Category: COVID

Link Found Between Telomeres and COVID Lung Damage

Researchers developing a therapy to regenerate lung tissue damaged by severe COVID have postulated that shortened telomeres are associated with the damage.

Telomeres are structures at the ends of chromosomes that maintain their integrity, and a small portion of them are lost with each cell division, such as when regenerating damaged tissue. As the telomere sections shorten, they eventually become unable to divide and are senescent. The team was already working on a way to regenerate lung tissue in pulmonary fibrosis, and adapted their research to the COVID pandemic. In pulmonary fibrosis, lung tissue becomes scarred and rigid, resulting in reduced lung capacity. In previous research, they had shown that telomere damage to the alveolar type II pneumocytes – which happen to be the same cells targeted by SARS-CoV-2.

Maria A Blasco, a researcher at CNIO said, “When I read that type II alveolar pneumocytes were involved in COVID-19, I immediately thought that telomeres might be involved.” The researchers believe short telomeres hinder tissue regeneration after severe COVID.

Blasco explained, “we know that the virus infects alveolar type II pneumocytes and that these cells are involved in lung regeneration; we also know that if they have telomeric damage they cannot regenerate, which induces fibrosis. This is what is seen in patients with lung lesions after COVID-19: we think they develop pulmonary fibrosis because they have shorter telomeres, which limits the regenerative capacity of their lungs.”

To support this, the team analysed the telomeres of 89 COVID patients. Although it might be expected that older patients had shorter telomeres, the researchers found that all of those with severe COVID had shorter telomeres – regardless of age.

The researchers wrote: “These findings demonstrate that molecular hallmarks of aging, such as the presence of short telomeres, can influence the severity of COVID-19 pathologies.”The involvement of shorter telomeres opens up the possibility of using telomerase to lengthen them again, as a potential treatment.The team will now move to an experimental mouse model, infecting mice with short telomeres and no telomerase with COVID, giving telomerase to some to see if the lung tissue can regenerate after severe COVID.

Source:News-Medical.Net

Journal information: Sanchez-Vazquez R, Guío-Carrión A, Zapatero-Gaviria A, Martínez P, Blasco M. Shorter telomere lengths in patients with severe COVID-19 disease. Aging (Albany NY). 2021. doi:10.18632/aging.202463

Gauteng Doctors’ Struggle in COVID “Fever Tents”

Angry doctors have opened up concerning recent images of severely ill patients at Steve Biko Academic Hospital (SBAH) being treated in tents amid pouring rain. These images came as David Makhura and MEC for Health Dr Nomathemba Mokgethi visited the hospital on Monday.

Speaking on condition of anonymity, two doctors at SBAH spoke to Daily Maverick about the reality of the situation. The doctors described a desperate situation of overwhelmed facilities, with patients possibly dying as much from the cold and rain as from untreated COVID – or indeed, a condition that presents similarly to COVID.

The image presented to the public by the government is “smoke and mirrors”, said Dr Felicia (not her real name). “This is a show. They [health officials] are lying to you people. They are lying. They are covering it up,” she said.”Fever tents” have been set up outside the Emergency Department, where patients remain while they are being screened for COVID. If they test negative, they are admitted to SBAH If they test positive, they are sent to Tshwane District Hospital.”

According to Dr Felicia, conditions in the tents are abysmal. “There is no nursing, there is no oxygen or beds in these tents. There is no oxygen in the tanks, we actually just do 10 minutes of CPR and many times we don’t have PPE to do it in.”

As infections continue to rise in South Africa, approaching 250 000 active cases, hospitals are buckling under the pressure, and doctors are expecting the worst to come.

Dr Monica (not her real name) spoke of her feelings of the situation. “I don’t feel like I am being protected by our hospital right now. I am running around like a chicken without a head. I feel very hopeless. I feel like I should not care anymore. Caring is actually just hurting me and the patients because instead of me doing what I said I was going to do when I left medicine, I am treating these people like numbers. Someone dies and you have to shrug your shoulders and move on to the next. There is not even a minute to mourn a person or to figure out what went wrong. I feel completely hopeless,” she said.

Dr Monica said people need to stop politicising the pandemic, and get the hospitals the resources they need. She also implored the reporters to convey their message. “Tell the people out there, this is serious. They must wear masks, they must social distance,” she said, breaking off and running to attend to a patient.

