Category: COVID

Categories : COVIDTags :

Prone Positioning in COVID Reduces the Need for Endotracheal Intubation

On By ModernMedia
Photo by Samuel Ramos on Unsplash

COVID patients hospitalised for acute respiratory distress syndrome (ARDS) are less likely to need endotracheal intubation with prone positioning, but evidence is inconclusive for other outcomes such as mortality, suggests an in-depth analysis of the latest evidence published by The BMJ.

Since the 1970s, prone positioning has been standard care for patients with severe ARDS as it encourages a larger part of the lung to expand, enabling bigger breaths. 

Usually, it is done for critically ill patients who are sedated and intubated. But in February 2020, reports emerged of possible benefits from prone positioning of awake COVID and it was widely adopted. 

Since then, several studies have examined its effectiveness in awake COVID patients , but results have been conflicting.

To try and resolve this uncertainty, researchers trawled databases for randomised trials comparing awake prone positioning to usual care for adult COVID patients with hypoxaemic respiratory failure.

They found 17 suitable trials, 12 with no bias risk, involving 2931 non-intubated patients who were able to breathe unassisted and who spent an average of 2.8 hours per day lying prone.

The primary outcome was endotracheal intubation, and secondary outcomes included mortality, ventilator-free days, intensive care unit (ICU) and hospital length of stay, change in oxygenation and respiratory rate, and adverse events.

High certainty evidence from a pooled analysis of 14 trials showed that awake prone positioning reduced the risk of endotracheal intubation compared with usual care (24.2% with awake prone positioning vs 29.8% with usual care). On average, awake prone positioning resulted in 55 fewer intubations per 1000 patients.

However, high certainty evidence from a pooled analysis of 13 trials evaluating mortality did not show a significant difference in mortality between the two groups (15.6% with awake prone positioning vs 17.2% with usual care), but the study may have lacked statistical power to detect a difference.

Awake prone positioning did not significantly affect other secondary outcomes either, including, ventilator-free days, ICU or hospital length of stay, based on low and moderate certainty evidence.

Limitations included lack of individual patient data, differences between the targeted and achieved duration of awake prone positioning, and variation in the definition and reporting of certain outcomes across studies.

But further sensitivity analysis supported these results, suggesting a high probability of benefit for the endotracheal intubation outcome and a low probability of benefit for mortality.

As such, the researchers conclude: “Awake prone positioning compared with usual care reduces the risk of endotracheal intubation in adults with hypoxemic respiratory failure due to covid-19 but probably has little to no effect on mortality or other outcomes.”

In a linked editorial, researchers point out that the benefits of prone positioning in COVID patients may be confined to those with more severe hypoxaemia and longer duration of prone positioning, so say it may be wise to focus efforts on these particular groups. 

Several unanswered questions remain, including the ideal daily duration of treatment, the level of hypoxaemia that should prompt prone positioning, and how best to improve patient comfort and encourage adherence, they write.

These questions may never be answered definitively in COVID patients as, fortunately, far fewer are experiencing hypoxaemic respiratory failure or critical illness, they explain.

“The pandemic should, however, renew interest and encourage further evaluation of awake prone positioning – an intervention that may benefit a wide range of patients with hypoxaemia,” they conclude.

Source: EurekAlert!

Categories : COVID Expert OpinionTags :

‘Stepwise Emergence’ Scenario of Omicron in Africa Challenged

On By ModernMedia
Image by Quicknews

A widely reported study published in Science that presented evidence for a distributed, ‘stepwise’ origin for Omicron across the African continent has drawn criticism from a number of prominent scientists.

Dr Tulio Oliveira, the director of CERI (Centre for Epidemic Response & innovation) and KRISP (KZN Research Innovation & Sequencing Platform) was one of these scientists expressing their doubts over Twitter.

Dr Oliveira tweeted that, like many other scientists, he was sceptical of the Science paper’s narrative of a stepwise emergence of Omicron in Africa.

