Inside Medicine. What Are You Seeing? [COVID-19 medical news]

Parents Forum Parent Cafe
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1621

The idea that college students at college are going to follow social distancing rules is a fantasy that no one should entertain. Maybe at little, earnest colleges they will, but at big football schools, forget it.

https://www.latimes.com/california/story/2020-07-30/coronavirus-usc-greek-row-covid-19-colleges-prep

It’ll be a shame if it turns out that those supposedly invulnerable young people end up with lasting heart or lung issues. We don’t know right now how prevalent the lasting issues will turn out to be. They might be pretty common.

1622

@Mwfan1921 my earlier post included a quote about those who are immune-suppressed. My uncertainty was about those with immune disorders that do not involve suppression of the immune system.

Type 2 and type 1 diabetes are different diseases. (They really need to come up with a different name for type 1.) Since type 1 is autoimmune, I was just wondering if they could still be a candidate for a trial. In other words, people with type 1 are not immune-suppressed but their immune systems are disordered.

I see reference to generic “diabetes” which usually means type 1. Type 2 is not a disorder of the immune system.

There are many with lupus (myself included) who are not immune-suppressed, even with high ANA’s, and same question. My assumption is that the trial would exclude anyone whose immune system attacks itself since vaccines stimulate that attack.

1623

GlaxoSmithKline and Sanofi to partner on $2 billion coronavirus vaccine contract
From CNN Health’s Maggie Fox

Drug giants GlaxoSmithKline and Sanofi Pasteur said Friday they had won a commitment from the US federal government to pay up to $2.1 billion to help the two companies move forward with their proposed joint coronavirus vaccine as part of Operation Warp Speed.

The companies had said in April they would work together to make a vaccine against Covid-19, using Sanofi’s flu vaccine technology and Glaxo’s adjuvant – a compound that boosts the power of a vaccine.

Now they have a deal with the US government to produce up to 100 million doses of vaccine next year, with an option for 500 million more doses. It’s the largest funding announcement for an Operation Warp Speed vaccine so far.

“The global need for a vaccine to help prevent Covid-19 is massive, and no single vaccine or company will be able to meet the global demand alone,” Thomas Triomphe, executive vice president and global head of Sanofi Pasteur, said in a statement.
The companies said they plan to start a combined Phase 1/2 safety study in September, with an advanced Phase 3 efficacy trial to start, if all goes well, by the end of the year.

“The portfolio of vaccines being assembled for Operation Warp Speed increases the odds that we will have at least one safe, effective vaccine as soon as the end of this year,” US Health and Human Services Secretary Alex Azar said in a statement distributed by Glaxo.

Moncef Slaoui, chief adviser to Operation Warp Speed, told CNN’s Elizabeth Cohen on Thursday that the program was going to fund eight different coronavirus vaccines.

These include vaccines made by Moderna and Pfizer, which started advanced trials in volunteers on Monday; a vaccine from AstraZeneca and the University of Oxford that is in Phase 3 trials in the UK, Brazil, and South Africa, and which is expected to start US trials in August; and vaccines made by Johnson & Johnson and Novavax scheduled to begin Phase 3 trials in September. The Sanofi-Glaxo joint effort would be the sixth to be named as part of the program.

Pfizer and its vaccine partner BioNTech have a $1.95 billion deal with Operation Warp Speed; Novavax has a $1.6 billion deal; AstraZeneca’s contract is for $1.2 billion; Moderna’s awards total $900 million; and Johnson & Johnson subsidiary Janssen has a $450 million contract, according to HHS’s Biomedical Advanced Research and Development Authority website.

1624

Plasma from coronavirus survivors reduced deaths by 57%, studies show
From CNN’s Maggie Fox

Blood plasma taken from coronavirus survivors and infused into hospitalized patients reduced their mortality rate by about 57%, a team of researchers reported Thursday.

“These results favor the efficacy of convalescent plasma as a COVID-19 therapeutic agent,” wrote the researchers, who are working with US federal government support to study plasma for coronavirus patients.

