Category: COVID

Categories : COVIDTags :

COVID Test Sensitivity Changes with Circadian Rhythm

On By ModernMedia
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A new study suggests that the sensitivity of tests for SARS-CoV-2 vary throughout the day according to the body’s circadian rhythm, which could have implications for how the disease is managed.

Carl Johnson, Cornelius Vanderbilt Professor of Biological Sciences, wondered how the virus might act differently depending on the time of day and the body’s circadian rhythms, and collaborated with colleagues to determine if the percentage of people testing positive for COVID varies based on time of day. They found that people were up to two times as likely to have an accurate positive test result if they tested in the middle of the day compared to at night. Their findings were published in the Journal of Biological Rhythms.

The data support the hypothesis that COVID acts differently in the body based on our natural circadian rhythm, which has also been implied by studies of other viral and bacterial infections. COVID virus shedding, when infected cells release infectious virus particles into the blood and mucus, appears to be more active around midday due to modulation of the immune system by our biological clock.

“Taking a COVID test at the optimal time of day improves test sensitivity and will help us to be accurate in diagnosing people who may be infected but asymptomatic,” Prof Johnson said. Their results indicate that viral load is lower after 8 pm. If people choose to get tested at that time, there could be a higher chance of a false-negative result. False negatives can be harmful to the community and for the patient, who might not seek additional care due to their negative test result.

A difference in COVID viral shedding throughout the day would help inform treatment for the disease. As Johnson and his co-authors report, the peak shedding in the afternoon, when patients are more likely to interact with others or seek medical care, could play a role in increasing the spread of the virus in hospitals and the wider community.

Further research is needed to confirm the diurnal nature of SARS-CoV-2. Experimentally testing COVID patients to see if individuals shed the virus differently throughout the day would have important public health implications, Prof Johnson said.

Source: Vanderbilt University

Categories : COVIDTags :

Lateral Flow Tests now Approved for Travellers to England

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Fully vaccinated passengers arriving in England and most under 18s arriving from non red-list countries (which now includes South Africa) can use a lateral flow test (LFT) on or before day 2 of their arrival in England, the UK government has announced.

LFTs must be taken as soon as possible on the day of arrival in England or at the latest before the end of a passenger’s second day and can now be purchased from the list of private providers on GOV.UK from as little as £22 – significantly cheaper than PCR tests.

LFTs for international travel must be purchased from a private provider as NHS Test and Trace lateral flow tests cannot be used for international travel. Passengers who have already bought a PCR to use for travel do not need to buy another test as PCRs can still be used.

Passengers have to take a photo of their lateral flow test and booking reference supplied by the private provider, then send it back to them to verify the result. Failure to do so could result in a fine of £1000 (R20 000). It is also possible for passengers to book a test at some airport testing centres. People using PCR tests for travel will have their test reported by the company they purchase the test from.

Anyone who tests positive will need to isolate and take a confirmatory PCR test, at no additional cost to the traveller, which can be genomically sequenced to help identify new variants. PCR tests can be accessed free of charge by ordering in the usual way through NHS Test and Trace – via nhs.uk/coronavirus or by calling 119.  Test providers will be expected to advise people to self-isolate and direct people towards the NHS Test and Trace booking page.

In addition, all travellers must complete a passenger locator form beforehand, including providing a test booking reference number supplied by a testing provider.

However, these new rules apply only to those arriving in England: anyone travelling on to Ireland, Northern Ireland, Scotland, Wales, the Channel Islands or the Isle of Man within 10 days after arrival in England have to follow the rules for testing and quarantine in those places.

Those passengers who are not fully vaccinated with an authorised vaccine returning from a non-red list destination must still take a pre-departure test (antigen/PCR), a PCR test on day 2 and day 8 test and complete 10 days’ self-isolation (with the option of doing Test to Release on day 5).

Source: UK Government

Categories : COVID Mental HealthTags :

A Case of Three Teens with COVID and Psychiatric Symptoms

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A case study details three teenagers with mild or asymptomatic COVID presented with suicidal thoughts, “paranoia-like fears,” delusions and “foggy brain”, which could be explained by anti-neural antibodies – ‘turncoat’ antibodies that may attack brain tissue.

Mounting evidence points to neurological and psychiatric effects of COVID, with a UK study finding a 13% risk of a first-time diagnosis after COVID. The study, published in JAMA Neurology, is the first to look at anti-neural antibodies in paediatric patients previously infected with SARS-CoV-2.

