The Canadian province of Quebec will impose a health tax on residents not vaccinated against COVID. The province is experiencing a surge in cases, and its 12 028 deaths as of Tuesday are the highest in Canada.
The province’s Premier Francois Legault announced on Tuesday that it would be the first in the nation to financially penalise the unvaccinated.
Around 12.8% of Quebec residents are unvaccinated, yet make up nearly half of all hospital cases.
At a news conference, the premier said that people who have not had a first vaccine dose will have to pay a “contribution”, which will be “significant”.
“I think right now it’s a question of fairness for the 90% of the population who made some sacrifices,” Mr Legault said. “I think we owe them this kind of measure.”
The province also announced last week that proof of vaccination would be required to shop in government cannabis and liquor stores.
Death rates are similar to January 2021, before widespread vaccinations had begun in the province. Unvaccinated patients make up 45% of COVID ICU cases.
Hospitals in Montreal, the province’s largest city, are nearing 100% capacity and have already started limiting non-Covid related care. Quebec’s positivity rate stands at 20%.
Though such approaches are rare, some unvaccinated individuals in other parts of the world face penalties from their governments.
Greece is set to require those over 60 to pay a €100 (R1750) fine for each month that they remain unvaccinated. Austria is considering an even stiffer €7200 (R126 000) fine for unvaccinated individuals. Unvaccinated COVID patients in Singapore will also have to pay their own medical bills: with ICU stays, this has been estimated at a median of S$25 000 (R287 500).
Scientists have developed a noninvasive brain imaging procedure to identify individuals whose performance has been impaired by THC, the psychoactive ingredient of cannabis. As reported in Neuropsychopharmacology, the technique uses functional near-infrared spectroscopy (fNIRS) to measure brain activation patterns linked to THC intoxication. The technology could have a great impact on road and workplace safety.
The increasing legalisation of cannabis has driven the need for a portable brain imaging procedure that can distinguish between THC-caused impairment and mild intoxication. “Our research represents a novel direction for impairment testing in the field,” explained lead author Jodi Gilman, PhD. “Our goal was to determine if cannabis impairment could be detected from activity of the brain on an individual level. This is a critical issue because a ‘breathalyser’ type of approach will not work for detecting cannabis impairment, which makes it very difficult to objectively assess impairment from THC during a traffic stop.”
In previous studies, THC has been shown to impair cognitive and psychomotor performance essential to safe driving, a factor thought to at least double the risk of fatal motor vehicle accidents. However, concentration of THC in the body does not correspond well to functional impairment. Regular cannabis users often can have high levels of THC in the body and not be impaired. Metabolites of THC can remain in the bloodstream for weeks after the last cannabis use, well beyond the period of intoxication. Thus, there is a need for a different method to determine impairment from cannabis intoxication.
In the study, 169 cannabis users underwent fNIRS brain imaging before and after receiving either oral THC or a placebo. Participants who reported intoxication after being given oral THC showed an increased oxygenated haemoglobin concentration (HbO) – a type of neural activity signature from the prefrontal cortex region of the brain – compared to those who reported low or no intoxication.
“Identification of acute impairment from THC intoxication through portable brain imaging could be a vital tool in the hands of police officers in the field,” said senior author and principal investigator A. Eden Evins, MD, MPH, founding director of the Center for Addiction Medicine. “The accuracy of this method was confirmed by the fact impairment determined by machine learning models using only information from fNIRS matched self-report and clinical assessment of impairment 76% of the time.”
The study suggested the feasibility of inexpensive, lightweight, battery-powered fNIRS devices that could be incorporated into a headband or cap, and thus require minimal set-up time.
“Companies are developing breathalyser devices that only measure exposure to cannabis but not impairment from cannabis,” said Dr Gilman. “We need a method that won’t penalise medical marijuana users or others with insufficient amounts of cannabis in their system to impair their performance. While it requires further study, we believe brain-based testing could provide an objective, practical and much needed solution.”
Researchers have found that greater grip strength in older women reduces mortality risk, regardless of weight change, suggesting that mobility and strength support should have more focus than weight loss in this group.
Grip strength and short physical performance battery (SPPB) are measures of physical functioning. Grip strength assesses strength of grip alone, whereas SPPB is a cumulative score considering three components: balance test, timed walk, and chair stands.
Previous studies have shown a link between increased grip strength and lower all-cause mortality. SPPB considers timed walk, balance test, and chair stands, and is associated with CVD risk in older women. However, studies of the effects of weight loss on grip strength which evaluated participants before and after weight loss interventions have shown inconsistent results.
