Category: Covid-19

Vaccines for COVID-19 and influenza may slightly increase the risk of strokes caused by blood clots in the brains of older adults, particularly when the two vaccines are given at the same time and when they are given to adults who are age 85 and older, according to a new study.The safety signal was detected by experts at the U.S. Food and Drug Administration who analyzed data from Medicare claims.It is the second study to find an elevated risk of stroke for seniors after COVID-19 and flu vaccinations given together. The U.S. Centers for Disease Control and FDA issued a public communication in January explaining that one of their near real-time vaccine safety monitoring studies called the Vaccine Safety Datalink had picked up a small risk of stroke for older adults who received a dose of Pfizers bivalent COVID-19 vaccine and a high-dose or adjuvanted flu shot on the same day. That study triggered the FDAs broader look at strokes after vaccination noted in the medical records of seniors on Medicare.That said, the risk identified in the FDAs study appears to be very small roughly 3 strokes or transient ischemic attacks for every 100,000 doses given and the study found it may be primarily driven by the high-dose or adjuvanted flu vaccines, which are specially designed to rev up the immune system so it mounts a stronger response to the shot.In additional analysis of the Medicare claims data, the FDA researchers found a slightly increased risk of stroke in adults ages 65 and older whod only gotten a high dose flu shot. In absolute terms, the extra risk from high-dose flu shots amounted to 1-2 strokes for every 100,000 doses.The absolute risk is miniscule, said Dr. Steve Nissen, a cardiologist and researcher at the Cleveland Clinic in Ohio. I mean it is trivial in comparison to the risk for people over 85 of dying from COVID. At least five other recent studies many launched to try to tease out this link, have not found any additional risk of stroke after vaccination for COVID-19, influenza or both.Available data do not provide clear and consistent evidence of a safety problem for ischemic stroke with bivalent mRNA COVID-19 vaccines when given alone or given simultaneously with influenza vaccines, said Dr. Tom Shimabukuro, director of the Immunization Safety Office at the CDC in a public presentation of the data on Wednesday to the CDCs Advisory Committee on Immunization Practices.Researchers say they are continuing to probe the possible link, but in the meantime, they say everyone should still get vaccinated since an increase in risk of a stroke after vaccination is dwarfed by the increased risk of stroke or other serious outcomes following either a flu or COVID-19 infection.The risk of serious disease associated with both influenza and COVID for the population at highest risk, which is of course, older persons, is so much greater than the potential increased risk associated with a vaccine, said Dr. William Schaffner, an infectious disease expert at Vanderbilt University.Thats a hard equation for the average person to do, Schaffner said. Spread out your shots?Schaffner said people who are worried could consider getting each shot at different times rather than together.Thats a reasonable thing to do, he said.Schaffner, who is in his mid-80s, said he got both his COVID and flu vaccines at the same time, in the same arm, and had very little reaction afterwards.A few weeks ago, however, Dr. Peter Marks, head of FDAs Center for Biologics Evaluation and Research, said he was planning to get his COVID-19 vaccine first, followed by his influenza vaccine about two weeks later.If you want to minimize the chance of interactions and minimize confusing the side effects from one with another, you wait about two weeks between the vaccines, Marks said on an FDA stakeholder call in September.Other experts said they hoped the information wouldnt confuse people or deter them from getting their vaccines, since the benefits of getting them still greatly outweigh the risks.The bottom line is that these are small signals. Were not entirely sure whether they are valid, and they certainly do not lead themselves to any change in the recommendations for people getting either COVID or influenza vaccines at the present time, Schaffner said.For the study, FDA investigators looked at the medical claims of more than 5.3 million adults ages 65 and older who were enrolled in Medicare and received a bivalent COVID-19 vaccine made by Pfizer or Moderna. They saw no increased risk of stroke in the overall group after COVID-19 vaccination.When they looked at adults ages 85 and older, they found an elevated risk of strokes caused by blood clots in those whod had Pfizer vaccines, but not in those who got Moderna shots.Seniors age 65 and older who got a bivalent vaccine and high-dose or adjuvanted flu shot at the same time also had an increased risk of blood clots in their brains.The study is observational, meaning it can only show associations, it cant prove cause and effect. It was also posted as a preprint ahead of peer review by outside experts and publication in a medical journal.Study sees link to seizures in young kidsA separate FDA investigation of more than 4 million records from three large commercial insurance databases, found a small and tenuous link between seizures in children between the ages of 2 and 5 and COVID-19 vaccination. Children this age appeared to be slightly more likely to have seizures after COVID-19 vaccination compared with background seizure rates in the general population in 2020 a year when infectious diseases were lower in kids because of masks and social distancing.The signal disappeared, however, when researchers compared it with background rates of seizures reported in U.S. children in 2022, a year when infections in kids rebounded.That study was also posted as a preprint.The study authors said their findings should be interpreted with caution, since most were associated with fevers, which are common in kids. Vaccination can also cause kids to run fevers.They said they hoped their findings would be investigated in a more robust epidemiological study.About 4% of children experience seizures triggered by fevers, according to the National Institute of Neurological Disorders and Stroke.Dr. Phillip Yang, a cardiologist at Stanford Health Care, said the findings didnt look particularly concerning.Its not unusual after COVID vaccine that we have little bit of a fever that could trigger a seizure, and kids who are more susceptible to it. So again, its not a surprising finding, Yang said.

