Scientists push back on call to endorse booster shots for all

Authors: By Ariel Hart,  Helena Oliviero– The Atlanta Journal-Constitution

Responding to the resurging pandemic and breakthrough infections, President Biden and some top health officials are pushing for the U.S. to begin vaccine booster shots by Sept. 20. But the committee of scientists who officially recommend whether to take such steps met Monday and pushed back.

The scientists said they still had fundamental questions to answer, such as whether the increase in COVID-19 infections after vaccination, so-called breakthrough cases, was related at all to waning effectiveness of the vaccines.

When the Sept. 20 date was announced “it led everyone—it led physicians, it led the public—to believe that they had access to information about these vaccines and the need for boosters that had not yet been publicly released,” said Dr. Sandra Fryhofer of Atlanta, a nonvoting member of the committee. “And to me, that kind of opened the door to a lot of confusion.”

The group, the Advisory Committee on Immunization Practices, advises the Centers for Disease Control and Prevention on whether scientific data merit approval or warnings on vaccines. From the moment its chairwoman opened Monday’s meeting, members made blunt statements that they would follow scientific data and processes on booster shots, regardless.

Other scientists were glad to hear it.

“There is a process that is being undermined by ‘science by leak,’” said Dr. Felipe Lobelo of Emory University, an epidemiologist and associate professor told the AJC. “We don’t really have strong data on when the waning starts; on whether the increased rates of infection and so called breakthrough infections…are occurring because of this waning effect— or is it because delta is more transmissible? Or is it because people are changing behaviors?”

Dr. Carlos del Rio, professor of medicine at Emory University, agreed. “The problem is by focusing on boosters we’re distracting from the biggest problem, which is all the unvaccinated people,” he said.

Without calling them “booster shots,” the FDA has authorized an extra shot for certain people with compromised immune systems, like organ transplant recipients, after they have completed their original coronavirus vaccine regimen. But no decisions have been made for other vulnerable groups, much less the general public.

That leaves Georgians who are now eager for a booster shot not knowing what comes next.

In Avondale Estates, Carolyn Chandler, 80, has marked her calendar for Oct. 16, the day she should get a booster if they’re recommended eight months from initial vaccination, as federal officials have touted.

Ever since Chandler started to see reports showing waning immunity from the vaccines, there was no question for her that she would get a booster.

“I just would like to stick around for a while,” Chandler said.

Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines

Authors: Bryant, Andrew MSc1,*; Lawrie, Theresa A. MBBCh, PhD2; Dowswell, Therese PhD2; Fordham, Edmund J. PhD2; Mitchell, Scott MBChB, MRCS3; Hill, Sarah R. PhD1; Tham, Tony C. MD, FRCP4 American Journal of Therapeutics: July/August 2021 – Volume 28 – Issue 4 – p e434-e460doi: 10.1097/MJT.0000000000001402

Abstract

Background: 

Repurposed medicines may have a role against the SARS-CoV-2 virus. The antiparasitic ivermectin, with antiviral and anti-inflammatory properties, has now been tested in numerous clinical trials.

Areas of uncertainty: 

We assessed the efficacy of ivermectin treatment in reducing mortality, in secondary outcomes, and in chemoprophylaxis, among people with, or at high risk of, COVID-19 infection.

Data sources: 

We searched bibliographic databases up to April 25, 2021. Two review authors sifted for studies, extracted data, and assessed risk of bias. Meta-analyses were conducted and certainty of the evidence was assessed using the GRADE approach and additionally in trial sequential analyses for mortality. Twenty-four randomized controlled trials involving 3406 participants met review inclusion.

Therapeutic Advances: 

Meta-analysis of 15 trials found that ivermectin reduced risk of death compared with no ivermectin (average risk ratio 0.38, 95% confidence interval 0.19–0.73; n = 2438; I2 = 49%; moderate-certainty evidence). This result was confirmed in a trial sequential analysis using the same DerSimonian–Laird method that underpinned the unadjusted analysis. This was also robust against a trial sequential analysis using the Biggerstaff–Tweedie method. Low-certainty evidence found that ivermectin prophylaxis reduced COVID-19 infection by an average 86% (95% confidence interval 79%–91%). Secondary outcomes provided less certain evidence. Low-certainty evidence suggested that there may be no benefit with ivermectin for “need for mechanical ventilation,” whereas effect estimates for “improvement” and “deterioration” clearly favored ivermectin use. Severe adverse events were rare among treatment trials and evidence of no difference was assessed as low certainty. Evidence on other secondary outcomes was very low certainty.

