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Maternal Seroprevalence and Placental Transfer of COVID-19 Antibodies in Pregnancy: A Hospital-Based Study - Cureus

Key Takeaways

People living with asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD) may have a weaker response to the COVID-19 vaccine than people with healthy lungs, making them more susceptible to COVID-19 than their vaccinated counterparts without lung disease, according to a new study.

According to lead author R. Lee Reinhardt, PhD, an associate professor in the Department of Immunology and Genomic Medicine at National Jewish Health, there are a few reasons why.

Chronic lung illness causes lung inflammation that may prevent the immune system from fully responding to the COVID vaccine, Reinhardt told Verywell.

Treatment for chronic lung diseases can also muddy vaccine response. Many patients take medications that suppress inflammation in the lungs, such as steroids and biologics.

These medications can dampen the immune systems reaction to vaccines, leaving the individual less fully protected than a healthy person, Reinhardt said.

If youre living with a lung disease like asthma or COPD, heres what experts want you to know about getting a COVID vaccine and the best way to deal with illness this winter.

For the study, the researchers looked at blood samples taken from 32 patients with either asthma, COPD, or ILD who had gotten a COVID vaccine. They checked the patients COVID antibody levels and compared them to the levels of 31 vaccinated people who did not have lung disease.

Three to four months after getting a COVID vaccine, about half of the participants with lung disease had lower COVID antibody levels than the people with healthy lungs. The researchers concluded that lower antibody levels meant that the patients with lung disease had a weaker response to the vaccine and may not have had as much protection as vaccinated people with healthy lungs.

Reinhardt emphasized that the study findings do not mean that people with chronic lung disease should avoid getting a COVID vaccinehaving slightly less protection is still better than having none.

The [COVID] vaccine is highly effective at controlling COVID-19 and preventing severe disease. Reinhardt said, adding that both the immune (T) cell and antibody responses are sufficient to protect the public.

Since they may not mount as strong an immune response, patients with chronic lung conditions may need an additional dose of a COVID vaccine as their immunity starts to wear off to ensure they stay protected.

Patients with underlying lung disease may have the same level of immunity at three months as healthy people have at six to eight months, so they may need two doses a year instead of one seasonal dose, Reinhart said.

There are no official guidelines on vaccinating people with chronic lung disease against COVID, so people with asthma, COPD, and ILD should talk to their healthcare providers to figure out the best plan.

Reinhardts team wants to find out if their studys findings on COVID vaccines might apply to other vaccine-preventable respiratory illnesses, like the flu, pneumonia, and respiratory syncytial virus (RSV).

Having more data to help providers make decisions about vaccinating at-risk patients is important, as previous studies looking at immune responses to flu vaccines among people with chronic lung disease have been mixed.

For example, a 2021 study found that asthma patients who controlled their condition with treatments like immunotherapy and steroids had similar immune responses to flu vaccines as those who didnt have asthma. However, older studies have suggested that people with asthma may mount a weaker response to flu vaccines.

A 2022 study found that the response to flu shots was similar between people with COPD and people who didnt have COPD. But the researchers added that personalizing flu shots based on immune responses would make them even more effective for high-risk people. And like with the asthma studies, other studies on COPD have suggested that people with the condition may not mount a strong response to flu shots.

Even though people with lung disease are at high risk for respiratory illnesses, theres still a lot that providers dont know when it comes to the best way to protect them. More studies are needed to understand how people with chronic lung diseases immune responses to vaccines stack up against those of people with healthy lungs, as well as establish guidelines to make sure they get the most protection from vaccines.

Anyone who is immunocompromised or concerned about reducing their risk of contracting respiratory illness during periods of community surges is encouraged to wear a mask when out in public, Tammy Lundstrom, MD, JD, Senior Vice President and Chief Medical Officer at Trinity Health in Livonia, Michigan, told Verywell.

If prolonged mask-wearing is difficult, a person should avoid crowded indoor spaces when RSV, influenza, or COVID are surging in their locale, said Lundstrom.

