Category: COVID

Categories : COVID Medical IndustryTags :

From Molecule to the Shelf

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Bada Pharasi, CEO of The Innovative Pharmaceutical Association of South Africa (IPASA)

Lessons from the COVID-19 pandemic have underlined the importance of continued investment into pharmaceutical innovation and R&D to not only bring life-saving medications to those in need, but to improve public health outcomes, writes Bada Pharasi, CEO of The Innovative Pharmaceutical Association of South Africa (IPASA).

From treatments for cancer, cardiovascular diseases and more recently, the COVID-19 vaccine, the pharmaceutical industry has made significant progress in the development of over 470 medications in the last 10 years alone.1

While the innovative pharmaceutical process typically takes between 10 and 15 years from discovery to regulatory approval2 – owing to factors including immense R&D costs, regulatory compliance, and the protection of patents3 – the fast-tracked development and approval of COVID-19 vaccines laid bare the need for pharmaceutical companies to be prepared to mitigate the risk of future outbreaks – and this means continued investment in innovation and R&D.

The pandemic underlined the need for countries to be prepared for outbreaks on the horizon. To ensure we can meet the next challenge, pharmaceutical innovations must match the pace at which diseases mutate. This kind of innovation is non-negotiable and requires continued investment as a safeguard against losing lives and endangering South Africa’s fragile healthcare system.

As we are in the midst of a cholera epidemic, as well as the recent measles outbreak,4 it’s important to continue driving innovation to treat diseases, with medicines developed by innovative pharmaceutical companies benefiting millions across the country every day.

This is evidenced by mortality rates for HIV/AIDS and TB in the country falling by 59.2% and 55.7% between 2007 and 2017, with at least 60 new medicines currently in the R&D pipeline to treat TB.5

While patents in pharmaceutical innovation protect the originators’ intellectual property, it is important that innovative medications be developed to ensure a continuous pipeline of access to generics once the patent has lost its exclusivity. This will drive consumer accessibility and affordability of life-saving treatments and medications that may otherwise be unattainable for many.

As we continue racing against the proverbial clock in protecting against current and future diseases, pharmaceutical companies should continue to invest in innovation and R&D to outsmart existing dreaded diseases, and provide agility and preparedness should the next unknown pandemic threaten. Our health, and lives, depend on it.

References:
1. #AlwaysInnovating: The pharmaceutical innovation journey [Internet]. IFPMA. 2023 [cited 2023 Jun 28]. Available from: https://www.ifpma.org/initiatives/alwaysinnovating/
2. Derep M. What’s the average time to bring a drug to market in 2022? [Internet]. N-SIDE; 2022 [cited 2023 Jun 28]. Available from: https://lifesciences.n-side.com/blog/what-is-the-average-time-to-bring-a-drug-to-market-in-2022
3. Ancliff S. 10 challenges facing the pharmaceutical industry in 2024 [Internet]. [cited 2023 Jun 29]. Available from: https://blog.i-nexus.com/10-challenges-facing-the-pharmaceutical-industry
4. Yoganathan V. Prepare for more pandemics in the future, experts warn [Internet]. Juta MedicalBrief. Medical Brief; 2023 [cited 2023 Jun 30]. Available from: https://www.medicalbrief.co.za/prepare-for-more-pandemic-in-the-future-experts-warn/
5. South Africa – the innovative hub for pharmaceutical development [Internet]. B2B Central. New Media; 2021 [cited 2023 Jun 29]. Available from: https://www.b2bcentral.co.za/why-south-africa-is-an-innovation-hub-for-pharmaceuticals/

Categories : COVIDTags :

Long COVID’s ‘Blue Legs’ Syndrome in Need of Greater Awareness

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An unusual case of a Long Covid patient’s legs turning blue after 10 minutes of standing highlights the need for greater awareness of this symptom among people with the condition, according to new research published in the Lancet.

The paper, authored by Dr Manoj Sivan at the University of Leeds, focuses on the case of one 33-year man who developed with acrocyanosis – venous pooling of blood in the legs.

