Category: Corona Virus

Mike Stucka| USA TODAY NETWORK

Updated COVID-19 booster shots have been authorized by the FDA

The FDA gave emergency authorization to a reformulated COVID booster shot that targets both the original virus and the BA.4 and BA.5 variants.

Just the FAQs, USA TODAY

Oregon reported far fewer coronavirus cases in the week ending Sunday, adding 4,231 new cases. That's down 10.3% from the previous week's tally of 4,719 new cases of the virus that causes COVID-19.

Oregon ranked fifth among the states where coronavirus was spreading the slowest on a per-person basis, a USA TODAY Network analysis of Johns Hopkins University data shows. In the latest week coronavirus cases in the United States decreased 17.1% from the week before, with 543,317 cases reported. With 1.27% of the country's population, Oregon had 0.78% of the country's cases in the last week. Across the country, 16 states had more cases in the latest week than they did in the week before.

The Labor Day holiday may have altered how many people can get tested and when, and when governments report testing results and deaths. This will skew week-to-week comparisons.

Lane County reported 327 cases and seven deaths in the latest week. A week earlier, it had reported 393 cases and one death. Throughout the pandemic it has reported 71,938 cases and 613 deaths.

Across Oregon, cases fell in 23 counties, with the best declines in Jackson County, with 194 cases from 293 a week earlier; in Marion County, with 357 cases from 430; and in Lane County, with 327 cases from 393.

>> See how your community has fared with recent coronavirus cases

Within Oregon, the worst weekly outbreaks on a per-person basis were in Wheeler County with 300 cases per 100,000 per week; Malheur County with 200; and Curry County with 183. The Centers for Disease Control says high levels of community transmission begin at 100 cases per 100,000 per week.

Adding the most new cases overall were Multnomah County, with 852 cases; Washington County, with 608 cases; and Clackamas County, with 386. Weekly case counts rose in 12 counties from the previous week. The worst increases from the prior week's pace were in Yamhill, Multnomah and Polk counties.

In Oregon, 44 people were reported dead of COVID-19 in the week ending Sunday. In the week before that, 41 people were reported dead.

A total of 879,640 people in Oregon have tested positive for the coronavirus since the pandemic began, and 8,427 people have died from the disease, Johns Hopkins University data shows. In the United States 94,748,404 people have tested positive and 1,047,498 people have died.

>> Track coronavirus cases across the United States

USA TODAY analyzed federal hospital data as of Sunday, Sept. 4. Likely COVID patients admitted in the state:

Likely COVID patients admitted in the nation:

Hospitals in 10 states reported more COVID-19 patients than a week earlier, while hospitals in 15 states had more COVID-19 patients in intensive-care beds. Hospitals in 21 states admitted more COVID-19 patients in the latest week than a week prior, the USA TODAY analysis of U.S. Health and Human Services data shows.

The USA TODAY Network is publishing localized versions of this story on its news sites across the country, generated with data from Johns Hopkins University and the Centers for Disease Control. If you have questions about the data or the story, contact Mike Stucka at mstucka@gannett.com.

Original post:

Lane County reported 327 additional COVID-19 cases this week this week - The Register-Guard

By Chelsea Donovan, WRAL reporter

People may be able to get a fresh new COVID-19 booster shot as soon as Tuesday.

The new booster is designed to protect against BA.4 and BA.5, which hare the most common strains of the virus across the country.

Last week, the U.S. Centers for Disease Control and Prevention recommended the updated boosters for adults and teenagers.

The North Carolina Department of Health and Human Services said the state has 500,000 COVID-19 boosters that should arrive in the next two weeks.

[Its like] peanut butter and jelly. Its two for one, said UNC Health Infectious Disease Specialist Dr. David Wohl.

Wohl said the new booster due out this week has bonus ingredients to fight COVID-19.

The cherry on top there is a component that helps your body fight of BA.5, Wohl said. Its the latest flavor of omicron most people getting infected with.

BA.5 accounts for 84% of cases reported in North Carolina during the past 2 weeks, according to DHHS.

This is a very super-spreading virus, Wohl said.

Pfizer and Moderna will offer the shots, which are also known as bivalent vaccines. They are designed to target both the original coronavirus strain and the currently circulating omicron subvariants BA.4 and BA.5.

Anyone 12 and older is eligible.

All of us who have not had a booster within last two months should seriously consider getting this, Wohl said.

Wohl said the new booster should last several months.

Together, it will protect with variant circulating and whatever comes down the pipe, Wohl said.

Many people WRAL News talked to are ready to get the new shot as winter season approaches.

I want to not only protect myself, but everyone else, said Shirley Varlea, who is fully vaccinated and boosted. I dont want someone to get it. I have grandchildren.

Others are playing a wait-and-see approach.

LaMont King said he was unfamiliar with the rollout of the new booster shot.

Its a bit cumbersome thinking about getting a lot of shots, King said.

Wohl believes the new boosters could be a key player in how the rest of the year plays out.

My hope is that since we have so many people immune to BA.5 because hundreds of thousands are catching it every week and because people are getting vaccinated, especially with this new booster, our community immunity will be such that we will blunt a huge surge, Wohl said.

Wake County plans to begin allowing residents to schedule their boosters on Wednesday morning with some appointments available on the same day.

Visit link:

New COVID-19 boosters expected to be available this week to people in North Carolina - WRAL News

The rate that emerging wildlife diseases infect humans has steadily increased over the last three decades. Viruses, such as the global coronavirus pandemic and recent monkeypox outbreak, have heightened the urgent need for disease ecology tools to forecast when and where disease outbreaks are likely. A University of South Florida assistant professor helped develop a methodology that will do just that predict disease transmission from wildlife to humans, from one wildlife species to another and determine who is at risk of infection.

The methodology is a machine-learning approach that identifies the influence of variables, such as location and climate, on known pathogens. Using only small amounts of information, the system is able to identify community hot spots at risk of infection on both global and local scales.

