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Science |
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Transmission |
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Authors: Cevik M et al Publication date: 19 November 2020 Journal: The Lancet Microbe DOI: 10.1016/S2666-5247(20)30172-5 Background: Viral load kinetics and duration of viral shedding are important determinants for disease transmission. We aimed to characterise viral load dynamics, duration of viral RNA shedding, and viable virus shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in various body fluids, and to compare SARS-CoV-2, SARS-CoV, and Middle East respiratory syndrome coronavirus (MERS-CoV) viral dynamics. Methods: In this systematic review and meta-analysis, we searched databases, including MEDLINE, Embase, Europe PubMed Central, medRxiv, and bioRxiv, and the grey literature, for research articles published between Jan 1, 2003, and June 6, 2020. We included case series (with five or more participants), cohort studies, and randomised controlled trials that reported SARS-CoV-2, SARS-CoV, or MERS-CoV infection, and reported viral load kinetics, duration of viral shedding, or viable virus. Two authors independently extracted data from published studies, or contacted authors to request data, and assessed study quality and risk of bias using the Joanna Briggs Institute Critical Appraisal Checklist tools. We calculated the mean duration of viral shedding and 95% CIs for every study included and applied the random-effects model to estimate a pooled effect size. We used a weighted meta-regression with an unrestricted maximum likelihood model to assess the effect of potential moderators on the pooled effect size. This study is registered with PROSPERO, CRD42020181914. Findings: 79 studies (5340 individuals) on SARS-CoV-2, eight studies (1858 individuals) on SARS-CoV, and 11 studies (799 individuals) on MERS-CoV were included. Mean duration of SARS-CoV-2 RNA shedding was 17·0 days (95% CI 15·5–18·6; 43 studies, 3229 individuals) in upper respiratory tract, 14·6 days (9·3–20·0; seven studies, 260 individuals) in lower respiratory tract, 17·2 days (14·4–20·1; 13 studies, 586 individuals) in stool, and 16·6 days (3·6–29·7; two studies, 108 individuals) in serum samples. Maximum shedding duration was 83 days in the upper respiratory tract, 59 days in the lower respiratory tract, 126 days in stools, and 60 days in serum. Pooled mean SARS-CoV-2 shedding duration was positively associated with age (slope 0·304 [95% CI 0·115–0·493]; p=0·0016). No study detected live virus beyond day 9 of illness, despite persistently high viral loads, which were inferred from cycle threshold values. SARS-CoV-2 viral load in the upper respiratory tract appeared to peak in the first week of illness, whereas that of SARS-CoV peaked at days 10–14 and that of MERS-CoV peaked at days 7–10. Interpretation: Although SARS-CoV-2 RNA shedding in respiratory and stool samples can be prolonged, duration of viable virus is relatively short-lived. SARS-CoV-2 titres in the upper respiratory tract peak in the first week of illness. Early case finding and isolation, and public education on the spectrum of illness and period of infectiousness are key to the effective containment of SARS-CoV-2. |
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Covid-19 patients |
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UK report on 16,689 patients critically ill with COVID-19 Institution: Intensive Care National Audit & Research Centre (ICNARC) Publication date: 27 November 2020 Read more... Authors: de Frel DL et al Publication date: 19 November 2020 Journal: Frontiers in Nutrition DOI: 10.3389/fnut.2020.597600 Background: COVID-19 is a global challenge to healthcare. Obesity is common in patients with COVID-19 and seems to aggravate disease prognosis. In this review we explore the link between obesity, chronic disease, lifestyle factors and the immune system, and propose societal interventions to enhance global immunity. Results: The relationship between obesity and unfavorable COVID-19 prognosis is discussed in light of the impact of chronic disease and lifestyle on the immune system. Several modifiable lifestyle factors render us susceptible to viral infections. In this context, we make a case for fostering a healthy lifestyle on a global scale. Conclusions: Obesity, additional chronic disease and an unhealthy lifestyle interactively impair immune function and increase the risk of severe infectious disease. In adverse metabolic and endocrine conditions, the immune system is geared toward inflammation. Collective effort is needed to ameliorate modifiable risk factors for obesity and chronic disease on a global scale and increase resistance to viruses like SARS-CoV-2. Authors: Pham KM et al Publication date: 16 November 2020 Journal: Frontiers in Nutrition DOI: 10.3389/fnut.2020.581043 Background: The COVID-19 pandemic causes a huge burden for affected countries. Several public health interventions were applied to contain the infection. However, the pandemic itself and the lockdown measure negatively influence people's lifestyles and psychological health. Purpose: To explore determinants of healthy dietary intake and depression, and examine the interaction between healthy dietary intake and COVID-19 lockdown on depression. Methods: A cross-sectional study was conducted at 18 hospitals and health centers from February 14 to May 31, 2020. Data of 8,291 outpatients were collected including patients' characteristics, clinical parameters, health literacy, healthy dietary intake (using the healthy eating score, HES), other health-related behaviors, and depression (using the patient health questionnaire, PHQ). Depression was defined as PHQ score ≥ 10. Results: Protective factors of healthy dietary intake and depression were higher education, better medication payment ability, higher social status, more physical activity, and higher health literacy, whereas older age, ever married, own business or other types of occupation, lockdown, suspected COVID-19 symptoms, and comorbidity were associated with lower HES scores and a higher depression likelihood. Besides, overweight/obesity and alcohol drinking were associated with lower HES scores. As compared with patients not under lockdown and with lowest HES score, those who were under lockdown and with lowest HES score had 10.6 times higher depression likelihood (odds ratio, OR, 10.60; 95% CI 6.88, 16.32; p < 0.001), whereas people with higher HES score had 15% lower depression likelihood (OR 0.85; 95% CI 0.82, 0.89; p < 0.001). Conclusions: Healthy dietary intake and depression were determined by several sociodemographic, clinical, and behavioral factors. Lockdown measure affects people's dietary intake behavior and depression. Importantly, healthy dietary intake potentially modifies the negative effect of lockdown on depression. |
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Mortality |
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“Do-Not-Resuscitate (DNR)” Status Determines Mortality in Patients with COVID-19 Authors: Alhatem A et al Publication date: 28 November 2020 Journal: Clinics in Dermatology DOI: 10.1016/j.clindermatol.2020.11.013 Objective: To investigate the influence of DNR status on mortality of hospital inpatients who died of COVID-19. Design: This is a retrospective, observational cohort study of all patients admitted to two New Jersey hospitals between March 15 and May 15, 2020 who had, or developed, COVID-19 (1270 patients). Of these, 640 patients died (570 (89.1 percent) with and 70 (10.9 percent) without a DNR order at the time of admission) and 630 survived (180 (28.6 percent) with and 450 (71.4 percent) without a DNR order when admitted). Among the 120 patients without COVID-19 who died during this interval, 110 (91.7 percent) had a DNR order when admitted. Results: Deceased positive SARS-CoV-2 patients were significantly more likely to have a DNR order on admission compared to recovered positive SARS-COV-2 patients (p < 0.05), similar to those who tested negative for SARS-COV-2. COVID-19 DNR patients had a higher mortality compared to COVID-19 non-DNR patients (log rank p < 0.001). DNR patients had a significantly increased hazard ratio of dying (HR 2.2 [1.5-3.2], p <0.001) compared to non-DNR patients, a finding that remained significant in the multivariate model. Conclusion: The risk of death from COVID-19 was significantly influenced by the patients’ DNR status. Global perspective of COVID‐19 epidemiology for a full‐cycle pandemic Author: John P A Ioannidis Publication date: 07 October 2020 Journal: European Journal of Clinical Investigation DOI: 10.1111/eci.13423 As of October 2020, there are >1 million documented deaths with COVID‐19. Excess deaths can be caused by both COVID‐19 and the measures taken. COVID‐19 shows extremely strong risk stratification across age, socioeconomic factors, and clinical factors. Calculation of years‐of‐life‐lost from COVID‐19 is methodologically challenging and can yield misleading over‐estimates. Many early deaths may have been due to suboptimal management, malfunctional health systems, hydroxychloroquine, sending COVID‐19 patients to nursing homes, and nosocomial infections; such deaths are partially avoidable moving forward. About 10% of the global population may be infected by October 2020. Global infection fatality rate is 0.15‐0.20% (0.03‐0.04% in those <70 years), with large variability across locations with different age‐structure, institutionalization rates, socioeconomic inequalities, population‐level clinical risk profile, public health measures, and health care. There is debate on whether at least 60% of the global population must be infected for herd immunity, or, conversely, mixing heterogeneity and pre‐existing cross‐immunity may allow substantially lower thresholds. Simulations are presented with a total of 1.58‐8.76 million COVID‐19 deaths over 5‐years (1/2020‐12/2024) globally (0.5‐2.9% of total global deaths). The most favorable figures in that range would be feasible if high risk groups can be preferentially protected with lower infection rates than the remaining population. Death toll may also be further affected by potential availability of effective vaccines and treatments, optimal management and measures taken, COVID‐19 interplay with influenza and other health problems, reinfection potential, and any chronic COVID‐19 consequences. Targeted, precise management of the pandemic and avoiding past mistakes would help minimize mortality. Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide? Authors: Beaney T et al Publication date: 10 September 2020 Journal: Journal of the Royal Society of Medicine DOI: 10.1177/0141076820956802 Conclusion Excess mortality is a measure that encompasses all causes of death and provides a metric of the overall mortality impact of COVID-19. When seeking to draw comparisons between countries, it is necessary to understand why mortality varies, through disentangling the constituent parts – of direct COVID-19 deaths and indirect, non-COVID-19 excess deaths – and there is urgent need for national bodies to report all-cause mortality. Where data collection and reporting systems are timely and comprehensive, excess mortality, used alongside cause-specific mortality, can be useful to monitor trends within and between countries and inform international, national and local public health policies. Read more... |
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Covid-19 and children |
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Urgent need to develop evidence-based COVID-19 recommendations for primary schools Authors: Patel S et al Publication date: 29 November 2020 Journal: The BMJ DOI: 10.1136/archdischild-2020-321017 Much has been learnt about the epidemiology of SARS-CoV-2 since December 2019. Children are not superspreaders of SARS-CoV-2.1 They appear to have far lower rates of infection and lower rates of transmission compared with adults, especially young children below 10–14 years of age.2–4 However, many of these data need to be interpreted with caution because they were collected early in the pandemic, when children had limited exposure to SARS-CoV-2 due to the introduction of national lockdowns and closure of schools. Encouragingly, more recent data collected following the reopening of schools in September suggest that rates of SARS-CoV-2 in children remain low compared with adults, even in areas with increasingly high prevalence (figure 1). |
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Therapeutics |
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Can food and food supplements be deployed in the fight against the COVID 19 pandemic? Authors: Cagla Celik, Ayse Gencay and Ismail Ocsoy Publication date: 22 November 2020 Journal: Biochimica et Biophysica Acta (BBA) - General Subjects DOI: 10.1016/j.bbagen.2020.129801 Background: Due to lack of approved drugs and vaccines, the medical world has resorted to older drugs, produced for viral infections and other diseases, as a remedy to combat COVID-19. The accumulating evidence from in vitro and in vivo studies for SARS-CoV and MERS-CoV have demonstrated that several polyphenols found in plants and zinc- polyphenol clusters have been in use as herbal medicines have antiviral activities against viruses with various mechanisms. Scope of review: Curcumin, zinc and zinc-ionophores have been considered as nutraceuticals and nutrients showing great antiviral activities with their medicinal like activities. Major conclusions: In this work, we discussed the potential prophylactic and/or therapeutic effects of curcumin, zinc and zinc-ionophores in treatment of viral infections including COVID-19. General significance: Curcuminoids and Zinc classified as nutraceuticals under GRAS (Generally Recognized As Safe) by FDA can provide complementary treatment for COVID 19 patients with their immunity-boosting and antiviral properties. COVID-19 and nutriceutical therapies, especially using zinc to supplement antimicrobials Authors: Desley Butters and Michael Whitehouse Publication date: 16 November 2020 Journal: Inflammopharmacology DOI: 10.1007/s10787-020-00774-8 The nutritional status of a patient can be critical for the efficacy of other pharmaceuticals, especially organic antibiotics, to treat viral pandemics. There may be political and scientific difficulties in achieving a constructive synergy of nutritional and prescribed allopathic remedies. For adequate treatment, timelines may need to extend well beyond eliminating viral proliferation, e.g., with vaccines, to include the goals of (a) reducing post-viral fatigue, (b) promoting earliest recovery, and (c) future resistance in often poorly nourished patients, e.g., obese (!). Many trace minerals (TM) and vitamins may need to be replenished. This review focusses only upon zinc to illustrate some problems in rectifying these TM deficiencies affecting the balance between continued ill-health (‘illth’) or regaining optimal physical and mental wellbeing. Ultimately, this is a matter of behaviour, lifestyle, and informed choice(s). Trace Element Zinc, a Nature’s Gift to Fight Unprecedented Global Pandemic COVID-19 Authors: Priyanka Sharma, Prasanna Kumar Reddy and Bhuvnesh Kumar Publication date: 10 November 2020 Journal: Biological Trace Element Research DOI: 10.1007/s12011-020-02462-8 With the advent of twenty-first century, we are in cruel grip of a pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the associated illness being called as COVID-19. Since its outbreak in December 2019 in Wuhan, China, there are no medicines to cure the disease till date. Based on their experience, scientists say that developing a coronavirus vaccine could take at least a year. There are many steps in place before the vaccine comes for the distribution like its safety and cost-effectiveness, especially for the developing countries. In this scenario, the only way to prevent the disease is by following certain safety guidelines and to boost up the body’s immune system. Zinc, a crucial trace element involved in several biological and metabolic processes, has been found to play a pivotal role in promoting and appropriately regulating the host defense mechanisms against viral infections. Zinc is naturally present in some foods, fortified in others and also available as dietary supplement. The current RDA (Recommended Daily Allowance) of zinc is 12 and 10 mg for males and females respectively. Zinc is the second most common trace mineral after iron in the cell. It is present in all organs and tissues in the body as it forms catalytic component of all 6 classes of enzymes encompassing almost 2000 enzymes in the body. Zinc is biologically essential for cellular processes, including growth and development, as well as DNA synthesis and RNA transcription. Zinc deficiency results in a number of metabolic changes besides a compromised immune system. In this review, the role of zinc in regulating the host defense and viral replication is being discussed with the main focus on COVID-19. Efficacy of honey and Nigella sativa against COVID-19: HNS-COVID-PK Trial Authors: Ashraf S et al Publication date: 06 November 2020 Journal: medRxiv preprint DOI: 10.1101/2020.10.30.20217364 Background: No definitive treatment exists for Coronavirus Disease 2019 (COVID-19). Honey and Nigella sativa (HNS) has established anti-viral properties. Hence, we investigated efficacy of HNS against COVID-19. Methods: We conducted a multicenter-randomized-controlled-trial in COVID-19 patients. Randomized patients received either honey (1 gm/Kg/day) and Nigella sativa (80 mg/Kg/day) or placebo upto 13 days. The outcomes included symptoms alleviation, viral clearance, and 30-day mortality. Results: Of 313 patients, 210 moderate and 103 severe underwent randomization. Among these 107 were assigned to HNS whereas 103 to placebo for moderate cases. For severe cases, 50 were given HNS and 53 placebo. HNS resulted in symptoms alleviation by 3 and 7 days in moderate and severe disease, respectively (Hazard Ratio [HR]: 6.11; 95% Confidence Interval [CI]: 4.23-8.84, P<0.0001 and HR: 4.04; 95% CI, 2.46-6.64, P<0.0001). HNS also cleared the virus 4 days earlier in moderate (HR: 5.53; 95% CI: 3.76-8.14, P<0.0001) and severe cases (HR: 4.32; 95% CI: 2.62-7.13, P<0.0001). HNS further led to a better clinical score on day 6 with normal activities in 63.6% (moderate, OR: 0.07; 95% CI: 0.03-0.13, P<0.0001) and 28% (severe, OR: 0.03; 95% CI: 0.01-0.09, P<0.0001) patients. A reduction in 30-day mortality among severe patients was shown with HNS (4% versus 18.87%, OR: 0.18; 95% CI: 0.02-0.92, P=0.029). No HNS-related adverse effects were observed. Conclusions: HNS improved symptoms, viral clearance and mortality in COVID-19 patients. Thus, HNS represents an affordable therapy and can be used alone or in combination with other treatments to achieve potentiating effects against COVID-19. |
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Immunity |