Source: Daily Maverick

US Health Workers’ Vaccine Hesitancy Is Cause for Concern

Health care workers in various parts of the United States are showing extraordinarily high rates of COVID vaccine hesitancy: 20% to 40% of front line workers in Los Angeles, and 60% of nursing home workers said they would refuse to take the vaccine. This has generated great concern along with some instances of shaming, but failing to address these worries is potentially going to worsen the progression of the pandemic.

Fortunately, national surveys show that vaccine hesitancy is decreasing with some 60% of Americans now intending to receive a vaccine, but the high numbers among healthcare workers demands attention. Speaking to the Guardian, Dr Whitney Robinson, an epidemiologist at the University of North Carolina, said that if this is not addressed, “It could mean after all this work, after all this sacrifice, we could still be seeing outbreaks for years, not just 2021, maybe 2022, maybe 2023.”

In Atlanta, while hundreds of healthcare workers were on the list for vaccines, the doses were literally “sitting in the freezers” because no-one would take them.In one survey, up to 55% of New York firefighters said would not take the vaccines, so the Uniformed Firefighters Association president put together a 50 minute video with a virologist friend, addressing their concerns. Subsequent calls from firefighters showed the video had helped to change minds and increase vaccination numbers.

The concerns are varied. Some are concerned about possible side effects and long term consequences, or have read misinformation online. Others are worried about the effect it will have on pregnant and breastfeeding women. Still others believe that having the vaccine is unnecessary after having recovered it, as they have the antibodies in their system. A lot of the distrust may be from minority groups’ deep-rooted distrust of large-scale health programs such as vaccinations, according to Dr Nikhila Juvvadi, the chief clinical officer at Loretto hospital in Chicago. Many specifically mentioned the Tuskegee Study, where federal health officials studied African-American men with sexually transmitted diseases which were deliberately not treated.

“I’ve heard Tuskegee more times than I can count in the past month – and, you know, it’s a valid, valid concern,” said Juvvadi.
However, she said that individual conversations were effective in helping alleviate concerns about the vaccines.

Source: The Guardian

COVID Variants May Increase False Negative Results, FDA Warns

The UK variant of the SARS-CoV-2 virus, known as B.1.1.7 could affect the accuracy of certain molecular COVID tests, causing increased false negative results, the US Food and Drug Administration (FDA) has warned.

A false negative from the UK variant could happen if the variant’s mutation happened to be in a part of the virus’ genome that was assessed by that test. However, genetic tests that target multiple parts of the virus genome are less likely to be affected by the new variants, the FDA advises.

Although the possibility of false negative results are to be expected from almost all tests, the effect of the COVID variants could impact the ability to properly monitor the disease, as well as complicating diagnosis.  

The FDA issued an alert on Friday, saying that they monitor tests which have received an Emergency Use Authorisation (EUA). They highlight three tests as being affected, with potentially less sensitivity to the mutations:

  • Accula SARS-Cov-2 Test, from Mesa Biotech
  • TaqPath COVID-19 Combo Kit, from Thermo Fisher Scientific)
  • Linea COVID-19 Assay Kit, from Applied DNA Sciences

However, the warning for Accula test was a result of “an abundance of caution”, and the latter two assess multiple genetic targets, so they are not likely to be impacted. The FDA issued recommendations for the users of these devices.The FDA’s warning was prompted by computer simulations showing reduced efficacy in certain tests for the virus variant.

In their press release, the FDA did not specifically mention whether any tests may be affected by mutations in the South African virus variant.

Source: MedPage Today

Pfizer/BioNTech Vaccine Effective against SA and UK COVID Variants

Amidst concerns that the SARS-CoV-2 virus might escape the protection of vaccines, initial results from new research shows that the Pfizer/BioNTech vaccine remains effective against the South African and UK COVID variants.

The new variants, which are much more transmissible, had created concern that due to mutations in their structure, they might not achieve the full protection of the current vaccines, especially in the SA variant.

However, this is a preliminary study that has not yet been through a peer review process, and the worrying E484K mutation in the South African strain which has been shown to reduce antibody recognition has not been tested on – that is still to be done.

Using blood samples from 20 individuals who had received the Pfizer/BioNTech vaccine, antibodies in the samples successfully defended against the virus variants. The results were made available on the bioRxiv site. Pfizer chief scientific officer Dr Philip Dormitzer said that “it was a very reassuring finding that at least this mutation, which was one of the ones people are most concerned about, does not seem to be a problem” for the vaccine.

However, should future mutations of SARS-CoV-2 achieve viral escape from the vaccines, the necessary adjustments to counter this could be made to the vaccines within a matter of weeks. Dormitzer said that this work was only the start “ongoing monitoring of virus changes to see if any of them might impact on vaccine coverage.”