Conclusions: 

Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally.

For More Information:https://journals.lww.com/americantherapeutics/Fulltext/2021/08000/Ivermectin_for_Prevention_and_Treatment_of.7.aspx

Anticoagulation in COVID-19: current concepts and controversies

  1. Authors: http://orcid.org/0000-0002-3809-8926Atanu Chandra16289Uddalak Chakraborty2, Shrestha Ghosh1, Sugata Dasgupta3

Abstract

Rising incidence of thromboembolism secondary to COVID-19 has become a global concern, with several surveys reporting increased mortality rates. Thrombogenic potential of the SARS-CoV-2 virus has been hypothesised to originate from its ability to produce an exaggerated inflammatory response leading to endothelial dysfunction. Anticoagulants have remained the primary modality of treatment of thromboembolism for decades. However, there is no universal consensus regarding the timing, dosage and duration of anticoagulation in COVID-19 as well as need for postdischarge prophylaxis. This article seeks to review the present guidelines and recommendations as well as the ongoing trials on use of anticoagulants in COVID-19, identify discrepancies between all these, and provide a comprehensive strategy regarding usage of these drugs in the current pandemic.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Introduction

The novel beta-coronavirus, appropriately named SARS-CoV-2 by the International Committee of Taxonomy of Viruses, belongs to a family of single-stranded RNA viruses, members of which have been recognised as causative agents of the SARS-CoV and Middle East respiratory syndrome coronavirus outbreak in 2002 and 2012, respectively.1 2 Presently, the novel COVID-19 poses a major global health crisis, having been declared a pandemic on 11 March 2020 by the WHO.

Over the past several months, an overwhelming amount of literature suggests an increased risk of thromboembolic manifestations associated with COVID-19.2 Several hypotheses have been suggested to understand the underlying pathophysiology behind development of a prothrombotic state in COVID-19 such as exaggerated inflammatory response resulting in activation of the coagulation cascade and endothelial injury.3 4 Usage of anticoagulants in COVID-19 remains an area of conjecture with no definite guidelines published to date highlighting the timing, dosage and duration of anticoagulation as well as the drug of choice. Most internationally published guidelines, based on consensus statements and expert opinions, recommend therapeutic doses of heparin only in patients diagnosed with or highly suspected of developing macrothrombi such as pulmonary embolism (PE) or deep vein thrombosis (DVT). However, these guidelines including those by CHEST, rarely address the requirement of post discharge thromboprophylaxis.5

For More Information: https://pmj.bmj.com/content/early/2021/04/12/postgradmedj-2021-139923

COVID-19 One Year Later

Authors: Giuseppe NovelliMichela BiancolellaRuty Mehrian-ShaiVito Luigi ColonaAnderson F. BritoNathan D. GrubaughVasilis VasiliouLucio Luzzatto & Juergen K. V. Reichardt 

COVID-19 has engulfed the world and it will accompany us all for some time to come. Here, we review the current state at the milestone of 1 year into the pandemic, as declared by the WHO (World Health Organization). We review several aspects of the on-going pandemic, focusing first on two major topics: viral variants and the human genetic susceptibility to disease severity. We then consider recent and exciting new developments in therapeutics, such as monoclonal antibodies, and in prevention strategies, such as vaccines. We also briefly discuss how advances in basic science and in biotechnology, under the threat of a worldwide emergency, have accelerated to an unprecedented degree of the transition from the laboratory to clinical applications. While every day we acquire more and more tools to deal with the on-going pandemic, we are aware that the path will be arduous and it will require all of us being community-minded. In this respect, we lament past delays in timely full investigations, and we call for bypassing local politics in the interest of humankind on all continents.

For More Information: https://humgenomics.biomedcentral.com/articles/10.1186/s40246-021-00326-3

Early High-Titer Plasma Therapy to Prevent Severe Covid-19 in Older Adults

Authors: Romina Libster, M.D., Gonzalo Pérez Marc, M.D., Diego Wappner, M.D., Silvina Coviello, M.S., Alejandra Bianchi, Virginia Braem, Ignacio Esteban, M.D., Mauricio T. Caballero, M.D., Cristian Wood, M.D., Mabel Berrueta, M.D., Aníbal Rondan, M.D., Gabriela Lescano, M.D., et al., for the Fundación INFANT–COVID-19 Group*

Therapies to interrupt the progression of early coronavirus disease 2019 (Covid-19) remain elusive. Among them, convalescent plasma administered to hospitalized patients has been unsuccessful, perhaps because antibodies should be administered earlier in the course of illness.

