Category: COVID

Categories : COVID Healthcare Politics and RegulationsTags :

SA’s Top 10 Health Topics to Watch in 2022

On By ModernMedia
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Spotlight highlights the country’s top 10 health topics to keep an eye on in 2022.

1. COVID prosecutions
Former health minister Dr Zweli Mkhize resigned amid allegations of wrongdoing in the Digital Vibes scandal, and hit back at the findings of the Special Investigations Unit, which had also implicated a number of top health department officials. Whether Health Minister Dr Joe Phaahla  will take decisive action against those found guilty will be an important litmus test. Last year, Dr Phaahla assured the public that the department “is going to thoroughly and decisively act to ensure nothing is swept under the carpet”.

2. The NHI Bill
Public hearings on the National Health Insurance Bill will be done by the end of January, with feedback in February and final report by April 1. It then goes to the National Council of Provinces for a similar stakeholder process, and before the end of 2022 it could be signed into law.
To date, public inputs on the Bill were mostly on governance issues. A critical point this year is whether MPs will take these inputs on board and make significant changes to the bill, or whether they will simply force through the bill largely unchanged.

3. Medico-legal claims
With R74 billion in medico-legal claims against the state, the State Liability Bill is back on Parliament’s agenda. Instead of government departments paying a lump sum for successful medical negligence claims, the Bill proposes a new settlement structure of separate payments to relieve budgetary pressure on hospitals. Since the necessary final report from the South African Law Reform Commission is months away, Spotlight does not think the Bill will be passed this year – and first prize would be to prevent medico-legal claims from happening.

4. Healthcare budget cuts
Unfortunately, there is still no end in sight to continued budget cuts to healthcare. Employing more nurses could reduce medico-legal claims, but in fact there is a growing shortage of nurses. Even th Office of Health Standards Compliance is also hamstrung by inadequate funding, with only 61 inspectors to cover more than 5000 public healthcare facilities, putting off private sector inspections until next year.

5. HIV prophylaxis
With the extremely promising results of injectable pre-exposure prophylaxis (PrEP) for HIV, there is still a process to go through before it will be made available in South Africa this year. COVID has shown that processes can be sped up if there is the will, but whether there is the same drive to treat HIV remains to be seen. As such, PrEP will most likely only be available in public healthcare facilities by the end of 2023.

6. An end to the COVID pandemic
While South Africa is heading towards living with COVID as an endemic disease, it is impossible to predict what surprises the coronavirus will have in store for the world this year in the form of new variants. However, according to Director of the Medical Research Council, Professor Glenda Gray, the winter months will give us an idea of the direction the pandemic will take with a fifth wave. Vaccination will remain key to reducing its severity.

7. SA’s TB programme
COVID severely set back SA’s TB programme, but 2022 should see the arrival of a number of delayed initiatives. These include rollout of the relatively new 3HP prevention pills, the results of new X-ray detection technology and  consequent possible changes to screening and testing, and an update to the Thembisa HIV model which will now include TB.

8. The National Mental Health Policy Framework
The new National Mental Health Policy Framework and Strategic Plan are expected to be finalised this year. However, as with the NHI, funding remains a problem. Only 5% of the current health budget goes to mental health services, and it only provides for one in 10 of those in need.

9. Improved procurement legislation
As illustrated by the government’s COVID procurement debacle, an overhaul is needed. Draft Public Procurement Bill proposes a single regulatory framework for all goods and services procured by government departments and has the potential to strengthen and streamline procurement processes. However, Spotlight notes that critically important pieces of legislation can simply vanish, as did the Medical Schemes Amendment Bill of 2018.

10. No-fault compensation fund
The COVID vaccine injury no-fault compensation fund has quietly fallen off the radar, with no payouts made to date. However, the NICD again urged people to report adverse events with the vaccine.

Source: Spotlight

Categories : COVIDTags :

Over 50s Have Greater Risk of Reduced Mobility after COVID

On By ModernMedia
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Adults over 50 with mild or moderate COVID have increased risk of worsening mobility and physical function, even if hospitalisation is not required to treat the virus, new research has found.