Over five months in 2020, 18 children and teens were hospitalised with confirmed COVID at UCSF Benioff Children’s Hospital San Francisco, three of whom were the patients in the study who underwent neurological evaluations.

The researchers examined the patients’ cerebrospinal fluid (CSF) and found that two of the patients, both of whom had histories of unspecified depression and/or anxiety, had antibodies indicating that SARS-CoV-2 may have invaded the central nervous system. They also had anti-neural antibodies in their CSF, suggesting a rampant immune system accidentally targeting the brain.

The research follows a previous UCSF study that also found a high level of autoantibodies in the cerebrospinal fluid of adult patients with acute COVID, who experienced neurological symptoms, including intractable headaches, seizures and loss of smell.

“It is way too soon to know whether COVID is a common trigger for neuropsychiatric illnesses, but it does seem to be a potent trigger for the development of autoantibodies,” said co-corresponding author Samuel Pleasure, MD, PhD. “It is currently totally unknown whether patients predisposed to neuropsychiatric illnesses are more likely to develop worsened symptoms after COVID, or whether COVID infection can act as an independent trigger.”

Unlike most psychiatric presentations, the three patients in the UCSF study had symptoms with sudden onset and rapid progression, representing a marked change from their baselines, said co-first author Claire Johns, MD. “The patients had significant neuropsychiatric manifestations despite mild respiratory symptoms, suggesting potential short and long-term effects of COVID.”

After hospitalisations lasting weeks and ongoing psychiatric medications, the two UCSF patients, whose cerebrospinal fluid tested positive for SARS-CoV-2 antibodies and anti-neural antibodies, were treated with intravenous immunoglobulin, an immunomodulatory therapy that curbs inflammation in autoimmune disorders. After five days, the first patient had “more organised thoughts, decreased paranoia and improved insight.”

Autoantibodies targeting the protein TCF4 were also found, which has genetic links in some schizophrenia cases. However, “we don’t know that the antibodies are actually interfering with the protein’s function,” said co-corresponding author, Michael R. Wilson, MD, noting that the diagnosis of schizophrenia is based on a constellation of symptoms, not a biomarker.
The second patient partially responded to immunotherapy with improved cognition and working memory, but continued to have “impaired mood and cognitive symptoms” six months later. The third patient, with no psychiatric history and without SARS-CoV-2 antibodies or anti-neural antibodies in their cerebrospinal fluid, recovered with psychiatric medications. Their symptoms were attributed to recreational drug use.

In another case study, a 30-year-old patient with mildly symptomatic COVID who presented at a hospital emergency department with delusions, violent outbursts, hyper-anxiety and paranoia was unresponsive to antipsychotic medication but after being diagnosed with possible “autoimmune-mediated psychosis”, responded to intravenous immunoglobulin.

Nonetheless, the researchers agree it’s unlikely that there were pre-existing autoantibodies, and they point to other disorders with psychiatric symptoms, like anti-NMDAR encephalitis syndrome, that are caused by anti-neural antibodies and respond to treatment directed at these rogue antibodies.

The researchers agree that more study is warranted, although Dr Pleasure noted that the rarity of cerebrospinal fluid samples from paediatric patients is a challenge, as they rarely have severe enough COVID to warrant a lumbar puncture.

Source: University of California San Francisco

Categories : COVIDTags :

Up to 180 000 Health Workers may Have Died from COVID

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Between 80 000 and 180 000 health and care workers (HCWs) are estimated to have died from COVID between January 2020 and May 2021, the World Health Organization (WHO) said on Thursday.

That grim estimate features in a new WHO working paper based on the 3.45 million coronavirus-related deaths reported globally to the UN health agency up to May. The WHO warns it may well be an underestimate of 60%. To highlight the need for better protection, WHO was joined by global partners working to end the pandemic, to issue an urgent call for concrete action on behalf of workers in the sector.  

WHO Director-General, Dr Tedros Adhanom Ghebreyesus, said that “the backbone of every health system is its workforce.”

“COVID-19 is a powerful demonstration of just how much we rely on these men and women, and how vulnerable we all are when the people who protect our health are themselves unprotected”, he added.  

WHO and partners said that besides the deaths, more and more HCWs are suffering from burnout, stress, anxiety and fatigue. They are urging  equitable access to vaccines so that HCWs are prioritised.  

By the end of last month, on average, two in five HCWs were fully vaccinated, but with considerable differences across regions.

“In Africa, less than one in ten health workers have been fully vaccinated. Meanwhile, in most high-income countries, more than 80% of health workers are fully vaccinated”, Dr Ghebreyesus pointed out.  

For him, over 10 months since the approval of the first vaccines, “the fact that millions of health workers still haven’t been vaccinated is an indictment on the countries and companies that control the global supply of vaccines”.

Currently, 82 nations risk missing the target of vaccinating 40% of their population by year end, and 75% of those countries are faced with insufficient supply. The remainder have some limitations that WHO is helping solve.

Speaking to journalists via videolink, Gordon Brown, former UK Prime Minister and currently WHO’s Ambassador for Global Health Financing, said it would be a “moral catastrophe of historic proportions” if G20 countries cannot act quickly.

These nations have pledged to donate more than 1.2 billion vaccine doses to COVAX. According to WHO, so far, only 150 million have been delivered.  

With wealthy countries stockpiling millions of unused doses, close to expiration, Brown said they should start an “immediate, massive, concerted” airlift of vaccines to low income countries.  

If they do not, he argued, they will be guilty of an “economic dereliction of duty that will shame us all.”  

Brown also warned that “the longer vaccine inequity exists, the longer the virus will be present.”

Source: UN News

Categories : COVID Obstetrics & GynaecologyTags :

No Finding of Early Miscarriage Risk from COVID Vaccinations

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A new study has found no association between COVID vaccinations and risk of first-trimester miscarriages, providing further evidence of the safety of COVID vaccination during pregnancy. The findings were published in the New England Journal of Medicine.

Study co-author Dr Deshayne Fell said, “The study analysed several national health registries in Norway to compare the proportion of vaccinated women who experienced a miscarriage during the first trimester and women who were still pregnant at the end of the first trimester.”  Dr Fell, is Associate Professor in the School of Epidemiology and Public Health in the University of Ottawa’s Faculty of Medicine and a Scientist at the Children’s Hospital of Eastern Ontario (CHEO) Research Institute.

“Our study found no evidence of an increased risk for early pregnancy loss after COVID vaccination and adds to the findings from other reports supporting COVID vaccination during pregnancy,” the study authors wrote. 

“The findings are reassuring for women who were vaccinated early in pregnancy and support the growing evidence that COVID vaccination during pregnancy is safe.”

Dr Fell and colleagues found no relationship between the type of vaccine received and miscarriage. In Norway, the vaccines used included Pfizer, Moderna and AstraZeneca.

“It is important that pregnant women are vaccinated since they have a higher risk of hospitalisations and COVID-complications, and their infants are at higher risk of being born too early. Also, vaccination during pregnancy is likely to provide protection to the newborn infant against COVID infection in the first months after birth,” the study authors stressed.

Source: University of Ottawa

Categories : COVID VaccinesTags :

Creating a Cross-protective Coronavirus Vaccine

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Researchers have found that by targeting the core region of the spike protein receptor-binding domain, which remains structurally similar among SARS-related viruses, they can create a vaccine that offers cross-protection against SARS coronaviruses.

The COVID pandemic, caused by the β-coronavirus SARS-CoV-2, alerted the world to the seriousness of the threat posed by novel viruses. To protect against similar future outbreaks, there is an urgent need for broadly protective vaccines against SARS-related coronaviruses. In a recent study published in Journal of Experimental Medicine, a team of researchers led by Osaka University generated an immune antigen that was based on a conserved protein on the surface of SARS-related viruses. In mice immunised with this antigen, cross-neutralising antibodies against SARS-related viruses were elicited.

The coronavirus spike protein, specifically the receptor-binding domain (RBD) of spike protein that enables the virus to attach to host cells is a target for the development of neutralising antibodies, and a promising vaccine candidate. The RBD is made of two regions: the head, which is more immune-reactive and so has the most antibodies created for it, and the core. The head however changes more rapidly, while the core region is more stable amongst SARS-related viruses. Antibodies raised against this conserved core region of the RBD can therefore generate cross-protection against multiple SARS-related viruses.

As lead authors Ryo Shinnakasu and Shuhei Sakakibara explained, “The key to generating a vaccine that offers broad cross-protection among related viruses is to target a structure on the viral surface that is highly conserved. Our approach was to generate a vaccine in which the non-conserved region was masked from the immune system by the introduction of a carbohydrate molecule (or glycan) by a method known as glycan engineering. This would in turn expose the conserved core region of the RBD of spike protein.” When used to immunise mice, protective antibodies were induced that recognised the RBD core region not only of SARS-CoV-2 but also of other SARS-related viruses, such as bat SARS-like coronavirus, WIV1-CoV.

This finding is particularly promising because it demonstrates the potential for highly protective vaccines against various SARS-related viruses. As senior author Tomohiro Kurosaki warned, “Despite the existence of effective vaccines against current viruses, there is potential for the emergence of similar viruses in the future. This highlights the real need for broadly protective vaccines against SARS-related coronaviruses.”

The novel approach of vaccine design that they describe may help protect against a future global health crisis such as that experienced during the COVID pandemic.

Source: Osaka University

Categories : COVID Ethics and LawTags :

Inquiry Accuses Brazilian President of ‘Crimes Against Humanity’

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A draft of a major inquiry into the Brazilian government’s handling of the COVID pandemic has recommended that the country’s President Bolsonaro should be charged with several serious crimes over his actions.

The report will be the culmination of a six-month inquiry that has revealed scandals and corruption in the country’s government.

Excerpts leaked to the media indicate that the panel wants Bolsonaro to face nine charges, though initial recommendations that the president be charged with homicide and genocide against indigenous groups were dropped on Tuesday.

The massive and highly unusual 1200 page report urges charges of crimes against humanity, forging documents and incitement to crime. It blames Bolsonaro’s policies for the deaths of 300 000 Brazilians, about half of the current COVID death toll in Brazil, which is the world’s second largest. He repeatedly pushed unproven drugs such as hydroxychloroquine long after they had found to be ineffective.

Despite the serious allegations, what this means for Bolsonaro is unclear, according to the BBC’s South America correspondent Katy Watson.

The draft report will still have to be voted on by the Senate commission, where it could be vetoed and altered. Given the political realities of Brazil, it is unclear if these will ever lead to criminal charges.
President Bolsonaro has dismissed the Congressional inquiry as politically motivated, and has frequently spoken out against COVID interventions such as lockdowns, masks and vaccinations.

In March this year, he infamously told Brazilians to “stop whining” about COVID, a day after the country saw a record rise in deaths over a 24-hour period.

However, Mr Bolsonaro’s popularity has already been dented by the pandemic, and this report could make life much harder for him if he wants to run for a second term in Brazil’s 2022 elections.

Speaking to the BBC in advance of the publication of the report, the inquiry rapporteur, Senator Renan Calheiros, said that the panel wanted to punish those who contributed to “this massacre of Brazilians”.

Source: BBC News

Categories : COVIDTags :

SARS-CoV-2 Can be Detected in Aircraft Wastewater

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Australian researchers have found SARS-CoV-2 virus in wastewater samples from long haul flights arriving from outside the country, demonstrating that they can detect it even before passengers show symptoms.

The CSIRO and University of Queensland scientists worked with Qantas to show that wastewater surveillance can provide valuable data for public health agencies.

CSIRO lead author Dr Warish Ahmed said as global travel returns, testing wastewater of incoming flights could screen incoming passengers for COVID at points of entry.

“It provides an extra layer of data, if there is a possible lag in viral detection in deep nasal and throat samples and if passengers are yet to show symptoms,” Dr Ahmed said.

“The rapid on-site surveillance of wastewater at points of entry may be effective for detecting and monitoring other infectious agents that are circulating globally and provide alert to future pandemics.”

Co-author Professor Jochen Mueller from UQ’s Queensland Alliance for Environmental Health Sciences said wastewater testing could be a useful extra tool.

“The paper recommends that wastewater surveillance be used as part of an efficient clinical surveillance and quarantine system – providing multiple lines of evidence of the COVID infection status of passengers during international travel,” Professor Mueller said.

The study, published in Environment International, analysed wastewater samples from 37 Australian Government repatriation flights from COVID hotspots including India, France, UK, South Africa, Canada and Germany between December 2020 and March 2021.

The research found SARS-CoV-2 in wastewater samples from 24 of the 37 repatriation flights (65%) despite all passengers (except children under age five) having tested negative to the virus 48 hours before boarding. Virus is shed in the faeces of infected people about two to five days before showing symptoms.

Traces of SARS-CoV-2 can also be detected in wastewater from previously infected people who still shed the coronavirus, but are no longer infectious – although typically a weaker signal.

During 14 days of the passengers’ mandatory quarantine upon arrival in Australia, clinical tests identified only 112 COVID cases among the 6570 passengers (1.7%).

Monitoring of wastewater has a number of applications. Through its wastewater monitoring programme, the Durban University of Technology found that the recent unrest in South Africa was a superspreader event that drove up cases in KwaZulu-Natal.

Source: University of Queensland

Categories : COVIDTags :

Gauteng Vaccination Goals Under Threat

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Gauteng Premier David Makhura has stated that the province is not vaccinating enough people, which he acknowledged jeopardises its ambitious plans of having 70% of the population vaccinated by year end.

In a media briefing on Monday regarding the province’s vaccination rollout, he revealed that of Sunday, 5.3 million vaccines have been administered. More than 2.6 million people in Gauteng have been fully vaccinated. Gauteng’s infection rate has stabilised, with the number of active cases having fallen to approximately 1000. 

The Premier said that as things currently stand, there are still 4.4 million people in Gauteng that have to be vaccinated by the end of December. Makhura said that while they are still focussed on the target, it is becoming difficult to achieve, given the low numbers of people coming in for vaccinations.

“We are not retreating on our target of 70%, but the idea that we will meet 70% by mid-December is becoming a target that is elusive. The vaccination rate per day in Gauteng, on average during the week we are just between 52 and 58 000. We have fallen below the mid 60 000 daily vaccination rate. In September, we were doing extremely well. We were getting around 65-75 000.”

Based on last week’s total of 313 790 vaccinations, with 11 weeks in the year that would mean only about 3.5 million vaccinations administered – let alone persons fully vaccinated with a second dose. Concerns had been voiced at the end of September about flagging vaccination rates in South Africa as a whole.

Makhura also highlighted the low turnout of people in the province’s townships.

“Our townships are lagging behind. The substantial vaccinations are happening in more suburban areas, and the townships are lagging behind. Those townships in the south, Orange Farm and Palestine, we have the lowest number of vaccinations in the south of Johannesburg, that’s where we have 11% vaccination in terms of just single doses,” he said. 

Professor Bruce Mellado, of the Gauteng Provincial Command Council, said that, there was still a need to be cautious, especially with big events on the horizon, such as the municipal elections, saying:

“While the situation in the Gauteng Province remains stable and low risk, the risk of a fourth wave is very, very high. In fact, we predict that the fourth wave will hit sometime between November and January as we expect a number of super-spreader events to follow in a row. That’s something we have to have in mind.”

“We should not be confused or misled by the fact that we are currently in a situation of low risk, but that can change quite rapidly,” Prof Mellado cautioned.

Source: The South African

Categories : COVIDTags :

High-dose Heparin Reduces Mortality in Moderately-ill COVID Patients

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SARS-CoV-2 viruses (yellow) infecting a human cell. Credit: NIH

A high dose of heparin, an inexpensive and globally available medication, reduces mortality risk in hospitalised, moderately-ill COVID patients, suggests a new study led by St. Michael’s Hospital.

Appearing in the BMJ, the RAPID Trial compared a high, therapeutic dose of heparin to a prophylactic low dose for patients with moderate COVID and elevated d-dimer levels admitted to hospitals. D-dimers are protein fragments produced when a blood clot gets dissolved; higher levels indicate increased clotting risks.

The researchers studied 465 patients in hospitals around the world and found that while the therapeutic dose of heparin was not associated with a significant reduction in the study’s primary outcome, a composite of death, the need for mechanical ventilation or admission to intensive care, the dosing of heparin did reduce all-cause death in moderately-ill COVID patients admitted to hospital by 78%.

“Our study confirms therapeutic heparin is beneficial in patients who are on the ward with COVID, but other studies suggest it could be harmful for patients who are in critical care,” said Dr. Peter Jüni, Director of the Applied Health Research Centre at St. Michael’s and co-lead of the study.

Therapeutic doses of heparin are used for deep vein thrombosis or pulmonary emboli, whereas prophylactic, or lower, doses are used for patients admitted to Internal Medicine wards to prevent blood clotting while they are in hospital.

Several trials have investigated using blood thinners in COVID patients due to heightened inflammation and clotting in blood vessels caused by the virus. Dr. Michelle Sholzberg, Head of the Division of Hematology-Oncology and Director of the Coagulation Lab at St. Michael’s, and co-lead on the study, hopes this research contributes to a change in treatment guidelines for COVID patients.

“This is a once-in-a-million opportunity – heparin is inexpensive, globally available, and exists in every single hospital pharmacy cabinet right now,” she said. “It’s an opportunity to rapidly repurpose a drug available around the world.”

In particular, she said, the treatment could make a difference in areas where vaccine availability or coverage continues to be limited. Heparin is included in the WHO’s list of essential medicines.

The researchers hope to learn more from the data collected by analysing it further to address new questions, and are also considering revisiting patient outcomes to understand whether these therapies reduce the odds of long COVID.

Source: Unity Health