitation is the lack of assessment of participants' pre-COVID-19 vaccine health status, making it challenging to differentiate pre-existing health issues from those related to the COVID-19 vaccine. The use of a reporting system for the participants to report the AEs themselves can introduce bias in exaggerating or underreporting some AEs. Although these limitations exist, our findings are consistent with those of other international studies. Lastly, the variation in response rate among countries with a low number of responses in some e.g. Syria may be due to the method of sample collection using an online questionnaire, compounded by political unrest in some countries (e.g. Syria) hindering internet access. It is important to interpret the data of vaccine and AE rates while considering such political conditions for further extensive studies. Such variation can affect the generalizability and comparisons of results among such countries.

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Exploring the reported adverse effects of COVID-19 vaccines among vaccinated Arab populations: a multi-national ... - Nature.com

L.L. Bean has just added a third shift at its factory in Brunswick, Maine, in an attempt to keep up with demand for its iconic boot.

Orders have quadrupled in the past few years as the boots have become more popular among a younger, more urban crowd.

The company says it saw the trend coming and tried to prepare, but orders outpaced projections. They expect to sell 450,000 pairs of boots in 2014.

People hoping to have the boots in time for Christmas are likely going to be disappointed. The bootsare back ordered through February and even March.

"I've been told it's a good problem to have but I"m disappointed that customers not getting what they want as quickly as they want," said Senior Manufacturing Manager Royce Haines.

Customers like, Mary Clifford, tried to order boots on line, but they were back ordered until January.

"I was very surprised this is what they are known for and at Christmas time you can't get them when you need them," said Clifford.

People who do have boots are trying to capitalize on the shortage and are selling them on Ebay at a much higher cost.

L.L. Bean says it has hired dozens of new boot makers, but it takes up to six months to train someone to make a boot.

The company has also spent a million dollars on new equipment to try and keep pace with demand.

Some customers are having luck at the retail stores. They have a separate inventory, and while sizes are limited, those stores have boots on the shelves.

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Older US adults should get another COVID-19 shot, advisers say - NBC Bay Area

THURSDAY, Feb. 29, 2024 (HealthDay News) -- Similar small cognitive deficits are seen for individuals who recovered from COVID-19 in whom symptoms had resolved in less than four weeks or at least 12 weeks, according to a study published in the Feb. 29 issue of the New England Journal of Medicine.

Adam Hampshire, Ph.D., from Imperial College London, and colleagues estimated a global cognitive score across eight tasks in 112,964 participants who completed an online cognitive assessment.

The researchers found that compared with individuals in the no-COVID-19 group who had not been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or had unconfirmed infection, participants who recovered from COVID-19 in whom symptoms had resolved in less than four weeks or at least 12 weeks had similar small deficits in global cognition (0.23 and 0.24 standard deviation [SD], respectively), while larger deficits were seen for those with unresolved persistent symptoms (0.42 SD). Participants who had SARS-CoV-2 infection during periods in which the original virus or the B.1.1.7 variant was predominant had larger deficits than those infected with later variants; deficits were also larger for those who had versus had not been hospitalized. These results were similar to those of propensity score-matched analyses. Memory, reasoning, and executive function tasks were associated with the largest deficit in comparison of the group with unresolved persistent symptoms versus the no-COVID-19 group.

"We found objectively measurable cognitive deficits that may persist for a year or more after COVID-19," the authors write. "The implications of longer-term persistence of cognitive deficits and their clinical relevance remain unclear and warrant ongoing surveillance."

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Cognitive Deficits Seen in COVID-19 Patients Regardless of Symptom Duration - HealthDay

(CNN) People age 65 and older should get an additional dose of the current Covid-19 vaccine, the US Centers for Disease Control and Prevention recommends.

The agencys independent vaccine advisers voted Wednesday to recommend the additional shot, and CDC Director Dr. Mandy Cohen endorsed the recommendation.

The vote of CDCs Advisory Committee on Immunization Practices was 11 yes and one no, with one person abstaining.

Under the new recommendation, people 65 and older can receive an additional dose of any updated Covid-19 vaccine at least four months after the previous shot.