Vaccines for COVID-19 and influenza may slightly increase the risk of strokes caused by blood clots in the brains of older adults, particularly when the two vaccines are given at the same time and when they are given to adults who are age 85 and older, according to a new study.

The safety signal was detected by experts at the U.S. Food and Drug Administration who analyzed data from Medicare claims.

It is the second study to find an elevated risk of stroke for seniors after COVID-19 and flu vaccinations given together. The U.S. Centers for Disease Control and FDA issued a public communication in January explaining that one of their near real-time vaccine safety monitoring studies called the Vaccine Safety Datalink had picked up a small risk of stroke for older adults who received a dose of Pfizers bivalent COVID-19 vaccine and a high-dose or adjuvanted flu shot on the same day. That study triggered the FDAs broader look at strokes after vaccination noted in the medical records of seniors on Medicare.

That said, the risk identified in the FDAs study appears to be very small roughly 3 strokes or transient ischemic attacks for every 100,000 doses given and the study found it may be primarily driven by the high-dose or adjuvanted flu vaccines, which are specially designed to rev up the immune system so it mounts a stronger response to the shot.

In additional analysis of the Medicare claims data, the FDA researchers found a slightly increased risk of stroke in adults ages 65 and older whod only gotten a high dose flu shot. In absolute terms, the extra risk from high-dose flu shots amounted to 1-2 strokes for every 100,000 doses.

The absolute risk is miniscule, said Dr. Steve Nissen, a cardiologist and researcher at the Cleveland Clinic in Ohio. I mean it is trivial in comparison to the risk for people over 85 of dying from COVID.

At least five other recent studies many launched to try to tease out this link, have not found any additional risk of stroke after vaccination for COVID-19, influenza or both.

Available data do not provide clear and consistent evidence of a safety problem for ischemic stroke with bivalent mRNA COVID-19 vaccines when given alone or given simultaneously with influenza vaccines, said Dr. Tom Shimabukuro, director of the Immunization Safety Office at the CDC in a public presentation of the data on Wednesday to the CDCs Advisory Committee on Immunization Practices.

Researchers say they are continuing to probe the possible link, but in the meantime, they say everyone should still get vaccinated since an increase in risk of a stroke after vaccination is dwarfed by the increased risk of stroke or other serious outcomes following either a flu or COVID-19 infection.

The risk of serious disease associated with both influenza and COVID for the population at highest risk, which is of course, older persons, is so much greater than the potential increased risk associated with a vaccine, said Dr. William Schaffner, an infectious disease expert at Vanderbilt University.

Thats a hard equation for the average person to do, Schaffner said.

Schaffner said people who are worried could consider getting each shot at different times rather than together.

Thats a reasonable thing to do, he said.

Schaffner, who is in his mid-80s, said he got both his COVID and flu vaccines at the same time, in the same arm, and had very little reaction afterwards.

A few weeks ago, however, Dr. Peter Marks, head of FDAs Center for Biologics Evaluation and Research, said he was planning to get his COVID-19 vaccine first, followed by his influenza vaccine about two weeks later.

If you want to minimize the chance of interactions and minimize confusing the side effects from one with another, you wait about two weeks between the vaccines, Marks said on an FDA stakeholder call in September.

Other experts said they hoped the information wouldnt confuse people or deter them from getting their vaccines, since the benefits of getting them still greatly outweigh the risks.

The bottom line is that these are small signals. Were not entirely sure whether they are valid, and they certainly do not lead themselves to any change in the recommendations for people getting either COVID or influenza vaccines at the present time, Schaffner said.

