Patients hospitalised with active cancer are more likely to die from COVID than those with a cancer history or diagnosis, according to a new study.
The findings published by Wiley early online in CANCER, a peer-reviewed journal of the American Cancer Society, also indicate that the greatest risk of death due to COVID was in those with active blood cancers. No mortality risk increase was found in patients who received cancer treatments in the three months (or longer) prior to hospitalisation.
To find out how cancer, or the various therapies used to treat it, could affect the health of patients with COVID infections, a team analysed the NYU Langone Medical Center’s records of 4184 hospitalised patients who tested positive for SARS-CoV-2, the virus that causes COVID.
This group included 233 patients who had a current, or ‘active’, cancer diagnosis. They found that more patients with an active cancer diagnosis (34.3 percent) were likely to die from COVID than those with a history of cancer (27.6 percent) and those without any cancer history (20.0 percent).
Among patients with active cancer, those with blood-related cancers had the greatest risk of death. However, undergoing systemic anticancer therapy, including chemotherapy, molecularly targeted therapies, and immunotherapy, within three months prior to hospitalisation was not linked to a higher risk of death, and the investigators found there were no differences according to the type of cancer therapy being received.
Senior author Daniel Becker, said, “We completed a large chart review-based study of patients hospitalised with COVID and found that patients with active cancer, but not a history of cancer, were more likely to die. Notably, however, among those hospitalised with active cancer and COVID, recent cancer therapy was not associated with worse outcomes.”
“People with active cancer should take precautions against getting COVID, including vaccination, but need not avoid therapy for cancer.”
An investigation by The BMJ uncovered undisclosed financial links between certain authors and the tobacco and e-cigarette industry in a number of COVID research papers, which had suggested that smokers were less likely to develop COVID.
In April 2020, two French studies (in preprint and not yet peer reviewed) suggested that nicotine might have a protective effect against COVID, which was coined the ‘nicotine hypothesis’.
The studies were reported on widely by the media, causing fears that it could undermine decades of tobacco control. What should have been an opportunity for promoting cessation of this practice which every year kills five million people around the world.
Since then, the ‘nicotine hypothesis’ has been soundly disproved, with several studies showing that, to the contrary, smoking is associated with an increased chance of COVID related death.
Journalists Stéphane Horel and Ties Keyze investigated the circumstances of these reports. They pointed out that one of the study authors, Professor Jean-Pierre Changeux, has a history of receiving funding from the Council for Tobacco Research, whose purpose was to fund research that would cast doubt on the dangers of smoking and focus on the positive effects of nicotine.
From 1995 to 1998, documents from the tobacco industry show that Changeux’s laboratory received $220,000 (£155,000; €180,000) from the Council for Tobacco Research.
When approached by The BMJ, Changeux assured them that he has not received any funding linked “directly or indirectly with the tobacco industry” since the 1990s.
In late April 2020, Greek researcher Konstantinos Farsalinos was the first to publish the ‘nicotine hypothesis’ formally in a journal, in an editorial in Toxicology Reports.
That journal’s editor in chief, Aristidis Tsatsakis was a co-author, as was A Wallace Hayes, who in 2013 had been a member of Philip Morris International’s scientific advisory board, and had served as a paid consultant to the tobacco company.
Another co-author is Konstantinos Poulas, head of the Molecular Biology and Immunology Laboratory at the University of Patras, where Farsalinos is affiliated.
The laboratory has been receiving funding from Nobacco, the market leader in Greek e-cigarettes and the exclusive distributor of British American Tobacco’s nicotine delivery systems since 2018. However, in their published scientific articles, neither Farsalinos nor Poulas had ever declared this Nobacco funding.
Yet the journalists showed that two grants were attributed in 2018 by the Foundation for a Smoke Free World—a non-profit established by tobacco company Philip Morris International in 2017—to ‘Patras Science Park’.
The grants, which according to tax documents came close to €83 000, went to NOSMOKE, a university start-up incubator headed by Poulas, which markets an ‘organic’ vaping product.
Last month, the European Respiratory Journal retracted a paper with Poulas and Farsalinos as co-authors, after two other authors failed to disclose conflicts of interest.