Source: Medical Xpress

A Four Century Old Manual for Social Distancing Rules

A feature article from the BBC details how one doctor in the era of the Plague created an eerily familiar set of social distancing guidelines that matches a lot of our non-pharmaceutical COVID controls.

Staying at home and only sending out one person to do the shopping, keeping six feet apart and disinfecting goods – all of these feature in a manual created over four centuries ago to help protect Alghero, a small Italian town against the plague. The methods by a doctor named  Quinto Tiberio Angelerio, published in a 57-page booklet on his methods, titled Ectypa Pestilentis Status Algheriae Sardiniae.

Unlike most plague outbreaks, it failed to spread to neighbouring areas and died out within eight months – though not without claiming about 60% of the town’s initial population of 6000. Angelerio’s rules are thought to be at least partly responsible.

Ravaging Europe as well as Asia and North Africa, the plague left an unimaginable mark on Western society; tunnelling projects in London regularly run into mass graves of plague victims. Italian poet Francesco Petrarca wrote that future generations would likely not be able to grasp the scale of the calamity, and he is probably right in that regard. The plague continued to reappear, and devastated regions when it did – The Great Plague of London saw 24% of its populace dying over 1665 to 1666.

Although the germ theory of disease was then still centuries in the future, and bathing in urine was thought to be effective treatment, physicians in Europe believed in the contagion theory, thinking that diseases were spread through “miasmas” or “bad air”. This enabled them to come up with the idea of quarantines, from the Italian for “forty days” which was the standard isolation period.

Facing huge obstacles from a recalcitrant citizenry, Angelerio nevertheless persevered and soon a lockdown was enacted. This was not unique, as whole cities would be quarantined. Other rules that were enforced included a social distancing of six feet (as measured by a pole to be carried around by anyone outside), advising people to be careful shaking hands during mass, as well as railing preventing customers coming into contact with shopkeepers. He also used superstition to keep people in line, as European people of the time believed the plague to be divine punishment – although rule breakers were common, as they are now with COVID. He also advised cleaning and disinfecting houses, and household goods (or burning if replaceable), in addition to the contemporary practice of disinfecting newly arrived cargo. This was accomplished by fire or exposure to the wind, among others. However, the common practice of killing cats in response to plague was likely counterproductive, as rats hosted plague-carrying fleas.

Nevertheless, Angelero’s work was ahead of its time, and helped lay the foundations of modern disease control.

.Source: BBC Future

New Treatment for Severe COVID with Tocilizumab and Sarilumab

Following clinical trials, the NHS is to use tocilizumab and sarilumab, two anti-inflammatory drugs for severe COVID treatment. The treatments can cut the risk of death from severe COVID by a quarter, saving one patient for every 12 treated. Dexamethasone, the first drug found to effectively treat severe COVID, was found to cut deaths by a third if on ventilators and by a fifth if on oxygen.

The UK government is working with the drugs’ manufacturer to ensure an adequate supply for its patients – currently standing at 30 000 COVID cases in hospitals. It has also placed an export ban on the medicines, preventing its purchase and resale overseas for a profit.

Using an innovative adaptive trial design, the REMAP-CAP trial involved 4858 total patients, 4089 of which had suspected or proven COVID and over 800.

Compared to dexamethasone at £5 per dose (R100), the drugs are extremely expensive, however, at £750 to £1000 (R15 000 to R20 000) per patient – but this is less than half the cost of an ICU bed per day in the UK.Prof Stephen Powis, national medical director of the NHS, said: “The fact there is now another drug that can help to reduce mortality for patients with Covid-19 is hugely welcome news and another positive development in the continued fight against the virus.”

As a result of the successful trial, UK doctors are being advised to administer  tocilizumab and sarilumab should dexamethasone prove insufficient for treating severe COVID cases. The anti-inflammatory drugs reduce the damaging lung inflammation caused by severe COVID.

UK Health and Social Care Secretary Matt Hancock said: “Today’s results are yet another landmark development in finding a way out of this pandemic and, when added to the armoury of vaccines and treatments already being rolled out, will play a significant role in defeating this virus.”

Source: BBC News

COVID Cases Surge in Africa

Over the past month, Africa has recorded the highest growth in new infections, with a 13% growth over the last week. With only two million cases and 45 000 deaths, Sub-Saharan Africa still only has a small part of the caseload of other regions. 