The study, published in JAMA Network Open, highlights the burden of COVID among middle-aged and older adults who are not hospitalised, and suggests that even those who experienced even mild COVID have lasting, troublesome symptoms.

Researchers surveyed more than 24 000 people over the age of 50 from across Canada during the initial phase of the lockdown in 2020 to determine the effect of a COVID diagnosis on their mobility. 

The team looked at mobility issues including difficulty getting up from sitting in a chair, ability to walk up and down stairs without assistance and walking two to three neighbourhood blocks, as well as changes in participants’ ability to move around the home, engage in housework and physical activity.

“We found that even those with mild and moderate illness due to COVID experienced adverse changes in mobility and physical function compared to individuals without COVID,” said co-author Professor Susan Kirkland.

“These findings are worth noting because they indicate that the negative effects of COVID are much broader and impact a wider range of older adults than those who are hospitalised for COVID.”

Participants with COVID had nearly double the odds of worsening mobility and physical function, although most had mild or moderate symptoms. Of the 2748 individuals with confirmed, probable or suspected COVID, 94% were not hospitalised.

Individuals with confirmed or probable COVID had double the odds of worsening ability to engage in household activities and participate in physical activity than those without COVID. Similar results were found for those with suspected COVID.

“Our results showed there was a higher risk for mobility problems in people who were older, had lower income, those with three or more chronic conditions, low physical activity and poorer nutrition,” said co-author, assistant professor Marla Beauchamp.

“However, those factors alone did not account for the mobility problems we observed among people with COVID. Rehabilitation strategies need to be developed for adults who avoid hospitalisation due to COVID but still need support to restore their mobility and physical function.”

The researchers concluded that there is a need to further understand the long-term impacts of COVID and consider “the development and implementation of effective intervention and management approaches to address any persistent deficits in mobility and functioning among those living in the community.”

Source: Dalhousie University

Categories : COVIDTags :

Fourth Wave Ending as COVID Becomes Endemic

On By ModernMedia
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Speaking to  the media on Friday, Dr Joe Phaahla said that vaccinations had “uncontestably” lowered the rate of hospitalisations as seen by reduced hospital admissions in the fourth wave. saying that there has been a decoupling between new infections and hospital admissions and deaths. An article awaiting peer review on the medRxiv preprint server shows evidence of this in Cape Town.

Vaccinations were still lower than expected, despite a renewed vaccination drive from 17 December, a situation he attributed to people focussing on their festivities. As of Thursday, 45.5% of all SA adults had received at least one dose, with just under 40% being fully vaccinated. However, only 31.6% of 18–34 year olds have been vaccinated. About one million doses have been administered to the newly opened 12–17 year age group.

In an interview with eNCA, Dr Phaahla said that he concurs with experts that COVID is heading towards becoming an endemic disease, emphasising that South Africa is prepared for this. A new dashboard is to be unveiled which will show the number of vaccinated and unvaccinated in hospitals.

Dr Phaahla has also said that the issue of mandatory vaccinations is currently being deliberated by the government and that an announcement will be made in due course. In the US, the Supreme Court blocked President Biden’s vaccine mandate for large companies, which is seen as a significant blow to his administration’s COVID response plan.

The NICD’s Dr Michelle Groome said that almost 99% of all COVID cases sequenced are caused by Omicron. Gauteng, has exited the fourth wave with a low rate of new cases (1.4 cases per 100 000) and slight (2.2%) increase, likely attributable to increased testing. All other provinces had observed a decrease in weekly incidence of new cases, save Northern Cape (21.9 per 100 000, 18.3% increase). A 14.3% positivity rate was seen as of 13 January, down from highs above 35% in mid-December.

Test positivity rate had fallen from 25–30% in the last week of 2022 to 14% on Thursday.

Categories : Cancer COVIDTags :

Many Young People with Cancer Experiencing Distress in the Pandemic

On By ModernMedia
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A new study has reported that many adolescents and young adults with cancer are suffering high psychological distress during the COVID pandemic. During the pandemic, adolescents and young adults with cancer had an 85% higher odds of experiencing psychological distress compared with a similar group surveyed in 2018.