The retracted article had found that “current smoking was not associated with adverse outcome” in patients admitted to hospital with COVID, and it claimed that smokers had a significantly lower risk of acquiring the virus.
The foundation has invested heavily in the COVID/nicotine hypothesis, said Horel and Keyzer.
In June 2020 it set aside €900 000 for research “to better understand the associations between smoking and/or nicotine use, and COVID-19 infection and outcome.”
Its request stated that the pandemic offered “both an opportunity and a challenge for individuals to quit smoking or transition to reduced risk nicotine products.”
They concluded that, in 2021, “amid a global lung disease pandemic, tobacco industry figures are increasingly pushing the narrative of nicotine as the solution to an addiction that they themselves created, with the aim of persuading policy makers to give them ample room to market their “smoke-free” products. This makes studies on the hypothetical virtues of nicotine most welcome indeed.”
Article information: Covid 19: How harm reduction advocates and the tobacco industry capitalised on the pandemic to promote nicotine, The BMJ, DOI: 10.1136/bmj.n1303 , www.bmj.com/content/373/bmj.n1303
President Cyril Ramaphosa said on Sunday that he did not know “how long or how severe the third wave will be” as he tightened restrictions in response to rising COVID infections.
In a national address on Sunday, President Cyril Ramaphosa announced that Level 2 COVID restrictions would in place from Monday in response to rising cases, saying that he did not know “how long or how severe the third wave will be”.
The new restrictions mostly target social gatherings as well as moving the night-time curfew forward by one hour to 11pm.
No more than 100 people can attend indoor events, while the number for outside was halved to 250. However, to the relief of the liquor industry and many South Africans, no alcohol restrictions have been put in place. This demonstrates a less economically restrictive approach than the initial lockdowns, which caused the economy to shrink by 7% last year.
COVID hospitalisations increased 17% in recent days and the Free State, the Northern Cape, the North West and Gauteng are already seeing a third wave, Ramaphosa said.
A third wave is considered to be underway when the seven-day moving average of new cases exceeds 30% of the previous wave’s peak, according to the definition used by the SA Covid-19 Modelling Consortium.
“It is only a matter of time before the whole country enters a third wave … gatherings are the biggest source of transmission and we urge South Africans to social distance,” Ramaphosa said.
The daily infection rate is sharply higher than the averages of between 1000 and 1500 for most of the year.
President Ramaphosa said cases averaged about 3700 in the past week, a 31% increase compared to the previous seven days, which he partly attributed to people’s increasing complacency over following health protocols.
“Because rates of infection have been low for some time, and because we are all suffering from pandemic fatigue, we have tended to become complacent.
“We have not been as vigilant about wearing our masks all the time, we have not been avoiding crowded places, and we have been socialising more,” the president said.
Due to the delay in infections and subsequent COVID testing, it may take several days for the new restrictions to have any noticeable impact on the daily number of new cases reported. The case positivity rate is now 11.9%, according to the most recent statistics for SA, now well above the 10% level which is considered acceptable.
French President Emmanuel Macron arrived in South Africa today for talks with President Cyril Ramaphosa on a range of issues including possible technological assistance to aid South Africa’s response to the COVID pandemic.
On the agenda of the visit is the economic, health, research and manufacturing responses to the COVID pandemic.
Arriving from Rwanda, where he acknowledged France’s role in the 1994 genocide, Macron held talks in Pretoria with President Ramaphosa, whom he met last week in Paris at a summit on African economies.
The pair were also due to attend an event to support vaccine production on the continent, sponsored by the European Union, the United States and the World Bank.
So far South Africa is the country worst hit by COVID on the continent as far available monitoring can determine, and has vaccinated just 1 percent of its population of 59 million people.
South Africa’s immunisation efforts have been hampered by delayed procurement, and then selling off its AstraZeneca vaccines obtained via Covax to other African countries after trial results showed drastically reduced effectiveness against the local B.1.351 variant. Rollout of the replacement Johnson & Johnson vaccine was paused for two weeks in April due to blood clot fears.
Now, along with India, South Africa is campaigning for a waiver of intellectual property rights on COVID vaccines, so that each country may produce its own doses. This effort has met with stiff resistance so far.