“First, the ‘fishing’ of intermediates in Africa should also have been performed in Europe and the USA, which were the regions of the world that introduced the majority of Omicron lineages to Africa -“

He also questioned the accuracy of their results due to possible contamination, and also the strength of their analyses, noting that phylogenetic analyses are weak.

For his fourth point, he says that “the Benin sequences could be recombinants of Delta and Omicron, real recombination, or recombination through contamination of the sequencing process.” He was unable to check for the prevalence of mutations.

He also makes a very simple observation regarding the timing of waves: if Omicron arose first in West Africa, why then did South Africa experience the Omicron wave before them?

The paper was also not presented as a preprint to allow for the research community to give feedback and improved the manuscript, a criticism echoed by biologist and physicist Richard Neher.

“Lastly, the results presented do not reject any of the three hypotheses of Omicron evolution (i.e. unsampled location, immune suppressed individual, animal reservoir).”

Nevertheless, he says that “I have many colleagues and collaborators in this paper and would like to recognize that the allele qPCR system to identify BA.1 is a great tool. Also that their mutation analyses are also good.”

Categories : COVIDTags : 1 Comment

Study Pushes Back Date of Omicron’s Origin

On By ModernMedia
PCR device for detecting pathogens like SARS-CoV-2 (symbolic image) © Charité | Arne Sattler

Seemingly out of nowhere, the Omicron variant was first detected in South Africa and rapidly spread around the world. Now, a study published in the journal Science shows that Omicron’s predecessors existed on the African continent long before cases were first identified, suggesting that Omicron emerged gradually over several months in different countries across Africa.

Since the beginning of the pandemic, the coronavirus has been constantly changing. The biggest leap seen in the evolution of SARS-CoV-2 to date was observed by researchers a year ago, when a variant was discovered that differed from the genome of the original virus by more than 50 mutations. First detected in a patient in South Africa in mid-November 2021, the variant later named Omicron BA.1 spread to 87 countries around the world within just a few weeks. By the end of December, it had replaced the previously dominant Delta variant worldwide.

Since then, speculations about the origin of this highly transmissible variant have centred around two main theories: Either the coronavirus jumped from a human to an animal where it evolved before infecting a human again as Omicron, or the virus survived in a person with a compromised immune system for a longer period of time and that’s where the mutations occurred. A new analysis of COVID samples collected in Africa before the first detection of Omicron now casts doubt on both these hypotheses.

The analysis was carried out by an international research team led by Prof Jan Felix Drexler, a scientist at the Institute of Virology at Charité and the German Center for Infection Research (DZIF). Other key partners in the European-African network included Stellenbosch University in South Africa and the Laboratory of Viral Hemorrhagic Fever (LFHB) in Benin. The scientists started by developing a special PCR test to specifically detect the Omicron variant BA.1. They then tested more than 13 000 respiratory samples from COVID9 patients that had been taken in 22 African countries between mid-2021 and early 2022. In doing so, the research team found viruses with Omicron-specific mutations in 25 people from six different countries who contracted COVID in August and September 2021 – two months before the variant was first detected in South Africa.

To learn more about Omicron’s origins, the researchers also sequenced the viral genome of some 670 samples. Such sequencing makes it possible to detect new mutations and identify novel viral lineages. The team discovered several viruses that showed varying degrees of similarity to Omicron, but they were not identical.

“Our data show that Omicron had different ancestors that interacted with each other and circulated in Africa, sometimes concurrently, for months,” explains Prof Drexler. “This suggests that the BA.1 Omicron variant evolved gradually, during which time the virus increasingly adapted to existing human immunity.” In addition, the PCR data led the researchers to conclude that although Omicron did not originate solely in South Africa, it first dominated infection rates there before spreading from south to north across the African continent within only a few weeks.

“This means Omicron’s sudden rise cannot be attributed to a jump from the animal kingdom or the emergence in a single immunocompromised person, although these two scenarios may have also played a role in the evolution of the virus,” says Prof Drexler.