A minute after standing, the patient’s legs began to redden and became increasingly blue over time, with veins becoming more prominent. After 10 minutes the colour was much more pronounced, with the patient describing a heavy, itchy sensation in his legs. His original colour returned two minutes after he returned to a non-standing position.

The patient said he had started to experience the discolouration since his COVID-19 infection. He was diagnosed with postural orthostatic tachycardia syndrome (POTS), a condition that causes an abnormal increase in heart rate on standing.

Dr Sivan, Associate Clinical Professor and Honorary Consultant in Rehabilitation Medicine in the University of Leeds’ School of Medicine, said: “This was a striking case of acrocyanosis in a patient who had not experienced it before his COVID-19 infection.

“Patients experiencing this may not be aware that it can be a symptom of Long Covid and dysautonomia and may feel concerned about what they are seeing. Similarly, clinicians may not be aware of the link between acrocyanosis and Long Covid.

“We need to ensure that there is more awareness of dysautonomia in Long Covid so that clinicians have the tools they need to manage patients appropriately.”

Long Covid affects multiple systems in the body and has an array of symptoms, affecting patients’ ability to perform daily activities. The condition also affects the autonomic nervous system, which is responsible for regulating blood pressure and heart rate.

Acrocyanosis has previously been observed in children with dysfunction of the autonomic nervous system (dysautonomia), a common symptom of post-viral syndromes.

Previous research by Dr Sivan’s team has shown that both dysautonomia and POTS frequently develop in people with Long Covid.

Dysautonomia is also seen in a number of other long-term conditions such as Fibromyalgia and Myalgic Encephalomyelitis, also known as Chronic Fatigue Syndrome or ME.

Dr Sivan said: “We need more awareness about dysautonomia in long term conditions; more effective assessment and management approaches, and further research into the syndrome. This will enable both patients and clinicians to better manage these conditions.”

The research is the latest work by the team in the field of autonomic medicine. Other developments include a home test for people with symptoms of autonomic dysfunction in conditions such as long COVID, chronic fatigue syndrome, fibromyalgia, and diabetes 1 and 2, where people experience dizziness or blackouts.

Source: University of Leeds

Categories : COVID Diseases, Syndromes and ConditionsTags :

Wristbands a Breeding Ground for Bacteria, Including E. Coli

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Photo by Jonathan Borba on Unsplash

The COVID pandemic took disinfecting to new heights. Now, a new study has uncovered a niche for bacteria to colonise: despite being worn daily, routine cleaning of wristbands is generally overlooked or simply ignored. Researchers from Florida Atlantic University tested wristbands of various materials to determine their risk for harbouring potentially harmful pathogenic bacteria, and found that plastic and rubber bands had a particularly high load, especially if worn at the gym.

For the study, researchers tested plastic, rubber, cloth, leather and metal (gold and silver) wristbands to see if there is a correlation between wristband material and the prevalence of bacteria. They investigated the hygienic state of these various types of wristbands worn by active individuals and identified the best protocols to properly disinfect them.

Using standard microbiological assays, researchers looked at bacterial counts, type of bacteria and their distribution on the wristband surfaces. They also conducted a bacteria susceptibility assay study screening the effectiveness of three different disinfectant solutions: Lysol™ Disinfectant Spray; 70% ethanol, commonly used in hospitals and alcohol wipes; and a more natural solution, apple cider vinegar.

Results of the study, published in the journal Advances in Infectious Diseases, suggest you stick with the ‘gold standard’ or at least silver the next time you purchase a wristband. Nearly all wristbands (95%) were contaminated. However, rubber and plastic wristbands had higher bacterial counts, while metal ones, especially gold and silver, had little to no bacteria.

“Plastic and rubber wristbands may provide a more appropriate environment for bacterial growth as porous and static surfaces tend to attract and be colonissd by bacteria,” said Nwadiuto Esiobu, PhD, senior author and a professor of biological sciences in the Charles E. Schmidt College of Science.

