Category: Corona Virus Vaccine

During the COVID-19 pandemic, people 50 years and older in a UK cohort experienced significant cognitive declineeven if they were never infected, reveals a study published in The Lancet Healthy Longevity.

University of Exeter researchers analyzed neuropsychologic data from 3,142 participants aged 50 and older before the pandemic (March 2019 to February 2020) and during the pandemic's first (March 2020 to February 2021) and second (March 2021 to February 2022) years. The average participant age was 67.5 years.

In the first pandemic year, executive function and working memory were significantly worse across the cohort (effect size, 0.15 for executive function and 0.51 for working memory) and in those with mild cognitive impairment (MCI; effect size, 0.13 and 0.40) or a history of COVID-19 (effect size, 0.24 and 0.46). In the second year, impaired working memory persisted across the cohort (effect size, 0.47).

Risk factors included less exercise (P = 0.0049; executive function) and increased alcohol use (P = 0.049; working memory) across the whole cohort, as well as depression (P = 0.011; working memory) in those who tested positive for COVID-19 and loneliness (P = 0.0038; working memory) in those with MCI.

In the second year, less exercise continued to affect executive function across the cohort, and associations persisted between worsened working memory and increased alcohol use (P = 0.0040), loneliness (P = 0.042), and depression (P = 0.014) in those with MCI and reduced exercise (P = 0.0029), loneliness (P = 0.031) and depression (P = 0.036) in those who had COVID-19.

Risk factors included less exercise and increased alcohol useacross the whole cohort, as well as depression in those who tested positive for COVID-19 and lonelinessin those with mild cognitive impairment.

"It is now more important than ever to make sure we are supporting people with early cognitive decline, especially because there are things they can do to reduce their risk of dementia later on," lead author Anne Corbett, PhD, said in a University of Exeter press release.

In a related commentary, Dorina Cadar, PhD, of University College London, said, "Looking back, COVID-19 has revealed the astonishing vulnerability of our societies, but also the lack of strategy and organisation from so many governments worldwide, and our shared fragility when confronted with infections."

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Forty percent of US parents who worked from home during the COVID-19 pandemic report experiencing more parenting stress, compared with 27% of those who worked onsite, according to a research letter published today in JAMA Network Open.

Northwestern University researchers surveyed 825 employed parents from all 77 neighborhoods in Chicago from May to July 2022 about their work situation in the first 2 years of the pandemic. Respondents were adult parents of at least one child living at home. Of the parents, 62.5% worked from home, and 52.5% were women.

The study period included 13 months of remote instruction in Chicago schools,forcing many parents to manage work and schooling at home, the authors noted.

"The COVID-19 pandemic changed work arrangements with more frequent work from home, or telework," they wrote. "Parents are a unique subset of employees, yet little is known about how telework is related to the health of working parents."

A higher percentage of remote-working parents were White (45.0%) than Black (14.6%) or Hispanic (28.5%), and a higher proportion of parents who worked onsite were Black (26.0%) or Hispanic (41.9%) than White (23.8%).

After adjustment, teleworking parents had greater odds of parenting stress than those who worked onsite (adjusted odds ratio [aOR],1.88)especially among fathers (aOR, 2.33 vs 1.53 for mothers), but there was no difference in respondents' general health status (aOR,1.23) or improved mental health (aOR,1.14).

Strategies to support parents who telework, such as promoting work schedule autonomy and employee assistance programs,may have important health implications for parents and children.

"For parents, especially fathers, telework during the COVID-19 pandemic offered a new opportunity to spend time with their children," the researchers wrote. "Our findings suggest teleworking may also add to parenting stress or that parents with more stressful parenting situations preferentially select telework arrangements."

The researchers noted that legislation has been proposed to both expandand limitremote work options. "Therefore, it is crucial that researchers, health professionals, and policymakers continue to assess the associations among telework, parenting stress, and parent health," they said.

"Strategies to support parents who telework, such as promoting work schedule autonomy and employee assistance programs,may have important health implications for parents and children."

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Survey: Teleworking parents more stressed than those who worked ... - University of Minnesota Twin Cities

COVID-19 hospitalizations in Lancaster County remain significantly higher than mid-summer, but are nowhere near the tally during the height of the pandemic.