“The fact that Omicron caught us by surprise is instead due to the diagnostic blind spot that exists in large parts of Africa, where presumably only a small fraction of SARS-CoV-2 infections are even recorded. Omicron’s gradual evolution was therefore simply overlooked. So it is important that we now significantly strengthen diagnostic surveillance systems on the African continent and in comparable regions of the Global South, while also facilitating global data sharing. Only good data can prevent policymakers from implementing potentially effective containment measures, such as travel restrictions, at the wrong time, which can end up causing more economic and social harm than good.”

Source: Charité – Universitätsmedizin Berlin

Categories : COVIDTags :

Apixaban Flops in HEAL-COVID Recovery Trial

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Image from Pixabay

A major UK-wide trial has found that the the oral anticoagulant apixaban does not help patients recovering from moderate and severe COVID compared to standard care – despite this approach being offered to patients.

To date, more than a thousand NHS patients hospitalised with COVID have taken part in HEAL-COVID, a platform trial that is aiming to find treatments to reduce the number who die or are readmitted following their time in hospital.

The trial’s preliminary results have shown that prescribing the oral anticoagulant Apixaban does not affect subsequent mortality or rehospitalisation of COVID over the following year (apixaban 29.1%, versus standard care 30.8%).

As well as being ineffective, anticoagulant therapy has known serious side effects, and these were experienced by participants in the trial with a small number of the 402 participants receiving apixaban discontinuing due to bleeding events.

There was also no benefit from Apixaban in terms of the number of days alive and out of hospital at day 60 after randomisation (apixaban 59 days, versus standard care 59 days).

Following these results, the trial will continue to test atorvastatin, which acts on other mechanisms of disease that are thought to be important in COVID.

Chief Investigator for the trial Professor Charlotte Summers is an intensive care specialist at Addenbrooke’s Hospital and the University of Cambridge.  She said: “These first findings from HEAL-COVID show us that a blood thinning drug, commonly thought to be a useful intervention in the post-hospital phase is actually ineffective at stopping people dying or being readmitted to hospital.  This finding is important because it will prevent unnecessary harm occurring to people for no benefit.   It also means we must continue our search for therapies that improve longer term recovery for this devastating disease.”

HEAL-COVID enrols patients when they are discharged from hospital, following their first admission for COVID.  They are randomised to a treatment and their progress tracked.

Source: University of Liverpool

Categories : COVIDTags :

Russia’s Estimated COVID Pandemic Toll In Excess of 1 Million

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A new study published in PLOS ONE estimates that over a million lives were lost in Russia to the COVID pandemic. In the study, the researchers also introduce an improved methodology for future pandemics, which counts a victim’s remaining number of expected years of life lost.

Calculating COVID pandemic mortality is crucial for future epidemiological and policy decisions. Getting a reliable estimate is however complicated by incomplete or inadequate registration data, difficulties in determining the primary cause of death, or challenges in tracking down indirect effects.

This is especially the case in Russia, where mortality estimates from COVID showed a high degree of uncertainty, with varying estimates reported by different studies within and outside of Russia. The country has also received international attention due to the especially high reported mortality compared to other parts of the world. To improve estimates on the human cost of the pandemic in Russia, an international team of researchers led by IIASA conducted the most detailed analysis on pandemic mortality in the country to date.

“While national figures show that excess mortality in Russia is perhaps among the highest in the world, there is a wide degree of regional variation that deserves further analysis,” says Stuart Gietel-Basten, a researcher at The Hong Kong University of Science and Technology and a coauthor of the study. “Such variation is key to devising better public health strategies to mitigate both the ongoing impact of COVID, and to rebuild and reshape health systems after the pandemic is over.”

The researchers used the concept of ‘excess mortality’ that looks at the difference between the actual number of deaths and what would have been expected if there was no pandemic. Unlike other measures, excess mortality includes deaths that may have stemmed from lockdowns, restriction on movement, postponed operations, and so on, giving a much more comprehensive and reliable estimate.