The most important predictor of wristband bacteria load was the texture of wristband material and activity (hygiene) of the subject at sampling time. There were no significant differences between males and females in the occurrence or distribution of the bacteria groups.

Intestinal organisms of the genera Escherichia, specifically E. coli. Staphylococcus spp was prevalent on 85% of the wristbands; researchers found Pseudomonas spp on 30% of the wristbands; and they found E. coli bacteria on 60% of the wristbands, which most commonly begins infection through faecal-oral transmission.

The gym-goer showed the highest staphylococcal counts, which emphasises the necessity of sanitising wristbands after engaging in rigorous activity at the gym or at home.

“The quantity and taxonomy of bacteria we found on the wristbands show that there is a need for regular sanitation of these surfaces,” said Esiobu. “Even at relatively low numbers these pathogens are of public health significance. Importantly, the ability of many of these bacteria to significantly affect the health of immunocompromised hosts indicates a special need for health care workers and others in hospital environments to regularly sanitize these surfaces.”

Findings from the study showed that Lysol™ Disinfectant Spray and 70% ethanol were highly effective regardless of the wristband material with 99.99% kill rate within 30 seconds. Apple cider vinegar was not as potent and required a full two-minute exposure to reduce bacterial counts. While these common household disinfectants all proved at least somewhat effective on all materials (rubber, plastic, cloth and metal), antibacterial efficacy was significantly increased at two minutes compared to thirty seconds.

Different disinfectants, depending on their active ingredients, kill bacteria in different ways, such as by disrupting cell membrane integrity, altering or removing proteins or interfering with metabolic activities.

“Other potential forms of bacterial transmission and facilitation of infection, such as earbuds or cell phones, should be similarly studied,” said Esiobu.

Source: Florida Atlantic University

Categories : COVID Ethics and LawTags :

The Judgment Handed down on COVID Vaccine Secrecy is a Victory for Democracy

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The Health Justice Initiative today reported an important court victory in their attempts to lift the veil of of secrecy over government’s vaccine procurement contracts. The result is a court ruling which orders the Department of Health to disclose these contracts, which will shed light on important questions such as whether these vaccines were purchased at inflated prices and unfavourable terms. They detail the court victory in a press release:

Health Justice Initiative v The Minister of Health and Information Officer, National Department of Health (Case no 10009/22).

Today, South African courts upheld the principles of transparency and accountability when our government procures health services using public funds. The Pretoria High Court ruled in our favour in our bid to compel the National Department of Health to provide access to the COVID-19 vaccine procurement contracts. The Court ordered (per Millar J) that all COVID-19 vaccine contracts must be made public within 10 days.

This is a massive victory for transparency and accountability.  The contracts concern substantial public funds, and the contracting process has been marred by allegations that the government procured vaccines at differential, comparatively inflated prices and that the agreements may contain onerous and inequitable terms including broad indemnification clauses, export restrictions, and non-refundability clauses.

This significant moment comes as we begin to emerge from the devastation of the COVID-19 pandemic.  It sets an important precedent, especially as our government pursues National Health Insurance (NHI).  With increasing reports of corruption within the healthcare sector, we cannot have a healthcare system shrouded in secrecy.  Procurement must be held in check, as it will involve powerful multinational companies, particularly from the pharmaceutical industry. 

The secrecy surrounding COVID-19 vaccine procurement at the height of the pandemic continues to be a global issue, not just limited to SA – it is important to know what was agreed to in our name at the behest of powerful vaccine manufacturers who have been reported to have bullied governments in the Global South especially, insisting on contracts that ultimately made them huge profits, without maximum accountability and openness. Therefore, this judgment can be leveraged by other countries to demand open contracting in their jurisdictions.

We believe that in the current Pandemic Treaty negotiations, where worrying attempts are being made to water down transparency, this judgment will support Pandemic Preparedness measures by bolstering provisions on transparency and accountability in these negotiations.

This case demonstrates that all governments should and can be held accountable when spending public funds, this also includes the parties it entered into contracts with. It is in the public interest to know what was agreed to. The judgment has affirmed that today.