In a study published in the Journal of the American Geriatrics Society, researchers followed 5039 older women for an average of 5.4 years. They found that loss of 5% or more body weight was associated with a 66% higher risk of dying. However, there was no association of weight gain with mortality.
The researchers also found that higher grip strength and better lower extremity functioning were associated with lower risks of death during follow-up, regardless of weight change.
“Our findings support increasing efforts to improve mobility and muscle strength in older women and less focus on long-term weight loss in this population,” said lead author Lisa Underland, DO, of Children’s Hospital at Montefiore.
Basal ganglia are deep grey matter structures in the brain involved in the control of posture and voluntary movements, cognition, behaviour, and motivational states. Several conditions are known to affect basal ganglia during childhood, but many questions remain.
In a study that included 62 children with basal ganglia diseases who were followed for two years, investigators identified multiple genetic aetiologies including mitochondrial diseases (57%), Aicardi–Goutières syndrome (20%), and single-gene causes of dystonia and/or epilepsy (17%) mimicking Leigh syndrome. Radiological abnormalities included T2-hyperintense lesions (n=26) and lesions caused by calcium or manganese mineralisation (n=9).
The researchers identified three clusters: the pallidal, neostriatal, and striatal, plus the last including mtDNA defects in the oxidative phosphorylation system with prominent brain atrophy. Mitochondrial biomarkers showed poor sensitivity and specificity in children with mitochondrial disease, whereas an interferon signature was observed in all patients with Aicardi–Goutières syndrome.
Radiological imaging tests also revealed several characteristics in patients that could help lead to an earlier diagnosis of basal ganglia diseases.
With the Omicron variant now dominating, a local study showed that, if confirmed, testing for COVID could be more accurate with much easier saliva sampling.
University of Cape Town researchers reported in a paper uploaded to medRxiv[PDF] that in Omicron cases, saliva samples yielded more accurate results in PCR analyses compared to nasal swabs.
With the Delta variant, on the other hand, nasal swabs were more accurate, according to the group, led by Diana Hardie, MBChB, MMedPath, who also heads the diagnostic virology laboratory at Groote Schuur Hospital.
The findings came from an analysis of 382 patients tested at Groote Schuur from August through this month, with viral whole-genome sequencing performed on isolates from those with positive results.
All patients had both saliva and mid-turbinate nasal samples taken for RT-PCR analysis. The ‘gold standard’ for positivity in the study was detection of SARS-CoV-2 RNA with either swab.
For the Delta variant, the positive percent agreement for each sampling method, in comparison with this ‘gold standard’, was 71% for saliva and 100% for the nasal swabs. But Omicron reversed the trend, with 100% agreement between saliva samples and the gold standard, but only 86% for nasal swabs.
COVID testing has used nasal swabs as standard since the discovery of the virus, but that may no longer be appropriate in an Omicron-dominated pandemic landscape, the authors concluded.
“These findings suggest that the pattern of viral shedding during the course of infection is altered for Omicron with higher viral shedding in saliva relative to nasal samples resulting in improved diagnostic performance of saliva swabs,” Hardie and colleagues wrote.
They noted, as have others, that Omicron is distinguished by “more than 50 distinct mutations.” While these increased infectivity, they could also have other effects, including the tissues it may prefer to infect.
The researchers cited a recent unpublished lab study from Hong Kong indicating that Omicron preferentially infects the upper airway. Not only does it suggest Omicron is less lethal, but also that the many mutations confer “altered tissue tropism.”
However, saliva sampling is not as simple as it sounds. At Groote Schuur, patients were instructed to swab the inside of the mouth for a total of at least 30 seconds. They were also told not to eat, drink, smoke, or chew anything for at least 30 minutes beforehand.
While most of the COVID testing kits in the US and elsewhere rely on nasal swabs, any change to saliva sampling would take months – by which time Omicron may have been displaced by another variant.
A surprising discovery in hedgehogs showed that a variant of the MRSA superbug appeared in nature well before antibiotics use in humans and livestock, which has traditionally been blamed for its emergence.
Staphylococcus aureus first developed resistance to the antibiotic methicillin around 200 years ago, according to a large international study which has traced the genetic history of the bacteria.