For the study, which was published in Psycho-Oncology, 805 individuals in Canada who were diagnosed with cancer between 15 and 39 years of age completed an online survey.  

More than two‐thirds of the group (68.0%) experienced high psychological distress. Additionally, those whose employment had been disrupted during the pandemic and those with blood cancer were more likely to experience high psychological distress, while those who were older and those with a personal income in 2020 that was less than $40 000 tended to have lower distress.  

The survey revealed overarching themes of pandemic experiences that included inferior quality of life, impairment of cancer care, COVID–related concerns, and extreme social isolation.  

“The pandemic has adversely impacted the mental health of adolescents and young adults with cancer,” said senior author Sapna Oberoi, MBBS, MD, DM, of the University of Manitoba. “The findings of this study underscore the importance of providing enhanced and tailored interventions to combat psychological distress among these patients. Cancer organisations and policymakers must prioritise mental health supports for adolescents and young adults with cancer to optimise their health outcomes and quality of life.”

Source: Wiley

Categories : COVIDTags :

Quebec to Impose Health Tax on The Unvaccinated

On By ModernMedia
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The Canadian province of Quebec will impose a health tax on residents not vaccinated against COVID. The province is experiencing a surge in cases, and its 12 028 deaths as of Tuesday are the highest in Canada.

The province’s Premier Francois Legault announced on Tuesday that it would be the first in the nation to financially penalise the unvaccinated.

Around 12.8% of Quebec residents are unvaccinated, yet make up nearly half of all hospital cases.

At a news conference, the premier said that people who have not had a first vaccine dose will have to pay a “contribution”, which will be “significant”.

“I think right now it’s a question of fairness for the 90% of the population who made some sacrifices,” Mr Legault said. “I think we owe them this kind of measure.”

The province also announced last week that proof of vaccination would be required to shop in government cannabis and liquor stores.

Death rates are similar to January 2021, before widespread vaccinations had begun in the province. Unvaccinated patients make up 45% of COVID ICU cases.

Hospitals in Montreal, the province’s largest city, are nearing 100% capacity and have already started limiting non-Covid related care. Quebec’s positivity rate stands at 20%.

Though such approaches are rare, some unvaccinated individuals in other parts of the world face penalties from their governments.

Greece is set to require those over 60 to pay a €100 (R1750) fine for each month that they remain unvaccinated. Austria is considering an even stiffer €7200 (R126 000) fine for unvaccinated individuals. Unvaccinated COVID patients in Singapore will also have to pay their own medical bills: with ICU stays, this has been estimated at a median of S$25 000 (R287 500).

Source: BBC News

Categories : COVIDTags :

Are Saliva Swabs the Best Way to Test for Omicron?

On By ModernMedia
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With the Omicron variant now dominating, a local study showed that, if confirmed, testing for COVID could be more accurate with much easier saliva sampling.

University of Cape Town researchers reported in a paper uploaded to medRxiv [PDF] that in Omicron cases, saliva samples yielded more accurate results in PCR analyses compared to nasal swabs.

With the Delta variant, on the other hand, nasal swabs were more accurate, according to the group, led by Diana Hardie, MBChB, MMedPath, who also heads the diagnostic virology laboratory at Groote Schuur Hospital.

The findings came from an analysis of 382 patients tested at Groote Schuur from August through this month, with viral whole-genome sequencing performed on isolates from those with positive results.

All patients had both saliva and mid-turbinate nasal samples taken for RT-PCR analysis. The ‘gold standard’ for positivity in the study was detection of SARS-CoV-2 RNA with either swab.

For the Delta variant, the positive percent agreement for each sampling method, in comparison with this ‘gold standard’, was 71% for saliva and 100% for the nasal swabs. But Omicron reversed the trend, with 100% agreement between saliva samples and the gold standard, but only 86% for nasal swabs.

COVID testing has used nasal swabs as standard since the discovery of the virus, but that may no longer be appropriate in an Omicron-dominated pandemic landscape, the authors concluded.

“These findings suggest that the pattern of viral shedding during the course of infection is altered for Omicron with higher viral shedding in saliva relative to nasal samples resulting in improved diagnostic performance of saliva swabs,” Hardie and colleagues wrote.