The team used the latest data released from the Russian Federal State Statistics Service and calculated excess mortality for Russia and its regions for 2020 and 2021, and for 2020 also assessing mortality by age, sex, and rural-urban residence. In 2020 and 2021, the researchers estimated over one million Russian lives lost to COVID.

“A number of researchers within Russia and outside had more or less similar estimates,” says Sergei Scherbov, lead author of the study and a researcher in the IIASA Population and Just Societies Program. “However, due to the advanced population projection methodology and software that we have developed at IIASA, we were able to make population projections for all regions, subdividing urban and rural populations, as well as gender and age groups. This allowed us to produce a very detailed estimate of excess mortality from COVID in Russia and its regions.”

One of the study’s main findings was that different regions within the country differed greatly in mortality. In 2021, excess deaths expressed as a percentage of expected deaths at the regional level ranged from 27% to 52%, with urban regions generally faring worse. The researchers suggested that apart from population density, socio-cultural, economic and, perhaps, geographic differentials could have contributed to the differences.

“Regions of the Northern Caucasus reporting high excess mortality are known for their tradition of elderly living in larger households of extended families together with their children and descendants,” explains Dalkhat Ediev, study coauthor and researcher in the IIASA Population and Just Societies Program. Such a tradition might have contributed to higher social exposure and, hence, higher losses.”

The study also introduced a new measure called the Mean Remaining Life Expectancy of the Deceased, showing how many years on average those whose death was among the excess deaths lost. They found that for Russia as a whole, an average person who died due to the pandemic in 2020 would have otherwise lived on average for a further 14 years.

“This finding disproves the widely held view that excess mortality during the pandemic period was concentrated among those with few years of life remaining — especially for females,” notes Scherbov.

The new and improved estimates will not only help policymakers in case of future decisions on mitigation strategies, but also take a major methodological step forward, helping us get a clearer view of pandemics in the future.

Source: International Institute for Applied Systems Analysis

Categories : COVID Healthcare Politics and RegulationsTags :

Supreme Court of Appeal Reverses Controversial Ivermectin Ruling

On By ModernMedia
Gavel
Photo by Bill Oxford on Unsplash

The Supreme Court of Appeal (SCA) has set aside a controversial supervisory order, granted in April 2021, compelling the South African Health Products Regulatory Authority (SAHPRA) to report back to court every three months on access to ivermectin for use in the treatment of COVID patients.

The court has ruled that there was no evidence to justify the order made by Pretoria High Court Judge Cassim Sardiwalla, that affected parties had not asked for the order, and that they had not been heard before he made it.

The judge had also failed to provide his reasons for making it, the court said.

The issue has its genesis in four applications, one by the African Christian Democratic Party in 2021 against SAHPRA seeking access to ivermectin for the treatment of COVID.

At that time, SAHPRA, which was wary of its use saying there was no reliable research to prove its efficacy, had already put in place its “controlled compassionate use” programme in response to reports of illicit ivermectin-containing products entering the South African market. The programme was stopped in May this year.

In terms of that programme, permission was granted to five importers of unregistered oral solid dosage forms of ivermectin. Health facilities were permitted to hold bulk stock but individual applications were still required. SAPHRA said it would monitor its use.

The ACDP and others approached the court for orders directing SAHPRA to remove restrictions and do “all things necessary to regulate and ensure the manufacture” of ivermectin until such time as clinical evidence demonstrated that it was not effective in the treatment of COVID.

The matter was settled along the same lines as SAHPRA’s programme.

But Judge Sardiwalla, in making the settlement agreement an order of court, also granted a “supervisory order”, putting SAHPRA under his judicial authority in respect of ivermectin.

SAHPRA and the Minister of Health applied for and were granted leave to appeal the order to the SCA.

Read the full judgment here

In heads of argument before the SCA, SAHPRA said its appeal concerned the propriety of the order directing an organ of state to report back to court and be subject to judicial supervision where the dispute had been settled and there was no evidence at all that SAHPRA and the minister would not comply with the settlement agreement.