The finding comes from research showing that up to 60% of hedgehogs in Denmark and Sweden carry a type of MRSA called mecC-MRSA. The new study also found high levels of MRSA in swabs taken from hedgehogs across their range in Europe and New Zealand. Their findings were published in the journal Nature.
The researchers believe that antibiotic resistance evolved in S. aureus as an adaptation to having to exist on hedgehog skin next to the fungus Trichophyton erinacei, which produces its own antibiotics. The discovery of this centuries-old antibiotic resistance predates antibiotic use in medical and agricultural settings.
“Using sequencing technology we have traced the genes that give mecC-MRSA its antibiotic resistance all the way back to their first appearance, and found they were around in the nineteenth century,” said Dr Ewan Harrison, a senior author of the study.
He added: “Our study suggests that it wasn’t the use of penicillin that drove the initial emergence of MRSA, it was a natural biological process. We think MRSA evolved in a battle for survival on the skin of hedgehogs, and subsequently spread to livestock and humans through direct contact.”
Antibiotic resistance in human pathogens was previously thought to be a modern phenomenon, driven by the clinical use of antibiotics. Antibiotic misuse is now accelerating the process, with antibiotic resistance rising dangerously worldwide.
Since nearly all antibiotics used today arose in nature, the researchers say it is likely that resistance to them already exists in nature too. Overuse of any antibiotic in humans or livestock will favour resistant strains of the bacteria, causing it to lose effectiveness over time.
“This study is a stark warning that when we use antibiotics, we have to use them with care. There’s a very big wildlife ‘reservoir’ where antibiotic-resistant bacteria can survive – and from there it’s a short step for them to be picked up by livestock, and then to infect humans,” said Professor Mark Holmes, a senior author of the report.
In 2011, mecC -MRSA was identified in human and dairy cow populations, which was assumed to have arisen due to the large number of antibiotics cows are routinely given.
MRSA was first identified in patients in 1960, and around 1 in 200 of all MRSA infections are caused by mecC-MRSA. Due to its resistance to antibiotics, MRSA is much harder to treat than other bacterial infections. The World Health Organization now considers MRSA one of the world’s greatest threats to human health.
Human infections are rare with mecC-MRSA however, even though it has been present in hedgehogs for more than 200 years.
South Africa’s easing of COVID regulations at the end of 2021 set a new trend in how countries are choosing to manage the pandemic. In an article for The Conversation, Wits University’s Professor Shabir Madhi and colleagues reflect on the boldness – and the risks.
In a significant departure, the government is choosing a new, more pragmatic approach while keeping an eye on severe COVID and threats to health systems. This reflects a willingness to “live with the virus” without causing further damage to the economy and livelihoods, especially in a resource-constrained country.
Prof Madhi and colleagues hope that “the government continues to pursue this approach and doesn’t blindly follow policies that are not feasible in the local context, and ultimately yield nominal benefit.”
This more nuanced approach is a stark contrast to reflexive restrictions in response to rising case rates, suggesting the government has listened to commentary saying that the focus should be on whether health systems are under threat.
A high level of population immunity guides this approach. A sero-survey in Gauteng, just prior to the onset of the Omicron wave indicated that 72% of people had been infected over the course of the first three waves. Sero-positivity was 79% and 93% in COVID unvaccinated and vaccinated people aged over 50: a group that had previously made up a high percentage of hospitalisations and deaths.
The sero-survey data show that immunity against severe COVID in the country has largely evolved through natural infection over the course of the first three waves and prior to the advent of vaccination. This has, however, come at the massive cost of 268 813 deaths based on excess mortality attributable to COVID
Antibody presence is a proxy for underlying T-cell immunity which appears to play an important role in reducing the risk of infection progressing to severe COVID. Current evidence indicates that such T cell immunity, which has multiple targets and even more so when induced by natural infection, is relatively unaffected even by Omicron’s many mutations and likely lasts more than a year. This sort of underpinning T-cell immunity protecting against severe disease should provide breathing space for at least the next 6–12 months, and possibly further.
Despite Omicron’s anti-spike evasion, vaccine and natural infection induced T-cell immunity has been relatively preserved. This could explain the uncoupling of case rate to hospitalisation and death rates. Omicron’s mutations also appear to make it predisposed to infecting the upper rather than the lower airway, reducing the likelihood of progressing to severe disease.
In the meantime, they stress that greater vaccine uptake is ensured, along with boosters for high-risk groups.
Additionally, since low test rates mean only 10% of infections are actually documented in SA , isolation and quarantine are ineffective and a more pragmatic approach is necessary, the authors argued.