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T cell and antibody functional correlates of severe COVID-19 Authors: Krystle KQ etal Publication date: 30 November 2020 Journal: medRxiv preprint DOI: 10.1101/2020.11.25.20235150 Comorbid medical illnesses, such as obesity and diabetes, are associated with more severe COVID-19, hospitalization, and death. However, the role of the immune system in mediating these clinical outcomes has not been determined. We used multi-parameter flow cytometry and systems serology to comprehensively profile the functions of T cells and antibodies targeting spike, nucleocapsid, and envelope proteins in a convalescent cohort of COVID-19 subjects who were either hospitalized (n=20) or not hospitalized (n=40). To avoid confounding, subjects were matched by age, sex, ethnicity, and date of symptom onset. Surprisingly, we found that the magnitude and functional breadth of virus-specific CD4 T cell and antibody responses were consistently higher among hospitalized subjects, particularly those with medical comorbidities. However, an integrated analysis identified more coordination between polyfunctional CD4 T-cells and antibodies targeting the S1 domain of spike among subjects that were not hospitalized. These data reveal a functionally diverse and coordinated response between T cells and antibodies targeting SARS-CoV-2 which is reduced in the presence of comorbid illnesses that are known risk factors for severe COVID-19. Our data suggest that isolated measurements of the magnitudes of spike-specific immune responses are likely insufficient to anticipate vaccine efficacy in high-risk populations. Airway antibodies wane rapidly after COVID-19 but B cell memory is generated across disease severity Authors: Cagigi A et al Publication date: 29 November 2020 Journal: medRxiv preprint DOI: 10.1101/2020.11.25.20238592 Understanding immune responses following SARS-CoV-2 infection in relation to COVID-19 severity is critical to predicting the effects of long-term immunological memory on viral spread. Here we longitudinally assessed systemic and airway immune responses against SARS-CoV-2 in a well-characterized cohort of 147 infected individuals representing the full spectrum of COVID-19 severity; from asymptomatic infection to fatal disease. High systemic and airway antibody responses were elicited in patients with moderate to severe disease, and while systemic IgG levels were maintained after acute disease, airway IgG and IgA declined significantly. In contrast, individuals with mild symptoms showed significantly lower antibody responses but their levels of antigen-specific memory B cells were comparable with those observed in patients with moderate to severe disease. This suggests that antibodies in the airways may not be maintained at levels that prevent local virus entry upon re-exposure and therefore protection via activation of the memory B cell pool is critical. |
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Testing |
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SARS-CoV-2 Testing: Sensitivity Is Not the Whole Story Publication date: 18 November 2020 Source: American Society for Microbiology Can frequent testing for SARS-CoV-2 using rapid, but less sensitive tests help bring the COVID-19 pandemic to an end? Maybe, but this approach warrants further discussion. The approach outlined in the recent New England Journal of Medicine article “Rethinking Covid-19 Test Sensitivity – A Strategy for Containment” by Mina, et al. uses frequent testing with lateral flow antigen tests, and we agree that it may offset limitations in test sensitivity and reduce transmission of the virus. However, there is an absence of real-world data to support this approach and the focus on test sensitivity is overly narrow. Other factors need to be considered, including test specificity (i.e., the potential for false positive results), test cost and feasibility of large-scale implementation. Rapid, point-of-care antigen tests for respiratory viruses historically have specificities of 98-99%, so false positive rates of 1-2% can be expected. Even small imperfections in specificity lead to large numbers of false positive results when tests are deployed on a large scale. If the prevalence of infection is low, a large proportion of positive results will be false positives. As has been recently demonstrated in Nevada skilled nursing facilities, such applications may produce test outcomes resulting in more problems than benefits. Using the manufacturer’s performance characteristics for the Abbott BinaxNOW COVID-19 test, we modeled the percentage of tests that will be positive and the occurrence of false positive results at different prevalence rates of COVID-19. Authors: Borger P et al Publication date: 27 November 2020 Source: Corman-Drosten Review Report In the publication entitled “Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR” (Eurosurveillance 25(8) 2020) the authors present a diagnostic workflow and RT-qPCR protocol for detection and diagnostics of 2019-nCoV (now known as SARS-CoV-2), which they claim to be validated, as well as being a robust diagnostic methodology for use in public-health laboratory settings. In light of all the consequences resulting from this very publication for societies worldwide, a group of independent researchers performed a point-by-point review of the aforesaid publication in which 1) all components of the presented test design were cross checked, 2) the RT-qPCR protocol-recommendations were assesses w.r.t. good laboratory practice, and 3) parameters examined against relevant scientific literature covering the field. The published RT-qPCR protocol for detection and diagnostics of 2019-nCoV and the manuscript suffer from numerous technical and scientific errors, including insufficient primer design, a problematic and insufficient RT-qPCR protocol, and the absence of an accurate test validation. Neither the presented test nor the manuscript itself fulfils the requirements for an acceptable scientific publication. Further, serious conflicts of interest of the authors are not mentioned. Finally, the very short timescale between submission and acceptance of the publication (24 hours) signifies that a systematic peer review process was either not performed here, or of problematic poor quality. We provide compelling evidence of several scientific inadequacies, errors and flaws. Considering the scientific and methodological blemishes presented here, we are confident that the editorial board of Eurosurveillance has no other choice but to retract the publication. Comparison of seven commercial SARS-CoV-2 rapid Point-of-Care Antigen tests Authors: Corman VM et al Publication date: 13 November 2020 Journal: medRxiv preprint DOI: 10.1101/2020.11.12.20230292 Background: Antigen point of care tests (AgPOCT) can accelerate SARS-CoV-2 testing. As first AgPOCT are becoming available, there is a growing interest in their utility and performance. Methods: Here we compare AgPOCT products by seven suppliers: the Abbott Panbio™ COVID-19 Ag Rapid Test; the RapiGEN BIOCREDIT COVID-19 Ag; the Healgen® Coronavirus Ag Rapid Test Cassette (Swab); the Coris Bioconcept Covid.19 Ag Respi-Strip; the R-Biopharm RIDA®QUICK SARS-CoV-2 Antigen; the NAL von minden NADAL COVID19-Ag Test; and the Roche/SD Biosensor SARS-CoV Rapid Antigen Test. Tests were evaluated on recombinant nucleoprotein, cultured endemic and emerging coronaviruses, stored clinical samples with known SARS-CoV-2 viral loads (n=138), stored samples from patients with respiratory agents other than SARS-CoV-2 (n=100), as well as self-sampled swabs from healthy volunteers (n=35). Findings: Limits of detection in six of seven tested products ranged between 2.08 × 106 and 2.88 × 107 copies per swab, the outlier at 1.58 × 1010 copies per swab. Specificities ranged between 98.53% and 100% in five products, with two outliers at 94.85% and 88.24%. False positive results were not associated with any specific respiratory agent. As some of the tested AgPOCT were early production lots, the observed issues with specificity are unlikely to persist. Interpretation: The sensitivity range of most AgPOCT overlaps with viral load figures typically observed during the first week of symptoms, which marks the infectious period in the majority patients. AgPOCTs with a limit of detection that approximates the virus concentration above which patients are infectious may enable shortcuts in decision-making in various areas of healthcare and public health. Read more… |
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Vaccines |
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Publication date: 02 December 2020 Source: UK Government What is in this leaflet
Covid-19 vaccines: where are the data? Authors: Martin-Moreno JM et al Publication date: 27 November 2020 Journal: The BMJ Through press releases, three pharmaceutical companies recently announced the interim, positive results of their covid-19 vaccine candidates clinical trials. Firstly, Pfizer/BioNTech presented the initial results for their mRNA based BNT162b2 vaccine, which showed that it was 90% effective in preventing covid-19. [1] The vaccine was tested on 43,538 participants and, so far, there have been 94 confirmed cases. [2] They will submit to the US Food and Drug Administration (FDA) for approval when the safety profile has reached a pre-determined milestone. In the meantime, Pfizer has continued to market the vaccine. Secondly, the Data Safety Monitoring Board, appointed by the National Institutes of Health (NIH) for the phase III study of the MODERNA mRNA-1273 vaccine candidate against covid-19, confirmed its trial met the statistical criteria pre-specified in the study protocol, with a vaccine efficacy of 94.5%. Public needs to prep for vaccine side effects Author: Meredith Wadman Publication date: 27 November 2020 Journal: Science DOI: 10.1126/science.370.6520.1022 This summer, computational biologist Luke Hutchison volunteered for a trial of Moderna's COVID-19 vaccine. But after the second injection, his arm swelled up to the size of a “goose egg,” Hutchison says. He can't be sure he got the vaccine and not a placebo, but within a few hours, Hutchison, who was healthy and 43, was beset by bone and muscle aches and a 38.9°C fever. “I started shaking. I had cold and hot rushes,” he says. “I was sitting by the phone all night long thinking: ‘Should I