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Covid-19 roundup: Booster protection against hospitalization drops after 3 months – The Daily Briefing

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The shortest known time between coronavirus infections is 20 days, the omicron subvariant BA.2.12.1 is gaining prevalence in the United States, and more in this week’s roundup of Covid-19 news.

Your top resources on the Covid-19 vaccines

  • Moderna on Thursday asked FDA to authorize its Covid-19 vaccine for children under 6. Based on clinical trial data, the company’s vaccine for children, which consists of two 25-microgram doses, was 51% effective against symptomatic infection for children between 6 months and 2 years and 37% effective for children ages 2 to 6. In addition to its vaccine for children under 6, Moderna has also requested FDA authorize its vaccine for children ages 6 to 11 and adolescents ages 12 to 17, with a spokesperson saying the company would complete its data submission for these groups in the next two weeks. During a Senate oversight heating, Peter Marks, who oversees vaccine regulation for FDA, suggested the agency might consider Moderna’s applications for children under 18 as a whole rather than individually. Separately, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said FDA may review children vaccine data from Moderna and Pfizer-BioNTech simultaneously to directly compare the two vaccines and not “confuse people.” According to the New York Times, federal regulators are unlikely to review Moderna’s application before June, when FDA’s outside advisory panel is scheduled to meet on vaccines for young children. (LaFraniere, New York Times, 4/28; Doherty, Axios, 4/28; AP/Modern Healthcare, 4/28; LaFraniere, New York Times, 4/26)
  • FDA on Monday expanded its approval for the IV antiviral Veklury, also known as remdesivir, to children under 12, making it the first Covid-19 treatment approved for this age group. According to MedPage Today, Veklury is now approved for use in children as young as 28 days who weigh at least three kilograms. The drug may be used for either hospitalized patients or those at risk of severe outcomes. “As COVID-19 can cause severe illness in children, some of whom do not currently have a vaccination option, there continues to be a need for safe and effective COVID-19 treatment options for this population,” said Patrizia Cavazzoni, director of the FDA’s Center for Drug Evaluation and Research. “Today’s approval of the first COVID-19 therapeutic for this population demonstrates the agency’s commitment to that need.” (Chen, Axios, 4/25; Reuters, 4/25; Walker, MedPage Today, 4/25)
  • Booster protection against hospitalization from Covid-19 declines after three months, according to a new Kaiser Permanente study published in The Lancet Respiratory Medicine. For the study, researchers analyzed Kaiser Permanente patient records between December 2021 and Feb. 6, 2022. In total, there were 11,123 hospital admissions or ED visits, and all patients included in the analysis had received at least three doses of the Pfizer-BioNTech vaccine. Overall, the researchers found that a booster dose was 80% to 90% protective against hospital admissions and ED visits caused by both the delta and omicron variants during the first three months of receiving it. However, after three months, protection against hospitalization from omicron decreased to 55%, while protection against ED visits decreased to 53%. “Pfizer BioNTech COVID-19 booster doses significantly improve protection against omicron, although that protection seems to wane after three months against emergency room visits, and even for hospitalization,” said Sara Tartof, an epidemiologist in Kaiser Permanente’s department of research and evaluation and the study’s lead author. “Trends in waning against delta-related outcomes were generally similar to omicron but with higher effectiveness at each time point than those seen for omicron.” (Carbajal, Becker’s Hospital Review, 4/25)
  • The shortest known time between separate coronavirus infections is 20 days, according to a case report presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID). According to researchers, a 31-year-old female health care worker in Spain first tested positive for Covid-19 on a PCR test on Dec. 20, 2021. She was fully vaccinated and had received a booster dose 12 days earlier. After this positive test, the patient, who was asymptomatic, self-isolated for 10 days before returning to work. Then, on Jan. 10, 2022, just 20 days after her original positive test, the patient began feeling unwell and tested positive on another PCR test. According to whole genome sequencing, there had been two different coronavirus variants, with the first being delta in December and the second being omicron in January. “This case highlights the potential of the omicron variant to evade the previous immunity acquired either from a natural infection with other variants or from vaccines,” said Gemma Recio, one of the study’s authors. “In other words, people who have had COVID-19 cannot assume they are protected against reinfection, even if they have been fully vaccinated.” (Gleeson, Becker’s Hospital Review, 4/21; ECCMID press release, 4/20)
  • Pfizer and BioNTech on Tuesday requested FDA authorize a booster dose of their Covid-19 vaccine for children ages 5 to 11. In an announcement, Pfizer said data from a Phase 2/3 trial indicated children in that group saw a “strong immune response” after receiving a booster dose six months after their primary vaccine series. If authorized, the dose would be the first booster available to children under 12. However, some health experts said a third dose may not be necessary for children at this point. “It may be that over time, those two doses don’t protect against serious illness, in which case one could reasonably [receive] a third dose,” said Paul Offit, who leads the Vaccine Education Center at Children’s Hospital at Philadelphia. “But for right now, protection against serious illness appears to be holding up.” In addition, it is not clear how much demand there will be for booster doses in this age group, according to NPR. Currently, CDC data shows that only 28.4% of children ages 5 to 11 are fully vaccinated, and only around 35% have received an initial dose. (Chen, Axios, 4/26; Stein, “Shots,” NPR, 4/26; Choi, The Hill, 4/26)
  • According to CDC data, the prevalence of the omicron subvariant BA.2 is decreasing in the United States as a new subvariant continues to spread. For the week ending April 23, BA.2 made up 68.1% of all new Covid-19 cases, down from 74.9% the week ending April 9. In comparison, the subvariant BA.2.12.1 made up 28.7% of new Covid-19 cases the week ending April 23, up from 13.7% the week ending April 9. Researchers estimate BA.2.12.1 has a 27% growth advantage over BA.2, which is already more transmissible than the original omicron BA.1 variant. BA.2.12.1, as well as a related subvariant BA.2.12, are currently driving a surge in Covid-19 cases in New York. Based on HHS data, Covid-19 cases nationwide have increased 53% over the past two weeks as of April 25. (Bean, Becker’s Hospital Review, 4/26)