As the average person in South Africa could have 20 close contacts per day, contact tracing is of little value, and even symptomatic cases are most infectious in the pre-symptomatic and early symptomatic phase. The fact that three quarters of the SA population were infected over the course of the first three waves demonstrates how ineffective contact tracing and quarantine is. They recommend that certain non-pharmacological interventions should be gradually dropped, especially hand hygiene and superficial thermal screening, while outdoor events should be allowed. Rather, government focus should remain on masking in poorly ventilated spaces and ensuring proper ventilation.
Mandatory vaccinations are still on the radar, since as well as the added risk to others that unvaccinated pose, there is the greater pressure they place on the health systems when they are hospitalised for COVID.
Attention also needs to be given to the management of incidental COVID infections in hospitals. The Department of Health guidance needs to be adapted to manage these patients with the appropriate level of care for the primary reason they were admitted. And patients with severe COVID disease require additional care and expertise to improve their outcomes.
Finally, an evaluation of both vaccination status and underlying immune deficiency needs to become a key element of the workup of hospitalised patients with severe COVID.
The authors stressed the need to minimise hospitalisations and deaths, without damaging livelihoods. SA’s Omicron wave death rate is about a tenth that of Delta, on par with pre-COVID seasonal influenza deaths – 10 000 to 11 000 per annum. TB caused an estimated 58 000 deaths in 2019.
While future variants are unpredictable, there is a trend towards lower rates of hospitalisation and death, especially if vaccine coverage can be increased to 90%, particularly in the over-50 age group. Omicron’s high infection rate will likely also contribute to future protection against COVID.
They note that while there is a risk of new variants, failure to change the pandemic mindset is another risk, as Omicron signals the end of COVID’s epidemic phase.
Past practices have had little effect, the authors concluded, and it is something that the SA government appears to have realised. Despite all the severe lockdowns, SA still suffered a high COVID death rate of 481 per 100 000.
Administering a booster shot of Johnson & Johnson’s COVID vaccine was found to be 85% effective in preventing serious illness in Omicron-dominated areas, preliminary results from a South African trial study show.
The South African Medical Research Council performed the study on health workers from 15 November to 20 December, but has not yet been peer-reviewed. It found the booster was effective in largely protecting staff as Omicron came to dominate the country.
“The increase in CD8+ T-cells generated by the Johnson & Johnson vaccine may be key to explaining the high levels of effectiveness against severe COVID disease and hospitalisation in the Sisonke 2 study, as the Omicron variant has been shown to escape neutralising antibodies,” Johnson & Johnson reported in a statement. That data showed that the booster jab “provides 85 percent effectiveness against hospitalisation in areas where Omicron is dominant/”
“This adds to our growing body of evidence which shows that the effectiveness of the Johnson & Johnson Covid vaccine remains strong and stable over time, including against circulating variants such as Omicron and Delta,” it continued.
Around half a million South African health staff have received Johnson jabs as part of clinical trials. South Africa has recorded more than 3.5 million cases and 94 000 deaths since the start of the pandemic.
An earlier South African study in December found the Pfizer/BioNTech vaccine to be less effective overall against Omicron, but still reduced hospital admissions by up to 70%.
Ghanaian health tech startup mPharma is building a network of community pharmacies across Africa as it plans to be the go-to primary healthcare service provider for millions of people. Drug supply in Africa is often unaffordable and counterfeits are rife.
The startup’s community (Mutti) pharmacies are essentially mini-hospitals offering affordable services, ranging from medical consultation to diagnostic and telehealth services.
The company plans more Mutti pharmacies to extend its reach ater raising $35 million, bringing the total amount raised by mPharma to $65 million.
According to mPharma co-founder and CEO Gregory Rockson told TechCrunch, the new financing will be used to ramp up its infrastructure, staff and expansion into African markets.
“We are hiring over 100 engineers to build all our technology in-house and this includes a massive data infrastructure we are creating. We are also investing in other skilled talent like doctors and nurses, professionals that are critical in the work we do,” Rockson told TechCrunch.
Originally founded in 2013, mPharma aims to manage prescription drug inventory for pharmacies and their suppliers, retail pharmacy operations and to provide market intelligence to hospitals, pharmacies and patients.
In October 2021, the startup added telehealth services to its portfolio, catching the telemedicine wave brought in by the COVID pandemic. Rockson told TechCrunch the startup was planning to have 100 virtual centres after six months. The number of virtual centres is primed to grow further alongside mPharma’s plan to increase its community pharmacies from 200 to over 2000 in three years.
