Category: COVID

COVID Most Infectious Early On, Says New Review

According to a meta-analysis of COVID research published in The Lancet, individuals with COVID are most infectious early on.

In a meta-analysis of 79 studies from around the world, they examined viral load dynamics, duration of viral RNA shedding, and viable virus shedding for SARS-CoV-2, and for comparison, 8 studies on MERS-CoV and 11 on SARS-CoV. The study only looked at symptomatic individuals.

For SARS-CoV-2, the average duration of viral RNA shedding was 17 days in the upper respiratory tract and 14.6 days in the lower respiratory tract. Similar durations were found for stool (17.2 days) and serum samples (16.6 days). 

The maximum duration of viral RNA shedding was 83 days in the upper respiratory tract, 59 days in the lower respiratory tract and 126 days in stools.  No role could be discerned for faecal shedding. Average shedding duration was positively correlated with age. No studies detected live virus after 9 days.

The viral load in the upper respiratory tract reached a peak in the first week of illness, which was shorter than SARS-CoV (peaking at days 10-14) and MERS-CoV (days 7-10). Most studies indicated faster viral load clearing in asymptomatic versus symptomatic SARS-CoV-2 carriers.

In view of these findings, the researchers suggest that repeat testing may not be necessary for patients no longer deemed infectious, and that isolation could be set for 10 days after the onset of symptoms.

The researchers concluded that early containment was key in fighting the spread of COVID, especially with regard to acting on atypical symptoms that might appear before other symptoms. Still, this could prove challenging to effect in practice. 

Source: The Lancet

Controversial Study: Cloth Masks Don’t Prevent Catching COVID

In a controversial result, researchers in Denmark have shown real-world evidence that masks do not protect against becoming infected with COVID.

4860 participants completed the study in Denmark, which at the time had a 2% infection rate. Half received surgical masks and were told to wear them outside while the other half were told not to wear masks. The researchers had hoped to see the masks halving the infection rate among wearers, but 1.8% of mask wearers became infected with COVID vs 2.1% of non-mask wearers.

“Our study gives an indication of how much you gain from wearing a mask,” said lead author Dr Henning Bundgaard, a cardiologist at the University of Copenhagen. “Not a lot.”

The results were met with scepticism by some, and noted that the lower prevalence of COVID in Denmark at the time made differences hard to detect.

Dr Thomas Frieden, chief executive of Resolve to Save Lives, an advocacy group, and former director of the CDC outlined the limitations of the study, saying, “There is absolutely no doubt that masks work as source control. The question this study was designed to answer is: Do they work as personal protection?” Frieden said that the answer to those questions lay in the amount of virus exposure and the nature of the masks involved.

“An N95 mask is better than a surgical mask,” he said. “A surgical mask is better than most cloth masks. A cloth mask is better than nothing.”

Dr Christine Laine, editor in chief of the Annals of Internal Medicine, characterised the evidence that masks were protective of wearers as weak.

“These studies cannot differentiate between source control and personal protection of the mask wearer,” she said. 

She added that the new study reinforced the need for other methods, such as social distancing. Masks “are not a magic bullet,” she said. “There are people who say, ‘I’m fine, I’m wearing a mask.’ They need to realise they are not invulnerable to infection.”

Source: Japan Times

Activists to Pressure SA Government over COVID Vaccine

With the recent news that Pfizer’s and Moderna’s vaccines both have over a 90% efficacy, and air cargo carriers are standing ready to transport them, concerns are mounting that South Africa, with no deals to access vaccines, will be left out in the scramble by richer countries to secure vaccines.

Mark Heywood, executive director of Section27 and a veteran activist, said: “Now that vaccines are becoming available, our government must use all its powers to ensure that people in South Africa have equal access. Neither price nor patents should be an obstacle, and government must start now to think about the systems that will be needed to ensure the smooth distribution of the vaccine, starting for those with the highest risk of Covid-19.”

Dr Anthonet Koen, principal investigator at a COVID vaccine trial site, said: “It’s important that we get a vaccine that’s right, especially for South Africa. We often get overseen and get left behind when it comes to life-saving treatments. If you think about HIV, we were last in line to get access to antiretrovirals, and we don’t want that to happen.”
Koen dispelled any possibility of a vaccine being available before the year is out. “We need to be realistic about this… but hopefully within the first quarter of 2021 we will have something.”