During the week ending Oct. 28, 20 new people were hospitalized in the county with COVID-19, a bit lower than Septembers peak of 34 and also down from Octobers peak of 27. That compares with two new people hospitalized during the second week of July, and 14 during the first full week of September. These numbers are from the federal Centers for Disease Control and Prevention.

Though new weekly hospitalizations were in the single digits during much of the summer, they sharply increased in August, jumping from six hospitalizations in the week ending Aug. 5 to 19 in the week ending Aug. 26.

The CDC and the state of Pennsylvania no longer track COVID-19 cases, so deaths and new weekly hospitalizations are some of the best indicators of virus levels in a community.

None of this years weekly numbers compare to the pandemics peak when new weekly hospitalizations in the county reached 233 during January 2022.

Since Sept. 9, Lancaster County has seen 12 deaths from COVID-19, bringing this years total to 94. These numbers, from the Pennsylvania Department of Health, are released on the last Wednesday of every month. The most recent data ends with Oct. 25.

Lancaster General Hospital has seen an increase in the number of patients hospitalized with COVID-19, according to Lancaster General Health chief physician executive Dr. Michael Ripchinski.

While there were around five COVID patients per day at that hospital back in July, mid-to-late October saw around 15 to 20, Ripchinski said by email. These numbers show the total number of COVID-19 patients in that hospital on one day, a different metric than new weekly hospitalizations.

And of these patients, few require oxygen support, Ripchinski said.

Recent COVID-19 tests administered to the community by LGH have been around 13 to 16% positive, but the number of people taking these tests is low, Ripchinski said.

As LNP | LancasterOnlinereported in October, Ripchinski said the virus will likely become more prevalent during late fall and winter. At an Oct. 19 press conference, he urged people to get the updated COVID-19 vaccine.

Vaccine induced immunity is more effective and safer than developing immunity from infection, Ripchinski said.

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COVID-19 hospitalizations fall slightly, still higher than mid-summer - LNP | LancasterOnline

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Medtech companies have benefited from elevated procedure volumes in recent quarters as providers work through a backlog of cases left over from when hospitals postponed non-emergency care to keep beds open for COVID-19 patients.

But it is unclear how long the boost will last.

On Intuitive Surgicals third-quarter earnings call, executives said uncertainty about the duration of pent-up demand is factored into the companys procedure growth forecast range for 2023. The surgical robot makers U.S. procedure growth of 17% in the latest quarter reflected a smaller benefit from patient backlogs than in the first half of the year, the company said.

Heart valve specialist Edwards Lifesciencescontinues to work to get patients off the sidelinesfollowing the rockiness of the COVID period,Larry Wood, group president of transcatheter aortic valve replacement (TAVR) and surgical structural heart, said on the companys third-quarter call.Edwards has posted three straight quarters of double-digit sales growth, Wood noted, after an analyst pointed out that TAVRprocedures were growing faster before the pandemic.

Needhams analysis shows Google searches for 20 U.S. elective procedures have been trending upward since the start of the pandemic, peaking this spring above 115% of pre-COVID levels. After a pullback in the third quarter, the figure climbed to 112% of pre-pandemic levels in the latest week.

Searches in the U.S. for orthopedic procedures in the week ended Oct. 28 were at 114% of pre-COVID levels, general surgery searches were at 103%, and cardiovascular procedure searches were at 107%, Needham found.

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Elective procedure interest still topping pre-COVID levels, survey finds - MedTech Dive

The COVID-19 pandemic caused Americans collective trauma, which predisposes to mental illness and chronic illnesses, according to a new online survey from the American Psychological Association (APA).

The Harris Poll surveyed 3,185 US adults nationwide for the Stress in America 2023 report from August 4 to 26.

"While the early pandemic lockdowns may seem like the distant past, the aftermath remains," APA Chief Executive Officer Arthur Evans Jr, PhD, said. "We cannot ignore the fact that we have been significantly changed by the loss of more than one million Americans, as well as the shift in our workplaces, school systems and culture at large."