call 911?’” Hutchison's symptoms resolved after 12 hours. But, he says, “Nobody prepared me for the severity of this.” He says the public should be better prepared than he was, because a subset of people may face intense, if transient, side effects, called reactogenicity, from Moderna's vaccine. Some health experts agree. Author: Peter Doshi Publication date: 26 November 2020 Source: The BMJ Only full transparency and rigorous scrutiny of the data will allow for informed decision making, argues Peter Doshi In the United States, all eyes are on Pfizer and Moderna. The topline efficacy results from their experimental covid-19 vaccine trials are astounding at first glance. Pfizer says it recorded 170 covid-19 cases (in 44,000 volunteers), with a remarkable split: 162 in the placebo group versus 8 in the vaccine group. Meanwhile Moderna says 95 of 30,000 volunteers in its ongoing trial got covid-19: 90 on placebo versus 5 receiving the vaccine, leading both companies to claim around 95% efficacy. Let’s put this in perspective. First, a relative risk reduction is being reported, not absolute risk reduction, which appears to be less than 1%. Second, these results refer to the trials’ primary endpoint of covid-19 of essentially any severity, and importantly not the vaccine’s ability to save lives, nor the ability to prevent infection, nor the efficacy in important subgroups (e.g. frail elderly). Those still remain unknown. Third, these results reflect a time point relatively soon after vaccination, and we know nothing about vaccine performance at 3, 6, or 12 months, so cannot compare these efficacy numbers against other vaccines like influenza vaccines (which are judged over a season). Fourth, children, adolescents, and immunocompromised individuals were largely excluded from the trials, so we still lack any data on these important populations. Will covid-19 vaccines be cost effective—and does it matter? Author: John Appleby Publication date: 26 November 2020 Journal: The BMJ DOI: 10.1136/bmj.m4491 The costs of other pandemic measures mean that covid-19 vaccines will probably turn out to be a good buy, says John Appleby, and the full calculations will raise questions about NICE methods Pfizer and BioNTech have announced the early results of their covid-19 vaccine trial,1 and immunisation for the novel coronavirus could be available in months. Of course hurdles remain, and more data need to be gathered about the efficacy and safety of the vaccines being trialled. One hurdle that new health technologies usually have to jump is cost effectiveness: is the value of the benefits worth the costs? Although they have saved lives, the tactics used so far to try to get on top of the pandemic have had huge costs to people’s livelihoods and, as the NHS reprioritised its work, to people’s health (fig 1, fig 2). A rolling series of lockdowns and targeted isolation have been the only interventions available for restricting coronavirus transmission, but they are not the ultimate answer to tackling covid-19. It seems inconceivable that governments would dither over the value for money of an effective covid-19 vaccine. Age and frailty in COVID-19 vaccine development Authors: Melissa K Andrew and Janet E McElhaney Publication date: 18 November 2020 Journal: The Lancet DOI: 10.1016/S0140-6736(20)32481-8 Older adults, particularly those who are frail or living in long-term care facilities, have been disproportionately affected by the COVID-19 pandemic.1 Vaccines that are safe and effective in this population have been eagerly anticipated. In The Lancet, Maheshi Ramasamy and colleagues present results of the safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine in older adults (those older than 55 years). Their results are part of a larger single-blind, randomised, controlled, phase 2/3 trial of the ChAdOx1 nCoV-19 vaccine (which is a replication-defective chimpanzee adenovirus-vector vaccine) with a MenACWY meningococcal vaccine comparison group. The study design was complex, with participants randomly assigned using block randomisation to one of ten different groups, and older adults were only enrolled after initial determination of safety in the youngest age group (aged 18–55 years). Participants in the two older age groups (aged 56–69 and ≥70 years) were further randomly assigned to receive either one dose (day 0) or two doses (day 0 and a boost dose on day 28) of vaccine. The ChAdOx1 nCoV-19 groups were also sequentially recruited to receive either a low dose or (after demonstration of safety) a standard dose of the vaccine. In this immunogenicity subgroup of the larger study, 560 healthy adults were included, distributed among the three age groups (160 participants aged 18–55 years, of whom 100 received the COVID-19 vaccine; 160 aged 56–69 years, of whom 120 received the COVID-19 vaccine, and 240 aged ≥70 years, of whom 200 received the COVID-19 vaccine). 280 (51%) of 552 analysed participants were female and the median age in the 18–55 years group was 43·0 years (IQR 33·6–48·0), in the 56–69 years group was 60·0 years (57·5–63·0), and in the 70 years and older group was 73·0 years (71·0–76·0). For 7 days after each dose, participants completed diary cards for solicited local and systemic adverse events. Serious adverse events were recorded and will be monitored for 1 year. Severity of reactions and adverse events was graded as mild, moderate, or severe, depending on their effect on daily activities. Immune responses were measured using assays of anti-spike protein IgG and neutralising antibody titres for humoral immunity and IFN-γ enzyme-linked immunospot (ELISpot) for cell-mediated immunity. |
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Non-pharmaceutical interventions |
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Impacts of face coverings on communication: an indirect impact of COVID-19 Authors: Gabrielle H Saunders, Iani R Jackson & Anisa S Visram Publication date: 27 November 2020 Journal: International Journal of Audiology DOI: 10.1080/14992027.2020.1851401 Objective: To understand the impact of face coverings on hearing and communication. Design: An online survey consisting of closed-set and open-ended questions distributed within the UK to gain insights into experiences of interactions involving face coverings, and of the impact of face coverings on communication. Sample: Four hundred and sixty members of the general public were recruited via snowball sampling. People with hearing loss were intentionally oversampled to more thoroughly assess the effect of face coverings in this group. Results: With few exceptions, participants reported that face coverings negatively impacted hearing, understanding, engagement, and feelings of connection with the speaker. Impacts were greatest when communicating in medical situations. People with hearing loss were significantly more impacted than those without hearing loss. Face coverings impacted communication content, interpersonal connectedness, and willingness to engage in conversation; they increased anxiety and stress, and made communication fatiguing, frustrating and embarrassing – both as a speaker wearing a face covering, and when listening to someone else who is wearing one. Conclusions: Face coverings have far-reaching impacts on communication for everyone, but especially for people with hearing loss. These findings illustrate the need for communication-friendly face-coverings, and emphasise the need to be communication-aware when wearing a face covering. The effectiveness of the three-tier system of local restrictions for control of COVID-19 Authors: Paul R Hunter, Julii Brainard and Alastair Grant Publication date: 24 November 2020 Journal: medRxiv preprint DOI: 10.1101/2020.11.22.20236422 Despite it being over 10 months since COVID-19 was first reported to the world and it having caused over 1.3 million deaths it is still uncertain how the virus can be controlled whilst minimising the negative impacts on society and the economy. On the 14th October, England introduced a three-tier system of regional restrictions in an attempt to control the epidemic. This lasted until the 5th November when a new national lockdown was imposed. Tier 1 was the least and Tier 3 the most restrictive tiers. We used publicly available data of daily cases by local authority (local government areas) and estimated the reproductive rate (R value) of the epidemic over the previous 14 days at various time points after the imposition of the tier system or where local authorities were moved into higher tiers at time points after reallocation. At day 0 there vas very little difference in the R value between authorities in the different groups but by day 14 the R value in Tier 3 authorities had fallen to about 0.9, in Tier 2 to about 1.0 and in Tier 1 the R value was about 1.5. The restrictions in Tier 1 had little impact on transmission and allowed exponential growth in the large majority of authorities. By contrast the epidemic was declining in most Tier 3 authorities. In Tier 2, exponential growth was being seen in about half of authorities but declining in half. We concluded that the existing three tier system would have been sufficient to control the epidemic if all authorities had been moved out of Tier 1 into tier 2 and there had been more rapid identification and transfer of those authorities where the epidemic was increasing out of Tier 2 into Tier 3. A more restrictive tier than Tier 3 may be needed but only by a small number of authorities. Surgical face masks impair human face matching performance for familiar and unfamiliar faces Authors: Daniel J Carragher and Peter J B Hancock Publication date: 19 November 2020 Journal: Cognitive Research: Principles and Implications DOI: 10.1186/s41235-020-00258-x In response to the COVID-19 pandemic, many governments