“It was simply imposed without justification. The order constitutes a grave violation of the Constitution … it violates the rule of law, the right to a fair hearing and the principle of separation of powers,” it argued.

The judge, SAHPRA said, had improperly made findings on matters not in dispute and his written reasons for the supervisory order “do not constitute reasons at all”.

In the SCA ruling, Judge Clive Plaskett said Judge Sardiwalla had suggested to the parties that he “regarded himself as seized of all matters involving ivermectin” and had proposed the supervisory order.

Both SAHPRA and the minister indicated they would oppose this and filed further papers.

While the judge had indicated that he would hear the parties on 6 April 2021, his registrar had informed SAHPRA’s attorney that morning that he had made a decision, he would not hear arguments, and he would send his order to the parties shortly.

No reasons accompanied the order.

SAHPRA and the minister asked for reasons but when these were furnished, they made no mention of the supervisory order or why he granted it.

Judge Plaskett said the first difficulty with the order was that Judge Sardiwalla had not given SAHPRA and the minister a hearing despite knowing that they did not agree to it.

“He agreed to a hearing but inexplicably changed his mind. In these circumstances, an oral hearing was, without doubt, essential.

“Courts decide matters, particularly opposed matters, in open court and the exceptions to this rule are limited.”

Judge Plaskett said the fact that the order had not been applied for by any party required that it be set aside.

He said, further, there was a complete absence of evidence to justify it.

“Important as supervisory orders may be in appropriate cases, the granting of this type of relief must be carefully considered – and justified on the facts – particularly because of its separation of powers implications.

“In this case, not only was there no evidence as to the necessity of a supervisory order but the fact that SAHPRA and the minister had settled the matter and agreed to an order suggests that there was probably no necessity for one.

“Had he allowed the parties to argue the matter, he would have been informed of the separation of powers problem …

“Finally, it strikes me as telling that the reasons he furnished made no mention of the supervisory order – and this despite being pertinently asked to furnish reasons on this very issue,” Judge Plaskett said, upholding the appeal, and setting aside the order.

The ACDP originally opposed SAHPRA’s appeal but shortly before the SCA hearing, it withdrew its opposition on the basis that no cost order would be made against it. The SCA therefore did not order costs.

The ivermectin programme was stopped in May this year.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : COVID Metabolic DisordersTags :

More Metabolic Imbalances in Paediatric T1D Diagnoses in the Pandemic

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Photo by Towfiqu Barbhuiya on Unsplash

During the COVID pandemic, significantly more children and young people had already developed diabetic ketoacidosis when diagnosed with type 1 diabetes (T1D) than in previous years. These findings were reported in The Lancet Diabetes & Endocrinology,

If children and young people have already developed metabolic imbalances (diabetic ketoacidosis) at the time of diagnosis of T1D, this can result in complications such as extended stays in hospital, poorer long-term control of blood sugar levels, brain enema, or even a higher mortality rate.

During the COVID pandemic, diabetes centres around the world saw an increased prevalence of diabetic ketoacidosis in diagnosed cases of T1D. DZD researchers, together with international colleagues, investigated whether the number of diabetic ketoacidosis cases associated with the diagnosis of paediatric T1D increased more than expected. To achieve this, they analysed the number of diabetic ketoacidosis cases before and during the pandemic.

The team evaluated data from 13 national diabetes registers, with 104 290 children and young people aged between 6 months and 18 years old who were diagnosed with T1D between 1 January 2006 and 31 December 2021. The observed prevalence of diabetic ketoacidosis during 2020 and 2021 was compared with predictions based on the years before the pandemic (2006–2019).

Increase greater than expected

Between 2006 and 2019, 23 775 of 87 228 children had diabetic ketoacidosis when diagnosed with T1D (27.3%). The mean annual increase in the prevalence of diabetic ketoacidosis for the entire cohort between 2006 and 2019 was 1.6%. During the pandemic, the numbers were significantly above the predicted prevalence. In 2020, the adjusted observed prevalence of diabetic ketoacidosis was 39.4% (predicted prevalence 32.5%) and 38.9% in 2021 (predicted prevalence 33.0%).