Our main goal is to develop this tool for preventive measures, said co-principal investigator Diego Santiago-Alarcon, assistant professor of integrative biology. Its difficult to have an all-purpose methodology that can be used to predict infections across all the diverse parasite systems, but with this research, we contribute to achieving that goal.

With help from researchers at the Universiad Veracruzana and Instituto de Ecologia, located in Mexico, Santiago-Alarcon examined three host-pathogen systems avian malaria, birds with West Nile virus and bats with coronavirus to test the reliability and accuracy of the models generated by the methodology.

The team found that for the three systems, the species most frequently infected was not necessarily the most susceptible to the disease. To better pinpoint hosts with higher risk of infection, it was important to identify relevant factors, such as climate and evolutionary relationships.

By integrating geographic, environmental and evolutionary developmentvariables, the researchers identified host species that have previously not been recorded as infected by the parasite under study, providing a way to identify susceptible species and eventually mitigate pathogen risk.

We feel confident that the methodology is successful, and it can be applied widely to many host-pathogen systems, Santiago-Alarcon said. We now enter into a phase of improvement and refinement.

The results, published in the Proceeding of the National Academy of Sciences, prove the methodology is able to provide reliable global predictions for the studied hostpathogen systems, even when using a small amount of information. This new approach will help direct infectious disease surveillance and field efforts, providing a cost-effective strategy to better determine where to invest limited disease resources.

Predicting what kind of pathogen will produce the next medical or veterinary infection is challenging, but necessary. As the rate of human impact on natural environments increases, opportunity for novel diseases will continue to rise.

Humanity, and indeed biodiversity in general, are experiencing more and more infectious disease challenges as a result of our incursion and destruction of the natural order worldwide through things like deforestation, global trade and climate change, said Andrs Lira-Noriega, research fellow at the Instituto de Ecologia. This imposes the need of having tools like the one we are publishing to help us predict where new threats in terms of new pathogens and their reservoirs may occur or arise.

The team plans to continue their research to further test the methodology on additional host-pathogen systems and extend the study of disease transmission to predict future outbreaks. The goal is to make the tool easily accessible through an app for the scientific community by the end of 2022.

Read more:

New methodology predicts coronavirus and other infectious disease threats to wildlife - University of South Florida

How Chinas Covid-19 control measures have evolved over the past 5 months  South China Morning Post

More:

How Chinas Covid-19 control measures have evolved over the past 5 months - South China Morning Post

In a recent study posted to medRxiv*, researchers suggested ways to address heterogeneity in immune responses conferred by coronavirus disease 2019 (COVID-19) vaccines.

The rapid development of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is remarkable. Preliminary reports suggested the high efficacy of vaccines in preventing symptomatic COVID-19, raising hopes that herd immunity could be achieved. However, this was undermined by the rapid waning of antibodies and the viral immune escape, resulting in reduced efficacy against infection.

Multiple reports suggest neutralizing antibody (nAb) titers correlate with immune protection. One study observed a dose-response relationship of nAb titers with protection against infection and severe disease outcomes. Numerous studies have shown declining vaccine efficacy against severe disease, contradicting the perception that durable T-cell responses would result in prolonged immunity against severe disease. Besides, there is a significant inter-individual variation in the nAb response.

In the present study, researchers quantified the heterogeneity in the durability of nAb responses. They used a mixed-effects modeling approach to measure population-level variability in the kinetics of nAbs and binding immunoglobulin G (IgG) elicited by SARS-CoV-2 vaccination. Clinical data were obtained from a phase-1 trial of Modernas mRNA-1273 vaccine.

A two-stage population mixed-effects model was applied to the IgG and neutralizing potency dataset to examine the expansion and decay of nAbs post-vaccination. The researchers found no significant correlation between initial nAb titers (at second dose) and model parameters. Besides, there was no significant association between age group and model parameters.

The median half-life of nAbs was significantly higher than that of IgG, consistent with the phenomenon of affinity maturation after vaccination. There was heterogeneity in the peak nAb titers and half-lives across the general population. The mean nAb half-life was 75 days, implying a 29-fold decay of nAb titers over a year post-vaccination.

The peak nAb titer post-vaccination was 4.4-fold higher than the mean convalescent plasma titers post-infection. In a model-simulated population, heterogeneity in the individual nAb pharmacokinetic parameters led to differences in nAb titers. Protection from mild symptomatic disease due to wildtype SARS-CoV-2 (VEs) ranged from near-complete at the 90th percentile to 90% in the 10th percentile after vaccination.

The variation in protection increased with the time since vaccination. Six months post-vaccination, the 90th percentile had 90% protection, whereas the 10th percentile had just 30% protection. The mean population VEm was reduced to 67% in this interval. In contrast, protection from severe disease caused by wildtype SARS-CoV-2 (VEs) was more persistent and higher than VEm.

VEs was near-complete in the population immediately post-vaccination. However, it declined to 75% in the 10th percentile. Notably, the mean population VEs remained at 90% after six months. Despite the relatively high VEs across the population in the first six months after vaccination, immune-evasive SARS-CoV-2 variants could erode this immunity.

The mean VEm against SARS-CoV-2 Delta immediately after vaccination was slightly above 80%, albeit the mean VEs against SARS-CoV-2 Delta was more than 95%. SARS-CoV-2 Omicron caused the highest impact on vaccine efficacy. On average, VEm against SARS-CoV-2 Omicron immediately after vaccination was less than 30%, while VEs was 70%.

The mean protection against mild disease caused by Omicron after six months post-vaccination was less than 30% across the population, whereas it dropped below 40% for severe disease. Further analysis revealed that an optimized anti-receptor-binding domain (RBD) IgG titers strongly predict the required nAb titers for 90% protection against severe disease, with 93% sensitivity and 72% specificity.