We look forward to the Department of Health’s cooperation by making available all the records HJI requested within the time period set out in the judgment (10 court days from 17 August 2023).

Categories : COVID HospitalsTags :

Nose-picking Healthcare Workers Were More Likely to Get COVID

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Photo by Ketut Subiyanto on Pexels

A study of healthcare workers (HCW) found that those who picked their nose were more likely to get COVID than the people who refrained from such explorations. The Dutch researchers published their probing results in the journal PLOS One.

In the early stages of the COVID pandemic, researchers noted a wide range of efforts to prevent the spread of SARS-CoV-2, such as the wearing of personal protective equipment and maintaining social distancing, especially in the hospital setting. Much research went into the impacts of, eg, wearing glasses on the effectiveness of masking, but little if any attention was paid to a widespread but secretive habit.

Sikkens and colleagues retrospectively surveyed healthcare workers at Amsterdam University Medical Centers were in December 2021 about their behaviours during the first and second waves of the pandemic. They matched these responses were matched against prospectively collected COVID test results at the hospitals from March to October 2020. The nose pickers were nearly three times more likely to catch COVID (17.3% vs 5.9%) than those who refrained at all costs. Surprising results were found for those HCWs who owned up to the habit.

Secret nose pickers can take some comfort in that 85% of the cohort admitted that they picked their nose either daily, weekly, or monthly, and nose pickers tended to be younger. More men picked their nose (90%) than women (83%), and doctors were the most likely to be among the nose-picking offenders: 100% of residents admitted to it, along with 91% of specialists.

Sikkens et al. noted that one limitation of the study was that nose pickers were not asked about “the depth of penetration and eating of boogers”.

Other behaviours such nail biting, having a beard were not associated with COVID infection, nor was wearing glasses, though it showed a relevant trend. Interestingly, nose picking frequency was not linked to difference in COVID infection risk; 27% of those who reported monthly picking, 35% among weekly pickers, and 32% of daily pickers.

Frequency of nose picking did not appear to be linked with any difference in COVID infection risk, with positive cases in 27% of those who reported monthly picking, 35% among weekly pickers, and 32% of daily pickers. No participants reported picking their nose every hour, thankfully.

One-third of the cohort reported nail biting, two-thirds wore glasses, and 31% of the men had beards.

A study strength was that SARS-CoV-2 positivity was determined by prospective longitudinal serological sampling, though this may not be generalisable to the current era of vaccines and circulating Omicron variants. The retrospective nature of the survey may have introduced recall bias.

Sikken et al. noted that it is surprising that SARS-CoV-2 transmission routes had been so thoroughly researched, yet simple behaviours had been overlooked. “Possibly this sensitive subject is still taboo in the health care profession. It is commendable we assume HCWs to not portray bad habits, yet we too are only human after all, as illustrated by the pivotal proportion of nose pickers in our cohort (84.5%).”

Categories : COVID Healthcare Politics and RegulationsTags :

Supreme Court of Appeal Rejects Appeal Over COVID Vaccine Sale Restriction

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The Supreme Court of Appeal has dismissed an application for leave to appeal by Solidarity and Afriforum over a 2021 court case where they challenged a condition by South African Health Products Regulatory Authority (SAHPRA) that the Johnson & Johnson vaccine be restricted to the government. SAHPRA said that this was not a condition that they had imposed.

On 26 July 2023, the Supreme Court of Appeal (SCA) dismissed an application for leave to appeal filed by Solidarity and Afriforum (the Applicants) on the grounds that there is no reasonable prospect of success.

The Pretoria High Court struck Solidarity and AfriForum’s application from the court roll on the grounds of an alleged lack of urgency, and the court also ordered them to pay SAHPRA’s legal costs which was filed in June 2021 by the Applicants, wherein they alleged that when SAHPRA approved and registered the J&J vaccine, SAHPRA imposed a condition that the sale of the J&J vaccine is restricted to the National Government. The applicants argued that SAHPRA was not mandated to stipulate the condition that only the government may purchase the J&J vaccine and questioned the legality of such a condition.

