H5N1

Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app

Via The Lancet Infectious Diseases: Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. The summary:

Background 

COVID-19 vaccines show excellent efficacy in clinical trials and effectiveness in real-world data, but some people still become infected with SARS-CoV-2 after vaccination. This study aimed to identify risk factors for post-vaccination SARS-CoV-2 infection and describe the characteristics of post-vaccination illness. 

Methods 

This prospective, community-based, nested, case-control study used self-reported data (eg, on demographics, geographical location, health risk factors, and COVID-19 test results, symptoms, and vaccinations) from UK-based, adult (≥18 years) users of the COVID Symptom Study mobile phone app. 

For the risk factor analysis, cases had received a first or second dose of a COVID-19 vaccine between Dec 8, 2020, and July 4, 2021; had either a positive COVID-19 test at least 14 days after their first vaccination (but before their second; cases 1) or a positive test at least 7 days after their second vaccination (cases 2); and had no positive test before vaccination. Two control groups were selected (who also had not tested positive for SARS-CoV-2 before vaccination): users reporting a negative test at least 14 days after their first vaccination but before their second (controls 1) and users reporting a negative test at least 7 days after their second vaccination (controls 2). 

Controls 1 and controls 2 were matched (1:1) with cases 1 and cases 2, respectively, by the date of the post-vaccination test, health-care worker status, and sex. In the disease profile analysis, we sub-selected participants from cases 1 and cases 2 who had used the app for at least 14 consecutive days after testing positive for SARS-CoV-2 (cases 3 and cases 4, respectively). 

Controls 3 and controls 4 were unvaccinated participants reporting a positive SARS-CoV-2 test who had used the app for at least 14 consecutive days after the test, and were matched (1:1) with cases 3 and 4, respectively, by the date of the positive test, health-care worker status, sex, body-mass index (BMI), and age. 

We used univariate logistic regression models (adjusted for age, BMI, and sex) to analyse the associations between risk factors and post-vaccination infection, and the associations of individual symptoms, overall disease duration, and disease severity with vaccination status. 

Findings 

Between Dec 8, 2020, and July 4, 2021, 1 240 009 COVID Symptom Study app users reported a first vaccine dose, of whom 6030 (0·5%) subsequently tested positive for SARS-CoV-2 (cases 1), and 971 504 reported a second dose, of whom 2370 (0·2%) subsequently tested positive for SARS-CoV-2 (cases 2). In the risk factor analysis, frailty was associated with post-vaccination infection in older adults (≥60 years) after their first vaccine dose (odds ratio [OR] 1·93, 95% CI 1·50–2·48; p<0·0001), and individuals living in highly deprived areas had increased odds of post-vaccination infection following their first vaccine dose (OR 1·11, 95% CI 1·01–1·23; p=0·039). Individuals without obesity (BMI <30 kg/m2) had lower odds of infection following their first vaccine dose (OR 0·84, 95% CI 0·75–0·94; p=0·0030). For the disease profile analysis, 3825 users from cases 1 were included in cases 3 and 906 users from cases 2 were included in cases 4. 

Vaccination (compared with no vaccination) was associated with reduced odds of hospitalisation or having more than five symptoms in the first week of illness following the first or second dose, and long-duration (≥28 days) symptoms following the second dose. Almost all symptoms were reported less frequently in infected vaccinated individuals than in infected unvaccinated individuals, and vaccinated participants were more likely to be completely asymptomatic, especially if they were 60 years or older. 

Interpretation 

To minimise SARS-CoV-2 infection, at-risk populations must be targeted in efforts to boost vaccine effectiveness and infection control measures. Our findings might support caution around relaxing physical distancing and other personal protective measures in the post-vaccination era, particularly around frail older adults and individuals living in more deprived areas, even if these individuals are vaccinated, and might have implications for strategies such as booster vaccinations.

Orlando urges reduced water usage as liquid oxygen used to purify water goes to COVID patients

Via the Orlando Sentinel: Orlando urges reduced water usage as liquid oxygen used to purify water goes to COVID patients. Excerpt:

The city of Orlando and its water utility made an urgent appeal Friday afternoon for residents to cut back sharply on water usage for weeks because of a pandemic-triggered shortage of liquid oxygen used to purify water. 

If commercial and residential customers are unable to reduce water usage quickly and sufficiently, Orlando Utilities Commission may issue a system-wide alert for boiling water needed for drinking and cooking. Without reductions in water usage, a boil-water alert would come within a week, utility officials said. 