Respondents aged 35 to 44 years reported the most significant jump in chronic conditions since the pandemic began (58% in 2023, up from 48% in 2019). The same age-group also reported the greatest increase in mental illness (45% vs 31%), most often citing money (77% vs 65%) and the economy (74% vs 51%) as contributing factors.

Respondents aged 18 to 34 had the highest rate of mental illness in 2023, at 50%.

Although 66% of respondents said they were diagnosed as having a chronic illness, 81% rated their physical health as good, very good, or excellent. Similarly, while 37% of adults said they had a mental illness diagnosisan increase of 5 percentage points over 2019's 32%81% said their mental health was good, very good, or excellent. The most common diagnoses were anxiety disorder (24%) and depression (23%).

Women reported a higher average level of stress than men and were more likely than men to rate their stress levels at 8 to 10.

A total of 67% of adults said they didn't think their problems were "bad enough" to cause stress, because others have bigger problems. When asked why they don't seek treatment, adults' top reasons were the belief that therapy isn't effective (40%) and a lack of time (39%) or insurance (37%). Yet 47% said they wish they had help to manage their stress, and 62% said they don't talk about their stress because they dont want to burden others.

A quarter of respondents (24%) rated their average stress level at 8 to 10 on a scale of 1 to 10, in which 1 means little or no stress. In 2019, 19% gave this rating. The rise was noted across all age-groups except for those 65 and older: 34% aged 18 to 34 reported this stress level in 2023 (+8 percentage points from 2019); 31% aged 35 to 44 (+10 percentage points); 22% aged 45 to 64 (+4 percentage points); and 9% aged 65+ (-1 percentage point).

Women reported a higher average level of stress than men (5.3 vs 4.8 out of 10) and were more likely than men to rate their stress levels at 8 to 10 (27% vs 21%).Among respondents who reported experiencing at least one act of discrimination, 36% attributed it to their age, 28% to their race, and 22% to their gender.

The proportion of parents of children younger than 18 who ranked their average stress level at 8 to 10 rose to 33% in 2023 from 24% in 2019. Parents were more likely than other adults to report having more financial problems in 2023 than in 2019 (46% vs 34%), that money caused family arguments (58% vs 30%), and that they are more likely to feel consumed by worry over money (66% vs 39%).

Parents were also more likely to say that their stress is completely overwhelming on most days (48% vs 26%), they are stressed to the point of numbness (42% vs 22%), or are so stressed they can't function (41% vs 20%).

"Stress affects all systems of the body, so it is crucial that Americans know the serious impacts of stress and what they can do to reduce the effect of stressors in their life, as well as receive help from their health care providers, workplace and support systems to prevent further health crises," Evans said.

And the trauma hasn't originated only from COVID-19. Global conflict, racism and racial injustice, inflation, and climate changerelated disasters are also weighing heavy on the American psyche, an APA news release said.

Long-term stress is a risk factor for mental illness, may increase sensitivity to daily hassles, can affect life outlook and goals, and alter the body's physiological response to stressors, the APA said.

"Coping with long-term stress requires a different set of skills than adjusting to temporary stressors," the APA noted. "Ongoing stress can accumulate, causing inflammation, wearing on the immune system, and increasing the risk of a host of ailments, including digestive issues, heart disease, weight gain, and stroke."

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Americans carry 'collective trauma' from COVID pandemic, survey ... - University of Minnesota Twin Cities

Researchers have genetically engineered the first mice that get a humanlike form of COVID-19, according to a study published online November 1 in Nature.

Led by researchers from NYU Grossman School of Medicine, the new work created lab mice with human genetic material for ACE2a protein snagged by the pandemic virus so that it can attach to human cells as part of the infection. The mice with this genetic change developed symptoms similar to those of young humans infected with the virus causing COVID-19, instead of dying upon infection, as had occurred with prior mouse models.

That these mice survive creates the first animal model that mimics the form of COVID-19 seen in most peopledown to the immune system cells activated and comparable symptoms, said senior study author Jef D. Boeke, PhD, the Sol and Judith Bergstein Director of the Institute for Systems Genetics at NYU Langone Health. This has been a major missing piece in efforts to develop new drugs against this virus.