around the world now recommend, or require, that their citizens cover the lower half of their face in public. Consequently, many people now wear surgical face masks in public. We investigated whether surgical face masks affected the performance of human observers, and a state-of-the-art face recognition system, on tasks of perceptual face matching. Participants judged whether two simultaneously presented face photographs showed the same person or two different people. We superimposed images of surgical masks over the faces, creating three different mask conditions: control (no masks), mixed (one face wearing a mask), and masked (both faces wearing masks). We found that surgical face masks have a large detrimental effect on human face matching performance, and that the degree of impairment is the same regardless of whether one or both faces in each pair are masked. Surprisingly, this impairment is similar in size for both familiar and unfamiliar faces. When matching masked faces, human observers are biased to reject unfamiliar faces as “mismatches” and to accept familiar faces as “matches”. Finally, the face recognition system showed very high classification accuracy for control and masked stimuli, even though it had not been trained to recognise masked faces. However, accuracy fell markedly when one face was masked and the other was not. Our findings demonstrate that surgical face masks impair the ability of humans, and naïve face recognition systems, to perform perceptual face matching tasks. Identification decisions for masked faces should be treated with caution. |
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Government and Health Authorities |
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Lockdowns |
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The Government's response to COVID-19: human rights implications of long lockdown Publication date: 21 September 2020 Source: UK Government In order to seek to control the impact of Covid-19, the Government has introduced successive restrictive measures, with varying degrees of severity, both nationally and locally. The impact of these measures has been widely felt, and some groups have been more affected than others. As part of the ongoing work into the Government’s response to the Covid-19 pandemic, the Joint Committee on Human Rights is examining the impact of lockdown restrictions on human rights and whether those measures only interfere with human rights to the extent that is necessary and proportionate. In particular, we are interested in the impact of long lockdown on certain communities. |
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Mortality |
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Publication date: 03 December 2020 Source: Care Quality Commission The Care Quality Commission (CQC) today publishes an interim report from its review into the application of do not attempt cardiopulmonary resuscitation (DNACPR) decisions during the COVID-19 pandemic. Early findings are that at the beginning of the pandemic, a combination of unprecedented pressure on care providers and other issues may have led to decisions concerning DNACPR being incorrectly conflated with other clinical assessments around critical care. As one example of the pressure and confusion at the time, CQC noted that guidance intended to help clinicians assess frailty as part of a wider, holistic assessment around the appropriateness of critical care may have been interpreted as the sole basis for clinical decisions in some instances. |
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Therapeutics |
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At-risk groups to receive free winter supply of vitamin D Publication date: 28 November 2020 Source: UK Government More than 2.5 million vulnerable people across England will be offered free vitamin D supplements for the winter, the government has announced today (Saturday 28 November). All care homes will automatically receive a provision for their residents, while individuals on the clinically extremely vulnerable list will receive a letter inviting them to opt in for a supply to be delivered directly to their homes. Deliveries will be free of charge, starting in January, and will provide 4 months’ worth of supplements to last people through the winter months. The supplements will support general health, in particular bone and muscle health. This is particularly important this year as these individuals are more likely to have been indoors for extended periods due to measures introduced to stop the spread of COVID-19. |
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Vaccines |
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UK authorises Pfizer/BioNTech COVID-19 vaccine Publication date: 02 December 2020 Source: UK Government A Department of Health and Social Care spokesperson said: The government has today accepted the recommendation from the independent Medicines and Healthcare products Regulatory Agency (MHRA) to approve Pfizer/BioNTech’s COVID-19 vaccine for use. This follows months of rigorous clinical trials and a thorough analysis of the data by experts at the MHRA who have concluded that the vaccine has met its strict standards of safety, quality and effectiveness. The Joint Committee on Vaccinations and Immunisations (JCVI) will shortly publish its final advice for the priority groups to receive the vaccine, including care home residents, health and care staff, the elderly and the clinically extremely vulnerable. Government asks regulator to approve supply of Oxford/AstraZeneca vaccine Publication date: 27 November 2020 Source: Department of Health and Social Care The government has formally requested the UK’s independent medicines regulator assess the suitability of Oxford/AstraZeneca’s COVID-19 vaccine for temporary supply, as soon as the company submits the necessary safety, quality and efficacy data. The move marks a significant first step in getting the vaccine approved for deployment, should it meet the regulator’s requirements. The UK will be one of the first countries in the world to receive the vaccine, if authorised, with AstraZeneca expecting to have up to 4 million doses ready for the UK by the end of the year and 40 million by the end of March 2021. Pfizer/BioNTech COVID-19 vaccine: MHRA statement confirming data received Publication date: 23 November 2020 Source: Gov.uk MHRA Chief Executive Dr June Raine said: We are pleased to have received further data for the Pfizer/BioNTech COVID-19 vaccine candidate. It is our job now to rigorously assess these data and the evidence submitted on the vaccine’s safety, quality and effectiveness. As we have received this data through a rolling review, we have already started our analysis and will aim to make a decision in the shortest time possible, without compromising the thoroughness of our review. Publication date: 20 November 2020 Source: US Food and Drug Administration The U.S. Food and Drug Administration has scheduled a meeting of its Vaccines and Related Biological Products Advisory Committee (VRBPAC) on Dec. 10 to discuss the request for emergency use authorization (EUA) of a COVID-19 vaccine from Pfizer, Inc. in partnership with BioNTech Manufacturing GmbH. “The FDA recognizes that transparency and dialogue are critical for the public to have confidence in COVID-19 vaccines. I want to assure the American people that the FDA’s process and evaluation of the data for a potential COVID-19 vaccine will be as open and transparent as possible,” said FDA Commissioner Stephen M. Hahn, M.D. “The FDA has been preparing for the review of EUAs for COVID-19 vaccines for several months and stands ready to do so as soon as an EUA request is submitted. While we cannot predict how long the FDA’s review will take, the FDA will review the request as expeditiously as possible, while still doing so in a thorough and science-based manner, so that we can help make available a vaccine that the American people deserve as soon as possible. A discussion about the safety and effectiveness of Pfizer and BioNTech’s vaccine with this committee, made up of outside scientific and public health experts from around the country, will help ensure clear public understanding of the scientific data and information that the FDA will evaluate in order to make a decision about whether to authorize a vaccine for emergency use for the prevention of COVID-19.” |
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Media – Science related |
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Origins |
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Don’t let an accident create another pandemic Publication date: 02 December 2020 Source: Unherd Here at The Post we like to feature new and interesting articles from outside the UnHerd universe. This one, from the Bulletin of the Atomic Scientists, is not at all new. In fact, it’s six years old — but that is what makes it all the more interesting. The author is Martin Furmanski, a medical historian, and his subject is “gain of function” experiments on disease-causing micro-organisms: While it’s highly unlikely that Covid-19 was deliberately engineered and released as a bio-weapon, it is possible that the current pandemic began as an accidental release from a laboratory experiment gone wrong. The plausibility (though by no means the certainty) of such a scenario is discussed here. A further reason why we should stay open-minded is that it’s happened before. In his article, Furmanski runs through a number of documented cases in which scientific error is thought to be (or sometimes definitely known to be) responsible for disease outbreaks. |
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Non-pharmaceutical interventions |