The authors found substantial heterogeneity in the degree and durability of nAbs. Because Modernas phase 1 trial excluded immunocompromised subjects from participating, the observed heterogeneity reflects the diverse outcomes expected in the general population. The small size of the participants in the study might not be representative of the entire population.

Moreover, the trial only covers three months of follow-up post-vaccination, which could limit the investigation of long-term kinetics of nAb response, including the possibility of a biphasic decay. A possible solution to address heterogeneity would be administering multiple vaccine boosters for those with poor immunity. Although frequent boosting could present enormous logistic challenges, next-generation vaccines should be designed to overcome the existing issues.

A recurrent failure of the current public health strategy has been overly optimistic assumptions about the pandemic and the delayed reaction/response to any deviations from those assumptions. Overall, the findings suggested the need to advance the protection conferred by vaccines by deploying next-generation vaccines and optimizing the dose and schedule of existing vaccines.

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Read this article:

What is the impact of inter-individual heterogeneity on the degree and duration of vaccinal protection against mild and severe COVID-19? -...

Background

The coronavirus disease 2019 (COVID-19) infection can have a variable impact on patients. Various host factors have been identified that play a significant role in the risk of COVID-19 infection and its severity. Patients with severe asthma have been clinically vulnerable since the first wave of the pandemic and the resurgence of COVID-19 in the United Kingdom in January 2020. In addition, those on treatment with monoclonal antibodies (mAbs) have been identified as being vulnerable to COVID-19 infection and severity by the World Health Organization and the Department of Health. However, the evidence to support this notion is limited, and there has been contrary evidence to suggest severe asthma is protective against COVID-19. In this study, a retrospective review of severe asthma patients in the Liverpool population between 1st January 2020 and 31st January 2021 was conducted. This study aimed to determine the association between asthma severity and the risk of COVID-19 infection and/or its severity for patients on mAb treatment.

We conducted a review of all patients from the Liverpool severe asthma database/spreadsheet who tested positive in the community and at the hospital. Admission records, primary records, emails, and microbiological data for Anglia ICE were reviewed at the Royal Liverpool and Aintree University Hospital.A COVID-19 diagnosis was predefined as a positive lateral flow test and a positive polymerase chain reaction test.The proportion of patients with COVID-19 pneumonia and severe COVID-19 disease requiring hospital admission and escalation to intensive care (observation, intubation, continuous positive airway pressure) was noted. Other patient characteristics were recorded including age, weight, body mass index (BMI), gender, smoking status (never, former, current smoker), bronchiectasis, and the forced expiratory volume.

In total, 760 patients were identified to have severe asthma, of whom 59 (7.8%) tested positive for COVID-19 and 701 (92.2%) tested negative. A total of 244 (32%) patients were taking mAbs, and 516 (68%) were not on mAb treatment. Patients were more susceptible to COVID-19 on an mAb (13.5%) versus non-mAb (5%) (odds ratio (OR) = 2.95; 95% confidence interval (CI) = 1.72 to 5.05) . A larger proportion of severe asthma patients on mAb treatment testing positive for COVID-19 were current smokers and had a higher BMI. Furthermore, severe asthmatics taking mAbs did not have a higher risk of severe COVID-19 disease, hospitalisation, and intensive care admission.

In the Liverpool severe asthma population, patients undergoing mAb therapy had a higher incidence of COVID-19 compared to non-mAb groups; however, they were not at a higher risk of severe disease progression. These findings suggest that continuing biologic therapy in severe asthmatics with COVID-19 appears to be safe to prevent exacerbations.

There were 10 million cases of coronavirus disease 2019 (COVID-19) and 500,000 deaths within the first six months of the first wave of the pandemic [1]. Patients presenting with comorbidities are known to have a higher risk of progressing to severe COVID-19 and hospitalisation [2]. A meta-analysis review showed that 50% of patients diagnosed with Middle Eastern respiratory syndrome (MERS) presented with pre-existing diabetes and hypertension, 30% presented with cardiac disease, and 16% were classed as obese [3]. These findings are consistent with current evidence which demonstrates the above conditions promote the downregulation of proinflammatory cytokines and dysregulate the innate and adaptive immune system making the host susceptible to infection with a poor prognosis [4,5]. While the aforementioned conditions have been linked to hospitalisation and severe COVID-19, few studies are available concerning the vulnerability of asthma patients and COVID-19 infection and severity. The available literature available is conflicting. In addition, studies concerning the role of treatment with monoclonal antibodies (mAbs) in severe asthma patients and the risk of severe COVID-19 are also limited [6]. This justifies and warrants further investigation.

Different mAbs target specific inflammatory pathways in eosinophilic inflammatory type 2 asthma and exert different effects. Mepolizumab and reslizumab exert their effects by downregulating the differentiation and activation of eosinophils through interaction of the interleukin (IL)-5 cytokines. Benralizumab acts as an IL-5 receptor antagonist and can activate natural killer cells, thus, promoting eosinophil apoptosis. Omalizumab prevents the release of mediators that are responsible for bronchospasm by blocking the interaction of immunoglobulin E and receptors located on mast and basophil cells. Dupilumab inhibits the release of proinflammatory cytokines by disrupting the IL-4 and IL-13 signalling pathways.

The current understanding is respiratory viruses such as coronaviruses are implicated in the exacerbation of asthma partly due to the association of bronchial inflammation [7-9]. However, there are conflicting studies that suggest asthma can have a protective role against COVID-19 through a dominant Th2 environment [10]. To unravel the clinical heterogeneity in this patient cohort, the risk of COVID-19 infection and severity in the severe asthma population was examined with respect to mAb treatment.