Patients in Ghana, Nigeria, Kenya, Zambia, Malawi, Rwanda and Ethiopia, where mPharma has a presence, can access these virtual services. Startups like mPharma aim to address healthcare gaps in Africa.
Sub-Saharan African countries have an average of 0.23 doctors for every 10 000 people against the best ratio of 84.2 doctors in some of the most developed countries. In addition, healthcare infrastructure remains critically underdeveloped.
“COVID showed us that the best form of care is local, it is in the community, and the closest thing in communities are pharmacies. We believe that the pharmacy of the future, which is what we are creating, is one built around longitudinal care not episodic care,” said Rockson.
“We are transforming community pharmacies into the foundation of a modern health system in Africa. We will have a Mutti pharmacy in every community on the continent, guarantee the availability and safety of medicines for each community and utilise the physical infrastructure of Mutti pharmacies to expand Mutti Doctor (the telemedicine service), creating the largest network of doctor offices and diagnostic centres.”
Astronaut Raja Chari sequences DNA from bacteria samples to understand the microbial environment on the International Space Station. Credit: NASA
The lack of gravity in outer space could be the key to the efficient production of large quantities of stem cells. Scientists at Cedars-Sinai have found that the microgravity environment in space stations can potentially aid life-saving advances on Earth by facilitating the rapid mass production of stem cells.
A new paper in Stem Cell Reports outlines key opportunities discussed at a space biomanufacturing symposium to expand the manufacture of stem cells in space.
With new rocket technology, the cost of access to space has plummeted, opening up new opportunities for research and industry, as well as spaceflight by private citizens. Biomanufacturing of therapeutic and research biomaterials can be more productive in microgravity conditions.
“We are finding that spaceflight and microgravity is a desirable place for biomanufacturing because it confers a number of very special properties to biological tissues and biological processes that can help mass produce cells or other products in a way that you wouldn’t be able to do on Earth,” said stem cell biologist Arun Sharma, PhD, head of a new Cedars-Sinai research laboratory.
“The last two decades have seen remarkable advances in regenerative medicine and exponential advancement in space technologies enabling new opportunities to access and commercialise space,” he said.
Attendees at the virtual space symposium in December identified more than 50 potential commercial opportunities for conducting biomanufacturing work in space, according to the Cedars-Sinai paper. The most promising fell into three categories: Disease modelling, biofabrication, and stem-cell-derived products.
Scientists use disease modelling, to study diseases and possible treatments by replicating full-function structures – whether using stem cells, organoids or other tissues.
Decades of spaceflight experience has shown that when the body is exposed to low-gravity conditions for extended periods of time, it experiences accelerated bone loss and ageing. By developing disease models based on this accelerated ageing process, research scientists can better understand the mechanisms of the ageing process and disease progression.
“Not only can this work help astronauts, but it can also lead to us manufacturing bone constructs or skeletal muscle constructs that could be applied to diseases like osteoporosis and other forms of accelerated bone ageing and muscle wasting that people experience on Earth,” explained Dr Sharma.
Biofabrication, another major topic of discussion at the symposium, produces materials like tissues and organs with 3D printing a core technology.
A major issue with biofabrication on Earth involves gravity-induced density, which makes it hard for cells to expand and grow. This requires the use of scaffolding structures, but it generally cannot support the small, complex shapes found in vascular and lymphatic pathways. With the lack of gravity in space, scientists are hopeful that they can use 3D printing to print unique shapes and products, like organoids or cardiac tissues, in a way that can’t be replicated on Earth. This technology is being tested on the International Space Station.
The third category has to do with the production of stem cells and understanding how some of their fundamental properties are influenced by microgravity. Some of these properties include potency, or the ability of a stem cell to renew itself, and differentiation, the ability for stem cells to turn into other cell types.
Understanding some of the effects of spaceflight on stem cells can potentially lead to better ways to manufacture large numbers of cells in the absence of gravity. In coming months, Cedars-Sinai scientists will send stem cells into space to test whether it is possible to produce large batches in a low gravity environment.
“While we are still in the exploratory phase of some of this research, this is no longer in the realm of science fiction,” Dr Sharma said. “Within the next five years we may see a scenario where we find cells or tissues that can be made in a way that is simply not possible here on Earth. And I think that’s extremely exciting.”