Given that mice have been the lead genetic model for decades, added Dr. Boeke, there are thousands of existing mouse lines that can now be crossbred with our humanized ACE2 mice to study how the body reacts differently to the virus in patients with diabetes or obesity, or as people age.

The new study revolves around a new method to edit DNA, the 3 billion letters of the genetic code that serve as instructions for building our cells and bodies.

While famous techniques like CRISPR enable editing DNA just one or a few letters at a time, some challenges require changes throughout genes that can be up to 2 million letters long. In such cases, it may be more efficient to build DNA from scratch, with far-flung changes made in large swaths of code preassembled and then swapped into a cell in place of its natural counterpart. Because human genes are so complex, Dr. Boekes lab first developed its genome writing approach in yeast, one-celled fungi that share many features with human cells but that are simpler and easier to study.

More recently, Dr. Boekes team adapted their yeast techniques to the mammalian genetic code, which is made up not only of genes that encode proteins but also of many switches that turn on different genes at different levels in different cell types. By studying this poorly understood dark matter that regulates genes, the research team was able to design for the first time living mice with cells that had more humanlike levels of ACE gene activity. The study authors used yeast cells to assemble DNA sequences of up to 200,000 letters in a single step, and then delivered these naked DNAs into mouse embryonic stem cells using their new delivery method, mSwAP-In.

Overcoming the size limits of past methods, mSwAP-In delivered a humanized mouse model of COVID-19 pathology by overwriting 72 kilobases (kb) of mouse Ace2 code with 180 kb of the human ACE2 gene and its regulatory DNA. To accomplish this cross-species swap, the study method cut into a key spot in the DNA code around the natural gene, swapped in a synthetic counterpart in steps, and with each addition, added a quality control mechanism so that only cells with the synthetic gene survived. The research team then worked with Sang Y. Kim, PhD, at NYU Langones Rodent Genetic Engineering Laboratory, using a stem cell technique called tetraploid complementation to create a living mouse whose cells included the overwritten genes.

In addition, the researchers had previously designed a synthetic version of the gene Trp53, the mouse version of the human gene TP53, and swapped it into mouse cells. The protein encoded by this gene coordinates the cells response to damaged DNA, and it can even instruct cells containing it to die to prevent the buildup of cancerous cells. When this guardian of the genome itself becomes faulty, it turns into a major contributor to human cancers.

Whereas the ACE2 experiments had swapped in an unchanged version of a human gene, the synthetic, swapped-in Trp53 gene had been designed to no longer include a combination of molecular code letterscytosine (C) next to guanine (G)known to be vulnerable to random cancer-causing changes. The researchers overwrote key CG hot spots with code containing a different DNA letter, adenine (A).

The AG switch left the genes function intact, but lessened its vulnerability to mutation, with the swap predicted to lead to a ten- to fiftyfold lower mutation rate, said first author Weimin Zhang, PhD, a postdoctoral scholar in Dr. Boekes lab. Our goal is to demonstrate in a living test animal that this swap leads to fewer mutations and fewer resulting tumors, and those experiments are being planned.

Along with Dr. Boeke and Dr. Zhang, NYU Langone study authors were Ran Brosh, PhD; Aleksandra Wudzinska, MPhil; Yinan Zhu; Noor Chalhoub; Emily Huang; and Hannah Ashe in the Institute for Systems Genetics and Department of Biochemistry and Molecular Pharmacology; Ilona Golynker; Luca Carrau, PhD; Payal Damani-Yokota, PhD; Camille Khairallah, PhD; Kamal M. Khanna, PhD; and Benjamin tenOever, PhD; in the Department of Microbiology; and Matthew T. Maurano and Dr. Kim in the Department of Pathology.

The work was funded by National Institutes of Health CEGS grant 1RM1HG009491 and Perlmutter Cancer Center Support Grant P30CA016087. Dr. Boeke is a founder of CDI Labs Inc., a founder of Neochromosome Inc., a founder of ReOpen Diagnostics LLC, and serves or has served on the scientific advisory boards of Logomix Inc., Modern Meadow, Rome Therapeutics, Sample6, Sangamo Therapeutics, Tessera Therapeutics, and the Wyss Institute. Dr. Boeke also receives consulting fees and royalties from Opentrons and holds equity in the company. These relationships are managed in accordance with the policies of NYU Langone Health.