High-risk groups, including older adults, immunocompromised people, and people with chronic lung conditions, should see their provider right away if they do get sick. Antiviral medications like Paxlovid can reduce the risk of COVID complications for high-risk people. Lagevrio may be a good alternative if youre taking a medication that interacts with Paxlovid.

Anyone who qualifies for the use of COVID outpatient treatments should seek care as soon as possible after diagnosis to maximize effect since the medications need to be given within five days of the onset of symptoms, Lundstrom said.

If you have chronic lung disease, you may have a weaker immune response to a COVID vaccine. However, having slightly less protection is better than having no protection, so experts say its still important to get vaccines against respiratory viruses like COVID and the flu. You can also continue to take other precautions, like wearing a mask, to guard yourself against getting sick this winter.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit ourcoronavirus news page.

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People With Asthma, COPD May Not Get Full Protection From COVID Vaccines - Verywell Health

Opinion

If the former health secretary wants to avoid being the fall guy for Britains pandemic failures, he should stop the constant overclaiming

Thu 30 Nov 2023 13.30 EST

Few public figures have emerged from the Covid-19 inquirys autumn hearings with more damage to their reputations than Matt Hancock. Admittedly, Mr Hancocks public standing was not high at the outset. But he has been one of the prime targets in the Whitehall blame game that has played out in the inquiry since October. Only Boris Johnson, who will give evidence himself next week, has taken worse hits to his public standing, as politicians, advisers and civil servants jockey to explain how Britain proved so unprepared for a pandemic that has killed more than 230,000 UK residents since the start of 2020.

Thursday was Mr Hancocks chance to strike back. He certainly made a go of it. His nuclear levels of self-confidence, to which the Cabinet Office civil servant Helen MacNamara had drawn attention in her testimony, and which reached their zenith in his reported wish to decide which NHS patients should live and which should die, were prominent in all his answers. No question seemed to puncture his belief, which was aggressively argued in exchanges with the inquiry counsel Hugo Keith, that his own actions were consistently timely, wise and tough, and that any fault lay wholly elsewhere, and mainly in 10 Downing Street.

There are two fatal problems with this approach. The first is that Mr Hancocks self-belief makes him overclaim. He puts a uniformly positive gloss on everything, leaving himself no room to retreat or compromise with dignity. He deserved credit for supporting lockdown and opposing herd immunity strategies. He was a critic of Eat out to help out. But his infamous claim to be putting a ring around care homes will haunt his reputation forever. His arbitrary promise of 100,000 tests a day left him with a target only achievable by creative counting. His claim, repeated on Thursday, that Britain was better prepared for Covid than other comparable countries is manifestly untrue. His insistence, again repeated, that Britain had a pre-pandemic plan is misleading, since it was not the right one to deal with Covid.

The second problem is that Mr Hancocks accounts are directly contradicted by too many others. The former Downing Street chief adviser Dominic Cummings, with whom Mr Hancock has a reciprocal loathing, tweeted that the former health secretary was lying to the inquiry when he claimed to have advised the prime minister to impose an immediate lockdown two weeks before it happened. With his contempt towards all elected politicians from the prime minister down, Mr Cummings is certainly no paragon. Mr Hancocks accusation that he encouraged a culture of fear in Downing Street is hard to dispute. But Mr Cummingss charges that MrHancock made claims without evidence, and that they subsequently proved to be false, have often been backed up by other civil servants and politicians.

In one important respect, however, what MrHancock told the inquiry was correct. In the end, the principal purpose of the inquiry is not to decide which minister or adviser was individually most to blame for the UKs failings in the face of Covid. Yes, that matters. And, yes, Britain was peculiarly hindered by the fact that Covid struck when a dithering Mr Johnson and his second-rate team were in government. Nevertheless, the more important task ultimately is to learn lessons. It is to put structures, approaches and resources in place so that the same lamentable errors, and the same egregious untruths that ministers told about them, are not repeated when the inevitable next pandemic arrives.