Macron has voiced support for a technology transfer to enable vaccine production sites to be set up in poorer countries.
Visit long delayed
Macron’s visit to South Africa has been long delayed due to the COVID pandemic. The initial purpose for the trip had been to discuss multilateral cooperation with South Africa, an important G20 partner which is also a regular guest at G7 summits.
According to Foreign Policy, the French leader will also seek to establish greater influence in a region that is experiencing greater instability, marked by recent insurgencies in Mozambique.
Jihadist attacks forced French energy giant Total to suspend work on a multi-billion euro gas project in Cabo Delgado province after a nearby town was targeted.
Before he returns to France, he will pay a visit to the Nelson Mandela Foundation, whose main missions are the fight against AIDS and education in rural areas.
US President Joe Biden has ordered intelligence officials to “redouble” their efforts in investigating the origins of COVID, as well as the theory that it was a ‘lab leak’ in China.
This comes days after details of a US intelligence report emerged in the Wall Street Journal, claiming that three doctors working at the Wuhan Institute of Virology had fallen ill with COVID-like symptoms in November 2019 – about when epidemiologists believe SARS-CoV-2 first began circulating in humans.
Mr Biden said the US intelligence community was divided on whether it was the result of a lab accident, or from jumping from human to animal. Mr Biden asked the groups to report back to him within 90 days.
China’s embassy in the US made a warning statement posted on its website, without mentioning the president’s remarks. “Smear campaigns and blame shifting are making a comeback, and the conspiracy theory of ‘lab leak’ is resurfacing. “To politicise origin tracing, a matter of science, will not only make it hard to find the origin of the virus, but give free rein to the ‘political virus’ and seriously hamper international cooperation on the pandemic,” it said.
Authorities linked early COVID cases to a seafood market in Wuhan, leading scientists to theorise the virus first passed to humans from animals.
Why now?
In a White House statement released on Wednesday, President Biden said he had asked for a report on the origins of COVID after taking office, “including whether it emerged from human contact with an infected animal or from a laboratory accident”. He asked for “additional follow-up” on receiving the report.
Mr Biden said most of the intelligence community had “coalesced” around those two scenarios, but “do not believe there is sufficient information to assess one to be more likely than the other”.
The president has now asked agencies to “redouble their efforts to collect and analyse information that could bring us closer to a definitive conclusion”, and report to him within 90 days.
He concluded by saying the US would “keep working with like-minded partners around the world to press China to participate in a full, transparent, evidence-based international investigation and to provide access to all relevant data and evidence”.
Beijing meanwhile has previously suggested a possible US lab origin for COVID. The Chinese embassy said it supported a full investigation into “some secretive bases and biological laboratories all over the world”.
Mr Biden’s statement coincided with a CNN report that the president’s administration earlier this year shut down a state department investigation into a possible lab leak origin.
The ‘lab leak’ theory
When they first arose last year, the laboratory leak allegations were widely dismissed as a fringe conspiracy theory, with many US media outlets describing the claims as debunked or false after then-President Donald Trump said COVID had originated from the Wuhan Institute of Virology.
Two months ago, the World Health Organization (WHO) issued a joint report with Chinese scientists on COVIDs origins, rating the likelihood of an accidental lab release as “extremely unlikely”. However the WHO Director-General Tedros Adhanom Ghebreyesus said that he was not satisfied that the investigation had looked at this possibility enough to rate. The investigation only stirred up more interest in the ‘lab leak’ theory, with 18 scientists signing an open letter calling for more investigation before it could be ruled out.
There is little evidence for the ‘lab leak’ theory in the public domain however, and intelligence reports such as the one the Wall Street Journal based its story on are often of unproven provenance.
Chief White House medical adviser Anthony Fauci still believes that COVID jumped from animals to humans, though this month he admitted he was no longer confident COVID had developed naturally. Mounting pressure
Mr Biden’s statement comes the day after Xavier Becerra, US secretary for health and human services, urged the WHO to ensure a “transparent” investigation into the virus’s origins.
“Phase 2 of the Covid origins study must be launched with terms of reference that are transparent, science-based and give international experts the independence to fully assess the source of the virus and the early days of the outbreak,” Mr Becerra said.