For the study, FDA investigators looked at the medical claims of more than 5.3 million adults ages 65 and older who were enrolled in Medicare and received a bivalent COVID-19 vaccine made by Pfizer or Moderna. They saw no increased risk of stroke in the overall group after COVID-19 vaccination.

When they looked at adults ages 85 and older, they found an elevated risk of strokes caused by blood clots in those whod had Pfizer vaccines, but not in those who got Moderna shots.

Seniors age 65 and older who got a bivalent vaccine and high-dose or adjuvanted flu shot at the same time also had an increased risk of blood clots in their brains.

The study is observational, meaning it can only show associations, it cant prove cause and effect. It was also posted as a preprint ahead of peer review by outside experts and publication in a medical journal.

A separate FDA investigation of more than 4 million records from three large commercial insurance databases, found a small and tenuous link between seizures in children between the ages of 2 and 5 and COVID-19 vaccination. Children this age appeared to be slightly more likely to have seizures after COVID-19 vaccination compared with background seizure rates in the general population in 2020 a year when infectious diseases were lower in kids because of masks and social distancing.

The signal disappeared, however, when researchers compared it with background rates of seizures reported in U.S. children in 2022, a year when infections in kids rebounded.

That study was also posted as a preprint.

The study authors said their findings should be interpreted with caution, since most were associated with fevers, which are common in kids. Vaccination can also cause kids to run fevers.

They said they hoped their findings would be investigated in a more robust epidemiological study.

About 4% of children experience seizures triggered by fevers, according to the National Institute of Neurological Disorders and Stroke.

Dr. Phillip Yang, a cardiologist at Stanford Health Care, said the findings didnt look particularly concerning.

Its not unusual after COVID vaccine that we have little bit of a fever that could trigger a seizure, and kids who are more susceptible to it. So again, its not a surprising finding, Yang said.

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COVID shots may increase risk of stroke in older adults, particularly when paired with flu vaccines - WTAE Pittsburgh

COLUMBIA, Mo. (KMIZ)

The final of three MU Health Caredrive-thru vaccine clinics began at 9 a.m. until 2 p.m. Saturday at South Providence Medical Park.

At the event, patients were able to receive the updated COVID-19 vaccine and a flu vaccine. According to an email from MU Health spokesman Eric Slusher, at the previous two clinics, there were a combined 1,679 doses of the COVID-19 administered and 1,781 influenza vaccines given.

A MU Health Care pharmacist told ABC 17 News that the updated COVID-19 vaccine is available for children ages five and older. Flu vaccines are available for those six months and older. According to previous reporting, only those 12 years old and older were able to receive theupdated COVID-19 vaccine.

People who went to the drive-through clinic remained in their cars, presented their insurance cards and signed a consent form. It was also encouraged to bring your COVID-19 vaccination card as well.

Patients were then guided by workers at the clinic to a vaccine station where they were administered the shots and vaccinations. They were asked to wait a few minutes before driving out of the clinic site.

Slusher also stated vaccines can be available at primary care clinics and Mizzou Quick Cares.

The Columbia/Boone County Public Health and Human Services previously stated that flu and updated COVID-19 vaccines were also available by appointment at its Worley Street location.

According to PHHS spokesman Ryan Sheehan, as of Tuesday, there have been 40 doses of the updated COVID-19 vaccines administered.

Sheehan also stated there were 3,200 doses of the flu vaccine given at school-based clinics in the county, another 500 were administered at outreach clinics and 300 were given at the PHHS building.

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Last MU Health Care drive-thru vaccination clinic held Saturday; 1,679 updated COVID-19 vaccines given so far - ABC17News.com

NEW YORK (AP) A month after federal officials recommended new versions of COVID-19 vaccines, 7% of U.S. adults and 2% of children have gotten a shot.

One expert called the rates abysmal.

The numbers, presented Thursday at a meeting held by the Centers for Disease Control and Prevention, come from a national survey of thousands of Americans, conducted two weeks ago.

The data also indicated that nearly 40% of adults said they probably or definitely will not get the shot. A similar percentage of parents said they did not plan to vaccinate their children.

In the late summer, government health officials made the nations COVID-19 vaccination campaign more like the annual flu campaign.

Officials approved updated shots that have a single target, an omicron descendant named XBB.1.5. They replaced vaccines that targeted the original coronavirus strain and a much earlier omicron version. Last month, the CDC recommended the new shots for everyone 6 months and older.

