Connect with us

Health

The coronavirus is unstoppable.

Published

 on

<!–

–>

Residents of Casalpusterlengo, an Italian town under lockdown, line up to enter a supermarket.

 

MIGUEL MEDINA/AFP via Getty Images

The global march of COVID-19 is beginning to look unstoppable. In just the past week, a countrywide outbreak surfaced in Iran, spawning additional cases in Iraq, Oman, and Bahrain. Italy put 10 towns in the north on lockdown after the virus rapidly spread there. An Italian physician carried the virus to the Spanish island of Tenerife, a popular holiday spot for northern Europeans, and Austria and Croatia reported their first cases. Meanwhile, South Korea’s outbreak kept growing explosively and Japan reported additional cases in the wake of the botched quarantine of a cruise ship.

The virus may be spreading stealthily in many more places. A modeling group at Imperial College London has estimated that about two-thirds of the cases exported from China have yet to be detected.

The World Health Organization (WHO) still avoided using the word “pandemic” to describe the burgeoning crisis today, instead talking about “epidemics in different parts of the world.” But many scientists say that regardless of what it’s called, the window for containment is now almost certainly shut. “It looks to me like this virus really has escaped from China and is being transmitted quite widely,” says Christopher Dye, an epidemiologist at the University of Oxford. “I’m now feeling much more pessimistic that it can be controlled.” In the United States, “disruption to everyday life might be severe,” Nancy Messonnier, who leads the coronavirus response for the U.S. Centers for Disease Control and Prevention, warned on 25 February. “We are asking the American public to work with us to prepare for the expectation that this is going to be bad.”

“Border measures will not be as effective or even feasible, and the focus will be on community mitigation measures until a vaccine becomes available in sufficient quantities,” says Luciana Borio, a former biodefense preparedness expert at the U.S. National Security Council who is now vice president at In-Q-Tel, a not-for-profit venture capital firm. “The fight now is to mitigate, keep the health care system working, and don’t panic,” adds Alessandro Vespignani, an infectious disease modeler at Northeastern University. “This has a range of outcomes from the equivalent of a very bad flu season to something that is perhaps a little bit worse than that.”Dye and others say it’s time to rethink the public health response. So far, efforts have focused on containment: slowing the spread of the virus within China, keeping it from being exported to other countries, and, when patients do cross borders, aggressively tracing anyone they were in contact with and quarantining those people for 2 weeks. But if the virus, named SARS-CoV-2, has gone global, travel restrictions may become less effective than measures to limit outbreaks and reduce their impact, wherever they are—for instance, by closing schools, preparing hospitals, or even imposing the kind of draconian quarantine imposed on huge cities in China.

Public health experts disagree, however, about how quickly the travel restrictions that have marked the first phase of the epidemic should be loosened. Early this week, the total number of cases stood at more than 80,000 with 2705 deaths—with 97% of the total still in China. Some countries have gone so far as to ban all flights to and from China; the United States quarantines anyone who has been in hard-hit Hubei province and refuses entry to foreign nationals if they have been anywhere in China during the past 2 weeks. Several countries have also added restrictions against South Korea and Iran.

The restrictions have worked to some degree, scientists say. “If we had not put a travel restriction on, we would have had many, many, many more travel-related cases than we have,” says Anthony Fauci, who heads the U.S. National Institute of Allergy and Infectious Diseases.

But many epidemiologists have claimed that travel bans buy little extra time, and WHO doesn’t endorse them. The received wisdom is that bans can backfire, for example, by hampering the flow of necessary medical supplies and eroding public trust. And as the list of affected countries grows, the bans will become harder to enforce and will make less sense: There is little point in spending huge amounts of resources to keep out the occasional infected person if you already have thousands in your own country. The restrictions also come at a steep price. China’s economy has already taken an enormous hit from COVID-19, as has the airline industry. China also exports many products, from pharmaceuticals to cellphones, and manufacturing disruptions are causing massive supply chain problems.

“It would be very hard politically and probably not even prudent to relax travel restrictions tomorrow,” says Harvard University epidemiologist Marc Lipsitch. “But in a week, if the news continues at the pace that it’s been the last few days, I think it will become clear that travel restrictions are not the major countermeasure anymore.”

Smaller scale containment efforts will remain helpful, says WHO’s Bruce Aylward, who led an international mission to China over the past 2 weeks. In a report from the mission that Aylward discussed but did not publicly release, the group concludes that the Chinese epidemic peaked between 23 January and 2 February and that the country’s aggressive containment efforts in Hubei, where at least 50 million people have been on lockdown, gave other provinces time to prepare for the virus and ultimately prevent “probably hundreds of thousands” of cases. “It’s important that other countries think about this and think about whether they apply something—not necessarily full lockdowns everywhere, but that same rigorous approach.”