On Tuesday, Mr Trump sought to take credit in an emailed statement to the New York Post, saying: “To me it was obvious from the beginning but I was badly criticised, as usual. Now they are all saying: ‘He was right.'”
Quickly and efficiently screening incoming travellers for COVID is currently beyond present technology, but dogs — with their keen sense of smell that has aided humans for thousands of years — may be a solution.
An Ekurhuleni-based company is in the final stages of training dogs to be deployed as COVID sniffers at South African points of entry, just in time for the expected third wave, eNCA reports.
Currently, the most widespread test is the rapid antigen (lateral flow) test, which has been shown to produce more false positives for COVID than real detections in low prevalence situations — such as travellers arriving in a country.
Alternatively, the polymerase chain reaction (PCR) test has the greatest sensitivity but is time-consuming and expensive. And most currently available tests involve nasopharyngeal swabs — an unpleasant experience for most people.
Dogs, with their keen sense of smell have long been used to sniff out drugs and explosives. In recent years they have also been trained to sniff out certain cancers and malaria, although they are not regularly used for this. Using medical sniffer dogs has the advantage of being extremely quick and could be used in resource-constrained settings.
In the first months of the pandemic, many wondered whether dogs could in fact smell the disease, and began training dogs to see if it was possible. Past studies had already established that the volatile organic compounds (VOCs) released in body odour change during respiratory infections. VOCs associated with COVID infection showed a clear distinction between infected and uninfected individuals, suggestive of a strong, distinctive smell.
Initial trials with trained sniffer dogs at airports in France, Lebanon and FInland found that the dogs were even capable of detecting infection before it could be picked up with clinical tests.
A recent study led by the London School of Hygiene & Tropical Medicine (LSHTM) estimated that a plane with 300 passengers could be screened in 30 minutes with two sniffer dogs, and only those passengers identified by the dogs would be required to take a PCR test.
The study, which is not yet peer-reviewed and which is currently available as a pre-print, found that dogs could be trained to detect COVID in 94.3% (test sensitivity) — comparable to the gold standard of PCR tests with 97.2% sensitivity. They also have a specificity of 92%, meaning that they have a low rate of false positives.
Dr Claire Guest, Chief Scientific Officer at Medical Detection Dogs, which assisted in the study, said: “These fantastic results are further evidence that dogs are one of the most reliable biosensors for detecting the odour of human disease. Our robust study shows the huge potential for dogs to help in the fight against COVID.
“Knowing that we can harness the amazing power of a dog’s nose to detect COVID quickly and non-invasively gives us hope for a return to a more normal way of life through safer travel and access to public places, so that we can again socialise with family and friends.”
Besides simple detection, the dogs could also serve as a visible deterrent to people wanting to travel with fake COVID passports, the authors said. The findings of their study also provided valuable knowledge which could be applied to future pandemics. The authors acknowledged the limitation that the dogs were conducting the tests in a controlled environment as opposed to the real world.
Osaka University researchers have discovered that infection with SARS-CoV-2 results in not only the production of neutralising antibodies that prevent infection, but also of infection-enhancing antibodies.
Both neutralising antibodies that protect against infection as well as infection-enhancing antibodies that increase infectivity are produced after infection with SARS-CoV-2 by analysing antibodies from COVID patients.
Virus-specific antibodies generally are considered antiviral, playing an important role in the control of virus infections. In some cases however, the presence of specific antibodies can benefit the virus. This activity is known as antibody-dependent enhancement of virus infection, a phenomenon in which virus-specific antibodies enhance the entry of virus, and in some cases the replication of virus, into monocytes/macrophages and granulocytic cells through interaction with Fc and/or complement receptors.
In COVID infections, antibodies that target the receptor binding site (RBD) of the SARS-CoV-2 spike protein play an important function as neutralising antibodies that suppress SARS-CoV-2 infection by preventing it from binding to the human receptor, ACE2. However, the function of antibodies against other sites of the spike protein was not known.