They noted, as have others, that Omicron is distinguished by “more than 50 distinct mutations.” While these increased infectivity, they could also have other effects, including the tissues it may prefer to infect.

The researchers cited a recent unpublished lab study from Hong Kong indicating that Omicron preferentially infects the upper airway. Not only does it suggest Omicron is less lethal, but also that the many mutations confer “altered tissue tropism.”

However, saliva sampling is not as simple as it sounds. At Groote Schuur, patients were instructed to swab the inside of the mouth for a total of at least 30 seconds. They were also told not to eat, drink, smoke, or chew anything for at least 30 minutes beforehand.

While most of the COVID testing kits in the US and elsewhere rely on nasal swabs, any change to saliva sampling would take months – by which time Omicron may have been displaced by another variant.

Source: MedPage Today

Categories : COVIDTags :

Living with COVID: SA’s New Approach

On By ModernMedia
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South Africa’s easing of COVID regulations at the end of 2021 set a new trend in how countries are choosing to manage the pandemic. In an article for The Conversation, Wits University’s Professor Shabir Madhi and colleagues reflect on the boldness – and the risks.

In a significant departure, the government is choosing a new, more pragmatic approach while keeping an eye on severe COVID and threats to health systems. This reflects a willingness to “live with the virus” without causing further damage to the economy and livelihoods, especially in a resource-constrained country.

Prof Madhi and colleagues hope that “the government continues to pursue this approach and doesn’t blindly follow policies that are not feasible in the local context, and ultimately yield nominal benefit.”

This more nuanced approach is a stark contrast to reflexive restrictions in response to rising case rates, suggesting the government has listened to commentary saying that the focus should be on whether health systems are under threat.

A high level of population immunity guides this approach. A sero-survey in Gauteng, just prior to the onset of the Omicron wave indicated that 72% of people had been infected over the course of the first three waves. Sero-positivity was 79% and 93% in COVID unvaccinated and vaccinated people aged over 50: a group that had previously made up a high percentage of hospitalisations and deaths.

The sero-survey data show that immunity against severe COVID in the country has largely evolved through natural infection over the course of the first three waves and prior to the advent of vaccination. This has, however, come at the massive cost of 268 813 deaths based on excess mortality attributable to COVID

Antibody presence is a proxy for underlying T-cell immunity which appears to play an important role in reducing the risk of infection progressing to severe COVID. Current evidence indicates that such T cell immunity, which has multiple targets and even more so when induced by natural infection, is relatively unaffected even by Omicron’s many mutations and likely lasts more than a year. This sort of underpinning T-cell immunity protecting against severe disease should provide breathing space for at least the next 6–12 months, and possibly further.

Despite Omicron’s anti-spike evasion, vaccine and natural infection induced T-cell immunity has been relatively preserved. This could explain the uncoupling of case rate to hospitalisation and death rates. Omicron’s mutations also appear to make it predisposed to infecting the upper rather than the lower airway, reducing the likelihood of progressing to severe disease.

In the meantime, they stress that greater vaccine uptake is ensured, along with boosters for high-risk groups.

Additionally, since low test rates mean only 10% of infections are actually documented in SA , isolation and quarantine are ineffective and a more pragmatic approach is necessary, the authors argued.

As the average person in South Africa could have 20 close contacts per day, contact tracing is of little value, and even symptomatic cases are most infectious in the pre-symptomatic and early symptomatic phase. The fact that three quarters of the SA population were infected over the course of the first three waves demonstrates how ineffective contact tracing and quarantine is.
They recommend that certain non-pharmacological interventions should be gradually dropped, especially hand hygiene and superficial thermal screening, while outdoor events should be allowed. Rather, government focus should remain on masking in poorly ventilated spaces and ensuring proper ventilation.

Mandatory vaccinations are still on the radar, since as well as the added risk to others that unvaccinated pose, there is the greater pressure they place on the health systems when they are hospitalised for COVID.

