Category: COVID

Categories : COVID ImmunologyTags :

COVID Antibody Drugs Work Best with Immune Cells

On By ModernMedia

Research into the current antibody-based drugs for COVID treatment shows that they need to be designed to work in concert with immune cells to be effective.

Three drugs using monoclonal antibodies are approved by the FDA to treat COVID, which provide the patient’s body with ready-made antibodies faster than can be produced by their own immune systems.

The distinctive Y shape of antibodies comes from their two short arms, which latch on to foreign molecules to clear them out, and a long effector arm which interacts with immune cells, inducing them to attack infected cells and release molecules that modulate the immune response.

In antibody-dependent enhancement, the long arm of antibodies can interfere with immune cells, such as in tropical dengue fever. Immunity against one strain against dengue fever causes life-threatening illness if infected with the other strain.

To investigate the possibility of this in COVID, some companies altered the long arm of their antibodies to prevent interaction with immune cells. Other companies took the opposite approach and strengthened antibody effector functions to boost the potency of their drugs.

“Some of the companies removed the effector functions from their antibodies, and other companies are trying to optimise the effector functions,” said senior author Michael S Diamond, MD, PhD, the Herbert S Gasser Professor of Medicine. “Neither of these strategies is backed by data in the context of SARS-CoV-2 infections. Based on our findings, if you have a potently neutralising antibody without effector functions and you give it before infection, as a preventive, it will probably work. But if you give it after infection, it won’t work well; you need to optimise effector functions to get maximal benefit.”

“‘Effector functions’ refers to a complex set of interactions between antibodies and other elements of the immune system,” said Prof Diamond, who also is a professor of molecular microbiology and of pathology and immunology. “You can introduce different point mutations to augment certain kinds of effector functions, and some might be harmful to the immune response while others might be beneficial. There’s a lot of nuance. We are still learning how to harness effector functions so you get what you want but not what you don’t want.”

To find how antibody effectors work with COVID, the researchers took an antibody which was known to be effective against the virus and disabled the effector so it could not interact with immune cells.

They administered the original antibodies, the disabled antibodies and placebo antibodies each to a different group of mice, which were infected a day later with SARS-CoV-2. Both normal and disabled effector antibodies were able to protect against the disease. There were no signs of antibody enhancement of the disease, fortunately.

To find out whether the effector function was needed for treatment after infection, they infected mice with SARS-CoV-2 and administered one of the three sets of antibodies to mice  one, two or three days later. Only the original antibodies protected the mice from the disease. The tests were run in hamsters with the same results.

The researchers discovered in the study that losing effector functions changed the types of immune cells recruited to fight the COVID infection and the way they behaved.

Source: Medical Xpress

Journal information: Emma S. Winkler et al, Human neutralizing antibodies against SARS-CoV-2 require intact Fc effector functions for optimal therapeutic protection, Cell (2021). DOI: 10.1016/j.cell.2021.02.026

Categories : COVID Medical IndustryTags :

Over Half of SA Has Had COVID, Says Discovery CEO

On By ModernMedia

From the number of excess deaths in South Africa, it appears that over half of South Africa has been infected with COVID at least once.

The CEO and founder of the Discovery Group, Adrian Gore, has said in an interview on 702’s The Money Show that he believes over half of the South African population has had COVID. He believes that there is “absolutely no ambiguity” that the “sky high” excess death rates recorded in SA are attributable to COVID. He said that the excess deaths point to over 50% of the SA population having been infected with COVID so far.

The latest data released by the South African Medical Research Council (SAMRC) puts the number of excess deaths in SA over the course of the pandemic at 137 731 – nearly triple the official death toll from COVID. Nearly 5000 Discovery members and 12 staff members have died. 
Last week, SA National Blood Service released a study showing that 32% of people in the Northern Cape up to 63% of people in the Eastern Cape had contracted COVID. Gore said that this high infection rate would hopefully reduce the impact of the third wave predicted to arrive in the colder winter months.

“We are hoping that a third wave may take longer and might be less because we think the infection rate has been high.” He said, adding that if the first and second phases of vaccination targetting healthcare workers and vulnerable individuals was completed by mid-year, a third wave might be completely avoided.

He said that young, healthy people who can afford a vaccine should not be able to get one before those who were older and more vulnerable. “Not following this process would mean low-risk people get vaccinated before the clinically vulnerable, resulting in unnecessary illness and death. This cannot and should not happen,” he said in a Linkedin post.