Greg Williams Phone: 212-404-3500 Gregory.Williams@NYULangone.org

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First Mice Engineered to Survive COVID-19 Are Like Young, Healthy ... - NYU Langone Health

In a recent study published in the Canadian Medical Association Journal, researchers evaluated age-stratified hospitalization and mortality risks from incident severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in British Columbia (BC), Canada, during the SARS-CoV-2 Delta variant of concern (VOC) and Omicron VOC predominance.

Study:Risk of hospital admission and death from first-ever SARS-CoV-2 infection by age group during the Delta and Omicron periods in British Columbia, Canada. Image Credit:FamVeld/Shutterstock/com

Studies have reported that individuals with a prior history of SARS-CoV-2 vaccination and infection have a reduced risk of coronavirus disease 2019 (COVID-19) severity outcomes compared to those without exposure, and identifying the fraction of uninfected individuals is crucial for ongoing risk evaluation.

In the initial phase of COVID-19, male sex and older age have been reported as independent estimators of COVID-19 severity. Seroprevalence estimates help capture and quantify infections, but their generalizability depends on the sample population.

The British Columbia Centre for Disease Control (BCCDC) performed eight population-level, cross-sectional SARS-CoV-2 seroprevalence surveys from March 2020 to August 2022.

The surveys indicated that COVID-19 incidence was 10% during the sixth survey in September 2021, 40% during the seventh survey in March 2022, and 60% during the eighth survey in July 2022.

In the present study, researchers conducted serosurveys 9.0 in December 2022, followed by serosurvey 10 in July 2023, respectively, to assess changes in SARS-CoV-2 seroprevalence, particularly in the elderly, and evaluate severe COVID-19-related outcome risk from incident COVID-19 during the inter-survey periods.

Cumulative COVID-19-induced seroprevalence, severe outcomes, population count, discharge abstracts, and vital statistical data were used to estimate infection hospitalization ratios (IFRs) and infection fatality ratios (IFRs) by gender and age during the period between serosurveys 6.0 and 7.0 (Delta VOC/Omicron VOCs BA.1 sub-VOC), serosurveys 7.0 and 8.0 (BA.2 sub-VOC/BA.5 sub-VOC), and serosurveys 8.0 and 9.0 (BA.5 sub-VOC/BQ.1 sub-VOC) inter-survey periods.

The derived IHRs and IFRs represented severe COVID-19-related outcome risk from incident infections during the predetermined inter-survey periods. COVID-19 was confirmed using nucleic acid amplification tests (NAATs). The sample population included individuals presenting for blood draws at the LifeLabs diagnostic outpatient center.

The LifeLabs Center provided BCCDC researchers with sera from 2,000 anonymized BC residents, including 200 serum samples for all age groups (zero to four years, five to nine years, and 10-year categories through 80years and older).

Samples obtained for COVID-19 testing from long-term care recipients, individuals with assisted living, and prisoners were excluded.

Antibodies against the SARS-CoV-2 spike protein subunit 1 (S1) and nucleocapsid (NP) protein were detected using chemiluminescent immunoassays. Non-orthogonal testing was performed in serosurveys 9.0 and 10, and observations from serosurveys 6.0 to 8.0 were similarly re-analyzed.

Bayesian analysis was performed to estimate seroprevalence, adjusting for gender, health authorities, and age.

On August 24, 2023, the team extracted COVID-19 severity outcome data from the British Columbia coronavirus disease 2019 cohort (BCC19C), including the discharge abstract database (DAD), the provincial vital statistical database, and the British Columbia Centre for Disease Control integrated surveillance data for cases of COVID-19 confirmed by NAAT and the International Classification of Diseases, 10th Revision, Canadian version (ICD-10-CA) codes.

The median participant age was 40 years, and 50% were female. The cumulative SARS-CoV-2 seroprevalence rate through December 2022 was 74%, and through July 2023 was 79%, surpassing 80% among individuals below 50 but persisting below 60% among individuals aged 80 years.

Period-specific infection hospitalization and fatality ratios remained consistently under 0.30% and 0.10%, respectively.