SAHPRA refuted this claim because this is not a condition that SAHPRA had imposed. Subsequently, the applicants proceeded to lodge an application for leave to appeal with the SCA . SAHPRA CEO, Dr Boitumelo Semete-Makokotlela said, “This court ruling indicates that SAHPRA is judicious in adhering to its mandate responsibly. We welcome the outcome of this judgement.”

Categories : COVIDTags :

Why mRNA Vaccines Don’t Offer Such Great Protection Against Omicron

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Photo: CC0

Vaccination protects against severe COVID but not against infection. Researchers in Sweden now show that protection against infection with the new omicron variants is linked to mucosal IgA antibodies, which are not induced by vaccination. These are the findings of two studies recently published in The Lancet Infectious Diseases, and The Lancet Microbe, and could explain the limited protection by currently available vaccines against infection.

Researchers from Karolinska Institut and Danderyd Hospital conducted the COMMUNITY study, which enrolled 2149 healthcare workers in the spring of 2020. Study participants and their immune responses against SARS-CoV-2 have continuously been monitored through regular blood and airway samplings complemented with PCR screenings.

A subset of 447 participants were enrolled in a weekly PCR screening study detecting SARS-CoV-2 infections in the autumn of 2022. Mucosal IgA in nasal samples and serum IgG were determined at enrolment. The results, published in The Lancet Infectious Diseases, revealed a 50% risk reduction for infection with the newer Omicron variants if detectable mucosal IgA at baseline.

Stronger protection with higher antibody levels

Protection against infection increased with increasing mucosal IgA levels, with a 25% risk reduction for every 2-fold increase. Moreover, mucosal IgA had a higher cross-binding capacity to other SARS-CoV-2 variants as compared to serum IgG, and there was no association between high serum IgG levels and protection against infection.

“While there was a clear link between serum IgG and protection against infection with previous SARS-CoV-2 variants, our findings now question the use of serum IgG levels as a correlate to protection against infection with recent Omicron variants” says Ulrika Marking, PhD student at the Department of Clinical Sciences at Karolinska Institutet and Danderyd Hospital, and first author.

Limited vaccine protection

Another sub study, initiated in fall of 2023 and recently published in The Lancet Microbe, investigated mucosal antibody responses to a fourth mRNA booster dose. Mucosal IgA in nasal samples and serum IgG in blood were analysed from 24 participants before and at repeated time points after the booster dose.

While serum IgG levels increased as expected, the fourth vaccine dose did not affect mucosal IgA levels.

“Currently available intramuscular vaccines continue to protect against severe disease and death, but their ability to protect against infection with the new omicron variants is limited” says Oscar Bladh, PhD student and first author.

“The findings from these two studies underscore the need for the development of novel vaccine platforms capable of inducing robust mucosal immune responses protecting against respiratory viral infections”, says Charlotte Thålin, associate professor at the Department of Clinical Sciences at Karolinska Institutet and Danderyd Hospital, and principal investigator of the COMMUNITY study.

“Although the primary aim of vaccination is to protect against severe disease and death, it is also crucial to prevent infection and viral transmission of respiratory viral families with high epidemic or pandemic potential”.

The COMMUNITY study continues with regular samplings from blood and mucosa, monitoring immune responses after repeated SARS-CoV-2 infections and vaccinations.

Source: Karolinska Institutet

Categories : COVIDTags :

Cognitive Impairment Persists Two Years after COVID Infection

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Image by Fusion Medical on Unsplash

Researchers from King’s College London have found that people with longer-term COVID symptoms including brain fog showed reduced performance in tasks testing different mental processes – up to two years after infection with the virus, according to results published in the journal eClinicalMedicine.

Researchers examined whether COVID infection affected performance in two rounds of online cognitive testing that took place in 2021 and 2022. Data was collected for over 3000 participants of the COVID Symptom Study Biobank study, across 12 tasks that tested memory, attention, reasoning, processing speed and motor control.