“We found that when infection-enhancing antibodies bind to a specific site on the spike protein of SARS-CoV-2, the antibodies directly cause a conformational change in the spike protein, resulting in the increased infectivity of SARS-CoV-2. Neutralising antibodies recognise the RBD, whereas infection-enhancing antibodies recognise specific sites of the N-terminal domain (NTD),” explained lead researcher Professor Hisashi Arase. “Furthermore, the production of infection-enhancing antibodies attenuated the ability of neutralising antibodies to prevent infection.”
The study found that patients with severe COVID produced more infection-enhancing antibodies. Non-infected individuals were also found to possibly have small amounts of infection-enhancing antibodies.
Though infection-enhancing antibodies may be involved in the development of severe disease, further research is necessary to determine whether they are in fact involved in the worsening of infection in the body.
A possible benefit would be that by analysing the antibody titer of infection-enhancing antibodies, it would be possible to see who would be prone to severe COVID. The findings are also important for the development of vaccines that do not induce the production of infection-enhancing antibodies.
“It is important to analyse not only neutralising antibodies but also infection-enhancing antibodies. In the future, it may be necessary to develop vaccines that do not induce the production of infection-enhancing antibodies, because infection-enhancing antibodies may be more effective against mutant strains in which neutralising antibodies are not sufficiently effective,” says Professor Hisashi Arase.
Journal information: Yafei Liu et al, An infectivity-enhancing site on the SARS-CoV-2 spike protein targeted by antibodies, Cell (2021). DOI: 10.1016/j.cell.2021.05.032
Although new COVID cases have not yet shown an upward surge, the fact that the test positivity rate had climbed past 10% is cause for concern.
According to health minister Dr Zweli Mkhize, the 2383 new infections recorded in the past 24 hours came from 23 352 tests at a positivity rate of 10.2%. Yesterday the positivity rate stood at 9.86%, and in the days beforehand had been gradually creeping upward.
The government has previously expressed concern when the positivity rate (the percentage of COVID tests that return positive) reaches the 10% and 12% marks. In late November, ahead of the second wave, the case positivity rate was 14.5%. Some provinces of South Africa are reporting rates well in excess of this, particularly the Northern Cape which last week had a reported positivity rate of 24.1%.
Dr Mkhize also reported that there were 72 Covid-19 related deaths in the past 24 hours. The health minister also reported that across SA there were now 171 860 people who had received their first shot of the two-dose Pfizer vaccine.
With these latest figures, there are now 1 637 848 cumulative cases and 55 874 cumulative fatalities since the outbreak of the coronavirus in SA in March last year. However, the true toll may be much higher, as South Africa’s ‘excess deaths’, those which are above the average rate of deaths from all causes, were up to 2.67 times higher than the official toll. A report from a team at the SA Medical Research Council and University of Cape Town believed that around 85% of those excess deaths were due to COVID.
Doctors in India have hit out against yoga guru Baba Ramdev over his controversial statements against modern medicine and mocking of COVID patients.
Recently, the controversial guru said that tens of thousands died of COVID after taking modern medicines, and also mocked patients for trying to get oxygen cylinders.
The guru subsequently withdrew his statement after being criticised by the country’s health minister. But on Monday he again took a swipe at modern medicine for not having a cure for some diseases.
Despite India’s modern allopathic healthcare system, alternative therapies like ayurveda and homoeopathy are hugely popular in India. This has helped many gurus to launch successful businesses with sales of herbal medicines and products. India also has a Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (Ayush) that promotes traditional medicine systems.
The Indian Medical Association (IMA), which represents allopathy doctors in India, has criticised the guru for his “insensitive” remarks in the middle of the pandemic. Such statements from a guru with millions of followers were “irresponsible and demoralising”, said doctors spoken to by the BBC. The country has been grappling with a surge of infections caused by a ‘double mutant’ SARS-CoV-2 variant as well as prematurely relaxed social distancing rules.
The controversy A video of Baba Ramdev mocking patients for trying to find oxygen went viral earlier this month, making references to oxygen shortages in several cities in April and May.
“God has given us free oxygen, why don’t we breathe that? How can there be a shortage when God has filled the atmosphere with oxygen? Fools are looking for oxygen cylinders. Just breathe the free oxygen. Why are you complaining about shortage of oxygen and beds and crematoriums?” he said.
The statement drew sharp criticism from doctors and families of COVID patients who demanded an apology.