Age-stratified infection hospitalization and fatality ratios were mostly below one percent and 0.1%. However, there were exceptions. Individuals aged between 70 and 79 years in the period between serosurveys 6.9 and 7.0 had an IHR and IFR of three percent and one percent, respectively.

Among the elderly aged 80 years during all inter-survey periods, IHRs were five percent, two percent, and four percent. IFRs for this age group were three percent, one percent, and one percent in the periods between serosurveys 6.0 and 7.0, 7.0 and 8.0, and 8.0 and 9.0, respectively. The pattern for severe COVID-19 outcome risks by age was J-shaped.

In the period between serosurveys 8.0 and 9.0, the team estimated one COVID-19-related hospitalization per 300 children aged below five years with incident COVID-19 vs. one hospitalization per 30 adult individuals aged 80 years with incident infection, with no COVID-19-related mortality in children but one death among every 80 adults with incident infection among individuals aged 80 years during the period.

The exploratory analyses showed some gradation in the risks of hospitalization and mortality per incident infection between individuals aged 60 to 64years (one per 1,400 and 10,000, respectively) vs. 65 to 69years (one per 500 and 2500, respectively).

Based on the study findings, through July 2023, the researchers estimated that 80% of BC residents were infected by SARS-CoV-2, with low risks of hospitalization or death from COVID-19 in the context of high vaccine coverage contributing to hybrid protection.

However, 40% of elderly individuals did not develop the SARS-CoV-2 infection but had a heightened severe outcome risk.

The findings indicated that incident infections among elder individuals might contribute considerably to the COVID-19 burden on healthcare systems, highlighting that health authorities must continue prioritizing the elderly for COVID-19 vaccinations and consider them during healthcare planning.

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From 46% to 61% of adults receiving mpox vaccination at two US public health clinics reported a decrease in sexual behaviors tied to viral transmission, including one-time encounters, sex partners, dating app or sex venuebased sex, and group sex, according to a study published late last week in Sexually Transmitted Diseases.

The study, led by Centers for Disease Control and Prevention (CDC) researchers, involved 711 adults seeking mpox vaccination at two clinics in Washington, DC, who completed questionnaires from August to October 2022.

Median participant age was 32 years, 52.0% were White, 20.5% were Black, 14.6% were Hispanic, 7.9% were Asian, 2.0% were multiracial, 0.3% were American Indian/Alaska Native, and 9% had HIV. Most participants were men who have sex with men (MSM) (61.0%), 27.0% were women, and 3.8% were men who have sex with only women.

During the 2022 multicountry mpox outbreak, more than 30,000 mpox cases were reported, mainly among MSM. "Decreases in U.S. mpox cases were likely accelerated by a combination of vaccination and modifications to sexual behaviors associated with mpox virus transmission," the researchers wrote.

Many participants reported fewer one-time sexual encounters (60.8%), sex partners (54.3%), less dating app or sex venuefacilitated sex (53.4%), and less group sex (45.6%). A total of 39% to 54% reported no change in these behaviors, and 0.4% reported an increase.

While reported cases of mpox continue to be low, individuals may return to behaviors and practices that they engaged in prior to the outbreak. In turn, behavior mitigation strategies may only be implemented as temporary protective measures, underscoring the importance of mpox vaccination for continued protection.

A greater proportion of Black participants reported decreases in all four behaviors since learning about mpox (61% to 76%), compared with White participants (41% to 54%). Also, a higher percentage of participants with HIV than those without HIV said they were engaging less in these activities (72% to 82% vs 43% to 59%).

"While reported cases of mpox continue to be low, individuals may return to behaviors and practices that they engaged in prior to the outbreak," the authors wrote. "In turn, behavior mitigation strategies may only be implemented as temporary protective measures, underscoring the importance of mpox vaccination for continued protection."

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COVID vaccines not linked to miscarriages | CIDRAP - University of Minnesota Twin Cities

Before COVID-19, Pakistan has not formal existing mechanism of multisectoral public health emergency response coordination. Most of the agencies engaged in the pandemic response, faced legal, financial, administrative challenges in developing and maintaining operational support for the emergency. Existing record within the agencies, suggest that an informal and ad-hoc inter-agency coordination strategies were established during COVID-19 response which extended during whole period. Interagency coordination system was backed by the strategic heads of government but not on the basis of on agreements or understandings. Findings reveal some of the agencies and departments were engaged in multiple tasks whereas a few were not clear in their roles and concepts of operations during COVID-19 response. Most of the emergency response coordination arrangements were made on need basis which supported response objectives at national and intermediate level.