Yet China’s domestic restrictions have come at a huge cost to individuals, says Lawrence Gostin, who specializes in global health policy at Georgetown University Law Center. He calls the policies “astounding, unprecedented, and medieval,” and says he is particularly concerned about the physical and mental well-being of people in Hubei who are housebound, under intensive surveillance, and facing shortages of health services. “This would be unthinkable in probably any country in the world but China,” he says. (Italy’s lockdowns are for relatively small towns, not major cities.)

China is slowly beginning to lift the restrictions in regions at lower risk, which could expose huge numbers of people to the infection, Dye says. “If normal life is restored in China, then we could expect another resurgence,” he adds.

Still, delaying illness can have a big payoff, Lipsitch says. It will mean a lower burden on hospitals and a chance to better train vulnerable health care workers on how to protect themselves, more time for citizens to prepare, and more time to test potentially life-saving drugs and, in the longer term, vaccines. “If I had a choice of getting [COVID-19] today or getting it 6 months from now, I would definitely prefer to get it 6 months from now,” Lipsitch says. Flattening the peak of an epidemic also means fewer people are infected overall, he says.

Other countries could adopt only certain elements from China’s strategy. An updated analysis co-authored by Dye and posted on the preprint server medRxiv concludes that suspending public transport, closing entertainment venues, and banning public gatherings were the most effective mitigation interventions in China. “We don’t have direct proof, of course, because we don’t have a properly controlled experiment,” Dye says. “But those measures were probably working to push down the number of cases.” One question is whether closing schools will help. “We just don’t know what role kids play” in the epidemic, Lipsitch says. “That’s something that anybody who has 100 or more cases could start to study.”

Some countries may decide it’s better not to impede the free flow of people too much, keep schools and businesses open, and forgo the quarantining of cities. “That’s quite a big decision to make with regards to public health,” Dye says, “because essentially, it’s saying, ‘We’re going to let this virus go.’”

To prepare for what’s coming, hospitals can stockpile respiratory equipment and add beds. More intensive use of the vaccines against influenza and pneumococcal infections could help reduce the burden of those respiratory diseases on the health care system and make it easier to identify COVID-19 cases, which produce similar symptoms. Governments can issue messages about the importance of handwashing and staying home if you’re ill.

Whatever the rest of the world does, it’s essential that it take action soon, Aylward says, and he hopes other countries will learn from China. “The single biggest lesson is: Speed is everything,” he says. “And you know what worries me most? Has the rest of the world learned the lesson of speed?”

Source link

Continue Reading

Health

Delivering new services ‘complicated,’ Freeland says of planned dental care program

Published

 on

OTTAWA — The government is working hard to meet its end-of-year deadline to deliver dental-care coverage to kids, the deputy prime minister said Tuesday, but added providing new services is “complicated.”

The Liberals agreed to offer dental coverage to low- and middle-income children by the end of the year as part of their confidence and supply deal with the New Democrats to keep the minority government from toppling before 2025.

Several groups have raised concerns about the very tight deadline, and four sources close to the program say the government is working on a temporary solution to give money directly to qualifying families while it comes up with a permanent program.

“As we experienced, for example, in rolling out child-care agreements across the country, delivering new services to Canadians is complicated,” Freeland said when asked about the stopgap plan at a news conference in Toronto.

“I think Canadians understand that.”

Freeland did not confirm or deny the government’s immediate plans but said the Liberals are committed to the dental-care program, and it’s a commitment she’s “happy to make.”

The government could pursue dental-care deals that resemble the ones it made with provinces to lower the cost of child care, in which it offered provincial governments money to administer their programs under a prescribed set of criteria. However, that route is looking increasingly unlikely.

Federal officials have also canvassed dental-health experts about other approaches. The government could contract out a national program to a private insurance firm or have federal public servants take on the work.

“Kids should not have their teeth get rotten just because their parents don’t have enough money to pay for them to go see a dentist, I think it’s as simple as that,” Freeland said.

The Liberals set aside $5.3 billion over five years to fully implement the program. They hope to start with children under the age of 12 with an annual household income of less than $90,000.

Last week NDP Leader Jagmeet Singh said he was confident the dental-care program would come together by the end of the year, as outlined in the agreement with the Liberals.

Freeland said the government is working “very, very hard” to make good on the promise to the NDP. The Liberals risk the NDP walking away from the supply and confidence agreement entirely if they don’t.

This report by The Canadian Press was first published Aug. 9, 2022.

 

Laura Osman, The Canadian Press

Continue Reading

Health

Top commander defends military’s vaccine requirement, says ‘tweak’ in the works

Published

 on

OTTAWA — Canada’s top military commander said he will “tweak” the vaccine mandate for the Armed Forces in the next few weeks but defended vaccine requirements as necessary to keep the military ready to respond to any emergency.

“This is an institution that’s unlike any other because we do have to be operationally ready, we are the nation’s insurance policy,” chief of the defence staff Gen. Wayne Eyre told The Canadian Press in an interview.

“We have to go into dangerous locations and close confined quarters, we have to deploy overseas, where there’s potentially an increased threat with the pandemic. We also don’t know the trajectory of this pandemic, where it’s going to go into the future.”

When Eyre ordered all troops vaccinated against COVID-19 last October, he said it was to both protect the force and “demonstrate leadership” as the Liberal government adopted vaccine mandates across the federal public service.

The public service vaccine mandate was suspended in June but the military one persists, a fact that has heightened criticism of the military’s policy.

The Department of National Defence said more than 98 per cent of Canadian troops complied with the order. Defence Minister Anita Anand was briefed in June that 1,137 remained unvaccinated.

Those who refuse vaccination face the risk of forced removal from the military. The department says 241 unvaccinated troops have been ousted with disciplinary measures initiated against hundreds more.

Eyre said he is trying to find the “sweet spot” between the military’s medical, legal, operational and ethical requirements.

“We need to maintain our operational viability going forward,” he said. “So over the course of the next number of weeks, we will tweak the policy, we’ll put out something amended. But we also need to realize that this is a dynamic environment, and things can change, the trajectory of the pandemic can change. So we’ve got to maintain that flexibility as well.”

He added that not only has the military been called upon to assist in communities across Canada that have been hit by the pandemic, but that vaccine requirements still exist in many allied and foreign nations and militaries.

The U.S. military still requires all troops to be vaccinated as do some NATO facilities and bases.

“There are going to be operational requirements where to operate with allies, (vaccination) is going to be essential,” he said. “But as we go forward, the options are being developed looking at those four factors that I talked about and finding the right balance.”

Eyre’s comments appear to contradict a draft copy of a revised vaccine policy obtained by the Ottawa Citizen last month, which suggested vaccine requirements for military personnel would be lifted.

The draft document, which officials say has not been approved by Eyre, said military personnel as well as new recruits would no longer have to attest to their vaccination status.

The document also noted potential legal difficulties ahead to deal with people who were kicked out of the military because of the vaccine mandate, suggesting they could be forced to apply for re-enrolment.

By contrast, other unvaccinated federal public servants were put on leave without pay but allowed to return to their jobs when the mandate was suspended.

The military mandate was unsuccessfully challenged several times in Federal Court, most recently last month.

Phillip Millar, the London, Ont.-based lawyer who appeared before the court to seek an injunction on behalf of unvaccinated service members, said the court ultimately decided it couldn’t rule on the issue until the new policy was released.

Millar, who is also representing James Topp, an army reservist charged with publicly speaking out against federal vaccine mandates while wearing his uniform, said he was disappointed with the decision given the lack of timeline for the new policy.

“The military is deliberately dragging its feet on this new direction because it just wants to kick people out,” Millar alleged, adding: “It’s obviously a political policy, not an operational policy.”

Eyre would not say whether Armed Forces members are still being kicked out, or whether such releases have been suspended pending the results of his review.

The Defence Department says there have been more than 9,500 cases of COVID-19 among military personnel, including 113 active cases as of Aug. 1. It did not say whether there have been any deaths associated with the illness.

This report by The Canadian Press was first published Aug. 9, 2022.

 

Lee Berthiaume, The Canadian Press

Continue Reading

Health

Double mRNA COVID-19 vaccination found to increase SARS-CoV-2 variant recognition – News-Medical.Net

Published

 on


In a recent study posted to the bioRxiv* preprint server, researchers evaluated the impact of double BNT162b2 messenger ribonucleic acid (mRNA) vaccination in recognition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VoCs).

Study: Double-dose mRNA vaccination to SARS-CoV-2 progressively increases recognition of variants-of-concern by Spike RBD-specific memory B cells. Image Credit: CKA/Shutterstock

Background

Studies have reported that double coronavirus disease 2019 (COVID-19) vaccinations generate high titers of SARS-CoV-2 S-targeted antibodies (Ab), Bmem and T lymphocytes; however, VoCs with SARS-CoV-2 S receptor-binding domain (RBD) mutations can evade humoral immune responses.

Booster doses have been reported to enhance VoC recognition by Abs; however, it is not clear whether VoC recognition is enhanced due to higher Ab titers or due to the increased capacity of Ab binding to S RBDs.

About the study

In the present study, researchers evaluated the benefit of double BNT162b2 vaccinations on SARS-CoV-2 VoC recognition.