The government also transitioned to a commercialized system that relied on the health-care industry not the government to handle the distribution of the shots. Many people who immediately went for shots said pharmacies or doctors didnt have them.

Americans have been urged to get different iterations of the vaccines for more than 2 and 1/2 years. This year, COVID-19 deaths and hospitalizations fell to lower levels than seen in the previous three years.

Cases remain low compared with the pandemics early months. Even so, health officials say about 18,000 hospitalization and 1,200 deaths are still being reported each week.

One expert at the meeting, Dr. Camille Kotton of Harvard Medical School, called the numbers abysmal and said part of the problem may be patient confusion. She urged stepped-up public education efforts.

Dr. David Kimberlin, of the University of Alabama at Birmingham, also expressed dismay.

The recommendations are not being heard, he said.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institutes Science and Educational Media Group. The AP is solely responsible for all content.

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2% of kids and 7% of adults have gotten the new COVID shots, US data show - The Associated Press

China's chief epidemiologist, who helped drive anti-COVID-19 measures that suspended access to cities and confined millions to their homes, has died

By

HUIZHONG WU Associated Press

October 27, 2023, 7:27 AM ET

3 min read

BANGKOK -- Wu Zunyou, an epidemiologist who helped drive the country's strict zero-COVID measures in China that suspended access to cities and confined millions to their homes, died on Friday. He was 60.

An announcement from Chinas Center for Disease Control and Prevention about Wu's death gave no cause, but said that rescue measures failed.

Wu's health had been poor. He disappeared out of the public eye for months last year while battling cancer.

Wu, who earned his masters and doctorate from the University of California, Los Angeles, had spent much of his early career working on HIV/Aids prevention in China.

Wu was instrumental in developing Chinas flagship policy in the HIV epidemic among intravenous drug users, according to his biography on the UCLA website. In recognition of this work, he was awarded the 2005 International Rolleston Award. Later, he was also awarded a UNAIDS Gold Medal in 2008 for his overall work.

Yet, as China battled the COVID-19 virus, Wu came to be criticized by some for his choice to publicly voice support for the countrys strict virus control measures even as the weaknesses of the strategy became more pronounced.

Dynamic zero-COVID is appropriate for Chinas reality, and is the best choice to control our countrys current COVID situation, he said in April 2022, during the height of Shanghais lockdown.

The strategy bought China time in the early days of the pandemic, but by 2022, as the virus became more and more easily spread, it showed signs of strain.

The mega city of Shanghai was unprepared for a lockdown and its residents scrambled for groceries and basic necessities, while many also found it hard to access urgent medical services as people were barred from leaving their homes or even entering hospitals. Many were also angry about a key aspect of virus controls, which involved mass field hospitals where people who tested positive were forced to go to by public health workers.

In private, Wu disagreed with the excesses of the zero-COVID strategy, but felt powerless to go against it.

As zero-COVID got unsustainable in the fall of 2022, he wrote an internal report urging the government to avoid excessive measures. But in public press conferences throughout the past few years, he voiced the official line.

Wu visibly aged during the virus fight. He was pictured in 2020 with mostly black hair; by 2022, his locks had gone entirely gray.

The news of Wu's death came just hours after the death of former Premier Li Keqiang was announced. Li was the countrys No. 2 leader during the pandemic.

___

AP writer Dake Kang contributed to this report from Shenzhen, China.

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China's chief epidemiologist who helped drive the anti-COVID fight dies at age 60 - ABC News

Despite decreased SARS-CoV-2 sequencing resulting from changing COVID-19 testing practices, U.S. genomic surveillance systems detected BA.2.86, a novel SARS-CoV-2 lineage circulating at very low levels. Using multiple surveillance systems enhanced early detection, tracking, and characterization of emerging SARS-CoV-2 variants. The first U.S. detection of BA.2.86 was identified through a health care facility specimen that was sent to CDC by the state laboratory for isolation and further characterization. Successful virus isolation at CDC allowed for the sharing of BA.2.86 isolates with other laboratories. TGS detected BA.2.86 in a sample from a traveler returning to the United States who was likely infected while abroad (5). NWSS facilitated BA.2.86 early warning in additional areas, and wastewater surveillance was a leading indicator in Ohio where BA.2.86 was identified 9 days before a respiratory sequence was reported in the same area.

Specimen collection dates support that BA.2.86 was likely beginning to circulate in the United States before the end of July 2023. Currently, BA.2.86 has not become predominant but is likely circulating across the United States at low levels. Preliminary laboratory research findings indicate that existing antibodies from previous SARS-CoV-2 infection or vaccination are effective in neutralizing BA.2.86 but real-world human outcome data are also needed to better understand the impacts of preexisting immunity,**** (6).