Century-old method: The team looked at all the studies they could find on the approach, which has been used in epidemics for at least 100 years. The idea is that blood from disease survivors is loaded with antibodies and other immune system compounds that can kick-start an immune response to a fresh infection. It’s a relatively cheap and low-tech approach.

They came up with studies covering more than 800 coronavirus patients around the world, including three randomized controlled trials, which are considered the strongest type of study because they involve randomly assigning patients to one treatment or another for a fair comparison.

“All studies included patients with severe or life-threatening COVID-19,” the team wrote in their report published on the pre-print server MedRxiv, which has not been peer-reviewed.

What are the findings: The researchers found patients transfused with convalescent plasma exhibiting a lower mortality rate. About 13% of patients who got plasma died, compared to 25% of those who did not get the infusions. That’s a 57% reduction in mortality.

“Given the safety of plasma administration in COVID-19 patients, the results of this real-time data aggregation provide encouragement for its continued use as a therapy and may have broad implications for the treatment of COVID-19,” said the team, led by the Mayo Clinic’s Dr. Michael Joyner.
“Importantly, many of the patients enrolled in the studies included in the present analyses received convalescent plasma transfusions later in their disease course,” they added. Earlier treatment could reduce mortality further, they speculated.

1625

Interesting article on why waning antibodies in recovered COVID patients do not mean an effective vaccine is not possible.

https://www.nytimes.com/2020/07/31/opinion/coronavirus-antibodies-immunity.html?smid=tw-nytopinion&smtyp=cur

1626

Another article that should shed light on the notion that children are not very good at spreading the virus:

https://www.wfla.com/community/health/coronavirus/260-kids-and-counselors-infected-with-covid-19-at-georgia-summer-camp/

1627

That whole premise based on the Korean study (https://wwwnc.cdc.gov/eid/article/26/10/20-1315_article)
seems off anyway, kids under 10 can be controlled much more than kids that can be more independent. As the schools were shut down, 10 yrs olds and under were isolated at home with their parents, older kids may well have been allowed to visit with friends etc. Outbreaks in Texas daycares seemed pretty informative.

1628

It has been a comforting refrain in the national conversation about reopening schools: Young children are mostly spared by the coronavirus and don’t seem to spread it to others, at least not very often.

But on Thursday, a study introduced an unwelcome wrinkle into this smooth narrative.

Infected children have at least as much of the coronavirus in their noses and throats as infected adults, according to the research. Indeed, children younger than age 5 may host up to 100 times as much of the virus in the upper respiratory tract as adults, the authors found.

That measurement does not necessarily prove children are passing the virus to others. Still, the findings should influence the debate over reopening schools, several experts said.

“The school situation is so complicated — there are many nuances beyond just the scientific one,” said Dr. Taylor Heald-Sargent, a pediatric infectious diseases expert at the Ann and Robert H. Lurie Children’s Hospital of Chicago, who led the study, published in JAMA Pediatrics.

snip

Still, experts were alarmed to learn that young children may carry significant amounts of the coronavirus.

“I’ve heard lots of people saying, ‘Well, kids aren’t susceptible, kids don’t get infected.’ And this clearly shows that’s not true,” said Stacey Schultz-Cherry, a virologist at St. Jude Children’s Research Hospital.

“I think this is an important, really important, first step in understanding the role that kids are playing in transmission.”

https://www.nytimes.com/2020/07/30/health/coronavirus-children.html

1629

I guess we’ll be finding out.

1630

I don’t think there’s anything new in this article from UCSF, but I think it’s a good overview of the various manifestations of Covid, what is now known, and what is still left to figure out:
https://www.universityofcalifornia.edu/news/we-thought-it-was-just-respiratory-virus

1631

FDA authorizes first 2 coronavirus tests to measure antibody levels
From CNN’s Shelby Lin Erdman

The US Food and Drug Administration has issued emergency use authorizations for the first two Covid-19 serology tests that can tell not only whether someone has antibodies to the virus, but can give some idea of how much antibody is there.