He also refuted the rumour that Discovery was not paying contributions towards non-members’ vaccinations. In fact, he said on The Money Show, that medical aid schemes have extra cash to pay for this since members had been going for fewer treatments during the pandemic. This amounts to some R24 billion in surplus, as revealed by regulatory filings, which would be right in the middle of cost estimates for SA’s entire vaccination programme as opposed to the 30% amount that medical aid companies were being expected to contribute.

Source: Business Insider

Categories : COVIDTags :

Real-world Results for Pfizer Vaccine Match Trials

On By ModernMedia

Encouraging results have been reported from Israel, where the real-world efficacy of the Pfizer vaccine closely matches that seen in clinical trials.

Israel has engaged in the world’s most aggressive COVID immunisation schedule, with some 30% of its population vaccinated by late January with at least one dose.

Israeli health fund Clalit matched 600 000 vaccinated individuals to an equal number of unvaccinated individuals. Those who were vaccinated experienced a similar rate of positive COVID tests as was observed in clinical trial data, equating to a 94% effectiveness. Crucially, almost no severe cases of COVID were observed in vaccinated individuals. This pattern was also seen in the over-70s age group, which is generally underrepresented in trials.

Public health doctor Prof Hagai Levine said that high vaccination coverage of the most susceptible groups was key. However, he said that he could not give an answer as to what number needed to be vaccinated before containment measures could be eased. 

“We still don’t know what the impact is on transmission,” he said. But he added that “the vaccine is useful for personal protection”.

The greatest drop in cases was seen in the over 60s age group, and in areas which had been vaccinated, indicating that this was not the result of lockdown. However, many people still remain unvaccinated, resulting in tens of thousands of cases. Prof Segal noted that the fall in cases was not as rapid as had been hoped, due to the B.1.1.7 or UK strain becoming dominant in Israel.

“We still have to exit our lockdown very cautiously,” he warned, or else hospitalisations would spike again.

The fact that the same rate was observed in clinical trials is important news for other countries, which are watching to see the effects of Israel’s vaccination programme.

Source: BBC News

Categories : COVID General InterestTags :

The Second Vaccine Dose Can Hit Hard

On By ModernMedia

The scuttlebut among healthcare workers is that the second dose of a COVID vaccine hits much harder than the first – unless you’ve had COVID, in which case the first is equally as bad.

TJ Maltese, DO, a neurologist in private practice on Long Island in New York state, was fine with the first dose of the Moderna vaccine but was flattened by the second one.

Dr Maltese got his second jab on a Friday at 4:30 pm. Within two hours his arm was sore. Overnight, he developed flu-like symptoms, and on Saturday experienced chills and body aches, with a lingering fever. He could have pushed through if he’d had to work, he said, but he rode out his symptoms on his couch with the help of the occasional painkiller.

By 9 pm on Saturday evening, Dr Maltese started to feel better, getting a good night’s sleep and on Sunday was fine again.

“I know plenty of people with minimal symptoms after the second dose, so it’s not definite you’ll feel side effects,” he wrote in a Facebook post. “But be prepared for the possibility.”

Immunology and the phase III clinical trial data from the vaccine backs up the view that the second dose is worse, and some hospitals have even altered their scheduling to allow time for recuperation after the second dose. Adverse reactions to the BCG vaccine in Brazilian school children, for example, have been reported to be common with the second dose, though still rare.  

Immunologists and infectious disease experts interviewed by MedPage Today and who shared their second-dose experiences said it’s not unexpected that second-dose reactions are more intense than the first. Typical reactions to the COVID vaccines include fever, headache and fatigue as the immune system responds to a vaccine’s antigens.

“The first time the immune system comes into contact with something, it’s getting primed,” said Purvi Parikh, MD, an immunologist at NYU Langone Health in New York City. “That goes for everything, from vaccines to allergies. It’s rare on the first time to have a strong reaction. After that, the immune system recognizes it, so you have a much stronger reaction.”

“We saw it in the trials, so it’s really not surprising,” Parikh added. “Now we’re seeing it in real time as the vaccines are being rolled out.”

More adverse effects were reported after the second dose in both Pfizer’s and Moderna’s phase III trial data. For Moderna, the rates were 54.9% versus 42.2% for placebo after the first dose and 79.4% versus 36.5% for placebo after the second dose.

Stanley Weiss, MD, an infectious disease specialist and epidemiologist at Rutgers New Jersey Medical School, told MedPage Today that because his institution served as a Moderna trial site, the primary investigator was able to give an early update on what to expect following vaccination.

“They said there was a very high rate of fatigue after the second dose, so we encouraged administrators … to figure that many healthcare workers getting the vaccine might not be well enough to work the day after the second dose,” Dr Weiss said.