The current Covid-19 vaccine, which was updated last fall, is considered highly effective. Early estimates from CDC studies show that although there has been no substantial waning yet, protection will wane over time. However, the protection offered by any vaccine disappears even quicker in older people because their immune systems dont respond as well.

The initial proposal used the word may, but the committee changed the language to should to emphasize how important it is to get vaccinated against Covid-19.

Although 98% of the US population has some kind of immunity to Covid-19, whether from infection, vaccination or both, that gives only some protection against infection or severe disease, CDC epidemiologist Dr. Ruth Link-Gelles told the advisers during Wednesdays meeting.

It doesnt protect absolutely, she said.

What the vaccines are doing now is providing an incremental benefit or an extra benefit beyond whatever benefit someone has remaining from their past infection or past vaccination, and we know that protection from past vaccination and past infection wanes, Link-Gelles said. Thats important for all people in the United States but especially important for those that are the highest risk.

Data from the CDC shows that throughout the pandemic, older adults have been the most vulnerable to the severe effects of Covid-19.

Covid-related hospitalizations for adults 65 and older have been consistently higher than for all other age groups. About two-thirds of Covid hospitalizations are people in this age group, CDC data shows. Seniors also make up the greatest proportion of those who died in a hospital with Covid and have the highest numbers of deaths even after theyve been discharged.

Of older adults hospitalized with Covid, the highest percentage had no record of any vaccination against the coronavirus since the original shot, according to data from last fall that was presented to the committee Wednesday.

The vaccine is recommended for everyone ages 6 months and older, but data from the CDC shows that people havent been getting the shots.

Strong evidence from new research shows that the vaccine can not only prevent severe disease but may cut the chances of getting a symptomatic infection by half, including against JN.1, the most common circulating variant of the virus. Yet only about 21% of adults and about 12% of children have gotten the vaccine since its update in September, according to the CDC. By comparison, nearly half of adults and kids in the US have gotten a flu vaccine this season.

The National Immunization Survey shows that most Americans still consider Covid-19 vaccines to be safe and important, but peoples confidence in the vaccine has fallen from 83.9% in January 2022 to 69.6% last month.

Disease risk perception has also changed, according to the survey, and fewer adults say they are moderately or very concerned about getting Covid. Despite the general perception, Covid is still very much a threat, particularly to vulnerable populations like older people and those with underlying conditions.

There were about 20,000 new hospital admissions and 2,000 Covid-19 deaths a week as of the week ending February 17, CDC representatives told the advisory committee. Even when numbers were at their lowest last summer, there were still about 500 Covid-19 deaths per week.

Part of the problem may be that doctors arent always advising their patients to get a Covid shot. The National Immunization Survey shows that in January, relative to 2021, fewer people said their providers encouraged them to get the vaccine.

It is shocking to see that 30% to 40% of the higher-risk populations at least for elderly, and I think its a similar number for immunocompromised are getting the updated vaccine, said advisory committee member Dr. Camille Kotton, clinical director of transplant and immunocompromised host infectious diseases at Massachusetts General Hospital.

Kotton thinks Americans have been confused about whether they should get the vaccine and thinks health leaders need to be clearer about the recommendations.

For me, this is a life and death situation for many of the patients that I take care of, she said.

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CDC recommends seniors get another Covid-19 shot - Baltimore Sun

THURSDAY, Feb. 29, 2024 (HealthDay News) -- For patients with hematologic cancers, the odds of developing severe COVID-19 despite vaccination remained high through mid-2022, according to a study published online Feb. 23 in JAMA Network Open.

Sonia T. Anand, Ph.D., M.P.H., from the VA Boston Cooperative Studies Program, and colleagues conducted a case-control study including all patients with hematologic malignant neoplasms in the national Veterans Health Administration with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection after vaccination. Patients with severe COVID-19 (cases) versus nonsevere COVID-19 (controls) were compared; data were included for 6,122 patients, 21.3 percent of whom had severe COVID-19.