The participants whose test scores were most affected by COVID were those who had experienced symptoms related to the virus for 12 weeks or more. In these people, the effect of COVID on test accuracy was comparable in size to the effect of a 10-year increase in age.

There was no significant improvement in these test scores between the two rounds of testing, which took place nine months apart. By the second round of testing, the average time since participants’ initial COVID infection was almost two years.

The researchers then separated participants by whether they felt fully recovered following COVID infection. People who felt fully recovered after COVID infection performed similarly to those who had not had the virus at all. In contrast, participants who did not feel fully recovered after infection had lower task accuracy scores on average.

Lead author Dr Nathan Cheetham, a Senior Postdoctoral Data Scientist at King’s College London said:

“Our findings suggest that, for people who were living with long-term symptoms after having COVID, the effects of the coronavirus on mental processes such as the ability to recall words and shapes are still detectable at an average of almost two years since their initial infection.

“However, the result that COVID had no effect on performance in our tests for people who felt fully recovered, even if they’d had symptoms for several months and could be considered as experiencing ‘long COVID’, was good news. This study shows the need to monitor those people whose brain function is most affected by COVID-19, to see how their cognitive symptoms continue to develop and provide support towards recovery.”

Professor Claire Steves, a Professor of Ageing and Health at King’s College London, added:

“We used sensitive tests to measure speed and accuracy across a range of brain challenges. This study shows that some individuals have measurable changes in these tests after COVID-19 going on for nearly two years. The fact remains that two years on from their first infection, some people don’t feel fully recovered and their lives continue to be impacted by the long-term effects of the coronavirus. We need more work to understand why this is the case and what can be done to help.”

Source: King’s College London

Categories : COVID ImmunologyTags :

Long COVID not Caused by COVID Immune Inflammatory Response, New Study Finds

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Research led by the University of Bristol has found that long COVID is not caused by an immune inflammatory reaction to COVID. Emerging data shows that immune activation may persist for months after contracting COVID. In this new study, published in eLife, researchers wanted to find out whether persistent immune activation and ongoing inflammation response could be the underlying cause of long COVID.  

To investigate this, the Bristol team collected and analysed immune responses in blood samples from 63 patients hospitalised with mild, moderate or severe COVID at the start of the pandemic and before vaccines were available. The team then tested patients’ immune responses at three months and again at eight and 12 months post hospital admission. Of these patients, 79% (82%, 75%, and 86% of mild, moderate, and severe patients, respectively) reported at least one ongoing symptom with breathlessness and excessive fatigue being the most common.

Dr Laura Rivino, the study’s lead author, explained: “Long Covid occurs in one out of ten COVID cases, but we still don’t understand what causes it.  Several theories proposed include whether it might be triggered by an inflammatory immune response towards the virus that is still persisting in our body, sending our immune system into overdrive or the reactivation of latent viruses such as human cytomegalovirus (CMV) and Epstein Barr virus (EBV).”

The team found patients’ immune responses at three months with severe symptoms displayed significant dysfunction in their T-cell profiles indicating that inflammation may persist for months even after they have recovered from the virus. Reassuringly, results showed that even in severe cases inflammation in these patients resolved in time. At 12 months, both the immune profiles and inflammatory levels of patients with severe disease were similar to those of mild and moderate patients.

Patients with severe COVID were found to display a higher number of long Covid symptoms compared to mild and moderate patients. However, further analysis by the team revealed no direct association between long COVID symptoms and immune inflammatory responses, for the markers that were measured, in any of the patients after adjusting for age, sex and disease severity.

Importantly, there was no rapid increase in immune cells targeting SARS-CoV-2 at three months, but T-cells targeting the persistent and dormant Cytomegalovirus (CMV) – a common virus that is usually harmless but can stay in your body for life once infected with it – did show an increase at low levels. This indicates that the prolonged T-cell activation observed at three months in severe patients may not be driven by SARS-CoV-2 but instead may be “bystander driven” ie driven by cytokines. 