Drs Weiss and Parikh both experienced a stronger response to the second COVID dose. 

Zubin Damania, MD, aka ZDoggMD, said he was knocked out by the second dose of Moderna vaccine, joking on his show that, “I couldn’t sleep, I had a fever, rigors, body aches, a headache — full-on man-flu.”

Paul Offit, MD, said that he also experienced fever and fatigue after taking the second dose of the Pfizer vaccine.

“That reaction is less common in people over 65, and I’m over 65, so I’m thinking I’m not going to suffer that, but I did,” Dr Offit said.

Older people are not expected to have as intense a reaction due to their weaker immune systems. According to Dr Parikh, “The idea is that their immune system is not as robust as a young person’s.”
The same immunological underpinnings of why reactions to the second dose are worse also apply to those who’ve had COVID.
Victoria Arthur, MD, of Lexington Pediatrics in Massachusetts, had suspected she had contracted COVID in March 2020 but could not prove it. When she received the Moderna vaccine, she felt much worse than her colleagues.

“How I felt was how everyone else was describing their second vaccine,” Dr Arthur told MedPage Today. Within three hours of her jab, she was suffering from a headache, neck pain, and cognitive fog. She awoke at 3am with nausea and stomach cramps, and spent the whole of the next day in bed. 

“I’m always grateful when I have a reaction, that means the body is doing its thing,” she said. “I’m very fortunate to have been given the vaccine, so any side effect is worth it.”

In spite of the side effects, these health care professionals all expressed gratitude at having been vaccinated.

Dr Weiss said that people shouldn’t be discouraged by the side effects from the second dose and not get vaccinated: “The benefits greatly overwhelm the risk of side effects. It’s not a reason to delay.”

Source: MedPage Today

Categories : COVIDTags :

Research Shows ‘UK Variant’ is up to 70% Deadlier

On By ModernMedia

A review of research on the COVID variant B.1.1.7, also known as ‘the UK variant’, has shown it to be 30% to 70% more deadly than the original wild-type COVID strain.

Concerns over the deadliness of B.1.1.7 were raised in January, when the UK government’s New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) presented initial findings suggesting that B.1.1.7 cases were deadlier than non-variant cases. After this, they released an updated report which is available online. The report makes the cases that the earlier linked community testing and mortality data were all based on the same datasets, and so had the same biases. However, the group explained that the new analysis was more valid.

“More recent analyses have added a wider range of data sets and been able to control for additional confounders, increasing confidence in the association of the [variant of concern] with increased disease severity,” the group wrote.  

London School of Hygiene & Tropical Medicine found a relative hazard of mortality within 28 days was 1.58 for variant-infected individuals, while Imperial College London used a case-control weighting method to find a case fatality ratio of 1.36 for variant cases. Public Health England  found a “death risk ratio” of 1.65 in matched cohort analysis for variant cases versus non-variant cases.

A number of other studies investigated the variant’s impact on hospitalisation. Public Health Scotland used S-gene target failure as a proxy for variant case detection. They found that S-gene target failure cases had a higher risk for hospitalisation than the S-gene positive cases.
Some studies did not support the higher fatality risk, such as the UK’s Office for National Statistics (ONS), which said that “the number of deaths are too low for reliable inference.”

A number of limitations were reported in the study, including potential bias in case ascertainment, representativeness, unmeasured confounders and secular trends. They also tried to control for nursing home status in hospital reports, but not all of these could be excluded.

“There are potential limitations in all datasets used but together these analyses indicate that it is likely that … B.1.1.7 is associated with an increased risk of [hospitalisation] and death compared to infection with non-[B.1.1.7] viruses,” the group concluded.

In mid-January, modelling by the CDC indicated that the UK variant would become the dominant strain in the United States by March. At the end of January, President Joe Biden had pledged to increase vaccinations to 1.5 million per day, a target which would still not be able to contain the spread of the variant.

Source: MedPage Today

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Categories : COVID General InterestTags :

WHO Team in China Denied Key COVID Information

On By ModernMedia

The World Health Organization team sent to China to investigate the origins of the COVID virus have been frustrated in their efforts to secure key data.

Team member Dominic Dwyer, infectious disease expert, said that they had only been given a summary instead of the raw patient data that they had requested.

Raw, anonymised patient data is part of standard outbreak investigation, Dwyer said, and this was particularly important because half of the initial 174 patients had no contact with the wet market.

“That’s why we’ve persisted to ask for that,” said Dwyer. “Why that doesn’t happen, I couldn’t comment. Whether it’s political or time or it’s difficult.”