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Authors: Baum MA et al Publication date: November 2020 Source: The Covid States Project As COVID-19 continues to surge nationwide, some particularly hard-hit localities are implementing (or re-implementing) relatively strict measures to protect public safety. While many of these measures have been shown to be effective at slowing down COVID- 19 transmission in the US (and other countries) in earlier months, the potential implementation of measures such as closing non-essential businesses, adopting distance learning, and restricting restaurants to take-out have provoked fierce debates around the country. While some advocates have sought to frame the debate as a choice between public health and education, on the one hand, or the economy, on the other, in many respects the decisions that public health officials face are far more complicated, and public views on these topics more nuanced. |
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Transmission |
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What the data say about asymptomatic COVID infections Author: Bianca Nogrady Publication date: 18 November 2020 Source: Nature How many people don’t experience any symptoms after becoming infected with SARS-CoV-2? And what is their role in spreading COVID-19? These have been key questions since the beginning of the pandemic. Now, evidence suggests that about one in five infected people will experience no symptoms, and they will transmit the virus to significantly fewer people than someone with symptoms. But researchers are divided about whether asymptomatic infections are acting as a ‘silent driver’ of the pandemic. Although there is a growing understanding of asymptomatic infections, researchers say that people should continue to use measures to reduce viral spread, including social distancing and wearing masks, regardless of whether they have symptoms. |
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Covid-19 patients |
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Hidden damage to lungs from Covid-19 revealed in new study from University of Sheffield Publication date: 01 December 2020 Source: The University of Sheffield Early findings from a study into longer-term effects of Covid-19 suggest the use of cutting-edge scanning techniques may detect previously unseen lung damage. Research by the University of Sheffield, in collaboration with the University of Oxford, is the first in Europe to use hyperpolarised xenon gas with MRI scanning to identify the impact on lung function as patients recover from Covid-19, when standard MR and CT scans may be normal. In some people, the symptoms of Covid-19 can continue for many months after the infection, which may adversely affect their quality of life, for example many people complain of persistent breathlessness and fatigue. Jim Wild, Professor of Magnetic Resonance Physics at the University of Sheffield and Fergus Gleeson, Professor of Radiology at the University of Oxford, are investigating possible reasons for patients remaining short of breath following treatment for Covid-19 pneumonia, even after they have been discharged from hospital. |
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Covid-19 and children |
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Authors: Gaythorpe KAM et al Publication date: 25 November 2020 Source: Imperial College London SARS-CoV-2 infections have been reported in all age groups including infants, children, and adolescents. However, the role of children in the COVID-19 pandemic is still uncertain. This systematic review of early studies synthesises evidence on the susceptibility of children to SARS-CoV-2 infection, the severity and clinical outcomes in children with SARS-CoV-2 infection, and the transmissibility of SARS-CoV-2 by children. A systematic literature review was conducted in PubMed. Reviewers extracted data from relevant, peer-reviewed studies published during the first wave of the SARS-CoV-2 outbreak using a standardised form and assessed quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. For studies included in the meta-analysis, we used a random effects model to calculate pooled estimates of the proportion of children considered asymptomatic or in a severe or critical state. |
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Mortality |
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Mortality monitor – COVID-19 update Publication date: 01 December 2020 Source: Institute and Facult of Actuaries Mortality monitor England & Wales population mortality updates The CMI publishes regular analyses of mortality in England & Wales: We have published “quarterly” updates since Q4 of 2018. We are publishing “pandemic” updates during the current coronavirus pandemic. These are shorter than the quarterly updates, with a focus on “excess mortality” during the pandemic. We initially published these weekly, but reduced the frequency as mortality returned to more typical levels. We have released “beta” software that allows Authorised Users to produce their own ad hoc updates. Working Paper 111 describes the methods used and contains the first update. NIPH: The mortality rate for corona in Norway has been 0.12 per cent since the summer Author: Magnus Blaker Publication date: 30 November 2020 Source: Nettavisen (Google translation from Norwegian) How dangerous has covid-19 been in Norway? In its latest risk report, the National Institute of Public Health has tried to map the outcomes of coronary heart disease in Norway over the past six months. This means that they have ignored the first months of the pandemic, when very little was known about how the disease should be treated. Mortality: 0.12 percent According to FHI, their best estimate is that 73,000 people have been infected in Norway between 1 June and 30 November:
Covid Misclassification: What Do the Data Suggest? Author: Gilbert G Berdine Publication date: 30 November 2020 Source: American Institute for Economic Research According to Worldometer, U.S. deaths from Covid-19 were 272,254 as of 11/29/2020. What are “deaths from Covid-19?” One definition would be deaths where Covid-19 was the primary cause. An example would be a patient who has a positive polymerase chain reaction (PCR) test for the virus responsible for Covid-19 and a clinical picture of hypoxemia, bilateral pulmonary infiltrates on imaging, no obvious other cause, such as influenza or congestive heart failure (CHF), and who dies from progressive acute respiratory distress syndrome (ARDS). Another definition would be deaths where Covid-19 was a contributing cause but not necessarily the primary disease. An example would be a patient with diabetes or end-stage renal disease who develops an upper respiratory infection URI, has a positive PCR test, never recovers from the URI, deteriorates over many weeks to months and eventually dies. In this case the underlying cause of death was the diabetes or end-stage renal disease weakening the host defenses and the Covid-19 was the precipitating cause of acute illness and eventual death. Another definition would be a patient who dies, has a positive PCR test, but the Covid-19 clearly had nothing to do with the death. An example would be a trauma victim who had no respiratory symptoms prior to trauma and coincidentally has a positive PCR test. Is the infection fatality rate for COVID-19 worse than that for influenza? (rapid Response) Author: Peter C Gøtzsche Publication date: 01 December 2020 Journal: The BMJ DOI: 10.1136/bmj.m4509 Rapid Response: Is the infection fatality rate for COVID-19 worse than that for influenza? Dear Editor Is the infection fatality rate for COVID-19 worse than that for influenza? Pastor-Barriuso et al. found an infection fatality rate for COVID-19 of 0.8% in Spain (1). They quote an unpublished review that found 0.68%, with estimates ranging from 0.16% to 1.60% (2). In their discussion, they mention this review again: “Our overall estimate of infection fatality risk was similar to that found in seroepidemiological surveys with a low risk of bias.” But what about other reviews? They quote in the introduction a 2020 review by John Ioannidis, which is in press in the Bulletin of the World Health Organization, (3) but do not say what he found, only that the magnitude of the infection fatality risk is being debated. Sure, but that is not informative. Ioannidis included 61 studies (74 estimates) and eight preliminary national estimates. He reported that the infection fatality rates ranged from 0.00% to 1.63% and that the median rate was 0.27% (3). |
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Vaccines |