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The Guardian view on Matt Hancock at the Covid inquiry: a loss of dignity - The Guardian

The Covid-19 pandemic landed a substantial blow to life expectancy in the U.S., and while life expectancy has been slowly increasing once again, it is yet to return to pre-pandemic levels. According to provisional data by the U.S. Centers for Disease Control and Prevention (CDC), life expectancy increased by 1.1 years to 77.5 in 2022 compared to 76.4 in 2021. "The good news is that life expectancy increased for the first time in two years," Elizabeth Arias, co-author of the paper, told NPR. "The not-so-good news is that the increase in life expectancy only accounted for less than 50% of the loss that was experienced between 2019 and 2021."

While Covid deaths have gone down, it is still the top cause of death in the U.S. "Holding everything else constant, we'd need to see another large decline in Covid mortality for life expectancy to increase," Arias told CNN. Along with fewer Covid deaths, there were also fewer deaths caused by cancer, heart disease, homicide and unintentional injuries, including drug overdoses. On the flip side, life expectancy would have been higher "had there not been a rise in deaths from pneumonia and the flu, malnutrition, kidney disease, birth defects and perinatal deaths," NBC News reported. Life expectancy varied between races with American Indians and Alaska Natives having the largest increases but still having the shortest expectancies.

While not listed in the top ten causes of death, the number of suicide deaths rose to its highest rate since 1941 with "increases pretty much across the board," Sally Curtin, who co-authored a separate report the CDC also released Wednesday, told PBS. Almost 50,000 lives were lost to suicide in 2022, with men four times more likely than women to die by suicide. However, the suicide rate increased twice as much for women in 2022, especially among white women and those between 25 and 34. The good news is that the suicide rate decreased among youth.

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Life expectancy increased in 2022 - The Week

Suffolk County reported the following information related to COVID-19 on November 29, 2023

According to CDC, hospital admission rates and the percentage of COVID-19 deaths among all deaths are now the primary surveillance metrics.

COVID-19 Hospitalizations for the week ending November 18, 2023

Daily Hospitalization Summary for Suffolk County From November 29, 2023

NOTE: HOSPITALS ARE NO LONGER REPORTING DATA TO NYSDOH ON WEEKENDS OR HOLIDAYS.

Fatalities 11/28/23

COVID-19 Case Tracker November 27, 2023

Note: As of May 11, 2023, COVID-19 Community Levels (CCLs) and COVID-19 Community Transmission Levels are no longer calculatable, according to the Centers for Disease Control and Prevention.

* As of 4/4/22, HHS no longer requires entities conducting COVID testing to report negative or indeterminate antigen test results. This may impact the number and interpretation of total test results reported to the state and also impacts calculation of test percent positivity. Because of this, as of 4/5/22, test percent positivity is calculated using PCR tests only. Reporting of total new daily cases (positive results) and cases per 100k will continue to include PCR and antigen tests.

COVID-19 Vaccination Information

Last updated 5/12/23

Vaccination Clinics

As of September 12, 2023, the Suffolk County Department of Health Services is not authorized to offer COVID-19 vaccines to ALL Suffolk County residents.

The department will offer the updated vaccine to only uninsured and underinsured patients through New York State's Vaccines for Children program and Vaccines for Adults program, also known as the Bridge Access Program.

Those with insurance that covers the COVID-19 vaccine are encouraged to receive their vaccines at their local pharmacies, health care providers offices, or local federally qualified health centers.

The department has ordered the updated COVID-19 vaccine and will announce when the vaccine becomes available.

FOR HEALTHCARE PROVIDERS

New York State Links

CDC COVID Data Tracker Rates of laboratory-confirmed COVID-19 hospitalizations by vaccination status

For additional information or explanation of data, click on the links provided in throughout this page.

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COVID-19 update 11-30-23 - Suffolk County Government (.gov)

This is a sign of the times.