Although Wuhan is the site of the initial outbreak, China has sought to cast doubt on its origin there, pointing to a source outside the country that may have come in with frozen food.

US national security adviser Jake Sullivan said that he had “deep concerns” over the initial findings of the investigation, saying that “It is imperative that this report be independent, with expert findings free from intervention or alteration by the Chinese government.”

Peter Ben Embarek, the WHO delegation leader, said that the virus likely had an animal origin and may have taken a “very long and convoluted path involving also movements across borders”. The possibility that it may have travelled in frozen food is worth investigating, he added.

After their two week quarantine, the WHO team members were only allowed to go on visits organised by their Chinese hosts. Thea Kolsen Fischer, an immunologist and another WHO team member, said to the New York Times that she saw the investigation as “highly geopolitical”.

“Everybody knows how much pressure there is on China to be open to an investigation and also how much blame there might be associated with this,” she said.

Team member Peter Daszak, and president of the EcoHealth Alliance, said that it “was not my experience”.

“As lead of animal/environment working group I found trust and openness with my China counterparts. We did get access to critical new data throughout,” he tweeted.

“New data included environmental and animal carcass testing, names of suppliers to Huanan market, analyses of excess mortality in Hubei, range of Covid-like symptoms for months prior, sequence data linked to early cases and site visits with unvetted live question and answer.”

Source: The Guardian

Categories : COVIDTags :

SA to Expedite 80 000 Doses of J&J Vaccine

On By ModernMedia

South Africa will accelerate the rollout of the Johnson & Johnson vaccine, it has been reported.

SA has secured orders for 9 million doses of the vaccine, of which the first 80 000 are expected to arrive in the country next week. Since immunity with the Johnson & Johnson vaccine is achieved with a single dose, this will be enough for 9 million people in South Africa, barring some inevitable wastage. Results from clinical trials in South Africa show that the vaccine has an effectiveness of 57%, 28 days after vaccination.

Professor Linda-Gail Bekker at the Desmond Tutu HIV Centre, University of Cape Town, who was involved in a South African trial last year, explained that there is a delay between the results of a clinical trial and the licence being granted for commercial use. She has urged the need for rapid vaccine rollout, and had also tested positive for COVID herself along with her family during the festive season. As a stopgap measure, an interim vaccination plan with 80 000 doses will be put into action at 32 locations around the country.

Explaining the programme, Prof Bekker said: “Can we together bring this expedited plan forward so that we can make sure we, as quickly as possible, rollout phase one recipients – mainly healthcare workers – into a kind of emergency programme.”

Prof Bekker describes the expedited rollout as being different to a clinical trial.

She continued, “This is not clinical research in the clinical trial concept; it really is programme evaluation, and many eyes are on it at the moment to make sure that we have covered all aspects – ethical, safety and scientific. We will not move without those approvals.”

Source: Eyewitness News

Categories : COVID General InterestTags :

Chinatowns around the World Battle COVID and Xenophobia

On By ModernMedia

The BBC explores how the various Chinatowns around the world have been battling loss of business caused by COVID lockdowns, along with fear and xenophobia.

Sam Wo’s, a restaurant in San Francisco’s Chinatown, had been hit hard by COVID just like other businesses there.

The lockdowns had not yet happened but anti-Asian sentiment kept customers away. “All the Italian restaurants in North Beach were still busy and packed and then you went through the tunnel to Union Square and those guys had lines waiting to get in. And then you drive around Chinatown and it’s completely empty,”  Sam Wo’s co-owner Steven Lee told the BBC.

“So we know that xenophobia was affecting small businesses. Why would other districts be busy and we’re not?”

In the 12 months since, it has been forced to cut its staff numbers from 23 to three due to a lack of customers.

“People wouldn’t show up, they were just scared,” Mr Lee tells the BBC. “We had to rally and tell people to fight the virus, not the people and all this kind of stuff – but it didn’t help much.”

In the Japanese city of Yokohama, this went beyond mere avoidance; anti-Chinese notes were left on the doors of restaurants in March. Sales had plummeted to 10% of what they were the year before. The mayor of Yokohama railed against these notes, and locals voiced their support for their Chinatown, telling businesses to “hang in there” and promising to visit again.

In many Chinatowns, the lockdowns then worsened an already dire situation. 

“I know many businesses in Chinatown have closed. It’s terrifying,” Ying Hou, who runs Shandong MaMa in the Australian city of Melbourne, told the BBC. “There are gift houses where tourists come to buy souvenirs – most of them didn’t make it and have closed down.”