It was found that since inception of pandemic Pakistan started emergency response coordination by engaging some relevant sectors especially Point of Entries (POEs), NDMA, NEOC, Central Health Establishment (CHE), WHO country office, UKHSA, CDC and other partners18. As the incident escalated the PHEOC expanded coordination and collaboration with all relevant agencies in both, health and other than health sectors. The developmental partners including WHO, UKHSA, JSI, UNICEF and many others supported government agencies in maintaining coordination, workforce capacity building and tactical operations during pandemic response.

The study results highlighted that almost all of the organizations faced challenges in developing their routine capacities in emergency response coordination. Main problem was with legislative and financial support (Fig.2) in the implementation of activities. Studies have demonstrated that financial and logistics challenges have also been observed for many of the departments and sectors engaged in COIVD-19 response19,20. Most of the organizations were not having dedicated funds to support day to day COVID-19 response activities (including testing, surge staff and deployment, quarantine, door to door vaccination etc.)21. For immediate nature of tasks, NCOC has coordinated with national and international developmental partners for logistic support in surveillance, medical countermeasure and lab services12. The World Banks PPR Tool assesses pandemic preparedness in various countries, revealing similar financial and logistics gaps in areas like surveillance, laboratory capacity, and risk communication in Kenya, Cameron and Nigeria22.

NIH took the initiative of planning for COVID-19 and developed the National Action Plan for COVID-19 by coordination with stakeholders in March 202023. Although plan including various activities of prevention, detection and response but not facilitate the partner organizations roles, involvement level, financial regulation, and resources utilization with a clear concept of operation24. In May 2020, MoNHSR&C developed a draft of the Pakistan Preparedness and Response Plan for COVID-19, including funding details12. It aimed to strengthen disease surveillance, detection, case management, risk communication, infection prevention, and control and provided the ways to reduce coordination gaps. NDMA also developed a Stakeholder Engagement Plan (SEP) under Pandemic Response Effectiveness in Pakistan in May 202025. The plans developed by the agencies facilitated pandemic response but could not fulfill all requirements emergency response coordination26,27. Results of present study also reveal that most of the agencies in health sector, faced challenges in developing agreements, activities and timeline, and a clear concept of operations for COVID-19 emergency.

Most of the organizations engaged in pandemic management have different functions and strengths. Prior to COVID-19, the concept of operations and level of engagement for other branches/departments of government organizations and other partners was not clear in Pakistan28. Evidence revealed that COVID-19 related planning and operations were being supported by the different ministries and departments including, animal health, law enforcement agencies, information and broadcast, agriculture, civil administration and finance etc.25.

The roles and responsibilities were assigned on need basis from the strategic level authorities. There was no clear framework of actions and task assigned to each of the response organization notified in the NAP23. Only few of the organizations have defined emergency response activities, parallel to normal day-to-day business.

None of the agencies had endorsed the concept of operations plan or level of engagement for other than health agencies. Evidence from the present study (Table 2) demonstrates that it was unclear how different agencies engaged its branches in the absence of a shared comprehensive response plan. Thus, the unavailability of the documented concept of operations affected the overall planning and emergency response operations collectively.

Prior pandemic, health agencies were deficient in existing coordination for emergency response in Pakistan29. At the strategic level, the government of Pakistan constituted a high-level National Coordination Committee chaired by the Prime Minister of Pakistan24,30. The aim was to enhance coordination of information and actions required by all national and provincial level agencies31,31. Later, NCOC developed effective coordination mechanism among all partners in addition to the COVID pandemic response. Although many agencies involved in coordinated response to COVID, but there was very little evidence on joint planning for the emergency response. During desk review it was found that MOUs with the different departments and partners were not in place at national level.