Health Minister Zweli Mkhizi reiterated that there was no vaccine for now, “so we need to adhere to containment measures”.

Not only the vaccine’s acquisition but its logistics for distribution must be taken into account. Economist Mike Schussler said, “The entire supply chain will have to be considered. What we know is that if we had to do half of the South African population it would cost about R40  billion, and that’s highly problematic and unaffordable so we have to think strategically about this.”

Source: IOL

COVID Antibodies in Children without the Disease

One case in Australia of children producing COVID antibodies while being exposed to their parents were ill with the disease has shed light into the way children appear to remain largely unaffected by it.

The parents of three children fell ill after attending a wedding, developing COVID with all the normal symptoms. Fortunately, they did not require hospitalisation but the whole family was tested for COVID. To the amazement of clinicians, the test for all three children came back negative, as did a subsequent re-test. The two older children had mild symptoms of COVID.
“It was jaw-droppingly amazing because they’d spent a week and a half with us while we were COVID-positive,” said their mother, Leila Sawenko.

Intrigued, researchers asked the family to come back for a series of tests. While polymerase chain reaction (PCR) tests failed to detect SARS-CoV-2, saliva samples showed SARS-CoV-2 antibodies. The children’s cytokine levels remained low, consistent with their lack of symptoms. 

Researchers believe that, unlike their parents, the children’s immune system staged such an effective response that viral replication was severely restricted. 

“The discordance between the virological PCR results and clinical serological testing, despite an evident immune response, highlights limitations to the sensitivity of nasopharyngeal PCR and current diagnostic serology in children,” wrote the researchers.

Source: Science Alert

Many HIV Deaths in Africa Due to Interrupted Care

An article written for The Conversation explores the reasons why, in an era of antiretroviral therapy (ART), so many people around the world are still dying of HIV.

Despite fierce resistance under Thabo Mbeku’s leadership, ART became widely available in South Africa. Yet in 2019, despite the world’s largest ART programme with 71% coverage, there were still 72 000 HIV-related deaths in South Africa. 

Medecins Sans Frontieres (MSF) supports hospitals across Africa in treating people with HIV, but because patients present with advanced HIV up to a third die during their hospital stay.

HIV is a lifelong disease, and requires lifelong treatment. Some struggle to take tablets on a daily basis, risking drug resistance.

People with advanced HIV now typically have interrupted or failing treatment. MSF-funded studies in Kenya and the DRC showed that only 20-35% of patients with advanced HIV had never received ART.

The “Welcome Back Services” provided by Medecins Sans Frontieres in Khayelitsha, Cape Town are an example of getting patients who have lapsed back into care.

In deprived settings, TB is the leading cause of death for people with HIV, along with cryptococcal meningitis and bacterial infection. These are all treatable if caught in time; cryptococcal meningitis effectively has a zero survival rate but mortality can be reduced by 40% when treated with flucytosine and amphotericin B. By testing patients before they reach the stage where hospitalisation is necessary, survival rates can be greatly improved.

Weight Link to COVID Risk Emphasised by CDC

The Centers for Disease Control and Prevention (CDC) in the US has included in its coronavirus risk warning people who are considered overweight (a BMI of 25 to 29.9, obese is above 30).

Dr Donald Hensrud, director of the Mayo Clinic Healthy Living Program, explained that obesity already is associated with several complications – diabetes, high blood pressure, dyslipidaemia and cardiovascular disease.

Dr Hensrud said, “Now COVID-19 comes along, and we’ve got all the issues we had before plus some additional ones. Obesity is associated with low-grade inflammation and an effect on our immune system. This affects our susceptibility to COVID-19. People who are obese are more likely to develop COVID-19 and complications from it, including dying, than people who aren’t obese. In addition, people with diabetes and some of the other complications from obesity are also at increased risk. So obesity and its complications independently take the risks of COVID-19 and elevate them significantly.”

Dr Hensrud said that he noted patients of his had put on weight during lockdown due to comfort eating and staying at home without any exercise. In order to reduce their risk, people should resolve to eat a healthy diet and engage in exercise, although he cautioned that losing more than 10% body weight in six months can impact the immune system.