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Publication date: 01 December 2020 Source: 2020 News On December 1, 2020, the ex-Pfizer head of respiratory research Dr. Michael Yeadon and the lung specialist and former head of the public health department Dr. Wolfgang Wodarg filed an application with the EMA, the European Medicine Agency responsible for EU-wide drug approval, for the immediate suspension of all SARS CoV 2 vaccine studies, in particular the BioNtech/Pfizer study on BNT162b (EudraCT number 2020-002641-42). Dr. Wodarg and Dr. Yeadon demand that the studies – for the protection of the life and health of the volunteers – should not be continued until a study design is available that is suitable to address the significant safety concerns expressed by an increasing number of renowned scientists against the vaccine and the study design. Publication date: 30 November 2020 Source: Moderna Moderna, Inc. (Nasdaq: MRNA), a biotechnology company pioneering messenger RNA (mRNA) therapeutics and vaccines to create a new generation of transformative medicines for patients, today announced that the primary efficacy analysis of the Phase 3 study of mRNA-1273 conducted on 196 cases confirms the high efficacy observed at the first interim analysis. The data analysis indicates a vaccine efficacy of 94.1%. Safety data continue to accrue and the study continues to be monitored by an independent, NIH-appointed Data Safety Monitoring Board (DSMB). The Company also announced that today, Moderna plans to request an Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) and conditional approval from the European Medicines Agency (EMA). The Phase 3 study, known as the COVE study, enrolled more than 30,000 participants in the U.S. and is being conducted in collaboration with the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), and the Biomedical Advanced Research and Development Authority (BARDA), part of the Office of the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services. ‘Absolutely remarkable’: No one who got Moderna’s vaccine in trial developed severe COVID-19 Author: Jon Cohen Publication date: 30 November 2020 Source: Science Continuing the spate of stunning news about COVID-19 vaccines, the biotech company Moderna announced the final results of the 30,000-person efficacy trial for its candidate in a press release today: Only 11 people who received two doses of the vaccine developed COVID-19 symptoms after being infected with the pandemic coronavirus, versus 185 symptomatic cases in a placebo group. That is an efficacy of 94.1%, the company says, far above what many vaccine scientists were expecting just a few weeks ago. More impressive still, Moderna’s candidate had 100% efficacy against severe disease. There were zero such COVID-19 cases among those vaccinated, but 30 in the placebo group. The company today plans to file a request for emergency use authorization (EUA) for its vaccine with the U.S. Food and Drug Administration (FDA), and is also seeking a similar green light from the European Medicines Agency. The Independent SAGE Report 25: Issues and recommendations concerning COVID-19 vaccine rollout Publication date: 27 November 2020 Source: The Independent SAGE Summary and recommendations Preliminary results from clinical trials indicate that there are at least three vaccines that could play an important part in addressing the COVID-19 pandemic. This is a very major advance in our fight against the virus. The following report identifies some of the key determinants of the most effective use of these vaccines in the future and presents some preliminary recommendations. The following recommendations have been developed from consideration of factors likely to influence how far vaccine roll out meets the goal of combating COVID-19. Re-starting global economy depends on tackling 'last mile' of vaccine journey Publication date: 25 November 2020 Source: University of Birmingham Re-starting the global economy for billions of people will depend on successfully overcoming logistical challenges in the ‘last mile’ of a COVID-19 vaccine’s journey to immunisation stations, according to a new report. Using cargo drones, mobile cold rooms, portable vaccine micro-chillers and other innovative means of delivering temperature sensitive vaccines to remote towns and villages may make the difference between life and death in low-income countries. Halting the spread of COVID-19 and safely re-connecting countries to international trade will also kick-start the global economy, but this only be possible with an effective rollout of vaccines to the billions of people who need them. |
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Social impacts |
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Authors: Tim Knox and Jim McConalogue Publication date: 01 December 2020 Source: Civitas: Institute for the Study of Civil Society Any attempt to quantify the costs of the measures that the UK and other governments have taken in response to the pandemic will lead to accusations from some quarters that we are being, in Aneurin Bevan’s words, a ‘desiccated calculating machine’. Others will say that, by comparing the number of the lives saved by government measures with the financial cost of those measures, we are putting a financial value on a life and hence being immoral – or at best, amoral. Yet others will say that by doing so we are failing to respect the great contributions made in fighting the pandemic by many of the heroes of 2020, from healthcare to supermarket workers, from refuse collectors to those researching the new vaccines. Some of these charges have some truth. But in our defence we should point out that in normal circumstances, it is the UK government which routinely quantifies the value of a life saved, whether it is licensing a new drug treatment or assessing whether it is worth making an investment in altering a particular road to improve its safety (eight government departments currently use the sum of £1.8 million for the ‘Value of a Prevented Fatality’, albeit that this number is often criticised as being too low). |
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Misinformation |
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Author: Ethan Yang Publication date: 01 December 2020 Source: American Institute for Economic Research On November 13, 2020, Johns Hopkins University Advanced Academic Programs posted a YouTube lecture conducted by Dr. Genevieve Briand, JHU’s MS in Applied Economics Assistant Program Director. The talk was titled Covid-19 Deaths: A Look at US Data and a full summary produced by AIER can be found here. The general idea of the lecture was that Covid-19 deaths as reported by the CDC may be misleading due to a number of accounting aberrations in the data. One of the most notable discrepancies Briand points out is the reclassification of death by other diseases, such as heart disease, as Covid-19 deaths simply because at the time of death the individuals also had Covid. She also makes claims suggesting that overall deaths in 2020 have not substantially increased from past years. Although I am sympathetic to the research, this article should not be construed to be an explicit endorsement of the findings. |
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Media – Reporting |
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Government controls |
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UK government running ‘Orwellian’ unit to block release of ‘sensitive’ information Authors: Peter Geoghegan, Jenna Corderoy and Lucas Amin Publication date: 23 November 2020 Source: Open Democracy The British government has been accused of running an ‘Orwellian’ unit in Michael Gove’s office that instructs Whitehall departments on how to respond to Freedom of Information requests and shares personal information about journalists, openDemocracy can reveal today. Experts warn that the practice could be breaking the law – and openDemocracy is now working with the law firm Leigh Day on a legal bid to force Gove’s Cabinet Office to reveal full details of how its secretive ‘Clearing House’ unit operates. Freedom of Information (FOI) requests are supposed to be ‘applicant-blind’: meaning who makes the request should not matter. But it now emerges that government departments and non-departmental public bodies have been referring ‘sensitive’ FOI requests from journalists and researchers to the Clearing House in Gove’s department in a move described by a shadow cabinet minister as “blacklisting”. Colorado County Refuses to Enforce Lockdowns as Civil Disobedience Spreads Across America Author: Jon Miltimore Publication date: 25 November 2020 Source: Foundation for Economic Education Colorado officials last week announced that several counties had moved into the “red level”—the second-highest measurement on its COVID-19 dial—and would be forced to implement new regulations on restaurants, gyms, and other parts of the economy to combat the virus. Then something remarkable happened. Weld County, a county in the northern part of the state with a population of roughly a quarter million people, politely said no. “Instead, county government continues to do what it has done since March, which is promote and encourage residents and business owners to take individual responsibility and make decisions to protect themselves, their families, their community and their businesses,” the Board of Commissioners said in a statement. |
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Covid-19 patients |
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Authors: Steve Almasy, Jason Hanna andMadeline Holcombe Publication date: 03 December 2020 Source: CNN The total number of coronavirus deaths reported in a day set a new record Wednesday and hospitalizations also reached an all-time high, and doctors and nurses across the US are trying to find creative ways to handle the surging number of patients. The numbers are grim. More than 100,200 patients were in US hospitals Wednesday, according to the COVID Tracking Project. There were more than 2,670 deaths reported Wednesday, according to Johns Hopkins University. Those totals have never been higher. The stress on frontline health care workers has never been greater. One county official in Wisconsin told CNN, "Our hospital ICUs and emergency rooms remain stretched beyond any reasonable limit and our healthcare workers as well as our patients need our help." |
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Therapeutics |
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Covid: Free Vitamin D pills for 2.5 million vulnerable in England Publication date: 28 November 2020 Source: BBC News More than 2.5 million vulnerable people in England will be offered free Vitamin D supplements this winter. The vitamin, which helps to keep bones, teeth and muscles healthy, will be delivered to people who are clinically extremely vulnerable, and care homes. Skin makes Vitamin D when exposed to sunlight - but the elderly and those with dark skin need topping up. The coronavirus pandemic means many more people than normal have spent time indoors. The groups most at risk are residents in care homes, and people with serious health conditions which mean they have spent extended periods shielding from the virus - a total of 2.7 million people. |