Retrospective data were collected from the Royal Liverpool and Aintree University Hospital between 1st January 2020 and 31st January 2021. The inclusion criterion was set to include all severe asthma patients attending the Liverpool asthma service. Patients had a confirmed diagnosis of severe asthma according to the British Thoracic Society. Patients residing outside of the Liverpool area, nonadherence to treatment, and patients testing positive for COVID-19 outside the set date were excluded. The data were collected from the dashboard, and admission records were reviewed from the Royal Liverpool and Aintree University Hospitals. Finally, the data were collated onto a spreadsheet using Microsoft Excel. To further this end, primary records were reviewed using eExchange to confirm patients testing positive or negative in the community for COVID-19. Correspondence emails were reviewed and sent by specialist asthma nurses, general practitioners, and patients that informed if they had tested positive for COVID-19 or were admitted elsewhere. To allow for a robust mode of data collection, microbiological data for Anglia ICE was utilised for confirmation of the positivity or negativity of COVID-19 swab tests. A COVID-19 diagnosis was predefined as a positive lateral flow test and a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Other patient characteristics were recorded that included age, weight, body mass index (BMI), gender, smoking status (never, former, current smoker), bronchiectasis, and forced expiratory volume (FEV1).The study was approved by the local ethics committee of the Royal Liverpool and Aintree University Hospital, and all patients provided their consent to be part of the study.

The incidence of COVID-19 was recorded in the severe asthma population. The number of patients testing positive in the community or hospital was noted as well as the confirmation of a positive swab. The proportion of patients who had COVID-19 pneumonia and severe COVID-19 was also recorded. To further this end, patients requiring either admission for COVID-19 or escalation to the intensive care unit (ICU) for observation, intubation, and continuous positive airway pressure (CPAP) were recorded. In addition, the number of patients requiring CPAPon the ward was documented. Following this, the number of severe asthma patients currently on mAbs and not on mAbs was calculated. The proportion of severe asthma patients on mAbs who tested positive or negative for COVID-19 was subsequently calculated. This was compared to the number of severe asthma patients not on mAbs who tested positive or negative for COVID-19. The average age, average weight, average BMI, gender, bronchiectasis, smoking status, and average FEV1 were calculated in patients testing positive or negative for COVID-19 with respect to the severe asthma population, severe asthma population on mAbs, and severe asthma population not on mAbs. An odds ratio (OR) was calculated with a 95% confidence interval (CI) taken as statistically significant. Because a small number of COVID-19 cases were anticipated in the Liverpool severe asthma population, regression analysis for adjustment of confounders was not planned.

Between 1st January 2020 and 31st January 2021, there were a total of 760 patients in the Liverpool severe asthma database. Of the 760 severe asthma patients, 59 (7.8%) tested positive and were laboratory confirmed for COVID-19 infection, and 701 (92.2%) tested negative. Overall, 27 of the 59 (45.8%)patients tested positive for COVID-19 in the hospital compared to 32 (54.2%) in the community. In total, 13 of the 59 (22%) patients who tested positive for COVID-19 developed COVID-19 pneumonia; 14 of the 59 (23.7%)patients progressed to severe COVID-19 disease; 22 of the 59 (37.3%)patients required admission; six (10.2%)patients received CPAP on the ward; and two (3.4%) patients of the 59 who tested positive for COVID-19 required ICU admission, both of whom received CPAP. This is summarised in Table 1.

Of the 760 patients identified from the Liverpool severe asthma database, 244 (32%) were on mAbs and 516 (68%) were not on mAbs. In total, 88 (36%)patients were on benralizumab, four (2%) were on dupilumab, 86 (35%) were on mepolizumab, 63 (26%) were on omalizumab, and three (1%) were on reslizumab. Of the 244 severe asthma patients on mAbs, 33 (13.5%) tested positive and confirmed for COVID-19 whereas 211 (86.5%) tested negative for COVID-19. In addition, of the 516 severe asthma patients not taking mAbs, 26 (5%) tested positive for COVID-19 compared to 490 (95%) who tested negative. This is summarised in Table 2.

The incidence of the severe asthma population undergoing mAb therapy testing positive for COVID-19 was higher compared to the severe asthma population not undergoing mAb therapywith a corresponding OR of 2.95 (95% CI = 1.72 to 5.05, p < 0.01).However, the incidence of the severe asthma population who tested positive for COVID-19 undergoing mAb therapy did not affect progression to severe COVID-19 disease and admission compared to those not on a mAb. This is summarised in Table 3.

In severe asthma patients on mAb therapy who tested positive for COVID-19, the average BMI was higher (35.9 vs. 33.3). In addition, more patients were current smokers (6.1% vs. 2.9%) compared to those who tested negative.

A key finding from this retrospective Liverpool study is the low incidence of COVID-19 (7.8%) in the severe asthma population. This links with other studies which document similar findings [11]. The low occurrence of COVID-19 seen in the Liverpool severe asthma population is consistent with an early study conducted in Wuhan which did not list asthma as a comorbidity but rather reported diabetes mellitus and hypertension as more common comorbidities [12,13]. Studies conducted in Italy and Belgium further support this notion [6,14]. This finding could be attributed to numerous causes. For example, it is thought an inflammatory type 2 response associated with cytokines (IL-4, IL-5, and IL-13) and the clinical inflammatory phenotype of asthma marked by eosinophilia may have protective effects through the activation of the antiviral host defence and promotion of viral clearance [15,16]. Moreover, the presence of eosinopenia was predominately seen in the peripheral blood among those testing positive for SARS-CoV-2 [12]. Perhaps, a pathological environment favouring a high eosinophil count may provide protection against COVID-19 such as the case evident in the airways of severe asthmatic patients.