Just two weeks later, another video surfaced in which he criticises doctors, blaming COVID deaths on them. Many doctors expressed their anger over Twitter, some went so far as to demand his arrest. In the face of mounting pressures, India’s Health Minister Dr Harsh Vardhan issued a statement asking the guru to withdraw his remarks.
“Allopathy and the doctors attached to it have given new lives to millions of people. It’s very unfortunate for you to say that people died from consuming allopathic medicines.
“We should not forget that this battle can only be won through united efforts. In this war, our doctors, nurses and other health workers are risking their lives to save people’s lives. Their dedication towards serving mankind in this crisis is unparalleled and exemplary,” Dr Vardhan said.
Baba Ramdev withdrew his controversial statement in a Sunday tweet — only to issue a letter the next day asking the IMA why modern medicine had no cure for 25 diseases, including diabetes and hypertension.
This has again infuriated doctors. Prominent pulmonologist Dr A Fathahudeen, who has treated thousands of COVID patients, told the BBC that such statements cause lasting damage.
“For more than a year, healthcare workers like me have been in a war-like situation. We have saved tens of thousand of lives. It’s really unfortunate, insulting and hurtful to read such statements,” he said.
Dr Fathahudeen added that modern medicine had evolved over the years with constant research and studies. “We follow evidence-based practice. At any given time, thousands of researchers are working to come up with cures. Look at the progress we have made in cancer treatment. We have to constantly evolve and learn. It’s hard to trust any branch of medicine that offers absolute cure for every disease.”
Dr Fathahudeen also said that such statements manifest doubts in the minds of people when trust in medicines and vaccines is most needed in the middle of a raging pandemic.
Baba Ramdev’s rise to fame Televised yoga classes were Baba Ramdev’s ticket to fame; he had a following of millions and he received worldwide praise for promoting yoga and healthy living.
He successfully leveraged his fame to create a business empire. In 2006, he helped launch a company called Patanjali Ayurveda to sell herbal medicines and a few years later, the business expanded to sell almost any product. Since last year, the company has been selling a product called Coronil that it has made a number of false claims over, including that it was a WHO-approved COVID treatment.
The Western Cape provincial government has said it is actively preparing for a resurgence of COVID cases while three other provinces have now declared they are in a third wave.
The province’s premier Alan Winde said in a statement on Sunday that based on current trajectories, the province is likely to officially enter its third wave two to three weeks from now.
Gauteng premier David Makhura confirmed that his province officially entered into a third wave more than a week ago. This was followed by similar declarations in the Free State and the Eastern Cape.
“The Western Cape is currently facing a resurgence as it has seen increases in its case numbers every day, over the past 12 days. While this is not yet a third wave, it is the first sign that we are moving towards one,” Winde said.
“Our guiding principle remains that no person will be denied access to life-saving medical treatment. We must make sure we have enough beds, staff and oxygen to respond effectively in the month ahead.”
He added that in the meantime South Africans should continue to follow the level 1 lockdown restrictions, adhering to social distancing and avoid social gatherings to help flatten this curve. But health experts have warned that the rise in cases could require further lockdown restrictions.
Head of the Western Cape Health Department Dr Keith Cloete told EWN that it is a national competency to put lockdown restrictions in place, but they are highly likely to appear given that the number of cases is on the increase countrywide.
Health minister Dr Zweli Mkhize has likewise warned of likely additional restrictions in South Africa due to rising COVID numbers.
He said that the government has discussed the rising numbers. “At some point we are going to have to start looking at additional restrictions,” he said.
“We are going to be recommending that there should be more focus on the size of gatherings, and look at the focus on some of the measures that were actually released when we thought the situation was much more improved.”
He highlighted the importance of trying to maintain a balance to ensure that people continue to be able to work. “We do need to send a strong message still, that people can’t be complacent.”
As of 23 May, there were 2894 new cases in South Africa and the COVID test positive rate stood at 9.86%. Data collected up to 15 May showed the highest positive rate was in the Northern Cape (24.1%), Free State (17.5%) and North West (15.1%) provinces. The percentage testing positive was <10% in all other provinces. (Source: NICD PDF, note this is a 10 MB size)