Attention also needs to be given to the management of incidental COVID infections in hospitals. The Department of Health guidance needs to be adapted to manage these patients with the appropriate level of care for the primary reason they were admitted. And patients with severe COVID disease require additional care and expertise to improve their outcomes.

Finally, an evaluation of both vaccination status and underlying immune deficiency needs to become a key element of the workup of hospitalised patients with severe COVID.

The authors stressed the need to minimise hospitalisations and deaths, without damaging livelihoods. SA’s Omicron wave death rate is about a tenth that of Delta, on par with pre-COVID seasonal influenza deaths – 10 000 to 11 000 per annum. TB caused an estimated 58 000 deaths in 2019.

While future variants are unpredictable, there is a trend towards lower rates of hospitalisation and death, especially if vaccine coverage can be increased to 90%, particularly in the over-50 age group. Omicron’s high infection rate will likely also contribute to future protection against COVID.

They note that while there is a risk of new variants, failure to change the pandemic mindset is another risk, as Omicron signals the end of COVID’s epidemic phase.

Past practices have had little effect, the authors concluded, and it is something that the SA government appears to have realised. Despite all the severe lockdowns, SA still suffered a high COVID death rate of 481 per 100 000.

Source: The Conversation

Categories : COVIDTags :

J&J Booster Shot Reduces Omicron Hospitalisation by 85%

On By ModernMedia
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Administering a booster shot of Johnson & Johnson’s COVID vaccine was found to be 85% effective in preventing serious illness in Omicron-dominated areas, preliminary results from a South African trial study show.

The South African Medical Research Council performed the study on health workers from 15 November to 20 December, but has not yet been peer-reviewed. It found the booster was effective in largely protecting staff as Omicron came to dominate the country.

“The increase in CD8+ T-cells generated by the Johnson & Johnson vaccine may be key to explaining the high levels of effectiveness against severe COVID disease and hospitalisation in the Sisonke 2 study, as the Omicron variant has been shown to escape neutralising antibodies,” Johnson & Johnson reported in a statement. That data showed that the booster jab “provides 85 percent effectiveness against hospitalisation in areas where Omicron is dominant/”

“This adds to our growing body of evidence which shows that the effectiveness of the Johnson & Johnson Covid vaccine remains strong and stable over time, including against circulating variants such as Omicron and Delta,” it continued.

Around half a million South African health staff have received Johnson jabs as part of clinical trials. South Africa has recorded more than 3.5 million cases and 94 000 deaths since the start of the pandemic.

An earlier South African study in December found the Pfizer/BioNTech vaccine to be less effective overall against Omicron, but still reduced hospital admissions by up to 70%.

Source: MedicalXpress

Categories : COVIDTags :

SARS-CoV-2: A ‘Predatory Virus’ That Raises All-cause Mortality Risk

On By ModernMedia
Source: CDC

SARS-CoV-2 is a “predatory virus” that appears to have multiplied the risk of death by a similar amount for most adults in the UK regardless of their underlying health status, according to new research published in PLOS Medicine.

The London School of Hygiene & Tropical Medicine (LSHTM)-led research team estimated excess mortality in the UK during Wave 1 of the COVID pandemic in nearly 10 million adults aged 40 and over. They then estimated and compared relative rates of all-cause mortality in people with and without more than 50 health and socio-demographic characteristics before the pandemic and during Wave 1.

The rate of death during Wave 1 increased on average by a factor of just over 40% (x1.4) for the study population compared to before the pandemic. This relative increase in the rate of death was surprisingly consistent across much of the population, regardless of health conditions and other characteristics.

However, before the pandemic, those with pre-existing health conditions such as heart disease or asthma had a higher mortality rate than those without a further mortality rate increase of 40% had a bigger absolute impact on them.

Exceptions included those with dementia and learning difficulties; both groups had approximately 3x the rate of death compared to people without the condition before the pandemic but approximately 5x the rate of death compared to people without the condition during Wave 1.

Non-white ethnicities were another exception: black people had 20% reduced rate of death compared to white people before the pandemic but a 50% increase in relative rate of death compared to white people during Wave 1. Also, those living in London also had a lower rate of death before the pandemic compared to people living outside of London, but substantially elevated relative rate during Wave 1.