In the Liverpool severe asthmatic population testing positive for SARS-CoV-2, patients were older,had a higher BMI, and a larger proportion of the patients were female compared to severe asthmatics testing negative for COVID-19. A similar finding was seen in previous studies which reported that patients with asthma and COVID-19 were older, predominately female, and obese [17,18]. The higher prevalence of women with COVID-19 has also been reported in previous research [19-21]. This could be due to a higher baseline prevalence of asthma in females in the Liverpool severe asthma population. The incidence of bronchiectasis in COVID-19-positive and negative patients was similar (8.5% vs. 8.7%). Current smokers in the COVID-19-positive cohort were lower (11.9%) compared to severe asthmatics testing negative (13.1%). However, the proportion of smokers in the severe COVID-19 group was higher compared to patients who did not progress to severe COVID-19 disease (14.3% vs. 11.1%). This implies smoking may increase the likelihood of disease progression and severity which is consistent with prior studies [22]. A lower FEV1 is observed in the severe asthma population testing positive for COVID-19 compared to patients testing negative (2.14 vs. 2.26). This suggests a lower FEV1 may be attributable to a higher risk of COVID-19 infection which was a key finding in a recent study [23].

A hallmark in COVID-19 pathogenesis involves a key receptor named angiotensin-converting enzyme-2 (ACE2). ACE2 is a cellular receptor utilised by the spike protein of SARS-CoV-2 to gain host entry [24]. This is facilitated by the membrane-bound protease serine 2 (TMPRSS2) [25,26]. Therefore, it follows comorbidities that increase the upregulation of the ACE2 and TMPRSS2 genes would thereby increase the susceptibility to COVID-19 infection. For instance, smoking promotes the upregulation of the ACE2 gene which has been linked with increased severity of illness [22]. This was shown in the Liverpool severe asthma population. For patients on mAb therapy, a higher proportion of patients testing positive for COVID-19 were current smokers and had a higher BMI. Educating patients on the importance of smoking cessation and weight loss is crucial in this subgroup.

A further critical finding of this Liverpool study is the incidence of COVID-19 in thesevere asthma patient population is higher in patients taking a mAb (13.5%) compared to those not taking a mAb (5%). A similar finding was seen in another study which highlighted that severe asthma patients on biologics were at higher risk of COVID-19 compared to the general Dutch population [27]. The mechanism of action of biologics varies in relation to the type of treatment used. For instance, mepolizumab and reslizumab work to counteract eosinophil expansion through inhibition of IL-5 inducing eosinophil cytotoxicity [28]. Considering the role of eosinophils in adaptive immunity and antiviral activity it follows depletion in numbers may increase the susceptibility to infections. Consequently, it can be deduced that careful monitoring of the eosinophil count is required for severe asthmatics under mAb treatment as low levels may increase the risk of COVID-19 infection. In addition, it was shown that severe asthma patients taking mAbs were not at a higher risk of severe COVID-19 disease, hospitalisation, or ICU admission in the Liverpool severe asthma population. A comparable result was found in a multitude of studies indicating no relationship between biologic use in severe asthmatics and poorer clinical outcomes of COVID-19 [29,30].The current evidence suggests it is safe to continue biological therapy in severe asthmatics with COVID-19 with no impact on disease severity.

A key strength of this study is the array of resources that were used to gather the data for this study which involved the use of a dashboard, ICE, eExchange and emails. This allowed for a more robust collection of primary and secondary care data.Objective measures of severity of disease (observation, intubation, CPAP) was anotherstrength of this study. A potential limitation of this study is COVID-19 infection rates in the Liverpool severe asthma population may have been underestimated due to patients not adhering to regular testing, strict shielding, and missed positive cases in the community due to nonreporting. In the future, telephone confirmation will be more appropriate to confirm presumed negative COVID-19 patients.

This study is among the first to review the incidence and severity of COVID-19 disease in the Liverpool severe asthma population undergoing biologic therapy. A fundamental finding is that severe asthmatic patients have a low incidence of COVID-19.Results also indicate patients on mAb treatment may be at a higher risk of COVID-19 infection. Furthermore, the presence of obesity or lifestyle factors such as smoking while on mAb therapy may increase the susceptibility to COVID-19 infection. It is also shown that severe asthmatics undergoing mAb treatment do not have a higher risk of severe disease progression or admission. This is consistent with previous studies. This research supports the current practice of continuing biologic therapy during COVID-19 infection in severe asthmatic patients.

View post:

The Incidence and Severity of COVID-19 in the Liverpool Severe Asthma Population Undergoing Biologic Therapy - Cureus

In a recent study posted to the medRxiv* preprint server, researchers compared the percent excess mortalities due to the zero-coronavirus disease 2019 (COVID-19) (ZC) policy or the living-with-COVID (LWC) policy.

Since the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant in 2021, several countries have applied the LWC instead of the ZC policy to facilitate the normalcy of pre-COVID life. However, the high infectivity and transmissibility of Omicron have raised concerns regarding the mortality burden associated with the LWC policy.

In the present study, researchers estimated the excess mortalities to compare the efficacy of the LWC and ZC policies in protecting human lives within the same country during the COVID-19 pandemic.

The team collected all-cause mortality from governmental sources for four countries, including Australia, New Zealand, South Korea, and Singapore, and one region, including Hong Kong. The information collected included weekly or monthly data related to mortalities observed between January 2020 and March 2022 in Singapore, April 2022 in South Korea, March 2022 in Australia, June 2022 in New Zealand, and April 2022 in Hong Kong. Furthermore, data related to confirmed COVID-19 cases as well as COVID-19-associated mortalities were collected for the four countries and one region from Googles COVID map.

Expected mortality estimated in the study was defined as deaths noted in a period assuming the absence of the pandemic. It is calculated according to past trends of all-cause mortality. The team employed the linear regression method to calculate expected mortality. Furthermore, excess mortality was estimated as the difference between observed and expected mortality, while percent COVID-excess mortality (PCEM) was calculated as the percentage of deaths associated with COVID-19 divided by expected mortality. The team then compared PCEM with percent excess mortality (PEM) to assess the contribution of COVID-19-related deaths to overall excess mortality.