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Testing |
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New Type of Test May Better Discern Immunity to the Coronavirus Author: Apoorva Mandavilli Publication date: 10 November 2020 Source: New York Times A new type of test can detect a person’s immune response to the coronavirus better than a widely used antibody test, according to research released on Tuesday. The test, if authorized by the Food and Drug Administration, would be the first commercial product to detect the response of a T cell — a type of immune cell — to the virus. Antibodies have dominated the conversation on immunity since the start of the pandemic, but scientists believe that T cells may be just as important in preventing reinfection. The test was developed by Adaptive Biotechnologies, a company based in Seattle. The company used small blood samples from 1,000 people across 25 metropolitan areas in the United States as well as another 3,500 participants from Europe to create the test, which can detect a recent or past infection of the coronavirus. |
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Health passports |
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Covid Passports Seen as Key to Resuming International Travel Authors: Charlotte Ryan and Tara Patel Publication date: 28 November 2020 Source: The Hill The travel industry is moving ahead with plans to ensure a coronavirus vaccine means tourism and travel, both domestically and internationally, can quickly be revived. Industry leaders are coordinating their efforts to create a digital passport that would say whether a passenger has been vaccinated for COVID-19. The International Air Transport Association (IATA) announced this week it is in the final phase of development for what it hopes will be universally accepted documentation that in turn could boost confidence among wary travelers. The digital health pass would include a passenger’s testing and vaccine information and would manage and verify information among governments, airlines, laboratories and travelers. |
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Vaccines |
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Why Covid-19 Vaccines Won’t Save The World Author: Bill Sardi Publication date: 03 December 2020 Source: Lew Rockwell The news headline is that COVID-19 vaccines are 95% effective against COVID-19 coronavirus. However, vaccines for other infectious diseases only have a 33.4% success rate. What gives? The effectiveness of a vaccine cannot exceed the infection rate of the population. If there are 100 million people and 1 million will become infected, a vaccine cannot possibly benefit more than 1 in 100, or 1%. In the District of Columbia as of November 29, 2020, 306,447 DC residents have been tested and 21,552 (7%) tested positive; 680 deaths were attributed to COVID-19 (2/10ths of one-percent). Maybe only 6% of these deaths were attributed to COVID-19 infection alone, or 41 deaths which is 1.3 deaths per 10,000 people. The effectiveness of a vaccine in regard to mortality cannot exceed that number. In regard to effectiveness to prevent infection, using the data above, a COVID-19 vaccine could not exceed 7% effectiveness because that is all that were infected. Yet COVID-19 vaccines now entering preliminary clinical studies are now being touted as 95+% effective at quelling symptoms, at least temporarily. Alleging serious side-effects, vaccine trial participant seeks Rs 5 cr from Serum Institute Author: Himani Chandna Publication date: 28 November 2020 Source: The Print New Delhi: A Chennai resident, who was a participant in trials for the Covid-19 vaccine being manufactured by the Pune-based Serum Institute of India, has allegedly suffered serious neurological and psychological symptoms after taking the experimental shots. A law firm has on his behalf sent a legal notice to SII seeking compensation of Rs 5 crore. The vaccine, Covishield, is being developed by the University of Oxford and drugmaker AstraZeneca. SII has a tie-up with Swedish-British pharma giant for the manufacturing of a billion doses. Covishield is among the frontrunners in the race to develop an effective vaccine against Covid-19. First doses of Pfizer coronavirus vaccine have flown to US from Belgium: report Author: Kaelan Deese Publication date: 28 November 2020 Source: The Hill The first doses of Pfizer's coronavirus vaccine candidate have been flown over to the U.S. from Belgium, a source familiar with United Airlines' COVID Vaccine Readiness Task Team planning confirmed to NBC on Saturday. On Friday, the Wall Street Journal reported that United commenced chartering flights to send doses of the vaccine to the United States. In a statement to The Hill on Friday, the Federal Aviation Administration (FAA) also confirmed that it was "supporting the first mass air shipment of a vaccine." A source told the network the FAA is allowing United to carry 15,000 pounds of dry ice per flight, which is five times over the permitted limit. Pfizer's vaccine must be kept at below-freezing temperatures to maintain efficacy of the dosages. Author: Dave Archard Publication date: 27 November 2020 Source: Nuffield Council on Bioethics I followed the example of Professor Jonathan Van-Tam, England's Deputy Chief Medical Officer, who, in the wake of the announcement of two successful COVID-19 vaccines, stated that he had encouraged his elderly mother ‘to be ready.’ I did the same. (See Professor Jonathan Van-Tam's announcement) Yet my own 99-year-old mother’s response was interesting. It was that she didn’t think she deserved priority and that the young should get it first. I have no reason to think her reply was disingenuous or confused. Like many of her age she has a sober and realistic understanding of her own mortality and she is cognitively very able. Nor was it a question of being vaccine hesitant. She simply thinks the priority rule is wrong. Oxford Covid vaccine: Regulator asked to assess jab Publication date: 27 November 2020 Source: BBC News The government has asked the regulator to assess the Oxford/AstraZeneca coronavirus vaccine, bringing the UK a step closer to a possible rollout. The referral to the Medicines and Healthcare products Regulatory Agency (MHRA) marked "a significant first step" in getting the vaccine "approved for deployment", the government said. It follows news that the jab was "highly effective" in advanced trials. The UK government has pre-ordered 100m doses of the Oxford vaccine. The government's latest request to the MHRA comes a week after the regulator was asked to assess the Pfizer/BioNTech vaccine. |
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Social Impacts |
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A day in the life of the Covid Physician Author: The Covid Physician Publication date: 30 November 2020 Source: The Critic Lockdown has dire, hidden consequences for unwell patients in general practice. Take for example the 34-year-old patient with motor neurone disease, English is a second language, she is an asylum seeker who thought she was escaping persecution and tyranny. In addition to the general muscular spasticity and weakness which will eventually lead to a slow death by respiratory failure she has a progressive bulbar palsy which means she can no longer speak nor swallow well. These will worsen. Each morning she risks a death by choking on her puréed breakfast. A feeding tube has been proposed, but she pretends to her specialist it hasn’t been. She is on medicines that sedate her. She can barely handle a mobile phone. Let us say life is already a multiple misery. Author: James Tapsfield Publication date: 30 November 2020 Source: Mail Online Boris Johnson today insisted he 'understands' the scale of Tory anger over the new coronavirus tiers as he finally published an impact assessment of the measures - but the document claimed it is impossible to gauge the economic hit. The PM appealed for his mutinous MPs to back the new system in a crunch vote tomorrow, as up to 100 threaten to defy the whip and oppose the plan. The government released its assessment of the economic and social effects of the pandemic and its response this evening. But the document made clear that it is not possible to say exactly how the tiers will hit local areas - something that has been a key demand of Conservatives. It also insisted there was no way of quantifying the consequences of imposing looser curbs - instead merely arguing it would be 'intolerable' to allow the NHS to be overwhelmed. Poverty during the Covid-19 crisis Publication date: 30 November 2020 Source: Legatum Institute Original analysis from the Legatum Institute using the Social Metrics Commission’s approach to poverty measurement demonstrates both the likely impacts of Covid-19 on poverty and the insulating effect that Government policy has had. The survey data that underpins the measurement of poverty in the UK and covers the pandemic period will not be available until 2022. This is obviously too late for decision makers who are seeking to ensure that the most vulnerable are shielded from the worst impacts of the pandemic. To fill the gap, this briefing presents the results of a ‘nowcasting’ exercise using the most up-to-date data on employment, earnings, and Government policy available, along with a range of assumptions, to model the likely level and distribution of poverty in both Summer and Winter 2020. |
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