Orlando Mayor Buddy Dyer asked residents to immediately stop watering their lawns, washing their cars and using pressure washers. Landscape irrigation consumes about 40% of the water provided by OUC. 

“It’s a pretty simple thing that we are asking our residential customers,” Dyer said. “Let’s just not water your yard for a week. In all likelihood, there will be thunderstorms during the week anyway.” 

Medical authorities have reported that along with a spike in hospitalizations for COVID cases, hospitals are relying increasingly on treatment involving high flows of supplemental oxygen for patients. 

That has spurred a nationwide shortage for liquid oxygen, which has been exacerbated by a lack of available tanker trucks and drivers. 

As the region’s largest water utility, OUC provides about 90 million gallons of potable water daily to 140,000 customers or an estimated 400,000 people within city limits and in Orange County. 

OUC said the call for reduced water usage will be in place for at least two to three weeks. The city has already stopped irrigation at parks and ballfields.

Inside India’s COVID-19 surge

Via The New Yorker, another excellent report by Dhruv Khullar: Inside India’s COVID-19 Surge. Excerpt:

The tale of the Indian pandemic is both mysterious and familiar. For much of the past year, the world’s largest democracy—with a population of some 1.4 billion living on a landmass a third the size of the U.S.—escaped the worst. 

Researchers have advanced all sorts of theories to explain this outcome. They point out that India is a young country, with a median age of twenty-eight; that it instituted an early and strict lockdown; that it has undercounted cases and deaths; and that Indians may have had some level of preëxisting immunity to the novel coronavirus, owing to exposure to similar viruses in the past. Studies have indicated, perplexingly, that more than half of the residents in some dense urban centers had previously been infected, even though their hospitals hadn't filled up. 

None of these explanations have been fully proved, and, separately or in combination, they may not account for why India was spared last year. That debate will likely continue for a long time to come.

The reasons for the country’s current surge, on the other hand, appear straightforward. Since the New Year, there’s been a substantial relaxing of public-health precautions. Mask-wearing declined; sporting events, political rallies, and religious festivals brought large numbers of people close together. Lacking a sense of urgency, the country’s vaccination campaign proceeded slowly: India is the world’s leading manufacturer of vaccines for a wide range of diseases, but has fully immunized roughly two per cent of its population against covid-19. 

Many assume that the rise of more contagious variants is accelerating the damage. Almost certainly, B.1.1.7—originally identified in the U.K. and now dominant in many countries, including the U.S.—is contributing to India’s viral spread. But a new variant, known as B.1.617, has also captured headlines and the attention of scientists and the general public. The predominant form of the variant, misleadingly referred to as the “double-mutant”—it has at least thirteen mutations—was first detected in December. B.1.617 has several mutations on its spike protein, including E484Q and L452R, which seem to increase the virus’s ability to bind to and enter human cells, and which may improve its capacity for evading the immune system. Some scientists have hypothesized that another mutation, P681R, could improve the variant’s ability to infect cells. 

Still, the role played by B.1.617 in India’s crisis is uncertain. India has sequenced only about one per cent of positive coronavirus tests, rendering claims about the relative contribution of variants hard to disentangle from other factors, such as a rise in unrestricted gatherings in a densely populated country with limited health-system capacity. In any case, Covaxin—India’s domestically developed covid-19 vaccine—appears to work against both B.1.1.7 and B.1.617. Arora told me that, although several fully vaccinated clinicians at his hospital have recently contracted the virus, none went on to develop severe disease—exactly the kind of protection the vaccines are designed to deliver. 

Last week, the Biden Administration announced that the U.S. would send a hundred-million-dollar aid package to India, including testing kits, ventilators, oxygen cylinders, and P.P.E. The U.S. has also removed restrictions on exporting raw materials for vaccines so that India can increase its production. Last weekend, syringes, oxygen generators, and ventilators poured in from across Europe, and a hundred and fifty thousand doses of Sputnik V, Russia’s vaccine, landed in Hyderabad. The Indian diaspora has committed tens of millions of dollars in aid. 

Whether these interventions will be enough remains to be seen. In a country as large, diverse, and bureaucratically complex as India, the logistical challenges of converting aid into impact cannot be overestimated. Meanwhile, the Indian experience holds a deeper lesson for the world—especially for wealthy countries that have hoarded vaccines and supplies. The constellation of forces that led to India’s crisis—pandemic fatigue, the premature relaxation of precautions, more transmissible variants, limited vaccine supplies, weak health-care infrastructure—is not unique; it’s the default in most of the world. Absent a paradigm shift in our approach, there’s no reason to believe that what’s happening in India today won’t happen somewhere else tomorrow.