“The increasing prevalence of diabetic ketoacidosis associated with the diagnosis of type 1 diabetes in children is a global problem. There was already an increase in prevalence before the COVID-19 pandemic. During the pandemic, this increase was even greater,” notes DZD scientist Prof. Reinhard W. Holl from Ulm University.

The authors suggest that providing a comprehensive explanation of the classic symptoms of T1D in childhood to the general public, those active in the childcare or daycare settings, and primary care physicians could help raise awareness of the symptoms of T1D. Furthermore, public health measures could be used, eg, implementing a general islet-cell autoantibodies screening program for children to reduce the number of dangerous metabolic imbalances.

Source: Deutsches Zentrum fuer Diabetesforschung DZD

Categories : COVIDTags :

Omicron Variant Transmitted Through Quarantine Hotel Wall Defects

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Image from Pixabay

A study of COVID transmissions in a Taiwanese quarantine hotel revealed that SARS-CoV-2 can spread through cracks in walls and floors, according to findings published in Emerging Infectious Diseases.

The researchers investigated a cluster of SARS-CoV-2 infections in a quarantine hotel in Taiwan in December 2021. This happened amidst a succession of outbreaks in quarantine hotels involving the Omicron variant. The cluster involved three patients who lived in nonadjacent rooms on different floors, and who had no direct contact during their stay.

All three had tested negative by RT-PCR for SARS-CoV-2 within 72 hours before arrival to Taiwan and by deep-throat saliva RT-PCR upon arrival at the airport. None had left their rooms at any point during the stay in the hotel. No other guest or staff member at the hotel had tested positive since the month prior to the start of the investigation.

By directly exploring the space above the room ceilings, the researchers revealed residual tunnels, wall defects, and truncated pipes between their rooms. To see how the rooms were interconnected, they performed a simplified tracer-gas experiment, using ethanol. Aerosol transmission through structural defects in floors and walls in this poorly ventilated hotel was the most likely route of virus transmission.

This event demonstrated the high transmissibility of Omicron variants, even across rooms and floors, through structural defects. “Our findings emphasise the importance of ventilation and integrity of building structure in quarantine facilities,” the authors concluded.

Categories : COVIDTags :

The Need for Long-COVID Rehabilitation in South Africa

On By ModernMedia
Photo by Alex Green on Pexels

By Ufrieda Ho

“I think I’m in trouble,” came the message through to Professor Veronica Ueckermann one evening during the first surge of COVID-19 in South Africa in the winter of 2020. It was a distressed call made by a 48-year-old theatre nurse who worked alongside Ueckermann in the ICU frontline. Ueckermann, who is also a professor of internal medicine at the University of Pretoria and an ICU specialist, shifted into high gear with other doctors to save their colleague who was diagnosed with COVID-19.

They succeeded.

But what they didn’t know then was that months later the nurse would be ailing from ongoing medical symptoms put down to the catch-all of long-COVID.

“It’s a case study, but it was also very close to my heart,” says Ueckermann, who has become a specialist and researcher on the long-term effects of COVID. She recently presented on long-COVID during a webinar of the South African Academy of Family Physicians. “The nursing sister had numerous comorbidities, including a raised BMI, diabetes, hypertension, and asthma. When her symptoms didn’t get better, the hospital just wanted to have her medically boarded because they couldn’t be sure when she would be well enough to work again,” says Ueckermann.

She is cautious too, pointing out that there’s still little definitively known about long-COVID and new research is only in its infancy. Much of the difficulty lies in the wide-ranging symptoms and how individuals are affected. There are also varying recovery times, different underlying conditions and susceptibilities, and the reality that many people are simply not diagnosed. It makes the term “long-COVID” an umbrella term for everything from brain fog or mental confusion and fatigue to depression and shortness of breath and chest pains. Others also describe general body aches and continued loss of smell and taste.