“Being able to measure a patient’s relative level of antibodies in response to a previous SARS-CoV-2 infection may be useful as we continue to learn more about the virus and what the existence of antibodies may mean,” Dr. Tim Stenzel, the director of the Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health, said in a news release Friday.
The tests, the ADVIA Centaur COV2G and Attelica COV2G, are both from Siemens, the FDA said. Like other serology tests, these tests detect the body’s immune response to the infection caused by the virus rather than detecting the virus itself.

“There are still many unknowns about what the presence of SARS-CoV-2 antibodies may tell us about potential immunity, but today’s authorizations give us additional tools to evaluate those antibodies as we continue to research and study this virus,” Stenzel said.

“Patients should not interpret results as telling them they are immune, or have any level of immunity, from the virus,” he added.

1632

About 7% of participants in British study tested positive for coronavirus antibodies
From CNN Health’s Lauren Mascarenhas

About 7% of participants in a British study tested positive for coronavirus antibodies, according to results from the first month of the nationwide study.

The test results, which indicate previous infection with coronavirus, ranged from 10.4% of Londoners to about 4.4% of people living in the southwest of England and Scotland.

The widespread United Kingdom serology, or antibody, study uses volunteers for a much larger, ongoing health study called the UK Biobank. UK Biobank has collected samples and health information from 500,000 volunteers for research.

The researchers have recruited more than 20,000 volunteers from regions across the UK for the coronavirus antibody study. They are being asked to provide monthly blood samples that the Oxford University-based Target Discovery Institute will test for the antibodies.

The first round of results focused on 17,776 participant samples, taken in May and June. Nationally, 7.1% were positive for Covid-19 antibodies, the researchers reported on the Biobank website. Just under 11% of people under 30 had antibodies, compared to 5.4% of those over 70.

The results confirm other studies that indicate Black, Asian and minority ethnic groups appeared to be hardest hit by Covid-19, which is consistent with findings from the United States.

Among Black participants, about 11.3% tested positive for antibodies, as opposed to 6.9% of White participants. Researchers noted that the differences between ethnic groups could not be fully explained by age or place of residence. But previous infection was also higher among those living in lower socioeconomic areas.

The team says that their continued research will provide insight into the way antibody levels change over time, hopefully answering questions about immunity, reinfection and the impact of stay-at-home orders.

1633

Frontline workers wearing protective equipment still at risk of Covid-19 infection, new study finds
From CNN’s Shelby Lin Erdman

Wearing personal protective equipment (PPE) when caring for patients with Covid-19 isn’t enough to completely eliminate the threat from the virus for frontline workers, according to a new study from King’s College London.
Health care workers with adequate gloves, gowns and face masks, still had 3.4 times the risk of contracting the coronavirus compared to the general population, the study found, and minority health care workers had an even greater risk of testing positive.
African American, Latinx and other minority care providers were 5 times more likely to contract Covid-19 than their White counterparts, the study found.
“A little over 20 percent of front-line health-care workers reported at least one symptom associated with SARS-CoV-2 infection compared with 14.4 percent of the general population; fatigue, loss of smell or taste, and hoarse voice were especially frequent,” the researchers wrote.
The researchers used the COVID Symptom Tracker app to study the data of more than 2 million people, including almost 100,000 frontline health care workers in the United States and the United Kingdom between March 24 and April 23.
They found more than 2,700 cases of Covid-19 per 100,000 health care workers compared with just over 240 cases per 100,000 among the general population.
“The data is clear in revealing that there is still an elevated risk of SARS-Co-V-2 infection despite availability of PPE,” said King’s College London professor and senior study author Sebastien Ourselin.
Not only did researchers find that minority health care workers had an increased risk of Covid-19 infection, they also found that they were more likely to report a lack of adequate PPE and to say they were forced to frequently reuse equipment, Ourselin said.
Previous studies have found that 10-20% of coronavirus infections occur among frontline workers.
“Our study provides a more precise assessment of the magnitude of increased infection risk among healthcare workers compared to the general community,” said Dr. Andrew Chang, a senior study author and director of cancer epidemiology at Massachusetts General Hospital.
At the time the study was conducted, health care providers in the US and the UK were experiencing severe shortages in gloves, gowns and face masks. The authors said the results of a similar study now might be different.
“Many countries, including the US, continue to face vexing shortages of PPE,” Chang said. “Our results underscore the importance of providing adequate access to PPE and also suggest that systemic racism associated with inequalities to access to PPE likely contribute to the disproportionate risk of infection among minority frontline healthcare workers.”
The research suggests health care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds.
The study was published Friday in the journal Lancet Public Health.