First-ever image of COVID-19 variant supports faith in current vaccines, UBC says

Via The Globe and Mail, a report by The Canadian Press: First-ever image of COVID-19 variant supports faith in current vaccines, UBC says.

The first images of a mutation on a COVID-19 variant of concern have been captured by researchers at the University of British Columbia who say the photos offer some reassurance about how the virus strain may react to current vaccines. 

The University of B.C. says the researchers are the first to publish structural images of the mutation found on one portion of the SARS-CoV-2 spike protein.

The spike protein is the part of the virus that opens the door to infection, while the mutation is the change believed partly responsible for the rapid spread of the variant first identified in the United Kingdom. 

 A team led by Dr. Sriram Subramaniam, professor in the department of biochemistry and molecular biology at UBC’s faculty of medicine, found the images show localized placement of the mutation allows it to enter human cells more easily. 

The team’s analysis, recently published in PLOS Biology, reveals that, once inside, the mutation can still be sidelined by antibodies from current vaccines. 

Researchers say that adds to growing evidence that most antibodies generated by existing vaccines are likely to remain effective in preventing mild and severe cases of the B.1.1.7 variant. 

The statement says its researchers are also using beams of supercooled electrons in powerful microscopes to visualize the detailed shapes of other COVID-19 variants that are 100,000 times smaller than a pinhead. 

“It’s important to understand the different molecular structures of these emerging variants to determine whether they’ll respond to existing treatments and vaccines and ultimately find ways to control their spread more effectively,” the statement says.

Oxygen leak kills 22 in Indian hospital as coronavirus infections mount

Via Reuters: Oxygen leak kills 22 in Indian hospital as coronavirus infections mount. Excerpt:

At least 22 patients died on Wednesday in a hospital in western India after a disruption to their oxygen supply caused by a leaking tank, the health minister said, as a nationwide surge in coronavirus cases soaks up supplies of the gas. 

The incident in the city of Nashik, one of India's worst-hit areas, happened after the tank of oxygen leaked, said Rajesh Tope, the health minister of Maharashtra, the richest state, where the city is located. 

"Patients who were on ventilators at the hospital in Nashik have died," Tope said in televised remarks. 

"The leakage was spotted at the tank supplying oxygen to these patients. The interrupted supply could be linked to the deaths of the patients in the hospital." 

The world's second most populous nation reported 295,041 new infections on Wednesday - the biggest daily rise reported in any country - stretching its hospitals to breaking point, officials said. 

Only the United States had a slightly higher one-day rise of 297,430 cases in January, though its tally has since fallen sharply. India's 2,023 deaths were also its highest in the pandemic.

Amazonas: Governor Wilson Lima receives equipment from Germany to combat Covid-19

Via The National Council of Health Secretaries: Governor Wilson Lima receives equipment from Germany to combat Covid-19. Excerpt from the Google translation:

The governor of Amazonas, Wilson Lima, received 80 lung ventilators and hospital accessories donated by the Government of Germany, this Saturday (03/27). This non-invasive equipment will reinforce the care of patients diagnosed with Covid-19, in the health units in Amazonas. The holder of the German embassy in Brasilia, Heiko Thoms, delivered the equipment to the State Government. 

In thanking the help of the German government, Wilson Lima explained how the devices will be used. “This equipment will be distributed on our network. It will be important to reinforce the care for patients who still need this support from the State, but also to attend to our brothers from other states, mainly from Rondônia, Roraima and Acre who, at that moment, are going through a complicated situation,” said the governor. 

The donation meets the request for help from the Government of Amazonas, made through an open letter addressed to the international community, in January this year. The equipment will be used in units that act as the entrance door, in wards and outpatient clinics. They do not replace intensive care unit (ICU) lung ventilators. 

The equipment arrived in Brazil brought by a German air force aircraft and disembarked at Eduardo Gomes International Airport, in Manaus. 

“Amazonas, like Brazil, is a strategic partner for Germany. We have a very deep cooperation with Brazil, we have a cooperation with the State of Amazonas. We know that this pandemic is a global phenomenon and no one is safe until everyone is safe. We need to help each other in this situation,” said the ambassador.