During the COVID-19 pandemic, Pakistan faced challenges in the field of technical professionals and logistics to manage the emergency33. Data show that most of agencies expect developmental partners have a lack of workforce and technical resources for response and coordination (Fig.1). Literature and departmental record reveal that NCOC is also lacking in permanent trained human resources support to perform all its functions.

Inter-agency human resources exchange was also a big challenge. Pakistans Joint External Evaluation (JEE) indicates that Pakistan lags behind in strategic emergency planning, preparedness, resource identification, and mapping34. NIH facilitated in capacity building of provincial and regional health departments to generate trained human resources for the emergency response coordination in 2020 and 202135. But the national level response organizations were lacking in capacity for their human resources to be engaged in emergency response at time of escalation. Most of the agencies did not deploy permanent liaison staff at operations center on regularly basis but called for specific assignments.

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The COVID-19 vaccination campaign in 141 countries averted 2.4 million excess deaths by August 2021 and would have saved another 670,000 more lives had vaccines been distributed equitably, estimates a working paper from University of Southern California (USC) and Brown Universityresearchers.

The National Bureau of Economic Research circulated the nonpeer-reviewed working paper for discussion and comment this week. The researchers estimated the real-world effectiveness of the global COVID-19 vaccine rollout on all-cause death rates, including both the direct and indirect effects of the pandemic.

"Within eight months, over 2 billion people were vaccinated globally, making it the largest public health campaign in history," the study authors wrote.

"To the best of our knowledge, this is the first study that estimates the effect of COVID-19 vaccines on the global all-cause mortality using observational data. Second, unlike existing studies, this study considers the waning effect of vaccines instead of assuming a constant effectiveness of vaccines over time."

In 43 countries included in the main regression analysis based on The Economist COVID-19 excess deaths tracker GitHub, vaccination saved an estimated 1.14 million lives from January to August 2021, a roughly 26% reduction in deaths compared with a scenario without the global vaccination campaign.

By extrapolating the results to the 141 countries, the researchers estimated that 2.36 million lives were saved in the first 8 months of the global COVID-19 vaccination campaign. The averted deaths were economically valued at $6.5 trillion, roughly equivalent to 9% of the combined gross domestic product (GDP) of the 141 countries.

In terms of absolute numbers, India and United States benefitted the most from the campaign, with 451,778 and 429,486 lives saved, respectively. Together, they made up 37% of the total lives saved in the 141 countries.

"Due to diminishing marginal health benefits of vaccination, redistributing vaccines from countries with high vaccination rates to countries with low vaccination rates can increase the number of deaths averted," the researchers wrote.

Had the vaccine been equitably distributed among the 141 countries, the COVID-19 vaccination campaign would have saved 3.03 million all-cause deaths during the study period. The deaths averted had an economic value, based on country- and region-specific estimates of the value of statistical life (VSL), of about $4.69 trillion.

These findings leave us with an unanswered question at the intersection of economics and public health: should we seek to maximize the number of lives saved or maximize the economic value of lives saved?

VSL estimates ranged from $0.06 million in Afghanistan to $9.4 million in Switzerland. The average American VSL was $7.2 million, compared with the global VSL estimate of $1.3 million. While India and the United States saved similar numbers of lives with vaccination, the Indian deaths averted were valued economically at $90 billion, making up just 1.4% of the total VSL among the 141 countries.

"Therefore, relative to the status-quo, we estimate that an additional 670,000 lives would have been saved, but with a $1.8 trillion decrease in the total economic value of deaths averted," the authors wrote.

"These findings leave us with an unanswered question at the intersection of economics and public health: should we seek to maximize the number of lives saved or maximize the economic value of lives saved?" they added. "We leave answering this question as an important future endeavor for ethicists and economists."

The results suggest that COVID-19 vaccination and treatments are much more effective at preventing death than other efforts aimed to contain SARS-CoV-2, such as lockdowns and mask mandates, the researchers said.

"Our study shows the enormous health impacts of COVID-19 vaccines, which in turn have huge economic benefits," coauthorChristopher Whaley, PhD, said in a Brown University news release. "In terms of lives saved and economic value, the COVID-19 vaccination campaign is likely the most impactful public health response in recent memory."

Link:

Global COVID vaccination saved 2.4 million lives in first 8 months ... - University of Minnesota Twin Cities