Dr John Nkengasong, who heads the African Centres for Disease Control (CDC), said: “I think this is serious, the second wave is extremely aggressive.”  The latest surge is thought to be driven by the more transmissible South African variant, known as 501Y.V2. President Cyril Ramaphosa said this variant, found in 90% of new cases, was likely responsible for the country’s latest surge, which has caused morgues to fill up and hospitals to run short of staff and critical resources such as oxygen.  North of the border, Zimbabwe this week started a month-long lockdown to curb a rise in new cases and protect its own overburdened health care system. Nearly two million Zimbabweans live in SA and regularly travel and forth, potentially spreading the virus.

Rashida Ferrand, a London School of Hygiene and Tropical Medicine professor working at the Parirenyatwa Group of Hospitals in the Zimbabwean capital Harare told Reuters that there was “a pretty high likelihood” that the new SA strain of the virus identified could be circulating in Zimbabwe.

Lockdowns may now not be enough to control the spread of the new variant – certain studies of the similar, highly transmissible UK variant suggests that it may now spread too fast for its R (reproduction) value to be brought below 1, or otherwise cause a much slower decline in infections. Fortunately, it seems that lockdown measures in the UK are having some effect. 
Meanwhile, there are concerns that the SA variant may also be able to evade the protection of current vaccines, according to new research – but that has not been peer reviewed yet. Research in SA on the question is expected to provide answers. Meanwhile, 12 gene sequencing laboratories are being geared up around Africa to track the spread of the virus variants, and some genome sequencing work has been done since December, but not enough to paint a clear picture.

Source: The Telegraph

Medical Aid Schemes to Share Cost of Nationwide Vaccination

As arrangements are being made to pay for the COVID vaccination programme for South Africa, medical aid schemes are expected to contribute to the cost towards ensuring at least 67% of the population receives a vaccine, which is the minimum number to establish herd immunity.

Across South Africa, there are some 9 million medical aid beneficiaries, making up some 16% of the population and who collectively spent R186 billion last year on healthcare. The total cost of providing sufficient vaccines for the South African population is thought to range from R5 billion to R20 billion, depending on whether the vaccine is simply bought for the commercial price or whether the distribution and administration costs are factored in as well.

Discussions into paying for the mass vaccinations have suggested that mass-employers, such as mines, ought to contribute  This week, the Council for Medical Schemes (CMS) confirmed that vaccination would be a minimum prescribed benefit, so this will not be paid for out of medical savings.”The CMS acknowledges that there may be an additional cost burden to medical schemes for the provision of the vaccine, but this is not expected to be prohibitively high,” the body said. “In addition, industry associations have assured the CMS that vaccine costs can be absorbed by most medical schemes.”

South Africa’s vaccine source is not yet clear, although President Cyril Ramaphosa has hinted that Canada may share its excess vaccine stock. Canada currently has enough vaccine pre-purchase agreements to vaccinate its population five times over.

Source: Business Insider

WHO Team Barred from Entry into China

According to the World Health Organization, its team sent to China to investigate the origins of COVID were denied entry.

Conveying his disappointment at the team being barred from entry into China due to visas not being issued, WHO Director-General Tedros Adhanom Ghebreyesus said, “today, we learned that Chinese officials have not yet finalized the necessary permissions for the team’s arrival in China.”

Addressing the media in Geneva, he continued, “I’m very disappointed with this news, given that two members had already begun their journeys and others were not able to travel at the last minute, but had been in contact with senior Chinese officials.”

“But I have been in contact with senior Chinese officials. And I have once again made it clear that the mission is a priority for WHO and the international team.” He added, “We are eager to get the mission underway as soon as possible.” 

The experts were to investigate the origins of the SARS-CoV-2 virus in Wuhan.  The team of 10 will be led by Peter Ben Embarek, WHO’s expert on zoonoses – diseases that cross over the species barrier into humans from animals.

Dr Michael Ryan, the emergencies chief at WHO, said the understanding was that the team would begin the deployment from Tuesday, and that two of its members had begun travelling to China, with one member already turned back due to visa issues while the other was still in transit.

“We did not want to put people in the air unnecessarily if there wasn’t a guarantee of their arrival in China being successful,” said Ryan. “Dr Tedros has taken immediate action and has spoken with senior Chinese officials and has fully impressed upon them the absolute critical nature of this.”
“We hope that this is just a logistical and bureaucratic issue that can be resolved very quickly,” he continued.

According to the The Financial Times, Hua Chunying, the Chinese foreign ministry spokesperson, on Wednesday said, “Tracing the source [of the virus] is a complicated issue. To ensure that the international team’s work progresses smoothly, they must go through the necessary procedures.”

Source: The Independent