80% of covid-19 intubated died in Brazil in 2020

Via BBC News Brasil: Exclusive: 80% of covid-19 intubated died in Brazil in 2020. Excerpt from the Google translation:

For a serious covid-19 patient with lungs that have lost the ability to oxygenate blood, intubation can relieve pain and be the only hope for survival. 

But in Brazil, the high percentage of deaths among those infected who need mechanical ventilation is frightening: the average was around 80% from February to December 2020, according to data from an unprecedented survey obtained exclusively by BBC News Brasil. 

In other words, 8 out of 10 patients intubated during the first year of the pandemic died. Mortality remained the same in the first and second semesters, which shows that Brazil did not know how to effectively apply the lessons learned on treating patients with covid-19. 

For comparison, the world average is around 50% mortality. And, according to the researchers involved in this study, preliminary data from 2021 show that the Brazilian mortality rate is expected to worsen.

Covid-19 vaccine websites violate disability laws, create inequity for the blind

Via KHN, Lauren Weber and Hannah Recht write: Covid Vaccine Websites Violate Disability Laws, Create Inequity for the Blind. Excerpt:

Many covid vaccination registration and information websites at the federal, state and local levels violate disability rights laws, hindering the ability of blind people to sign up for a potentially lifesaving vaccine, a KHN investigation has found. 

Across the country, people who use special software to make the web accessible have been unable to sign up for the vaccines or obtain vital information about covid-19 because many government websites lack required accessibility features. At least 7.6 million people in the U.S. over age 16 have a visual disability. 

WebAIM, a nonprofit web accessibility organization, checked covid vaccine websites gathered by KHN from all 50 states and the District of Columbia. On Jan. 27, it found accessibility issues on nearly all of 94 webpages, which included general vaccine information, lists of vaccine providers and registration forms. 

In at least seven states, blind residents said they were unable to register for the vaccine through their state or local governments without help. Phone alternatives, when available, have been beset with their own issues, such as long hold times and not being available at all hours like websites. 

Even the federal Centers for Disease Control and Prevention’s Vaccine Administration Management System, which a small number of states and counties opted to use after its rocky rollout, has been inaccessible for blind users. 

Those problems violate the Rehabilitation Act of 1973, which established the right to communications in an accessible format, multiple legal experts and disability advocates said. The federal Americans with Disabilities Act, a civil rights law that prohibits governments and private businesses from discriminating based on disability, further enshrined this protection in 1990.

Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada

Old people use a lot of primary care, and my wife and I have seen what a difference the pandemic has made in the quantity and quality of that care. Via CMAJ: Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada. The abstract:

BACKGROUND: Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the initial months of the pandemic in Ontario, Canada. 

METHODS: This population-based study compared comprehensive, linked primary care physician billing data from Jan. 1 to July 28, 2020, with the same period in 2019. We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period. We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics. We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period. 

RESULTS: Compared with 2019, total primary care visits between March and July 2020 decreased by 28.0%, from 7.66 to 5.51 per 1000 people/day. The smallest declines were among patients with the highest expected health care use (8.3%), those who could not be attributed to a primary care physician (10.2%), and older adults (19.1%). In contrast, total visits in rural areas increased by 6.4%. Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits. The lowest uptake of virtual care was among children (57.6%), rural residents (60.6%) and physicians with panels of ≥ 2500 patients (66.0%). 

INTERPRETATION: Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic. Total visits declined least among those with higher health care needs. The determinants and consequences of these major shifts in care require further study.

COVID-19: PAHO donates oxygen cylinders and supplies to Manaus, Brazil

A news release: PAHO donates oxygen cylinders and supplies to Manaus, Brazil. Except:

Brasília, Brazil, February 1, 2021 (PAHO) – The Pan American Health Organization (PAHO) donated 4,600 oximeters last week to the Amazonas State Health Department and to the Manaus Municipal Health Department. These devices help monitor the health conditions of patients with COVID-19.   

PAHO has also sent 45 oxygen cylinders to supply health facilities in the state and 1,500 thermometers to take patients’ temperatures.   

In addition, the international organization has guaranteed the delivery of 60,000 rapid antigen tests to support COVID-19 diagnosis. PAHO has donated these supplies to several countries in the Americas in order to facilitate the identification of people infected with the disease, even in hard-to-reach communities.   

Rapid antigen tests are more accurate in determining if someone is currently infected. In contrast, rapid antibody tests can show when someone has had COVID-19 but usually provide a negative result during the early stages of infection.