The post-COVID condition

In October 2022, the World Health Organization (WHO) released a factsheet that states that between 10% and 20% of people who are diagnosed with COVID-19 continue to have symptoms beyond three months of first getting ill and develop what the WHO refers to as post-COVID condition. Many more people say symptoms plague them still even after nearly two years.

“The condition can be debilitating, causing disabling symptoms and functional deficits. It can significantly impact people’s ability to work, engage and participate fully in family and community life. Mental health effects can directly result from long-COVID, but may also develop due to prolonged suffering and distress caused by the condition,” reads the WHO factsheet.

The WHO’s recommended treatment, however, is non-specific, stating: “Post-COVID-19 condition can be supported with help from their families, peers, employers, and the community and they can also benefit from tailored rehabilitation.”

According to the National Institute for Communicable Diseases (NICD), “Every long-COVID patient is different, as such, every patient will need treatment specific to their symptoms which can be managed by their family doctor or clinic. There are no drugs to prevent long-COVID. Long-COVID is not a contraindication to vaccination, and COVID-19 vaccination may even sometimes improve long-COVID symptoms. Long-COVID is treated by slow, stepwise rehabilitation, and appropriate management of symptoms.”

Greater awareness and education needed

Ueckermann agrees with the WHO’s call for greater awareness and education so patients feel heard and supported. Many people resort to joining online support groups through platforms like Facebook. They share their challenges and stories and give each other support when they feel misunderstood and frustrated that they can’t get well and doctors can’t help. Ueckermann says there needs to be help for patients’ individual needs because not finding solutions will add to mounting pressure on the healthcare system.

“Because of COVID disruptions, many cancers are now presenting at later stages. There are cases of TB and other illnesses that were neglected. And now we have long-COVID that requires diagnosis after diagnosis for exclusion so all of this drives up costs,” she says.

lung There are other associated costs for people who cannot work or are performing sub-optimally trying to work while feeling unwell. Children affected by long-COVID do worse at school and lose interest in their sports and other activities that they used to enjoy, she says.

Last year, Spotlight reported on a dedicated long-COVID clinic at Groote Schuur Hospital in Cape Town. As far as we could establish, such specialised long-COVID clinics are very rare in South Africa.

“Long-COVID remains inaccurately defined and as a result, standard treatment guidelines for the condition as a whole have not yet been developed,” says Foster Mohale, Spokesperson for the National Department of Health. “However, standard treatment guidelines to address the symptoms and conditions associated with long-COVID are in place,” he says. “These guidelines guide assessment and treatment, and provide criteria for referral from primary healthcare to more specialised services.”

Mohale adds that the burden of disease is of “enormous concern and needs to be better understood and quantified”. But says the department’s data shows that visits by adults to public sector primary healthcare facilities remain below pre-pandemic levels, which suggests that any increase in the burden of disease has not resulted in an increased burden on health services. He also emphasises the need to have up-to-date vaccinations, adding that “people who are vaccinated are less likely to develop long-COVID”.

Research ongoing

Ueckermann says it’s a positive development that as awareness is growing, so are studies, including studies by the Medical Research Council and many of the country’s universities. She says scientists are looking at everything from the role of green tea extracts and the use of SSRIs (Selective serotonin reuptake inhibitors) that are commonly used to treat depression.

“These are all ongoing studies, so we have to wait to see the data coming through but it’s promising that everyone is trying to understand exactly what this long-COVID is and the most important thing is that we continue making this a greater area of priority in healthcare,” she says. It matters for the growing number of patients, or for her colleague who she says still needs help to get from “doing better,” to fully recovered.

Republished from Spotlight under a Creative Commons 4.0 Licence.

Read the original article here.

Categories : COVIDTags :

GroundUp: Vaccine drive is Running out of Steam

On By ModernMedia
Covid vaccines
Photo by Mat Napo on Unsplash

By Daniel Steyn

Daily COVID vaccinations have more or less plateaued since July. At the peak of the vaccination drive, South Africa was administering up to 240 000 vaccine doses a day. But this number has dropped to just over 5000 a day. Less than half of these are first doses and a third are booster shots.