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Rare Cases of Monkeypox Diagnosed in Britain | Health | thesuburban.com – The Suburban Newspaper

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TUESDAY, May 17, 2022 (HealthDay News) — Four men in England have been infected with a “rare and unusual” monkeypox virus.

Investigators from the U.K. Health Security Agency are investigating the cases and whether there is any connection between the men, according to the Associated Press. None of the individuals had traveled to the African countries where the virus is endemic. Three of the men are in London, and one is in Northeast England.

Three earlier cases were announced last week. In those cases, two of the patients lived in the same household. The third person had previously traveled to Nigeria, one of the countries where the virus is endemic in animals. Most people who get monkeypox recover quickly, within several weeks. The virus has symptoms that include fever, muscle ache, chills, and fatigue. A rash similar to that found in chickenpox and smallpox can form on the face and genitals in more severe cases.

The latest four cases all happen to be in men who identify as gay, bisexual, or men who have sex with men. However, monkeypox does not easily spread between people, and it is not known to be transmitted sexually. In Western and Central Africa, the virus is typically spread by touching or being bitten by an infected wild animal. However, it could be spread among people with extremely close contact, the British health officials said.

“The evidence suggests that there may be transmission of the monkeypox virus in the community, spread by close contact,” said Susan Hopkins, M.D., chief medical advisor for the U.K. Health Security Agency, the AP reported. “We are particularly urging men who are gay or bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay.”

Public health officials consider the risk to the general population to be low. They are working with hospitals and international partners to determine if there is a similar rise in cases in other places. This includes tracing people who had contacts with the monkeypox cases, including airline passengers, the AP said. Doctors who see patients with unexplained rashes should seek advice from a specialist, public health officials said.

Associated Press Article

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Long COVID: Half of patients hospitalised have at least one symptom two years on – Australian Hospital + Healthcare Bulletin

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Long COVID: Half of patients hospitalised have at least one symptom two years on

Two years on, half of a group of patients hospitalised with COVID-19 in Wuhan, China, still have at least one lingering symptom, according to a study published in The Lancet Respiratory Medicine. The study followed 1192 participants in Wuhan infected with SARS-CoV-2 during the first phase of the pandemic in 2020.

While physical and mental health generally improved over time, the study found that COVID-19 patients still tend to have poorer health and quality of life than the general population. This is especially the case for participants with long COVID, who typically still have at least one symptom including fatigue, shortness of breath and sleep difficulties two years after initially falling ill.1

The long-term health impacts of COVID-19 have remained largely unknown, as the longest follow-up studies to date have spanned around one year.2 The lack of pre-COVID-19 health status baselines and comparisons with the general population in most studies has also made it difficult to determine how well patients with COVID-19 have recovered.