For More Information: https://www.nejm.org/doi/full/10.1056/NEJMoa2033700

Returning to physical activity after covid-19

Authors: David Salman, academic clinical fellow in primary care12,  Dane Vishnubala, consultant in sports and exercise medicine and honorary senior lecturer in primary care and public health23,  Peter Le Feuvre, military physiotherapist and research fellow in complex trauma rehabilitation15,  Thomas Beaney, academic clinical fellow in primary care2,  Jonathan Korgaonkar, consultant in sports and exercise medicine4,  Azeem Majeed, professor of primary care and public health2,  Alison H McGregor, professor of musculoskeletal biodynamics1

What you need to know

  • Risk stratify patients before recommending a return to physical activity in people who have had covid-19. Patients with ongoing symptoms or who had severe covid-19 or a history suggestive of cardiac involvement need further clinical assessment
  • Only return to exercise after at least seven days free of symptoms, and begin with at least two weeks of minimal exertion
  • Use daily self monitoring to track progress, including when to seek further help

For More Information: https://www.bmj.com/content/372/bmj.m4721

Coronavirus Recovery: Breathing Exercises

Authors: Peiting Lien, DPT, PT

The coronavirus that causes COVID-19 attacks the lungs and respiratory system, sometimes resulting in significant damage. COVID-19 often leads to pneumonia and even acute respiratory distress syndrome (ARDS), a severe lung injury. Recovering lung function is possible but can require therapy and exercises for months after the infection is treated.

“Working toward recovery starts simple: with a focus on breathing,” says Johns Hopkins physical therapist Peiting Lien. She offers a series of breathing exercises to aid in recovery for those who had COVID-19 or another serious illness.

For More Information: https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-recovery-breathing-exercises

The hallmarks of COVID-19 disease

Authors: Daolin Tang ,Paul Comish,Rui Kang 

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that has caused a worldwide pandemic of the human respiratory illness COVID-19, resulting in a severe threat to public health and safety. Analysis of the genetic tree suggests that SARS-CoV-2 belongs to the same Betacoronavirus group as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Although the route for viral transmission remains a mystery, SARS-CoV-2 may have originated in an animal reservoir, likely that of bat. The clinical features of COVID-19, such as fever, cough, shortness of breath, and fatigue, are similar to those of many acute respiratory infections. There is currently no specific treatment for COVID-19, but antiviral therapy combined with supportive care is the main strategy. Here, we summarize recent progress in understanding the epidemiological, virologic, and clinical characteristics of COVID-19 and discuss potential targets with existing drugs for the treatment of this emerging zoonotic disease.

For More Information: https://journals.plos.org/plospathogens/article?id=10.1371%2Fjournal.ppat.1008536

Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)

Authors: CDC

  • New information on potential for under-detection of occult hypoxemia by pulse oximetry, especially among persons with dark skin
  • New information on dermatologic manifestations associated with COVID-19
  • New information on prolonged shedding of replication-competent SARS-CoV-2 in severely immunocompromised persons
  • New information on reports of reinfection with variant viruses

Clinical Presentation, Clinical Course, Laboratory and Radiographic Findings, Clinical Management and Treatment, Discontinuation of Transmission-Based Precautions or Home Isolation

This document provides guidance on caring for patients infected with SARS-CoV-2, the virus that causes COVID-19. The National Institutes of Health (NIH) have published guidelines for the clinical management of COVID-19external icon prepared by the COVID-19 Treatment Guidelines Panel. The recommendations are based on scientific evidence and expert opinion and are regularly updated as more data become available.

For More Information: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html

Considerations for Certain Concomitant Medications in Patients With COVID-19

Authors: NIH

  • Patients with COVID-19 who are receiving concomitant medications (e.g., angiotensin-converting enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], statins, systemic or inhaled corticosteroids, nonsteroidal anti-inflammatory drugs, acid-suppressive therapy) for underlying medical conditions should not discontinue these medications during acute management of COVID-19 unless discontinuation is otherwise warranted by their clinical condition (AIIa for ACE inhibitors and ARBs; (AIII) for other medications).
  • The COVID-19 Treatment Guidelines Panel recommends against using medications off-label to treat COVID-19 if they have not demonstrated safety and efficacy in patients with COVID-19, except in a clinical trial.

For More Information: https://www.covid19treatmentguidelines.nih.gov/therapies/concomitant-medications/