The four fixed-site City of Toronto COVID-19 vaccination centres will soon be shutting down.

A statement from the City of Toronto says on December 13th, the clinics at Metro Hall, Cloverdale Mall, North York Civic Centre and the site near the Scarborough Town Centre will permanently close.

Toronto Medical Officer of Health Dr. Eileen de Villa, says this is the end of the final chapter in the citys fixed vaccination clinics which she says were initially established as a temporary measure in response to the COVID global health crisis.

Over the course of the pandemic, Toronto Public Health administered more than 2.2 million doses of COVID-19 vaccines at fixed-site and mobile clinics.

Dr. de Villa reminds us to stay current with our COVID, flu and routine vaccinations which says is especially crucial as we enter the respiratory illness season.

The responsibility for COVID vaccinations will now fall to primary healthcare providers and pharmacies in Toronto.

The closures come as wastewater data now shows that the rate of COVID-19 infection in Ontario is at its highest point in more than a year. The Public Health Ontario data also suggests that other indicators are pointing to rapidly rising levels of viral activity as the temperature drops and residents spend more time indoors.

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TORONTO'S FIXED SITE COVID-19 VACCINATION CENTRES TO PERMANENTLY CLOSE DECEMBER 13TH - Zoomer Radio

Click here for the latest Information on COVID-19 Vaccine availability Landstuhl Regional Medical Center Emergency Department will not test for COVID-19 unless ordered by a medical provider.

Commanders / Supervisors should refrain from sending symptomatic Service Members / employees for testing to the Emergency Department. If a home test cannot be conducted, call the LRMC appointment line to make an appointment with the appropriate primary care clinic. Civilian employees should visit their host nation primary care manager as authorized through their healthcare plan.

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COVID-19 Risk Reduction and Response - TRICARE Newsroom

Many patients impacted by the COVID-19 virus experience mild illness and recover at home after a few days. Some of the symptoms for these patients include fever, chills, cough, shortness of breath, fatigue, muscle or body aches, headaches, sore throat, and diarrhea. These individuals can usually treat their symptoms with OTC medications such as acetaminophen or ibuprofen.

For patients that may have comorbidities or experience more severe COVID-19 disease, there are other treatment options available that can help not only improve the symptoms, but also reduce the risk of hospitalization. These medications are effective especially if they are prescribed and started within 5 to 7 days of the symptoms appearance. This is especially important for older adults (>50 years), those who are unvaccinated or not up to date with their vaccinations, and those with certain medical conditions, such as lung disease, heart disease, or a weakened immune system.

Image credit: Mike Mareen | stock.adobe.com

The FDA has approved and authorized several antiviral medications that can be used to treat mild to moderate COVID-19 symptoms in those that are very sick or at risk of more severe illness, including antiviral treatment medications. Antiviral agents target specific parts of the virus to stop it from growing and multiplying in the body. These options include nirmatrelvir and ritonavir (Paxlovid; Pfizer), remdesivir (Veklury; Gilead), and molnupiravir (Lagevrio; Merck).

Combination nirmatrelvir and ritonavir is authorized for adults and children 12 years and older and should be started as soon as possible within 5 days of initial symptoms. This medication comes in a 300mg/100mg dose pack and 150mg/100mg dose pack for patients use. It is important to educate patients on potential adverse effects, including liver problems, allergic reactions, and drug-drug interactions.

Remdesivir is another antiviral agent that can be used in adults and children. This medication is to be started as soon as possible within 7 days of symptom emergence. Remdesivir is only available intravenously (IV) in a health care facility and is a nucleotide prodrug of an adenosine analog, which binds to the viral RNA-dependent RNA polymerase and inhibits the replication of the RNA transcription. The IV formulation is approved by the FDA for the treatment of COVID-19 patients aged 28 days and weighing 3 kg. In those hospitalized with COVID-19, treatment with remdesivir should continue for 5 days or until discharge.