Early warning of SARS-CoV-2 variant detection enables timely assessments of risk, mobilization of resources, clear and timely communication, and coordinated public health action (7). The complementary surveillance systems provided critical data and specimens for culture, treatment effectiveness evaluation, and will facilitate the development of other treatments, as needed. Integrating pathogen genomic sequencing throughout the different surveillance system components added important molecular resolution for tracking variant emergence and transmission dynamics. Digital public health surveillance can provide a signal to enhance and focus other surveillance systems toward detection of new variants. Global information-sharing and partnerships for early warning also played an important role; these systems and partnerships are crucial in light of the decrease in specimen sequencing.

Other existing surveillance systems might become critical to monitoring the impacts of BA.2.86. If circulation increases, epidemiologic data related to relative transmissibility, disease severity, and vaccine and therapeutic effectiveness will be important to understanding this variants impact on human health. If BA.2.86 exceeds 1% of circulating variants within the United States, it will be reported through CDCs Nowcast estimates over time and by region. If BA.2.86 circulation expands to represent a significant proportion of circulating variants in the United States, other complementary COVID-19 surveillance systems that capture detailed laboratory- and patient-level data can be tracked in parallel to understand epidemiologic impacts. If new data become available that result in heightened concern, CDC can launch epidemiologic field studies on transmissibility and severity.

The findings of this report are subject to at least five limitations. First, data analyzed from complementary surveillance systems included varying levels of geographic, epidemiologic, clinical, and demographic information. Links between surveillance data and epidemiologic and clinical data necessary to guide action are often missing, limiting the level of analysis performed. In addition, unequal levels of global sequencing capacity and funding also limit understanding of geographic spread. Second, digital public health surveillance methods employed both informal and formal manual data gathering, which was resource-intensive. Third, global genomic surveillance is limited by the variable lag times between specimen collection and reporting, which can impact real-time actionability. Fourth, standardized national methods for genomic sequence (or partial sequence) data reporting into different public repositories are lacking; this limitation is especially apparent for wastewater sequences. Finally, data quality, reporting, and aggregation standards are needed for multicomponent pathogen genomic surveillance.

The emergence of BA.2.86 has highlighted the importance of early detection through multiple, complementary surveillance systems involving diverse approaches, populations, and specimen types. These systems can be further improved by addressing timeliness, improving understanding of both the strengths and limitations of each system, and increasing cross-public health coordination and action. Leveraging, maintaining, and prioritizing these robust, multipurpose public health surveillance systems require sustained financial resources.

Early detection data are more actionable as the lag time between specimen collection and reporting of results decreases, and when more clinical and epidemiologic data are available. Innovations in pathogen testing and genomic sequencing, capacity building, and reporting systems can support earlier public health action. New technology is also needed from the private sector to offer less expensive, targeted, and more sustainable products (e.g., cheaper, faster diagnostic tests) to support the future of public health surveillance. Continuous, automated data scraping for early warning signs (e.g., robust event-based surveillance) can more efficiently alert health authorities of global events to guide preparation measures. Complementary surveillance systems in place for early warning can be used for other known and novel public health threats. As public health and surveillance advancements continue, the deployment of multiple innovations to strengthen early warning, preparedness, and response will be critical.

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Early Detection and Surveillance of the SARS-CoV-2 ... - CDC

BANGKOK (AP) Wu Zunyou, an epidemiologist who helped drive the countrys strict zero-COVID measures in China that suspended access to cities and confined millions to their homes, died on Friday. He was 60.

An announcement from Chinas Center for Disease Control and Prevention about Wus death gave no cause, but said that rescue measures failed.

Wus health had been poor. He disappeared out of the public eye for months last year while battling cancer.

Wu, who earned his masters and doctorate from the University of California, Los Angeles, had spent much of his early career working on HIV/Aids prevention in China.

Wu was instrumental in developing Chinas flagship policy in the HIV epidemic among intravenous drug users, according to his biography on the UCLA website. In recognition of this work, he was awarded the 2005 International Rolleston Award. Later, he was also awarded a UNAIDS Gold Medal in 2008 for his overall work.

Yet, as China battled the COVID-19 virus, Wu came to be criticized by some for his choice to publicly voice support for the countrys strict virus control measures even as the weaknesses of the strategy became more pronounced.