Lead author Professor Bin Cao, of the China-Japan Friendship Hospital, China, said, “Our findings indicate that for a certain proportion of hospitalised COVID-19 survivors, while they may have cleared the initial infection, more than two years is needed to recover fully from COVID-19. Ongoing follow-up of COVID-19 survivors, particularly those with symptoms of long COVID, is essential to understand the longer course of the illness, as is further exploration of the benefits of rehabilitation programs for recovery. There is a clear need to provide continued support to a significant proportion of people who’ve had COVID-19, and to understand how vaccines, emerging treatments and variants affect long-term health outcomes.”3

The authors of the new study sought to analyse the long-term health outcomes of hospitalised COVID-19 survivors, as well as specific health impacts of long COVID. They evaluated the health of 1192 participants with acute COVID-19 treated at Jin Yin-tan Hospital in Wuhan, China, between 7 January and 29 May 2020, at six months, 12 months and two years.

Assessments involved a six-minute walking test, laboratory tests and questionnaires on symptoms, mental health, health-related quality of life, if they had returned to work and healthcare use after discharge. The negative effects of long COVID on quality of life, exercise capacity, mental health and healthcare use were determined by comparing participants with and without long COVID symptoms. Health outcomes at two years were determined using an age-, sex- and comorbidities-matched control group of people in the general population with no history of COVID-19 infection.

Two years after initially falling ill, patients with COVID-19 are generally in poorer health than the general population, with 31% reporting fatigue or muscle weakness and 31% reporting sleep difficulties. The proportion of non-COVID-19 participants reporting these symptoms was 5% and 14%, respectively.

COVID-19 patients were also more likely to report a number of other symptoms including joint pain, palpitations, dizziness and headaches. In quality of life questionnaires, COVID-19 patients also more often reported pain or discomfort (23%) and anxiety or depression (12%) than non-COVID-19 participants (5% and 5%, respectively).

Around half of study participants had symptoms of long COVID at two years, and reported lower quality of life than those without long COVID. In mental health questionnaires, 35% reported pain or discomfort and 19% reported anxiety or depression. The proportion of COVID-19 patients without long COVID reporting these symptoms was 10% and 4% at two years, respectively. Long COVID participants also more often reported problems with their mobility (5%) or activity levels (4%) than those without long COVID (1% and 2%, respectively).

The authors acknowledged limitations to their study, such as moderate response rate; slightly increased proportion of participants who received oxygen; it was a single centre study from early in the pandemic.

References:

1. – National Institute for Health and Care Excellence – Scottish Intercollegiate Guidelines Network – Royal College of General Practitioners. COVID-19 rapid guideline: managing the long-term effects of COVID-19. https://www.nice.org.uk/guidance/ng188
2. – Soriano – JB Murthy – S Marshall – JC Relan – P Diaz JV – on behalf of the WHO Clinical Case Definition Working Group on Post-COVID-19 Condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2021; 22: e102-e107
3. – Huang L – Yao Q – Gu X – et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet. 2021; 398: 747-758

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2SLGBTQ+ lobby group head speaks on the trauma of conversion therapy

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Although conversion therapy has now been outlawed in Canada, many are still victims causing them to go through a lot of trauma in the process.

According to Jordan Sullivan, Project Coordinator of Conversion Therapy Survivors Support and Survivors of Sexual Orientation and Gender Identity and Expression Change Efforts (SOGIECE), survivors of conversion therapy identify the need for a variety of supports including education and increased awareness about SOGIECE and conversion practices.

Also needed is access to affirming therapists experienced with SOGIECE, trauma (including religious trauma), safe spaces and networks, and access to affirming healthcare practitioners who are aware of conversion therapy or SOGIECE and equipped to support survivors.

“In January of 2021 when I was asked to be the project coordinator, I was hesitant because I wasn’t sure that my experience could be classified as SOGIECE or conversion therapy. I never attended a formalized conversion therapy program or camp run by a religious organization. Healthcare practitioners misdiagnosed me or refused me access to care.

In reality, I spent 27 years internalizing conversion therapy practices through prayer, the study of religious texts, disassociation from my body, and suppression or denial of my sexual and gender identities. I spent six years in counselling and change attempts using conversion therapy practices. I came out as a lesbian at age 33, and as a Trans man at age 51. I am now 61 and Queerly Heterosexual, but I spent decades of my life hiding in shame and fear and struggled with suicidal ideation until my mid-30s.

At times I wanted to crawl away and hide, be distracted by anything that silenced the emptiness, the pain, the wounds deep inside. I realized that in some ways, I am still more comfortable in shame, silence, and disassociation, than in any other way of being and living, but I was also filled with wonderment at the resiliency and courage of every single one of the participants.

However, many of us did not survive, choosing to end the pain and shame through suicide. Many of us are still victims in one way or another, still silenced by the shame, still afraid of being seen as we are. Still, many of us are survivors, and while it has not been an easy road, many of us are thrivers too,” said Jordan.

In addition, Jordan said conversion practices and programs are not easily defined or identified, and often capture only a fragment of pressures and messages that could be considered SOGIECE.

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