Source: Medical Xpress

Moderna COVID Vaccine Confers 94.5% Protection

The BBC reports that, hot on the heels of Pfizer/BioNTech’s announcement of 90% protection conferred by their vaccine, Moderna has announced that their trial with 30 000 participants has achieved a 94.5% level of protection.

This is based on the first 95 participants to develop COVID, with only five having received the vaccine while the others received the placebo. Additionally, although 11 participants developed severe COVID, none came from the vaccine group.

Slight, short-lived adverse effects including headaches, fatigue and pain were reported after receiving the vaccine by patients. Prof Peter Openshaw, of Imperial College London commented, “These effects are what we would expect with a vaccine that is working and inducing a good immune response.”

Moderna’s vaccine also has an advantage over the Pfizer vaccine in that it can be stored at -20C for up to six months, and in a refrigerator for one month. This will significantly improve the logistics of its distribution, requiring a less intensive cold storage chain.

Elon Musk Says He May Have COVID

Elon Musk, CEO of SpaceX and Tesla tweeted that he may have COVID, according to Bloomberg.

The 49 year old tech entrepreneur said that so far his symptoms resemble those of a cold. He took four rapid antigen tests, which are cheaper and faster but two of them came back as negative and two came back as positive. He commented that these results were “extremely bogus”.

No stranger to courting controversy, Musk has in the past cast doubts about COVID, even claiming in March that there would be “zero” cases in the United States by April (which currently has recorded 153 496 new daily cases as of writing this article). He then appeared to cast further doubts, saying that the number of cases would “explode” due to the number of false positives.

Spike Protein Mutation May Be COVID’s Achilles Heel

New research suggests that the very spike protein that makes SARS-CoV-2 so infective may also make it more vulnerable to vaccines. The characteristic “crown” of spikes on the virus gives rise to its “coronavirus” name.

A common mutation in the D614G protein makes a flap open in the spike. This spike makes it easier for the virus to latch onto cells, but this same flap opens a pathway directly into the virus’ core. This makes it easier for antibodies, such as those in the vaccines presently undergoing testing, to infiltrate into the virus, and disable it.

Yoshihiro Kawaoka, a virologist at the University of Wisconsin-Madison, explains: “The original spike protein had a ‘D’ at this position, and it was replaced by a ‘G,’ Several papers had already described that this mutation makes the protein more functional and more efficient at getting into cells.”

This mutation, they found, makes the virus replicate 10 times faster and also makes it more infectious.

When hamsters were exposed to the mutated and unmutated coronavirus strains, the ones infected with the mutated strain were found to transmit the virus much faster than those infected with the unmutated strain. Neither strain seemed to make the hamsters sicker, suggesting that the mutation does not make the virus more lethal. Researchers caution that the animal test results may not hold true for humans, and that constant vigilance in observing and documenting mutations in the SARS-CoV-2 virus is necessary. 

Source: Medical Xpress

Hydroxychloroquine Confirmed Ineffective in the Prevention of COVID

An article published in The Lancet examines the evidence for the drug hydroxychloroquine’s controversial application as a treatment for COVID, which was initially very encouraging based on the drug in vitro inhibition of the SARS-CoV-2 virus. However, the evidence now definitively shows that hydroxychloroquine is ineffective for COVID.

This would have been very useful if hydroxychloroquine, regularly used to treat rheumatic diseases, could have been used as an easily available treatment.

However, numerous studies since the beginning of the COVID pandemic have reiterated the same findings: that hydroxychloroquine does not reduce mortality risk for people hospitalised with COVID, nor does it shorten recovery times. Nevertheless, interest persisted in the possible preventative effects of hydroxychloroquine against COVID.    

Using electronic health records for 30 569 patients, a study comparing hydroxychloroquine use by rheumatoid arthritis or systemic lupus erythematosus sufferers to non-users with the same maladies reported no significant difference in standardised cumulative COVID mortality associated with hydroxychloroquine use (0.23% among hydroxychloroquine users and 0.22% among non-users) with an adjusted hazard ratio of 1.03 (95% CI 0·80–1·33).

These results reflect those of two studies where hydroxychloroquine was administered as prophylaxis to frontline and health care workers, which also showed no effect.