1634

NIH invests $248.7 million to fund technology that could improve Covid-19 testing
From CNN’s Jen Christensen and Naomi Thomas

The National Institutes of Health announced Friday that it is investing $248.7 million in new technologies that should help ease some of the country’s problems with Covid-19 testing.

The NIH launched the Rapid Acceleration of Diagnostics (RADx) in April after it received an emergency supplemental appropriation of $1.4 billion from Congress. There was an “overwhelming response” to the department’s call for new technology, the NIH said. It received more than 650 applications.

The initiative gives contracts to seven biomedical testing companies that should significantly increase the number and kinds of tests available as early as September. The demand for tests is estimated to be millions more per day than what is currently available, the NIH said.

The seven companies that got the contracts use different approaches to testing. Four of the technologies should speed up and increase the capacity of lab testing, using next generation sequencing methods. Three of the technologies use platforms that should give more rapid results in point-of care-settings like in childcare centers, nursing homes, schools and workplaces. Some of these new tests should also be easier to use than the current nasal swab, and will use saliva instead.

The seven companies that have been awarded contracts are Mesa Biotech, Quidel, Talis Biomedical, which all provide point-of-care tests, and Ginkgo Bioworks, Helix OpCo, Fluidigm and Mammoth Biosciences, which have laboratory tests.

All the companies that have won these contracts either have emergency use authorization from the FDA for their technology or their applications are in process, according to the NIH.

“This is an exciting milestone,” said Bruce J. Tromberg, director of the National Institute of Biomedical Imaging and a leader of RADx Tech, said in a release.

“It will increase US testing capacity exponentially over the next few months. These and other technologies emerging from our RADx pipeline will guide patient care and inform public health measures to stop the spread of the virus and leave us better equipped to address future pathogens and other diseases.”

1635

That study on health care workers doesn’t mention face shields, or goggles. I think Fauci is right in letting us all know that eye exposure is important. Also, gloves worn by health care workers may be a factor in spread, if they touch their faces.

I just want to say how much the input on this thread is appreciated. Quite a few posts give a little hope and the information is most welcome.

@doschicos as always you find a way to help :slight_smile:

1636

So we have face shields for our medical practice to wear over our masks. Some of us wear glasses. No one wants to wear the face shields. They are very light. Might have to rethink this.

1637

I hate the face shields; I feel like I am going through menopause again! As I am on the phone all day with patients and insurance companies, talking on the phone with a face shield is a pain. I have trouble getting the phone over or under the shield without banging the two.

While the nurses have goggles, we were not provided any, so I think I am going to buy my own pair for comfort. It is hard enough talking on the phone with a mask, adding the shield makes our voice more muffled.

1638

Is it possible to use a headset for phone usage?

1639

We asked for headsets; unfortunately, they sent wired ones that were crappy. Not only could we not hear out of them, corded isn’t conducive when you have to get up every few minutes!

Life would be easier if the company would have provided plexiglass shields like we asked for back in March. I really expected when I returned from furlough that they would have been installed, but they didn’t bother. We were provide some shields in June at one section of the front, but they are too short and narrow. Most patients head is about the top, and many come around to the side that is opened to talk to us.

1640

Time for workforce to take a unified stand!