Another option is molnupiravir. This is another antiviral agent for adults, to be started within 5 days of symptom onset. This medication can be taken at home by mouth, and the 4 capsules should be taken every 12 hours for 5 days. Patients can take this medication with or without food.

As of December 2022, nearly 6 million Americans have taken nirmatrelvir/ritonavir. To date, remdesivir has been made available to more than 10 million patients around the world, including 7 million in 127 countries through the manufacturer Gilead. As we move forward with COVID-19, many of these medications are becoming more available and affordable for the public.

It is important for the patients taking any of the mentioned treatment options to be knowledgeable about the medications, know how to take them, and for how long. Patients should generally be instructed to report symptoms of sickness, such as fever, chills, cough, shortness of breath, fatigue, muscle and body ache, and headaches to their health care providers as soon as possible, so they can be started on the most appropriate COVID-19 therapy as early as possible for better outcomes. With wider testing available, diagnosing COVID-19 has become easier and many patients now have access to important treatment options against the COVID-19 virus.

References

1. Symptoms of COVID-19. CDC. Updated October 26, 2022. Accessed November 29, 2023. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

2. COVID-19 Treatments and Medications. CDC. Updated November 17, 2023. Accessed November 29, 2023. https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html

3. Remdesivir. NIH COVID-19 Treatment Guidelines. Updated July 21, 2023. Accessed November 29, 2023. https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/remdesivir/

4. Fact Sheet for Patients and Caregivers: EUA of Lagevrio (molnupiravir) capsules for Coronavirus Disease 2019 (COVID-19). FDA. Revised October 2023. Accessed November 29, 2023. https://www.fda.gov/media/155055/download

5. Recht H. COVID-19 treatment Paxlovid has been free so far. Next year, sticker shock awaits. PBS. December 18, 2022. Accessed November 29, 2023. https://www.pbs.org/newshour/health/covid-19-treatment-paxlovid-has-been-free-so-far-next-year-sticker-shock-awaits

6. FDA Approves Veklury (Remdesivir) for the Treatment of Non-Hospitalized Patients at High Risk for COVID-19 Disease Progression. Gilead. January 21, 2022. Accessed November 29, 2023. https://www.gilead.com/news-and-press/press-room/press-releases/2022/1/fda-approves-veklury-remdesivir-for-the-treatment-of-nonhospitalized-patients-at-high-risk-for-covid19-disease-progression

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Clinical Updates: Treatment Options for COVID-19 - Pharmacy Times

The concept of "severe COVID-19" can be a frightening one, especially when the term itself is so often misunderstood or confused with having self-assessed severe symptoms of COVID-19.

Approximately 80% of those who test positive for COVID-19 have mild to moderate illness.1 But adults 50 and older and people of any age with certain underlying health conditions are at high risk of progression to severe COVID-19. That adds up to two in five people worldwide who are at increased risk for severe COVID-19.2 In the U.S. approximately 75% of adults are at high risk of progression to severe illness.3

According to the CDC, "Severe outcomes of COVID-19 are defined as hospitalization, admission to the intensive care unit (ICU), intubation or mechanical ventilation, or death."4

Severe illness is different from having symptoms that are subjectively assessed as severe, says Florin Draica, MD, MBA, Senior Medical Director, COVID-19 Antiviral Team Lead. For example, a patient can have severe headache and cough (severe symptoms) but the disease, from a clinical spectrum, can still be mild-to-moderate.

In order to take the right steps for ourselves and to protect our high-risk populations, it's important to understand the differences between having subjectively diagnosed severe symptoms and having severe COVID-19 disease," Draica says.

Here's what you need to know:

There is no typical COVID-19 infection. Those who test positive for the virus can fall along a broad spectrum from asymptomatic to critically ill.5 Some people who get COVID-19 may not notice any effects while others may experience muscle or body aches, cough, sore throat, shortness of breath, congestion, headache, and loss of taste or smell.5,6 Although these symptoms may range from mild to moderate or even feel more serious, these cases would not necessarily be classified as severe COVID-19.5

"The disease can progress to severe or critical illness as the symptoms worsen, but also as the patient has additional specific symptoms that define the severe or critical stages of COVID-19 that you don't have in the mild or moderate illness, Draica explains.