Dr Rivino added: “Our findings suggest that prolonged immune activation and Long COVID may correlate independently with severe COVID. Larger studies should be conducted looking at both a larger number of patients, including if possible vaccinated and non-vaccinated COVID patients, and measuring a larger range of markers and cytokines. 

“Understanding whether inflammation and immune activation associate with Long COVID would allow us to understand whether targeting these factors may be a useful therapy for this debilitating condition.”

Source: University of Bristol

Categories : Cardiovascular Disease COVIDTags :

European COVID Lockdowns Cost Heart Attack Patients up to Two Years of Life

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Patients who had heart attacks during the first COVID lockdown in the UK and Spain are predicted to live 1.5 and 2 years less, respectively, than their pre-COVID counterparts. That’s the finding of a study just published in European Heart Journal – Quality of Care and Clinical Outcomes.

“Restrictions to treatment of life-threatening conditions have immediate and long-term negative consequences for individuals and society as a whole,” said study author Professor William Wijns of the Lambe Institute for Translational Medicine, University of Galway, Ireland. “Back-up plans must be in place so that emergency services can be retained even during natural or health catastrophes.”

Research has shown that during the first wave of the pandemic, about 40% fewer heart attack patients went to hospital as governments told people to stay at home, fear of catching the virus, and the stopping of some routine emergency care. Compared to receiving timely treatment, heart attack patients who stayed at home were more than twice as likely to die, while those who delayed going to the hospital were nearly twice as likely to have serious complications that could have been avoided.

Heart attacks require urgent treatment with stents (called percutaneous coronary intervention or PCI) to open the blocked artery and restore blood flow. Delays, and the resulting lack of oxygen, lead to irreversible damage of the heart muscle and can cause heart failure or other complications. When a large amount of heart tissue is damaged, potentially fatal cardiac arrest results.

This study estimated the long-term clinical and economic implications of reduced heart attack treatment during the pandemic in the UK and Spain. The researchers compared the predicted life expectancy of patients who had a heart attack during the first lockdown with those who had a heart attack at the same time in the previous year. The study focused on ST-elevation myocardial infarction (STEMI), where a coronary artery is completely blocked. The researchers also compared the cost of STEMIs during lockdown with the equivalent period the year before.

A model was developed to estimate long-term survival, quality of life and costs related to STEMI. The UK analysis compared the period 23 March (when lockdown began) to 22 April 2020 with the equivalent time in 2019. The Spanish analysis compared March 2019 with March 2020 (lockdown began on 14 March 2020). Survival projections considered age, hospitalisation status and time to treatment using published data for each country. For example, using published data, it was estimated that 77% of STEMI patients in the UK were hospitalised prior to the pandemic compared with 44% during lockdown. The equivalent rates for Spain were 74% and 57%. The researchers also compared how many years in perfect health were lost for patients with a STEMI before versus during the pandemic.

The analysis predicted that patients who had a STEMI during the first UK lockdown would lose an average of 1.55 years of life compared to patients presenting with a STEMI before the pandemic. In addition, while alive, those with a STEMI during lockdown were predicted to lose approximately one year and two months of life in perfect health. The equivalent figures for Spain were 2.03 years of life lost and around one year and seven months of life in perfect health lost.

The cost analysis focused on initial hospitalisation and treatment, follow-up treatment, management of heart failure and productivity loss in patients unable to return to work. For example, the cost applied to a STEMI admission with PCI was £2837 in the UK and €8780 in Spain. Heart failure costs were estimated at £6086 in year one and £3882 in all subsequent years for the UK. The equivalent figures for Spain were €3815 (year one) and €2930 (each subsequent year).

Professor Wijns said: “The findings illustrate the repercussions of delayed or missed care. Patients and societies will pay the price of reduced heart attack treatment during just one month of lockdown for years to come. Health services need a list of lifesaving therapies that should always be delivered, and resilient healthcare systems must be established that can switch to emergency plans without delay. Public awareness campaigns should emphasise the benefits of timely care, even during a pandemic or other crisis.”

Source: European Society of Cardiology