The government still hasn’t reached its target of 67% adult vaccination, which it wanted to achieve by the end of 2021. Half of the adult population in South Africa is currently vaccinated. Among adults 60 years or older, nearly 73% have been fully vaccinated.

GroundUp visited the District Six Community Day Centre, a government clinic, in Cape Town. We asked for a COVID vaccine and were directed to a small room on the first floor, where one of us waited over 1.5 hours to get a vaccine (though two of us were vaccinated considerably quicker – about 30 minutes). This wasn’t because there was a long queue.

The nurse administering the vaccines was busy treating patients elsewhere in the clinic. The person logging the vaccines on the computer system told GroundUp that on average, 12 people a day come to the clinic for vaccines.

GroundUp visited a Clicks store in Cape Town where, three months ago, vaccines were still being administered. But they no longer do COVID vaccines.

The government’s dedicated Coronavirus website has a list of “active vaccination sites”, many of which are no longer active, and the “Find My Jab” page has completely different information.

Meanwhile, people are still getting ill from the virus. About 2000 new cases are reported each week, but according to the National Institute for Communicable Diseases (NICD) only 16% of cases are being detected. Testing sites are also few and far between.

Professor Glenda Gray says that the vaccine has done a good job at reducing deaths, serious illness and hospitalisations. Official daily deaths and hospitalisation rates are low in relation to previous waves. In the past four weeks, 125 deaths from COVID were reported.

The real number of deaths is likely much more than this. A weekly report published by the Medical Research Council and the University of Cape Town calculates the number of excess deaths – the deaths above the historical average before COVID: there have been close to 50 000 excess deaths so far this year. While in earlier waves the researchers were able to estimate that 85% to 95% of these excess deaths were due to COVID, the changing nature of the epidemic has made it much harder to estimate how many of this year’s excess deaths are due to COVID.

More than 85% of COVID infections in the country are from the Omicron BA.5 variant, which is widespread and infectious but usually causes very mild illness.

To prevent serious illness and death, getting the vaccine and booster shots are still recommended. Gray says that it is especially important for immunocompromised people, such as people living with HIV, to get vaccinated.

“Sadly, the virus has done a far better job of generating immunity than our government, which continues to be maddeningly slow at getting the vaccine out,” says Professor Francois Venter, infectious diseases clinician and head of Ezintsha at Wits University.

Although being infected by and recovering from the virus does provide a level of immunity, getting a vaccine still greatly improves one’s protection against the virus.

“I think we were all hoping once we had immunity from either infection or a vaccine or two, it would be enough. But from what we are seeing internationally, new waves of COVID, while not killing people in the numbers we saw in 2020 and 2021, are still making people very sick,” Venter says.

Dr Nicholas Crisp, Deputy Director-General of the National Department of Health, is the coordinator of the national vaccination drive. He agrees the current status of the vaccination drive is “very disappointing”.

He says the vaccination program is being integrated into primary health care, targeting areas geographically where communities or segments of a community are not vaccinated.

To monitor and manage the pandemic, Crisp says the government is continuing with daily testing, gene sequencing and wastewater sampling. Crisp says that the government is preparing for the future of COVID as well as other potential pandemics.

Future variants of the virus could be more dangerous. “As long as there is transmission, there is going to be mutation,” Gray told GroundUp. How the virus mutates in the future is yet to be seen.

In the US, new bivalent vaccines designed to target the Omicron variant are already available. But, Gray says, there is not yet sufficient evidence that these work better than the current vaccines.

According to Crisp, the government is not considering any new vaccines. “We are not buying vaccines this year and may not buy vaccines next year,” he says.

South Africa still has 8 million doses of the Pfizer vaccine and 10 million doses of the Johnson and Johnson vaccine. He says paediatric Pfizer vaccines will be purchased with some of the credit that South Africa has with the Covax facility. These will be given to children who are immunocompromised.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp