A preliminary study recently uploaded on the medRxiv preprint server, researchers detail the detection and characteristics of the C.1.2 variant of SARS-CoV-2, which has not yet been assigned a variant of interest (VOI) status, but which could potentially have increased transmission and immune escape potential.
The researchers describe how they identified a new SARS-CoV-2 variant, C.1.2. The first detection of this variant was during the third wave of infections in South Africa from May 2021 onwards, and has also been detected in seven other countries around the world.
New SARS-CoV-2 variants are commonly associated with new waves of infection. Like several other variants of concern (VOCs), C.1.2 has accumulated a number of substitutions beyond what would be expected from the background SARS-CoV-2 evolutionary rate. This suggests the likelihood that these mutations arose during a period of accelerated evolution in a single individual with prolonged viral infection through virus-host co-evolution. Deletions within the N-terminal domain have been evident in cases of prolonged infection, further supporting this hypothesis.
C.1.2 contains many mutations that have been identified in all four VOCs (Alpha, Beta, Delta and Gamma) and three VOIs (Kappa, Eta and Lambda) as well as additional mutations. Many of the shared mutations have been associated with improved ACE2 binding or furin cleavage, and reduced neutralisation activity, raising concern about the transmission potential of this variant. The next step is determining the functional impact of these mutations and to find out if they give it a replication advantage over the Delta variant.
The C.1.2 lineage is continuing to grow, and as of 20 August 2021, there were 80 C.1.2 sequences in GISAID, and the variant has now been detected in Botswana and in the Northern Cape of South Africa. Note that this study is yet to have the peer review process completed.
An article in Science explores the evidence for the animal origin of COVID, which was first detected in December 2019, but inferred to be present in Hubei province, China, for about a month beforehand.
The current COVID epidemic can be better understood by examining the severe acute respiratory syndrome coronavirus (SARS-CoV) outbreak which began in 2002. Investigations later found that horseshoe bats (Rhinolophus) in China harboured related coronaviruses. It was inferred that a sarbecovirus circulating in horseshoe bats seeded the progenitor of SARS-CoV in an intermediate animal host, most probably civet cats Although other possible intermediate hosts for SARS-CoV were identified, it is a population of civet cats within markets that appear to have acted as the conduits of transmission to humans from the horseshoe bat reservoir of SARS-CoV. Presumably a captive civet cat initially became infected by direct contact with bats or was infected before capture.
SARS-CoV-2 first emerged in Wuhan city, over 1500 km from the closest known naturally occurring sarbecovirus collected from horseshoe bats in Yunnan province. Coronaviruses genetically close to SARS-CoV-2 are circulating in horseshoe bats with wide geographic ranges indicate that the singular focus on Yunnan is misplaced. Confirming this assertion, the evolutionarily closest bat sarbecoviruses are estimated to share a common ancestor with SARS-CoV-2 at least 40 years ago, showing that these Yunnan-collected viruses are highly divergent from the SARS-CoV-2 progenitor.
Though the virus may have jumped to humans from direct horseshoe bat–to–human contact, a known risk for SARSr-CoVs, the first detected SARS-CoV-2 cases in December 2019 are associated with Wuhan wet markets. This is consistent with multiple animal-market–associated spillover events in November and December (9). It is currently not possible to be certain of the animal source of SARS-CoV-2, but it is notable that live animals, including civet cats, foxes, minks, and raccoon dogs, all susceptible to sarbecoviruses, were for sale in Wuhan markets, including the Huanan market (identified as an epicenter of the outbreak in Wuhan) throughout 2019.
Together, this suggests a central role for SARSr-CoV–susceptible live intermediate host animals as the primary source of the SARS-CoV-2 progenitor that humans were exposed to, as was the case with the origin of SARS.
Spillover events are not so rare, indicated by evidence of SARSr-CoV–specific antibodies in people living in rural areas, and even higher rates recorded in people living near bat caves. When exposed a densely packed human population, such as in Wuhan city, these spillover events have a much higher chance of resulting in substantial onward spread
Interestingly, the proximity of humans to wildlife may have been increased by demand for alternative meat sources caused by reduced availability of pork in 2019. This was caused by the African swine fever virus (ASFV) pandemic, which led to ∼150 million pigs being culled in China, resulting in a pork supply reduction of ∼11.5 million tonnes in 2019, and from which the country is still recovering. Increased use of cold-chain logistics in the wake of the ASFV pandemic means that frozen animal carcasses carrying SARS-CoV-2 may have been brought from much farther afield.
Once crossed over, SARS-CoV-2 readily established itself in humans by being a generalist, as opposed to being specialised for humans. Ironically, since humans are now the largest reservoir of the virus, animals in contact with humans are at risk of virus spillover. The article authors closed by stressing the need for much greater viral surveillance to spot emerging threats, as current coverage is extremely spotty.
In a study of more than 40 000 COVID cases, those infected with the delta variant have about twice the hospitalisation risk as those infected with the alpha variant. The findings were published in The Lancet Infectious Diseases.
The risk of hospitalisation or emergency hospital care within 14 days of infection with the delta variant was 1.45 times greater than the alpha variant. This is the first study reporting hospitalisation risk for the delta versus alpha variants based on cases confirmed by whole-genome sequencing.
Dr Gavin Dabrera, one of the study’s lead authors and a Consultant Epidemiologist at the National Infection Service, Public Health England, said: “This study confirms previous findings that people infected with Delta are significantly more likely to require hospitalisation than those with Alpha, although most cases included in the analysis were unvaccinated.”
The delta variant emerged in India in December 2020 and early studies found it to be up to 50% more transmissible than the alpha variant, which first appeared in the UK. A preliminary study from Scotland previously reported a doubling of hospitalisation risk with the delta variant over the alpha variant and it is suspected that delta is associated with more severe disease. The previous study used patients’ initial PCR test results and determined which variant they had by testing for a specific gene that is more common in the delta variant.
The researchers analysed healthcare data from 43 338 COVID-positive cases in England between 29 March and 23 May 2021. During the study period, there were 34 656 cases of the alpha variant (80%) and 8682 cases of the delta variant (20%). While the proportion of delta cases in the study period overall was 20%, it eventually encompassed two thirds of new COVID cases in the week starting 17 May 2021 (65%), effectively becoming the dominant strain in England.
Around one in 50 patients were admitted to hospital within 14 days of their first positive COVID test (2.2% alpha cases; 2.3% delta cases. After accounting for factors that are known to affect susceptibility to severe illness from COVID, including age, ethnicity, and vaccination status, the researchers found the risk of being admitted to hospital was more than doubled with the delta variant compared with the alpha variant (2.26-fold increase in risk).
It has been shown in multiple studies that full vaccination prevents both symptomatic infection and hospitalisation, for both alpha and delta variants. Indeed, in this study, only 1.8% of COVID cases (with either variant) had received both doses of the vaccine; 74% of cases were unvaccinated, and 24% were partially vaccinated. With the small number of vaccinated people being hospitalised, it is not possible to statistically compare hospitalisation risk between alpha and delta in such cases, so the results of the study apply to unvaccinated or partially vaccinated cases.
One of the study’s lead authors, Dr Anne Presanis, Senior Statistician at the MRC Biostatistics Unit, University of Cambridge, said: “Our analysis highlights that in the absence of vaccination, any Delta outbreaks will impose a greater burden on healthcare than an Alpha epidemic. Getting fully vaccinated is crucial for reducing an individual’s risk of symptomatic infection with Delta in the first place, and, importantly, of reducing a Delta patient’s risk of severe illness and hospital admission.”
Limitations to the study included some demographic groups possibly being more likely to seek hospital care, which could have biased the results, and there may have been changes in hospital admission policy during the period of the study, although adjustment for demographics and calendar time should have minimised such bias. The authors also did not have access to information about patients’ pre-existing health conditions, which are known to affect the risk of severe illness from COVID. By using age, gender, ethnicity, and estimated level of socioeconomic deprivation, they were able to account for this.
SARS-CoV-2 viruses (yellow) infecting a human cell. Credit: NIH
Dr Shankara Chetty, a general practitioner with a natural science background in genetics, advanced biology, microbiology and biochemistry, has been critically reviewing information that has arisen from observations of the COVID pandemic from around the world. Knowledge gained from a broad natural science background convinced him that there was a missing element in these reports. This is a summary of an article published in Issue 5 of Modern Medicine in 2020.
“A wealth of knowledge of hospital presentations, pathology and investigations has been generated, but there has been a distinct lack of information regarding initial presentation, progression and pathogenesis,” said Dr Chetty. Type 1 hypersensitivity reaction When COVID arrived in South Africa, Dr Chetty isolated himself so as to limit interactions with family and the public and erected a tented field clinic in his practice parking so as to be able to examine and follow up on every COVID patient without risk to his other patients. According to him he had a theoretical understanding of the possible pathogenesis but needed to verify his suspicions.
“From the examination, treatment and follow up of over 200 symptomatic COVID patients, it is my opinion that COVID illness has two aetiologies. It is initially a respiratory viral infection with typical symptoms, progression and outcomes over the initial 7 days. On around day 7, a Type 1 hypersensitivity reaction is triggered in those that are sensitive, leading to the sequelae typically seen on admission.
“This reaction causes the release of chemical mediators in the ling, resulting in inflammation, oedema, and in time, massive cell damage. The resultant cellular disruption is what triggers the ‘cytokine storm’ in an attempt to repair damaged cells and remove debris. This release of cytokine produces the variety of pathologies that are seen,” said Dr Chetty.
Rapid response to treatment His treatment protocol included the use of hydrochloroquine, azithromycin and doxyclcline to combat the viral component and antihistamines, leukotriene receptor antagonists and steroids, amongst others, for the Type 1 hypersensitivity reaction. This protocol produced consistent outcomes, no sequelae, and rapid recovery of all patients. In all, they had no deaths, no hospitalisations and recover of all patients, regardless of age, within 14 days.
“Outcomes of identifying and treating a Type 1 hypersensitivity reaction were most telling in the more severe dyspnoiec patients, with saturations below 85% on presentation that had improvement to over 95% in 24 hours, with outpatient management on room air, negating the need for oxygen or hospitalisation,” said Dr Chetty.
According to Dr Chetty, the rapid response to these medications used to treat Type 1 hypersensitivity reactions confirmed its existence. This could have some serious implications for the future management of the COVID pandemic. Monitoring for a hypersensitivity reaction and prompt treatment would decrease morbidity and mortality significantly.
SARS-CoV-2 viruses (yellow) infecting a human cell. Credit: NIH
Viral load as determined by cycle threshold (Ct) has limited utility in guiding decisions regarding isolation and quarantine of COVID patients, according to a study of COVID cases in university students.
Though some in vitro studies indicate that virus load levels in infected individuals affects the successful rate of virus transmission, whether the viral load carried at the individual level can determine transmissibility was unknown. In this study published in The Journal of Molecular Diagnostics, university students underwent regular testing and contact tracing after positive tests, and significant overlap in cycle thresholds (Ct) was found between spreaders and nonspreaders. This brings into question using Ct values to determine transmission rates, with even those with low viral loads able to transmit the virus. Real-time RT-PCR Ct values represent the number of amplification cycles required for the target gene to exceed a threshold level. Ct values are therefore inversely related to viral load and can provide an indirect method of quantifying the copy number of viral RNA in the sample; however, the use of Ct values as a proxy of viral load is influenced by the assay itself (correlation would stand in the linear dynamic range of the specific RT-PCR assay used) and factors within the sample matrix that can affect amplification efficiency
“We wanted to find whether there was a scientifically sound way to quickly triage students with potential high-risk exposure to COVID positive students for quarantine,” explained co-lead authors Patrice Delafontaine, MD, Department of Medicine, and Xiao-Ming Yin, MD, PhD, Departments of Pathology and Laboratory Medicine, Tulane University School of Medicine. “Some studies have found that the Ct value of the RT-PCR assay is a surrogate for infectivity, and cutoff Ct values have been proposed as a way to guide isolation practices. Through testing and contact tracing, we found that Ct value could not predict transmissibility. We should not overlook positive patients with low viral load, and all positive patients should be quarantined.”
A high-throughput SARS-CoV-2 surveillance testing program was established at Tulane University to support isolation and contact tracing efforts at the campus. Students were tested twice weekly and asked about symptoms they may be experiencing. Contact tracers spoke to all positive case subjects to identify close contacts. The study looked at 7440 patients who were screened between September 1, 2020 and October 31, 2020, among whom 602 positive cases were identified. From this group, 195 index cases were identified with one or more reported close contacts, who were then tested during their mandated 14-day quarantine period for evidence of transmission from the associated index cases. Of these index cases, 48.2% had at least one contact who became COVID positive, whereas 51.8% of the index cases were nonspreaders with no contacts who subsequently tested positive. Mean Ct values of the spreaders and the nonspreaders were nearly identical.
The researchers then reversed approach, where index cases were traced for 481 students undergoing quarantine due to known exposure to the disease. Eighteen percent of the students became positive during their quarantine. Index cases for the 481 quarantined students were considered spreaders if they were linked to one or more quarantine students with a positive test result, or nonspreaders if they were associated only with students with negative test results. Mean Ct values of the spreader and the nonspreader groups were similar.
The researchers next identified and evaluated 375 positive cases to assess the relationship between symptom presentation and Ct values. Reported symptoms included lethargy, fever, headache, cough, runny nose and gastrointestinal symptoms. Mean and median Ct values were lower in symptomatic cases than in asymptomatic cases, indicating a higher viral load, This suggests that infections with a higher viral load could more often lead to symptom development, or that symptomatic individuals tend to have higher viral loads or maintain their viral loads for a longer period of time. Ct levels may be useful at a population level, in association with symptomatic presentation, to indicate the likelihood of transmission. These values may thus have epidemiologic or surveillance importance.
“Taken together, these index cases suggest that Ct values alone do not predict transmission risk and reporting of Ct values at the individual level, such as by setting a cutoff value of 32, would provide little diagnostic value for case management,” note Dr. Delafontaine and Dr. Yin. “A sensitive and robust SARS-CoV-2 diagnostic testing method is needed to effectively control viral transmission by maximizing the ability to identify and quarantine even those with a low level of virus.”
A review of surveys towards COVID vaccines in South Africa has revealed that there are multiple factors at work, with an underlying scepticism towards vaccines in general that appears to be growing in the very face of the pandemic.
The findings, published in Expert Review of Vaccines, highlight the multi-faceted and unique aspects of vaccine hesitancy in South Africa, such as men being more likely to reject a vaccine.
Vaccine hesitancy is not new; two years before the emergency of COVID the World Health Organization identified it as a top ten threat to health, underscored by outbreaks of preventable diseases such as measles.
A previous review of 126 surveys in 2020 found a global decline of COVID vaccine acceptance from 70% in March to 50% by October. Vaccine hesitancy has been an obstacle in South Africa for a long time: it was a factor in various measles outbreaks from 2003 to 2011, and it became more apparent during the nation-wide school HPV vaccination programme begun in 2014.
The researchers searched for surveys on COVID vaccine hesitancy in South Africa up until 15 March 2021, with sample sizes ranging from 403 to 75 518.
Unlike elsewhere, men are more hesitant In a survey by Ask Africa, men were more likely to distrust vaccines (39%) than women (26%). Of the women who would refuse, there was a higher percentage who would However, women were more likely to take the vaccine even if they thought it was unsafe. The authors cautioned that this result should be interpreted with caution; however, Department of Health deputy director Dr Nicholas Crisp also recently pointed this out, suggesting that more recent survey data helped inform his opinion. Curiously, this is in contrast to other COVID studies and other vaccine studies in general, which indicate that women are more hesitant than men when it comes to vaccines in general.
Age, race, education, geographical location Three of the studies found that age may be important, with older adults having less concerns and/or being more accepting of COVID vaccination.
The COVID-19 Democracy survey found that people 55 or older were more likely to take the vaccine (74%) compared to those 18 to 24 years old (63%). The same survey found that white adults were the least likely racial group to accept vaccination, with only 56% willing to be vaccinated compared to 69% of black African adults. Education was another factor, with just 59% of tertiary educated people willing to be vaccinated compared to 72% of this who did not complete high school.
Council for Medical Schemes (CMS) survey found that vaccine acceptance was higher (83%) in urban suburban settings compared to other settings (73% and 78%).
Doubts about safety significant Three rounds of Ipsos survey data showed a huge drop in acceptance from 64% in July/August and 68% in October to 53% in December. Of those not accepting, concern about side effects as a reason rose from 30% in October to 65% in December.
The Ask Afrika survey indicated that stopping the roll-out of the AstraZeneca vaccine early this year reduced both levels of trust in vaccine safety and confidence in the process.
Of particular concern were several surveys indicating South African antipathy to all vaccines; in the Ipsos surveys, about a quarter refusing COVID vaccines were also opposed to vaccines in general. Thus, this hesitancy to COVID vaccines, the authors suggest, is just the tip of the iceberg of South African vaccine hesitancy. Indeed, the Africa CDC survey indicated that at least one in five South Africans were less likely to get vaccinated in general than before the pandemic.
More research and targeted messaging needed Overall, the authors found about a third of the adult South African public is hesitant towards COVID vaccines. Age, race, education, geographic locations and possibly gender all influence the social nature of vaccine acceptance in South Africa.
The authors conclude that responding to vaccine hesitancy, including COVID vaccine hesitancy, requires a better understanding of the often complex and multi-layered issues influencing vaccination views and practices, and tailoring interventions accordingly. Individualistic, decontextualised, and ‘one-size-fits-all’ approaches are unlikely to have great success.
A new study published in JAMA Internal Medicinehas found that individuals infected with the virus are most contagious two days before, and three days after, they develop symptoms.
The study also found that infected individuals were more likely to be asymptomatic if they contracted the virus from a primary case (the first infected person in an outbreak) who was also asymptomatic.
“In previous studies, viral load has been used as an indirect measure of transmission,” explained Dr Leonardo Martinez, assistant professor of epidemiology at BUSPH, and who co-led the study with Dr Yang Ge, research assistant in the Department of Epidemiology & Biostatistics at the University of Georgia College of Public Health. “We wanted to see if results from these past studies, which show that COVID cases are most transmissible a few days before and after symptom onset, could be confirmed by looking at secondary cases among close contacts.”
The investigators performed contact tracing and studied COVID transmission among approximately 9000 close contacts of primary cases in the Zhejiang province of China from January 2020 to August 2020. ‘Close’ contacts included household contacts (individuals living in the same household or who dined together), co-workers, people in hospital settings, and riders in shared vehicles. The researchers monitored infected individuals for at least 90 days after their initial positive COVID test results to distinguish between asymptomatic and pre-symptomatic cases.
Of the primary cases, 89 percent developed mild or moderate symptoms, and only 11 percent were asymptomatic — and none developed severe symptoms. Household members of primary cases, as well as those exposed to primary cases more often or for longer time, had the highest infection rates among close contacts. But regardless of these risk factors, close contacts were more likely to contract COVID from the primary infected individual if they were exposed shortly before or after the individual developed noticeable symptoms.
“Our results suggest that the timing of exposure relative to primary-case symptoms is important for transmission, and this understanding provides further evidence that rapid testing and quarantine after someone is feeling sick is a critical step to control the epidemic,” Dr Martinez said.
Compared to mild and moderate symptomatic individuals, asymptomatic primary individuals were much less likely to transmit COVID to close contacts — but if they did, the contacts were also less likely to experience noticeable symptoms.
As the official COVID death toll in South Africa passes the 80 000 mark, the Department of Health is now shifting focus to addressing flagging vaccine demand.
The department said this will include making access easier, such as vaccinating at shops or places of work.
Another change would be providing transportation to vaccine sites to help those in underprivileged areas. One option being looked into is the introduction of home vaccinations and ‘pop-up’ sites in rural areas where travel is harder to come by and at busy commercial areas such as shopping centres.
The government also hopes for assistance from the religious sector, with the possibility of churches offering vaccines on a Sunday. Mosques, synagogues and other places of worship would also offer a ‘familiar environment’ where people feel comfortable receiving a vaccine.
Public awareness Social media will be heavily employed for vaccine promotion, and could incude online influencers and ambassadors to encourage vaccination. This could extend to identifying ‘apolitical’ vaccine champions relevant to the target group who have also great influence, such as celebrities and traditional leaders.
A number of awareness initiatives are being considered, including making use of channels such as social media and teachers to provide information to young people and counteract misinformation, as well as more traditional media efforts such as radio slots and signage.
Vaccine skepticism high in men Department of Health Deputy director-general Dr Nicholas Crisp, pointed out that South Africa has a particular problem with men not wanting to be vaccinated.
“This is not good,” Dr Crisp said. “It means that men are going to end up very sick and in hospital, and we don’t want that to happen just before Christmas.”
Mandatory vaccinations on the cards Health minister Dr Joe Phaahla warned of a very long road ahead as new cases continue to spike.
The ministerial advisory committee on COVID is now discussing the possibility of mandatory vaccination for certain groups of people, which could include healthcare workers and those professions spending time indoors with other people, according to the Sunday Times.
Scientists and health activists told the paper that the right to refuse a vaccine is outweighed by the health hazard of the pandemic.
The country would then be able to reopen and operate in a way as close as possible to the pre-COVID era, said leading vaccinologist Professor Shabir Madhi.
“In these settings, if people choose not to be vaccinated, they should be compelled to undergo testing every three or four days at their own expense,” he said.
While vaccinations don’t confer complete COVID protection, it is still significant, and more impactful if a greater proportion are vaccinated, Prof Madhi said.
A small interventional trial with 15 severely ill COVID patients showed an ‘astounding’ effect of fenofibrate as a treatment.
Recently, Professor Yaakov Nahmias’ team at the Hebrew University of Jerusalem (HU) reported that COVID causes abnormal accumulation of lipids, known to initiate severe inflammation through a process called lipotoxicity. In 2020, the researchers conducted lab testing of fenofibrate, a lipid-lowering drug, showing it both reduced lung cell damage while blocked virus replication. These results have since been confirmed by other studies, and in October 2020 an observational study was reported to support the original findings. This led to an interventional, single-arm open-label study to validate the findings.
The study recruited 15 severe-hospitalised COVID patients with pneumonia requiring oxygen support, who were given 145 mg/day of fenofibrate for 10 days in addition to standard care and continuously monitored for disease progression and outcomes.
‘Astounding’ results “The results were astounding,” Prof Nahmias declared. “Progressive inflammation markers, that are the hallmark of deteriorative COVID, dropped within 48 hours of treatment. Moreover, 14 of the 15 severe patients didn’t require oxygen support within a week of treatment, while historical records show that the vast majority severe patients treated with the standard of care require lengthy respiratory support,” he added.
No ‘silver bullet’ Fenofibrate is a well-known, FDA-approved drug for the treatment of hypertriglyceridemia, primary hypercholesterolemia, or mixed dyslipidemia and has a good safety profile. “There are no silver bullets,” cautioned Nahmias, “but fenofibrate is far safer than other drugs proposed to date, and its mechanism of action makes is less likely to be variant-specific.”
“All patients were discharged within less than a week after the treatment began and were discharged to complete the 10-day treatment at home, with no drug-related adverse events reported,” noted Professor Shlomo Maayan, head of Infectious Disease Unit at Barzilai, where the study was conducted. “Further, fewer patients reported COVID side effects during their 4-week follow-up appointment,” he added. These preliminary findings are promising for patients who severe the acute phase of severe COVID.
However, the researchers stressed that while the results were extremely promising, only randomised placebo-controlled studies can serve as basis for clinical decisions. “We entered the second phase of the study and are actively recruiting patients,” explained Prof Nahmias, noting that two Phase 3 studies are already being conducted.
The findings, which are currently under peer review, were released on Research Square.
A ‘meta-trial’ of 1100 hospitalised COVID patients requiring high-flow nasal cannula oxygen therapy suggests that prone positioning soon after admission can significantly reduce the need for mechanical ventilation.
While acute respiratory distress syndrome patients have been placed prone for years by critical care specialists, this study provides clinical evidence needed to support the use of prone positioning for patients with COVID requiring high-flow nasal cannula oxygen therapy.
The findings, published today in the Lancet Respiratory Medicine, were conducted on severely ill COVID patients between April 2020 and January 2021.
“Breathing in the prone position helps the lungs work more efficiently,” explained the study’s lead author Dr. Jie Li, associate professor and respiratory therapist at Rush University Medical Center. “When people with severe oxygenation issues are laying on their stomachs, it results in better matching of the blood flow and ventilation in the lungs which improves blood oxygen levels.”
Prof Li noted that several interventions are available to improve oxygenation in critically ill patients, but that there was little outcomes-focused clinical evidence to show that prone positioning prior to mechanical ventilation is beneficial.
Adult patients with COVID needing respiratory support from a high-flow nasal cannula agreed to participate in this clinical trial, and were randomly assigned to the supine or prone positioning groups. They were asked to stay in that position for as long as they could tolerate. Both positioning groups received high-flow oxygen therapy and standard medical management.
Patients were continually monitored to determine if mechanical ventilation was needed. This study’s data showed that patients in the prone positioning group were significantly less likely to require mechanical ventilation (33% in the awake prone positioning group vs 40% in the supine group).
Another study lead author, Stephan Ehrmann, MD, PhD, said that “for the clinical implications of our study, awake prone positioning is a safe intervention that reduces the risk of treatment failure in acute severe hypoxemic respiratory failure due to COVID-19. Our findings support the routine implementation of awake prone positioning in critically ill patients with COVID19 requiring high flow nasal cannula oxygen therapy. It appears important that clinicians improve patient comfort during prone positioning, so the patient can stay in the position for at least 8 hours a day.”
Reducing the need for mechanical ventilation cuts down on resources needed. “Ventilators can indeed save the lives of people who are no longer able to breathe on their own. That said, we now have strategies to keep patients off the ventilator, saving those devices for the sickest patients who truly need them.” Prof Li added.