Dynamic zero-COVID is appropriate for Chinas reality, and is the best choice to control our countrys current COVID situation, he said in April 2022, during the height of Shanghais lockdown.

The strategy bought China time in the early days of the pandemic, but by 2022, as the virus became more and more easily spread, it showed signs of strain.

The mega city of Shanghai was unprepared for a lockdown and its residents scrambled for groceries and basic necessities, while many also found it hard to access urgent medical services as people were barred from leaving their homes or even entering hospitals. Many were also angry about a key aspect of virus controls, which involved mass field hospitals where people who tested positive were forced to go to by public health workers.

In private, Wu disagreed with the excesses of the zero-COVID strategy, but felt powerless to go against it.

As zero-COVID got unsustainable in the fall of 2022, he wrote an internal report urging the government to avoid excessive measures. But in public press conferences throughout the past few years, he voiced the official line.

Wu visibly aged during the virus fight. He was pictured in 2020 with mostly black hair; by 2022, his locks had gone entirely gray.

The news of Wus death came just hours after the death of former Premier Li Keqiang was announced. Li was the countrys No. 2 leader during the pandemic.

AP writer Dake Kang contributed to this report from Shenzhen, China.

Excerpt from:

China's chief epidemiologist who helped drive the anti-COVID fight dies at age 60 - The Associated Press

Vivek Ramaswamy says he took care of newborn son while wife worked through COVID-19 pandemic

Updated: 12:46 AM EDT Oct 26, 2023

VIDEO: During a meal with New Hampshire voters, Republican presidential candidate Vivek Ramaswamy said he took care of his newborn son while his wife was in New York City working in health care during the COVID-19 pandemic. See more "Candidate Caf" highlights.

VIDEO: During a meal with New Hampshire voters, Republican presidential candidate Vivek Ramaswamy said he took care of his newborn son while his wife was in New York City working in health care during the COVID-19 pandemic. See more "Candidate Caf" highlights.

Excerpt from:

Vivek Ramaswamy says he took care of newborn son while wife worked through COVID-19 pandemic - WMUR Manchester

CANBERRA, Australia (AP) A cruise operator that failed to cancel a voyage from Sydney that led to a major COVID-19 outbreak was ruled negligent in its duty of care to passengers in an Australian class-action case Wednesday.

The Ruby Princess ocean liner left Sydney on March 8, 2020, with 2,671 passengers aboard for a 13-day cruise to New Zealand but returned in 11 days as Australias borders were closing. COVID-19 spread to 663 passengers and claimed 28 lives.

Passenger Susan Karpik was the lead plaintiff in the case against British-American cruise operator Carnival and its subsidiary Princess Cruises, the ships owner.

Federal Court Justice Angus Stewart ruled that Carnival had been negligent as defined by Australian consumer law by allowing the cruise to depart in the early months of the pandemic. He said Carnival had a duty to take reasonable care of her health and safety in regard to COVID-19.

I have found that before the embarkation of passengers on the Ruby Princess for the cruise in question, the respondents knew or ought to have known about the heightened risk of coronavirus infection on the vessel and its potentially lethal consequences and that their procedures for screening passengers and crew members for the virus were unlikely to screen out all infectious individuals, Stewart said.

Carnival had already experienced outbreaks on its cruises in the previous month aboard the Grand Princess off California and the Diamond Princess off Japan, the judge said.

Carnival had failed to explain why it offered free cancellation for all cruises worldwide leaving from March 9 the day after the Ruby Princess departed and suspended all cruises on March 13, he said.

To the respondents knowledge, to proceed with the cruise carried significant risk of a coronavirus outbreak with possible disastrous consequences, yet they proceeded regardless, Stewart said.

Susan Karpik had sued Carnival for more than 360,000 Australian dollars ($230,000).

However, she was only awarded her out-of-pocket medical expenses of AU$4,423.48 ($2,823.28) for reasons including that the judge did not accept she suffered from long COVID and that Carnival had refunded all the passengers fares.

But she said she was happy with the outcome.

I was very pleased with that finding. And I hope the other passengers are pleased with that finding too, she told reporters outside court.

I hope the finding brings some comfort to them because theyve all been through the mill and back, she added.

Her lawyer Vicky Antzoulatos said other passengers who suffered worse consequences from their sickness could expect larger payouts.

While Susan Karpiks symptoms were relatively mild, her husband Henry Karpik spent two months in hospital and almost died from his infection.

Susans husband was very catastrophically injured, so we expect that he will have a substantial claim, and that will be the same for a number of the passengers on the ship, Antzoulatos said.