Researcher co-leader, LSHTM’s Dr Helen Strongman, said: “Our work has shown that the threat posed by COVID increases evenly with frailty or ill health caused by ageing and a wide range of respiratory and non-respiratory medical conditions. This compares to flu, which also tends to be more dangerous in the elderly but also affects young children and is more strongly associated with respiratory conditions such as asthma, COPD and smoking.”

Whilst the health and demographic factors studied are known to be associated both with mortality in non-pandemic years and mortality due to COVID during the pandemic, this is the first time the two have been linked – analysing all-cause mortality rather than COVID-specific mortality. 

Dr Strongman said: “As we learn to live with COVID, we all need to be aware of and manage our own risk and that of others around us. Our study shows that SARS-CoV-2 is a predatory virus, amplifying mortality rates across the board, and having the biggest impact on those with existing ill health or who are frail. This emphasises how important it is for everyone to protect themselves and the most vulnerable in society through measures such as vaccination and wearing face masks. However, more basic research about why and how the virus exploits any vulnerability is needed.”

Dr Helena Carreira from LSHTM and co-lead author, added: “While we saw increases in the rate of death during the first wave of the pandemic across the population, our study also reinforced how COVID has disproportionately affected some groups, including people with dementia and learning disabilities, possibly through higher levels of exposure due to institutional or home-based care or occupation.”

Further research is needed to clarify whether there were differences across waves in the UK, especially for ethnicity, deprivation and other factors, and independent effects of individual health and demographic risk factors should be investigated.

Limitations include possible misclassification of the date of death for some individuals and the misclassification of health factors through incomplete information. However, the similarity of the results obtained from sensitivity analyses suggest only a minor impact on their findings.

Source: London School of Hygiene and Tropical Medicine

Categories : COVIDTags :

Why Omicron May Hit Other Countries Harder

On By ModernMedia
COVID heat map. Photo by Giacomo Carra on Unsplash

South Africa may have gotten off more lightly from Omicron due to widespread immunity from previous infection combined with vaccine coverage, researchers think, which may not bode well for other countries which have not completed their vaccination nor seen the worst COVID surges.

The South African Medical Research Council in collaboration with Discovery Health on Tuesday last week presented data from a large study showing  that South Africans infected with Omicron are, on average, less likely to be hospitalised, and recover faster, compared to the other variants.

Their study looked at more than 200 000 COVID cases in South Africa during a Delta-driven surge in September and October, and the start of the Omicron-driven surge in November, as that variant began increasing rapidly. About a quarter of the people in the study already have a chronic illness, putting them at higher risk of severe COVID.

The researchers found a hopeful trend: The risk of hospitalisation for adults dropped 30% during the early days of the Omicron surge from the levels seen there in September and October.

“The hospital admissions during omicron, standing at 58 per 1000 infections, are the lowest of the four COVID waves, and one-third of what we experienced during the delta surge,” said Discovery Health CEO Ryan Noach.

Why was this so? One explanation could be the immunity from COVID recovery present in the population. South Africa had experienced three huge COVID surges with low vaccination rates compared to the US and Europe.

When the Omicron variant appeared, only about a quarter of the population were vaccinated but the vast majority of residents had likely already been infected with previous variants of SARS-CoV-2. This was based on the excess mortality rate observed in the country through the pandemic, and so it is thought that South Africans likely had some immunity granted by infection.

“Thus, Omicron enters a South African population with considerably more immunity than any prior SARS-CoV-2 variant,” concluded Dr Roby Bhattacharyya, an infectious disease specialist, and epidemiologist William Hanage in a recent working paper. This means that most Omicron cases are likely to be reinfections, rather than first infections.
Other countries will not have as broad a ‘coverage’ of vaccination and previous infection as South Africa. Around 125 million Americans are unvaccinated, and a recent study estimated that about 20% of Americans had been infected with COVID from the start of the pandemic, up to August, 2021.

The data therefore suggest that a minimum of 20% of Americans who are completely ‘naive’, as scientists term it, when it comes to exposure to SARS-CoV-2.

Source: NPR