The researchers found that the odds of severe disease were higher in association with age (adjusted odds ratio [aOR] per one-year increase, 1.05), treatment with antineoplastic or immune-suppressive drugs (e.g., in combination with glucocorticoids: aOR, 2.32), and comorbidities (aOR per comorbidity, 1.35). Booster vaccination was associated with lower odds of severe disease. Overall, 3.7 percent of patients with SARS-CoV-2 infection during the period after oral antiviral drugs became widely used in March 2022 had progression to severe COVID-19.

"Although the magnitude of benefit of antiviral treatments during nonsevere disease could not be quantified, the relatively low proportion of treated patients who developed severe COVID-19 is sufficient to promote greater use," the authors write.

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Odds of Severe COVID-19 High for Hematologic Cancer Patients During Pandemic - HealthDay

COVID-19 may have an impact on peoples cognitive and memory abilities that lasts a year or more after infection.

A new study by Imperial College London researchers reveals small deficits in the performance of cognitive and memory tasks in people who had recovered from COVID-19 compared with those who had not had COVID-19.

This includes people who had long duration symptoms (i.e., Long COVID) that had eventually resolved.

The study also shows that the cognitive deficits were larger for people who were hospitalised, who had ongoing long duration symptoms, or who were infected with earlier variants of the virus.

The study is published today in the New England Journal of Medicine.

The Imperial-led study, called REACT Long COVID, enrolled more than 140,000 participants, who undertook at least one cognitive task, with many having experienced COVID-19 at various levels of severity and persistence.

Participants in the study were asked to perform an innovative online cognitive assessment on the Cognitron platform, which comprises tasks that can detect subtle changes in different aspects of their brain function, such as memory, reasoning, executive function, attention and impulsivity.

The large scale of the study and the sensitivity of the computerised tests allowed factors that explained cognitive deficits post-COVID to be examined in very fine detail while controlling for population variables such as age, demographics and pre-existing medical conditions.

The study revealed small deficits that were still detectable a year or more after infection, even in people who had short duration illness. They were larger for people who had symptoms lasting 12 weeks or more (consistent with Long COVID), those who had been to hospital for their illness or those who were infected with one of the early variants of the SARS-CoV-2 virus.

However, people who had longer lasting symptoms that had resolved by the time they did the cognitive assessment showed small deficits that were similar in size to those of people who had a shorter duration illness.

The results showed that COVID-19 was associated with deficits in multiple areas of cognition, most notably in memory, such as the ability to remember pictures of objects that were viewed a few minutes earlier. The researchers believe this may be due to problems forming new memories rather than accelerated forgetting.

People also showed small deficits in some tasks testing executive and reasoning abilities, such as those that require spatial planning or verbal reasoning.

First author of the study Professor Adam Hampshire, from the Department of Brain Sciences at Imperial College London, said: The potential long-term effects of COVID-19 on cognitive function have been a concern for the public, healthcare professionals, and policymakers, but until now it has been difficult to objectively measure them in a large population sample.

By using our online platform to measure multiple aspects of cognition and memory at large scale, we were able to detect small but measurable deficits in cognitive task performance. We also found that people were likely affected in different ways depending on factors such as illness duration, virus variant and hospitalisation.

Professor Paul Elliott, senior author and Director of the REACT programme, from the School of Public Health at Imperial College London, said: It is reassuring that people with persistent symptoms after COVID-19, that had resolved, may expect to experience some improvement in their cognitive functions to similar levels as those who experienced short illness.

Furthermore, the cognitive impact of COVID-19 appears to have reduced since the early stages of the pandemic, with fewer people having persistent illness, and cognition being less affected amongst those that were infected during the time when Omicron was the dominant strain. However, given the large numbers of people who were infected, it will be important to continue to monitor the long-term clinical and cognitive consequences of the COVID-19 pandemic.

Cognition and memory after COVID-19 in a large community sample by Hampshire, A., et al is published in NEJM. DOI:https://doi.org/10.1056/NEJMoa2311330

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COVID-19 may have small but lasting effects on cognition and memory | Imperial News - Imperial College London