The Singaporean government's monthly mortality statistics generated a PEM curve from January 2020 to March 2022. Before August 2021, PEM in Singapore under the ZC policy ranged between 0 and 10%. In August 2021, Singapore adopted the LWC policy and then had the Delta epidemic. Peak PEM reached a value of 31.53%, while the average value from September to December 2021the time of the Delta outbreakwas 24.23%. Under the LWC program, the mortality burdenmeasured as the discrepancy between observed mortality and predicted mortalityrose sharply. Overall, Singapore's LWC strategy throughout the studied period could not effectively reduce the death burden.

In South Korea, PEM dropped to less than 0% in January 2022. According to the most recent data, PEM significantly rose following the policy change. Additionally, during the Omicron outbreak, the PECM curve was much lower than the PEM curve, indicating that COVID indirectly caused a high number of deaths under the LWC policy when coming into contact with the Omicron variety. It could be attributable to overburdened medical resources or an underestimation of mortality linked to COVID. Overall, the LWC policy in South Korea did not successfully reduce the mortality burden throughout the studied period, particularly in response to the Omicron variation.

According to the most recent data, PEM significantly rose following the regulation change. Additionally, the PCEM curve was much lower than the PEM curve, indicating that a sizable portion of deaths under the LWC policy was driven by COVID-19 indirectly. It could be attributable to overburdened medical resources or an underestimation of mortality linked to COVID. The mortality burden under the LWC policy also increased significantly, as shown by the discrepancy between observed mortality and predicted mortality. Before April 2022, Australia's LWC program as a whole did not effectively reduce the mortality burden.

In accordance with the LWC strategy, New Zealand was the only country to reach an average PEM of around 10%. This might be due to the country's extremely high vaccination rate, particularly among the elderly. The lack of a significant disparity between the PCEM and the PEM curves suggests that the mortality burden associated with COVID-19 was accurately reflected in the data on COVID-related deaths.

Furthermore, even during the period of the policy shift, the mortality burden, as shown by the discrepancy between observed mortality and projected mortality, remained virtually unchanged. Overall, the LWC strategy in New Zealand throughout the studied period had a satisfactory success rate in reducing the mortality burden.

The study findings showed that PEM was considerably higher when the LWC policy was applied than during the ZC policy application. The researchers believe that the precondition associated with the transition of each policy should be thoroughly examined, while the current LWC policy needs appropriate revision to attain a lower PEM.

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Original post:

Researchers compare the percent excess mortalities due to the zero-COVID-19 policy or the living-with-COVID policy - News-Medical.Net

In a recent study posted to the medRxiv* server, researchers investigated the vaccine efficacy (VE) of various coronavirus disease 2019 (COVID-19) vaccines against the BA.2, BA.4, and BA.5 sub-lineages of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant.

The UK experienced a surge of BA.4 and BA.5 cases after April 2022, despite the recent BA.1 and BA.2 wave. There have been extensive vaccination efforts since December 2020, with up to four doses offered by March 2022 to high-risk groups. The emergence of newer variants and sub-lineages highlights the need to investigate and monitor the effectiveness of the currently used vaccines in limiting severe infections by all co-circulating sub-lineages.

In the present study, researchers in the UK estimated the effectiveness of the vaccines currently being administered in preventing hospitalization following BA.4 and BA.5 sub-lineage infections compared to BA.2 infections, with all three sub-lineages co-circulating.

The BA.4 and BA.5 spike proteins are similar to those of BA.2, with additional mutations that increase their ability to evade antibodies in vaccinated individuals or BA.1-infected. The COVID-19 vaccination program in the UK offered a primary course of two doses of the Pfizer-BioNTech (BNT162b2), AstraZeneca (ChAdOx1-S), or Moderna (mRNA-1273) vaccines, and a third dose of either BNT162b2 or mRNA-1273 (half-dose). By March 2022, a fourth dose was being offered to the 75 years or older and high-risk groups.

The team carried out a test-negative case-control study to estimate the VE against hospitalization in individuals 18 or older infected with BA.2, BA.4, or BA.5 sub-lineages. The VE was defined as the odds of vaccination in cases divided by the odds of vaccination in controls, subtracted from one. They also compared the incremental VE of individuals with a third or fourth dose with those who had their second dose 25 weeks ago and had waned immunity. The incremental VE of the third and fourth dose vaccines were also compared by the manufacturer.

The data consisted of 32,845 individuals who underwent a polymerase chain reaction (PCR) test at a hospital or public health laboratory and were hospitalized between April 18 and July 17, 2022. Of these, 25,862 were negative and formed the control group. The number of BA.2, BA.4, BA.5, and BA.4 or BA.5 cases were 3,432, 273, 947, and 2,331, respectively. The vaccination status information was procured from the National Immunization Management System (NIMS) database, and the hospital admission data was gathered from the Secondary Care Hospital Admission Data (SUS) database.

The researchers found no evidence of reduced effectiveness of the vaccines against hospitalization for the sub-lineages BA.4 and BA.5 as compared to BA.2. The incremental VE in individuals with third or fourth doses of vaccination was 56.8%, 59.9%, and 52.4% for BA.4, BA.5 and BA.2 respectively, which waned to 1.5%, 23.3%, and 9.8%, respectively, at 25 weeks or more since the second dose.

Vaccine-specific incremental VE for the third or fourth dose did not show any significant difference for combined BA.4 and BA.5 cases compared to BA.2. The Moderna vaccine had a slightly higher incremental VE compared to the Pfizer-BioNTech vaccine, but the confidence intervals overlapped. The mRNA-1273 (Moderna) vaccine had a 62.2% incremental VE at two to 14 weeks after the third or fourth dose, which decreased to 42.0% at 15 to 24 weeks, while that of the BNT162b2 (Pfizer-BioNTech) vaccine decreased from 49.6% at two to 14 weeks to 16.7% at 15 to 25 weeks.