Ms Ying says her business is down 50%, but fortunately the shop is the only one in Chinatown to sell fish dumplings. Melbourne gave rent relief to many businesses, but this is now coming to an end. And now Melbourne is about to be plunged into a new five day lockdown surrounding the Australian Open. 

However, many are finding new answers to the problems posed by COVID. In New York, after Chinatown turned into a “ghost town” with the lockdowns closing down even essential businesses by May, Karho Leung took a page out of Hong Kong barber shops’ reactions to COVID and installed dividers and other measures. He advertised these safety enhancements, which went viral and resulted in a surge of business from pent-up demand.

Mr Leung added to his business and others that were struggling by embracing social media and online delivery companies such as Uber Eats. 
Organisations made up of ordinary citizens are also helping to keep their cities’ Chinatowns afloat as well. Send Chinatown Love is helping Chinatown businesses there with their online and social media presence to help generate business, creating “food crawls” to drum up foot traffic.

“Everything started happening around January, February of last year, which is the most lucrative and joyous and festive times for Chinatown. They took a hit with that business and lost most of it,” said Louise Palmer, who is a representative for the group. “So they ended up going into lockdown in March at a deficit, which kind of set a really terrible precedent for what the rest of the year would look like.”

Meanwhile, in San Francisco, in a hopeful development, business is picking up again since outdoor dining became allowed. Mr Lee said that Chinatown is booming again, and is planning to open a nightclub.

“We’re the oldest Chinatown in the country. We’re the tourist attraction that everybody comes to when they come to San Francisco. So we have to preserve it,” Mr Lee said.

Source: BBC News

Categories : Addiction COVIDTags :

Opioid Overdoses in US Increasing due to COVID

On By ModernMedia

The COVID pandemic has not seen a drop in the United States’ opioid crisis, rather there has been an exacerbation of the problem.

A study published in JAMA Psychiatry examined the impact that the COVID pandemic had on the US opioid crisis. 

Opioid misuse and addiction is an ongoing and increasing problem in the US, making up two thirds of overdoses. Some three million Americans have suffered opioid use disorder at some point. With approximately 100 million Americans living with chronic or acute pain, the situation is seemingly intractable. In 2019, there were 70 000 deaths from opioid overdoses, making it a top priority in public health, academic, and political debates. When the COVID pandemic hit, it did not displace the opioid crisis through distraction or somehow preventing access to opioids, it fanned the flames of it. 

Researchers analysed 190 million ED visits, and over March to October 2020. they observed an increase of  up to 45% in weekly opioid overdose admissions over the same period in 2019. Overall, ED visits for opioid overdoses had increased 28.8% compared to the previous year.

In September, the CDC warned that deaths from opioid overdoses were up by 38.4% in the first half of the year. The many stresses of the pandemic, such as its associated lockdowns and job losses and losing loved ones, has fuelled the opioid abuse. The same study also found that visits to the ED for mental health conditions, domestic violence, and child abuse and neglect increased over the same period of time, along with suicide attempts. 

Source: ABC News

Journal information: Holland KM, Jones C, Vivolo-Kantor AM, et al. Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic. JAMA Psychiatry. Published online February 03, 2021. doi:10.1001/jamapsychiatry.2020.4402

Categories : Ageing COVID General InterestTags :

Europe’s Oldest Living Person, 116, Survives COVID

On By ModernMedia

A 116 year old French nun who is Europe’s oldest living person has survived COVID after testing positive.

French nun Sister Andrée had tested positive for COVID in her retirement home in Toulon, but had remained symptom-free. Most of the 88 residents at the home contracted the virus, 10 of whom died. 

Sister Andrée, who is blind and in a wheelchair, said that her main complaint was the solitude necessitated by being confined to her room.
“I didn’t even realise I had it,” she told Var-Matin newspaper:

David Tavella, a spokesperson for the nursing home, told the newspaper that she had no fear of the virus.

“She didn’t ask me about her health but about her routine. She wanted to know for example if the meal and bed times were going to change. She showed no fear of the illness, in fact she was more worried about the other residents,” Mr Tavella said.

When asked by France’s BFM Television if she had been scared of having COVID, she responded: “No, I wasn’t scared because I wasn’t scared to die … I’m happy to be with you, but I would wish to be somewhere else – join my big brother and my grandfather and my grandmother.”

In addition to being Europest oldest living person, she is also the world’s second oldest living person. The oldest living person in the world is Kane Tanaka in Japan, who turned 118 on January 2. Having lived through the First World War as a child, Sister Andrée will turn 117 on Thursday.

Source: The Guardian