Healthy and SARS-CoV-2- naïve persons (n=30) without immunological or hematological diseases were enrolled in the study to assess their peripheral blood B-lymphocyte subsets between February and June 2021.  Samples were obtained before the BNT162b2 vaccination, after three weeks of the first vaccination, and four weeks following the second vaccination.

Serum memory B lymphocytes (Bmem) counts and Ab titers were assessed using recombinant SARS-CoV-2 spike (S) protein RBDs of the Wuhan, Gamma, and Delta strains. Neutralizing Ab (NAb) titers were evaluated using 293T-ACE2 cells and SARS-CoV-2 pseudotyped viral assays. Further, the nature of RBD-targeted Bmem was examined based on the expression of cluster of differentiation (CD) 21, 27, and 71.

Enzyme-linked immunosorbent assays (ELISA) were performed to evaluate variant-specific S RBD antibody titers and the serum dilution needed for preventing 50% SARS-CoV-2 entry (ID50) values were ascertained. Flow cytometry (FC) was performed to evaluate Bmem counts. Immunoglobulin G (IgG) titers against SARS-CoV-2 nucleocapsid (N) protein RBD and S RBD were evaluated before and post the first and second BNT162b2 vaccination.

Results

In total, 28, 30, and 30 samples were obtained pre-vaccination, after three weeks of the first dose and after four weeks of the second dose, respectively. All the participants remained SARS-CoV-2-naïve throughout the study without anti-SARS-CoV-2 N antibodies. Most participants (n=22) induced NAbs after the first vaccination, and the NAb titers after the second vaccination had IC50 values >100.

Double BNT162b2 vaccination generated robust NAb responses among all study participants. Immunoglobulin G+ (IgG+) and IgM+ RBD-targeted Bmem were generated after the first vaccination, and IgG1+ Bmem counts increased after the second vaccination. Most RBD-targeted Bmem showed binding with Delta and/or Gamma VoCs, which increased significantly after the second vaccination.

The RBD-targeted Bmem compartment comprised mainly IgG1+ or IgM+ cells, and contrastingly, the total Bmem compartment comprised more IgG2+ cells and fewer IgG1+ cells compared to the RBD-targeted Bmem compartment.

After the second vaccination dose, RBD-targeted IgG1, 2 and 3-expressing Bmem populations expanded significantly, although the total Bmem lymphocyte compartment was unaltered.

The number of RBD-targeted IgG+ Bmem correlated positively with RBD-targeted serum IgG post first and second vaccinations. While two subsets of IgM+ Bmem lymphocytes (CD27+ IgM+ and CD27+ IgM+ IgD+) proportionally decreased after the second vaccination dose, the absolute cell counts were identical to those observed post the first vaccine dose. Taken together, BNT162b2 vaccinations particularly affected the antigen-targeted Bmem lymphocyte counts, and the production of IgG1-expressing Bmem lymphocytes was boosted after the second BNT162b2 vaccination.

CD27 was expressed by 95% of anti-RBD and IgG-expressing Bmem lymphocytes, the proportion of which did not differ between the initial and subsequent BNT162b2 vaccination. After the first vaccine dose, 15% of anti-RBD Bmem lymphocytes were CD21lo, the proportion of which was marginally but significantly lower (reduced to 10%) after four weeks of the second vaccination.

CD71 was expressed by 10% of anti-RBD Bmem lymphocytes after the first and second vaccination. In the total population of Bmem lymphocytes, the results after the first and second vaccination did not differ significantly, denoting the Bmem compartment stability. After four weeks of vaccination, anti-RBD Bmem lymphocytes exhibited a nature and resting Bmem lymphocyte immunophenotype.

Anti-Wuhan S RBD- IgG titers exhibited partial recognition of the Beta, Gamma and Delta VoCs with more prominent reductions for Gamma and Beta VoCs than for the Delta VoC. The second vaccine BNT162b2 dose significantly enhanced anti-Wuhan RBD antibody binding to Gamma and Beta VoCs; however, the neutralization potency of vaccine-induced NAbs against Gamma and Beta was lesser than for Delta.

Delta RBD and Gamma RBD were recognized by 50% and 70% of RBD-targeted Bmem lymphocytes after the first and second vaccinations, respectively, and the increase in VoC-recognizing Bmem counts was largely due to elevated IgG1+ Bmem counts.

Conclusion

Overall, the study findings showed that the second BNT162b2 vaccination elevated NAb titers and SARS-CoV-2 RBD-targeted Bmem counts and that double BNT162b2 vaccination was especially needed for Delta and Gamma VoC recognition. The findings indicated that the second vaccine dose improved S RBD-targeted Bmem counts and the Bmem affinity to overcome VoC mutations.

*Important notice

bioRxiv 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.

Journal reference:

Adblock test (Why?)



Source link

Continue Reading

Trending