In summary, the study results showed that there was no decrease in VE against hospitalization for infections with SARS-CoV-2 Omicron sub-lineages BA.4 and BA.5 as compared to those with BA.2. Vaccine efficacy did not seem to vary significantly according to the manufacturer either, with third or fourth doses of either mRNA-1273 or BNT162b2 vaccines conferring similar levels of protection against severe infections. The findings of this study confirm that the vaccines currently administered in the UK effectively protect against severe Omicron BA.4 and BA.5 infections.

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information

Continued here:

Are current COVID-19 vaccines in England effective against severe BA.4 and BA.5 Omicron sub-lineage infections? - News-Medical.Net

The CSIRO has delivered a comprehensivereporton how we should prepare for future pandemics.

The report identifies six key science and technology areas such as faster development of vaccines and onshore vaccine manufacturing to ensure supply, new antivirals and ways of using the medicines we already have, better ways of diagnosing cases early, genome analysis, and data sharing.

It also recommends we learn more about viruses and their hosts across the five most concerning virus families. These causes of disease could fuel the next pandemic.

We asked leading experts about the diseases they can cause and why authorities should prepare well.

COVID-19, Middle East respiratory syndrome (MERS), severe acquired respiratory syndrome (SARS)

The first humanCoronaviruses(229E and OC43) were found in 1965 and 1967 respectively. They were low-grade pathogens causing only mild cold-like symptoms and gastroenteritis. Initial understanding of this family came from study of related strains that commonly infect livestock or laboratory mice that also caused non-fatal disease. TheHKU-1 strain in 1995again did not demonstrate an ability to generate high levels of disease. As such, coronaviridae were not considered a major concern until severe acquired respiratory syndrome (SARS-1) first appeared in 2002 in China.

Coronaviridae have avery long RNA genome, coding up to 30 viral proteins. Only four or five genes make infectious virus particles, but many others support diseases from this family by modifying immune responses. The viruses in this family mutate at a steady low rate, selecting changes in the outer spike to allow virus entry into new host cells.

Coronaviridae viruses are widespread in many ecological niches and common in bat species that make up20 per centof all mammals. Mutations spread in their roosts can spillover into other mammals, such as thecivet cat, then into humans.

Coronaviridaegenome surveillanceshows an array of previously unknown virus strains circulating in different ecological niches. Climate change threatens intersections of these viral transmission networks. Furthermore, pandemic human spread of SARS-CoV-2 (the virus that causes COVID) has now seeded new transmissions back into other species, such as mink, cats, dogs and white-tailed deer.

Ongoing viral evolution in new animal hosts and also in immune-compromisedHIV patients in under-resourced settings, presents an ongoing source of new variants of concern.

Damian Purcell

Dengue fever, Japanese encephalitis, Zika, West Nile fever

The flaviviridae family causes several diseases, including dengue, Japanese encephalitis, Zika, West Nile disease and others. These diseases are often not life-threatening, causing fever, sometimes with rash or painful joints. A small proportion of those infected get severe or complicated infection. Japanese encephalitis can cause inflammation of the brain, and Zika virus can cause birth defects.

While all these viruses may be spread by mosquito bites, when it comes to each individual virus, not all mosquitoes bring equal risk. There arekey mosquito speciesinvolved in transmission cycles of dengue and Zika virus, such asAedes aegyptiandAedes albopictus,that may be found in close to where people live. These mosquitoes are found in water-holding containers (such as potted plant saucers, rainwater tanks), water-filled plants, and tree holes. They also like to bite people.

The mosquitoes that spread these viruses are not currently widespread in Australia; they're generally limited to central and far north Queensland. They are routinely detected through biosecurity surveillance at Australia's majorairports and seaports. With a rapid return to international travel, movement of people and their belongings may become an ever-increasing pathway of introduction of the diseases and mosquitoes back into Australia.

Different mosquitoes are involved in thetransmissionof West Nile virus and Japanese encephalitis. These mosquitoes are more likely to be found in wetlands and bushland areas than backyards. They bite people but they also like tobite the animalsmost likely to be carrying these viruses.

Theemergence of Japanese encephalitis, a virus spread by mosquitoes between waterbirds, pigs, and people, is a perfect example. Extensive rains and flooding that provide idea conditions for mosquitoes and these animals create a "perfect storm" for disease emergence.

Cameron Webb and Andrew van den Hurk

Influenza

Before COVID-19, influenza was the infection mostwell-knownfor causing pandemics.

Influenza virus is subdivided into types (A, B, and rarely C and D). Influenza A is further classified into subtypes based on haemagglutinin (H) and neuraminidase (N) protein variants on the surface of the virus. Currently, the most common influenza strains in humans are A/H1N1 and A/H3N2.

Zoonotic infectionoccurs when influenza strains that primarily affect animals "spill over" to humans.

Major changes in the influenza virus usually result fromnew combinationsof influenza viruses that affect birds, pigs and humans. New strains have the potential to cause pandemics as there is little pre-existing immunity.

Since the beginning of the 20th century, there have been four influenzapandemics, in 1918, 1957, 1968, and 2009. In between pandemics, seasonal influenza circulates throughout the world.

Although influenza is not as infectious as many other respiratory infections, the very short incubation period of around 1.4 days means outbreaks can spread quickly.

Vaccines are available to prevent influenza, but are onlypartiallyprotective. Antiviral treatments are available, including oseltamivir, zanamivir, peramivir and baloxavir. Oseltamivirdecreasesthe duration of illness by around 24 hours if started early, but whether it reduces the risk of severe influenza and its complications iscontroversial.

Allen Cheng

Nipah virus, Hendra virus

Paramyxoviridae are a large group of viruses that affect humans and animals. The most well known are measles and mumps, as well as parainfluenza virus (a common cause ofcroupin children).