Each passenger will have to prove their claims unless Carnival agrees to settle, she said.

Its been a long time coming and a very comprehensive victory for the passengers on the Ruby Princess, Antzoulatos said.

Carnival Australia said in a statement it was considering the judgment in detail.

The pandemic was a difficult time in Australias history, and we understand how heartbreaking it was for those affected, Carnival said.

See original here:

Carnival ruled negligent over cruise where 662 passengers got COVID-19 early in pandemic - The Associated Press

Oral versions of currently intravenous-only drugs such as remdesivir are in development, which would make them easier to access. Longer duration treatments are also needed, which could help reduce toxicity and lower the likelihood of drug resistance developing. Trials are already under way to study longer duration courses of nirmatrelvir-ritonavircomparing the current five day course with 10 and 15 daysin immunocompromised adults.13

But as drug resistance is an ever growing worry, combination treatments seem a likely avenue for immediate exploration.14 One small scale trial has found that a combination of remdesivir and nirmatrelvir-ritonavir with monoclonal antibodies induced a good clinical response in immunocompromised patients with prolonged or relapsed covid-19. Other trials suggest that combinations of convalescent plasma with different antivirals may be effective.15

Alternatives are needed, however, particularly where contraindications have severely limited the use of existing drugs. The ritonavir part of Paxlovid, for instance, works by preventing the liver from breaking down certain compounds, but this could be a major problem with other drugs a patient might need, as these also wont be broken down so might build to harmful levels.

Stephen Griffin, virologist at the University of Leeds, UK, says that ritonavir was part of the reason Paxlovid isnt licensed for under 18s. He explains, Theres such a huge raft of interactions between ritonavir and other drugs, because it acts on the liver to stop it degrading things. That is a real concern going forward for many clinically vulnerable people.

For clinically vulnerable people on multiple medications, its a bit of a minefield. Referring that out to GPs to manage may be a little difficult. Theyve got to work out, How does this interact with the meds my patient is on?

Yes, but it faces questions over how effective it is and whether its cost effective and practical as a standard treatment.

Originally developed to fight Ebola virus, the antiviral remdesivir was tested against SARS-CoV-2 at the height of the covid pandemic and was found to be effective as a covid treatment.

The catch is that remdesivir is administered intravenously. The major issue is logistical, says Arturo Casadevall of Johns Hopkins University. You need three infusions in three sequential days, and that can be very difficult for some patients, depending on their resources.

More commonly, doctors give it to hospital inpatients as a five or 10 day course. In non-ventilated patients with covid-19, remdesivir may shorten the time to recovery and reduce mortality.16

However, Alex Richter of the University of Birmingham highlights problems with availability. In the UK, she tells The BMJ, access to remdesivir is very patchy and depends on individual hospital trusts and how they have chosen to interpret current NICE and government commissioning guidelines in the context of clinical unmet need. She adds that theres an urgent need to clarify current treatment options so that all clinically vulnerable patients can get access to treatments and clinical advice from clinicians with experience of treating covid infection in immune vulnerable people.

In immunocompromised patients remdesivir can suppress, but not always eradicate, SARS-CoV-2 when used over a longer period.17 However, the problem with repeated or prolonged treatment with remdesivir is the possibility of viral resistancesomething that concerns Stephen Griffin, a virologist at Leeds University. The consequences of a pandemic virus becoming resistant, particularly for vulnerable people, could be really bad. Theres no rescue therapy there, he tells The BMJ.

Recent studies have also questioned the efficacy of remdesivir. One test of hospital inpatients18 showed no evidence that it cleared the virus more quickly than if the drug hadnt been taken; another showed no benefit in patients severely ill with covid-19.19 The suspicion is that the antiviral effects of remdesivir shown in the laboratory may not be replicated in patients.

Despite this, remdesivir does have advantages over some other covid treatments. Unlike Paxlovid, it can be used in under 18s, and few side effects or drug interactions have currently been reported. Oral versions of remdesivir are under investigation.20

Another major factor is cost. In the US remdesivir cost $520 (397; 465) per 100 mg vial at the time of writing.21 First treatment is two vials, then one vial daily until the end of the course, so a three day course totals over $2000, and the minimum hospital course of five days costs more than $3000. Added to the questions over its efficacy, this has led some experts to say that theres little justification for its use in hospital inpatients.