Again, the severity of symptoms is not what defines having severe COVID-19 at all. Instead, a diagnosis of severe COVID-19 is based on specific clinical signs, including a respiratory rate over 30 breaths per minute, oxygen saturation below 94%, and lung infiltrates over 50%, as shown on radiographs.5

COVID-19 symptoms such as headache, fever, or a runny nose can be managed at home with over-the-counter pain relievers if the disease is mild or moderate and if the patients are not at high risk of progression to severe illness, Draica says. Patients who have a high risk for progression to severe illness and have COVID-19 should seek care from a healthcare provider and discuss whether a COVID-19 treatment might help to prevent disease progression, even if their symptoms are mild. Patients with severe or critical illness should be hospitalized and may need intensive care or supportive ventilation.3,7

Symptoms can be mild or severe while a patient has a mild to moderate COVID-19, according to Draica. "The disease management should be driven by the patient's risk status, not the subjective severity of symptoms," he says, explaining that these symptoms can worsen quickly, just as the disease can progress quickly to severe or critical, if the patient is at high risk for severe illness.

The severity of symptoms is what gets a lot of attention, but that's not necessarily the right focus, says Draica. What should be the focal point is the patient's risk for progression to severe illness.

Those who are age 50 or over or have certain underlying medical conditions, including chronic asthma, COPD, kidney disease, heart conditions or cardivascular disease, diabetes, obesity or being overweight, or people who are immunocompromised due to certain medications, organ or stem cell transplants, or have AIDS, face a greater risk of a COVID-19 infection progressing to severe illness.2,7 In the United States, approximately 75% of adults have at least one underlying health condition that places them at high risk of developing severe COVID-19.3

Despite the risks, a large proportion of patients who are at high risk and eligible for outpatient COVID-19 treatment do not receive those treatments, Draica says. He believes the oversight is related to COVID-19 patients not being aware of their high-risk status, and this not seeking care, and thus not seeking care, and their focus on symptom severity, not the risk of developing severe disease.

To complicate matters, Draica notes that two-thirds of those who have underlying conditions are unaware that they are at high risk of progression to severe illness after testing positive for COVID-19, making them less likely to seek testing or care.

To address this, Pfizer partnered with the global digital health company Ada Health Inc. to develop the Ada Health COVID-19 Care Journey. This online platform asks a series of questions for patients to learn if they have underlying conditions or other factors that put them at risk for progression to severe COVID-19. If they test positive for COVID-19, they can answer the questions and then use the information to talk to a healthcare provider via telehealth about treatment options if they test positive for COVID-19.

With the COVID-19 public health emergency having ended, we're in a different point in the pandemic.8 Still, COVID-19 was the fourth leading cause of death in United States in 2022, and the virus continues to spread.9

Staying up-to-date on COVID-19 vaccines reduces the risk of serious illness, hospitalization, and death from COVID-1910, and for appropriate patients, taking prescribed medication after testing positive for the virus can reduce the risk of developing severe COVID-19.11

Understanding what constitutes a high risk for severe COVID-19, staying informed on preventive, detection, and treatment options, and being proactive in discussions with healthcare providers about that risk is also crucial.

Those who have one or more high-risk factors should speak with a healthcare provider even if they have mild symptoms. Remember, symptom severity is not predictive of your risk for severe illness and its possible to develop severe COVID-19 even if you have mild symptoms or youre asymptomatic.5

Everybody should be alert and test to limit the spread of the disease to others who may be at high risk for severe illness, Draica says. If somebody is at high risk or uncertain of their risk and has symptoms or a known exposure, they should consult with a healthcare professional.

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Severe COVID-19: Symptoms of Moderate to Severe, Protecting ... - Pfizer

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