Globally,measlesis a dangerous disease for young children, particularly those who are malnourished. Vaccines are highly effective with the measles vaccine aloneestimatedto have saved 17 million lives between 2000 and 2014.

One group of paramyxoviruses is of particular importance for pandemic planning henipaviruses. This includes Hendra virus, Nipah virus and the newLangya virus(as well as the fictional MEV-1 in the filmContagion). These are all zoonoses (diseases that spill over from animals to humans)

Hendra virus was firstdiscoveredin Queensland in 1994, when it caused the deaths of 14 horses and their horse trainer. Infected flying foxes have since spread the virus to horses in Queensland and northern New South Wales. There have been sevenreportedhuman cases of Hendra virus in Australia, including four deaths.

Nipah virus is moresignificantglobally. Infection may be mild, but some people develop encephalitis (inflammation of the brain). Outbreaks frequently occur in Bangladesh, where the firstoutbreakwas reported in 1998. Significantly, Nipah virus appears to be able to betransmittedfrom person-to-person though close contact.

Allen Cheng

Chikungunya fever, Ross River fever, Eastern equine encephalitis, Western equine encephalitis, Venezuelan equine encephalitis

The most common disease symptoms caused by infection with alphaviruses like chikungunya and Ross River viruses are fever, rash and painful joints.

Like some flaviviruses,chikungunya virusis thought to be only spread by mosquitoes in Australia. This limits risks, for now, to central and far north Queensland.

Many different mosquitoes play a role in transmission of alphaviruses, including dozens of mosquito species suspected as playing a role in the spread ofRoss River fever. Many of these mosquitoesare commonly found across Australia.

But what role may these local mosquitoes play should diseases such as eastern equine encephalitis or western equine encephalitis make their way to Australia? Given the capacity of our home-grown mosquitoes to spread other alphaviruses, it is reasonable to assume they would be effective at transmitting these as well. That's why the CSIRO reportnotesfuture pandemic preparation should work alongside Australia's established biosecurity measures.

Cameron Webb and Andrew van den Hurk

Allen Cheng is Professor in Infectious Diseases Epidemiology atMonash University; Andrew van den Hurk is Medical Entomologist at The University of Queensland; Cameron Webb is Clinical Associate Professor and Principal Hospital Scientist, University of Sydney; and Damian Purcell is professor of virology and theme leader for viral infectious diseases at The Peter Doherty Institute for Infection and Immunity.This piece first appeared on The Conversation.

Read more:

After COVID-19, these are the five virus families that could cause the next pandemic, according to the experts - ABC News

Gov. Phil Murphy said Sunday that New Jersey will soon begin a comprehensive review of the states response to the COVID-19 pandemic a step he promised more than two years ago.

During a TV interview on Fox News Sunday, the Democratic governor also said he expects people to debate forever and for always whether New Jersey closed schools for too long during the crisis and that officials had no other choice early on.

In addition, Murphy addressed speculation over whether he may run for president in 2024, saying he would back President Joe Biden should the president seek re-election and that he has not met with donors about his own possible bid if Biden decides not to.

Murphy first vowed New Jersey would conduct a postmortem on its handling of the pandemic in April 2020, just weeks after the coronavirus started spreading rapidly in the state, an early epicenter of the illness.

Last week, he reiterated officials are committed to a review but didnt have a date, saying the state is still not out of the woods with the virus.

Asked Sunday if that means there will be no review if COVID-19 is still in New Jersey, Murphy said: No, it does not.

I dont have news to break today, but I think were in a matter of weeks of coming up with a comprehensive program, he added, saying the review will focus on the states entire COVID response, including long-term care.

I want to make sure its effective, not just in teaching us what went right and what went wrong, but also that it can be a tool for future governors, future administrations, the governor said. COVID, sadly, is still with us. It will continue to be with us. But we cant wait til the last case to do that review, and we wont. Well be doing something, starting something soon.

The virus has killed more than 34,000 residents in the state in the last 2 1/2 years. More than 9,500 of those deaths have been among residents and staff members at nursing homes and other long-term care facilities, according to state data.

Murphy closed New Jerseys schools and switched them to remote classes in March 2020, days after the state reported its first coronavirus case. In-person classes did not return until the beginning of the 2021-22 school year.

Fox host Mike Emanuel a Westfield native and Rutgers University alum noted that test scores show evidence of learning loss because of virtual classes and asked Murphy if he felt the state kept schools closed for too long.

I think thats gonna be one of those things that folks debate forever and for always, Murphy said. We knew learning loss, we know its real, we know the mental health stress on everybody kids in particular, educators, families.

But Murphy said early on, when officials had little knowledge about the virus, we had no other choice.

He also insisted New Jersey will be laser-focused on closing those gaps when it comes to learning loss.

As for 2024? Murphy is considered by some to be a potential candidate if Biden, a fellow Democrat, doesnt run for re-election. People close to Murphy have said they consider him a strong contender and have discussed a possible campaign for the Democratic nomination.

Asked about Murphy for President in 2024, Murphy said he expects Biden to run again and that he would support him for a second term.

Hell have no bigger backer than yours truly, the governor said. I think thats really the base case right now. In the meantime, Im gonna have my nose pressed against the Jersey glass.

MORE: President Murphy? N.J. governor could run for White House if Biden doesnt.

Murphy said hes focused on New Jersey morning, noon and night.

Asked if he has met with donors about a 2024 campaign, he said: Ive met with no donors about my personal ambitions in that respect.

Murphy acknowledged a pair of political organizations formed by allies that could raise his national profile. He said those are focused mostly getting the word out in terms of what weve done in New Jersey.

Our journalism needs your support. Please subscribe today to NJ.com.

Brent Johnson may be reached at bjohnson@njadvancemedia.com. Follow him at @johnsb01.

View post:

Murphy says review of how state handled COVID will start soon, addresses speculation on presidential run - NJ.com