In the UK the latest recommendations from NICE state22: Compared with standard care, remdesivir reduces death at day 28 in hospitalised people who require no or low-flow oxygen. However, there is no evidence that remdesivir is more effective than placebo or standard care in treating hospitalised patients with covid-19 who require high-flow oxygen supplementation, non-invasive ventilation or invasive ventilation compared to standard care.

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What do we know about covid in immunocompromised people? - The BMJ

Woman Suffering From Cold

Youve probably heard it before Dont go out in the cold, youll catch pneumonia! For centuries, weve known that certain infections, such as influenza, typically peak during the winter months in temperate climates. But why is there seasonality associated with some diseases, like the common cold, the flu, and Covid-19? Does venturing outside in cooler temperatures really make you more susceptible to infection? Or is it simply due to more people congregating indoors during frigid weather? Here are the top three reasons youre more likely to contract a cold or the flu during the winter months, and steps you can take to prevent these common infections.

It happens almost every winter cracked skin, irritated eyes, and dryness in the nasal passage and throat. These common symptoms are due to low humidity, which results from a reduced concentration of water in colder air. But dry skin and itchy eyes arent the only possible outcomes of low humidity during the winter months. Low humidity also promotes transmission of viruses, including influenza and SARS-CoV-2.

When a person with influenza or Covid-19 coughs or sneezes, the virus spreads within microscopic respiratory droplets. Under ideal conditions i.e., a relative humidity of 40-50% those droplets are large enough that they will typically fall to the floor or a surrounding surface within 4 to 6 feet. This is why social distancing efforts can be highly effective in reducing the rate of transmission of respiratory infections. But when the humidity level falls i.e., 20-35% relative humidity the size of respiratory droplets decreases significantly. These smaller droplets can spread further in the air, making it more likely that those nearby will be exposed.

Recent studies have shown that adding a humidifier to an indoor space, such as a classroom, can reduce the amount of virus on surfaces as well as the number of infected people compared to rooms without a humidifier. The take-home message increase the amount of humidity in the air and reduce the distance viruses can spread.

The human body possesses an amazing array of natural defenses to help prevent infection. In the upper respiratory tract, there are several natural barriers that become less effective during the cooler months. First, the respiratory epithelial cells in the nasal passage are lined with cilia or small hair-like projections that typically work to move foreign objects (e.g., a virus or bacteria) out of the respiratory tract. But cold, dry air can damage the respiratory epithelium, resulting in cilia that dont function as efficiently to remove foreign invaders.

Second, there is typically a thin layer of viscous fluid that lines the respiratory tract and serves as a natural, physical barrier for the respiratory epithelium. Think of it like a stream (i.e., the layer of viscous fluid) running over a river bed (i.e., the respiratory epithelium). When the stream is flowing as it should, foreign objects like small branches or pebbles cant settle on and cause damage to the river bed. Similarly, the layer of viscous fluid lining the epithelial cells helps to prevent infection and damage to those cells. But during the winter months, this thin layer of fluid can dry up, removing the protective barrier and increasing the odds that a virus can infect the underlying respiratory epithelium and subsequently cause disease.

The Coronaviruses Owe Their Name To The The Crown Like Projections, Visible Under Microscope, That ... [+] Encircle The Capsid. The Virus Responsible For Covid-19 Belongs To This Family. (Photo By BSIP/UIG Via Getty Images)

Did you know there are antibodies in your respiratory tract that help to reduce infections? These antibodies known as immunoglobulin A (IgA) often act as a first line of defense when we are exposed to a virus, such as influenza. But studies have demonstrated that cold temperatures can result in an inhibition in IgA secretion, which may increase the probability of infection.

Winter not only brings cooler temps, but also darker days. The reduction in sunlight and ultraviolet rays can have multiple effects on the spread of viruses. First, warmer temperatures and stronger UV light can inactivate some viruses, so viral pathogens are more likely to persist for longer periods of time during colder, darker months. Second, exposure to sunlight can lead to higher levels of vitamin D, which can stimulate the innate immune response. Consequently, more limited exposure to sunlight during the winter can result in vitamin D deficiency, which may negatively impact our ability to fight off an infection.

So as we head into the winter months, consider taking a few steps to reduce the odds of being infected with a respiratory virus. First, keep indoor environments appropriately humidified and well-ventilated. Second, try to get exposure to sunlight each day. Third, wear a mask if indoors in a public setting. And finally, get vaccinated against influenza, RSV (if eligible), and Covid-19.

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'Tis The Season Why Influenza And Covid-19 Surge In The Winter - Forbes