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🦘Cacatman's Personal Coronavirus COVID-19 Update Thread

cacatman

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B1.1.7 British Variant
SARS-CoV-2, B.1.1.7, or otherwise known as VOC 202012/01, which was discovered in the United Kingdom back in December may lead to a large increase in the number of COVID-19 cases.
Investigators have said B.1.1.7 is more contagious than the original virus, but no determination has been made that this variant can lead to severe cases and higher mortality.

It is between 30% and 100% more deadly than previous dominant variants. It has 23 mutations in its genetic code - a relatively high number - and some of them have made it far more easily spread. Scientists say it is about 40%-70% more transmissible than previous dominant variants that were circulating.

64% higher risk of dying from it.

17 mutations, 4 mutations affect viral function and enhances virus binding affinity to ACE 2.

It is about 55-74% more infective

COVID latches on to cells with spike proteins. The B.1.1.7 (UK variant) needs less amount of virus to make you sick ie they're stickier. Implications are that you may have a briefer or smaller exposure and get infected and because it's "stickier", you may get a higher viral load which will increase the chance of death as well as making you more infective. This is why more young people will potentially die if we aren't careful.
 

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J & J (Johnson & Johnson) Vaccine Paused
Six cases of cerebral venous sinus thrombosis (CVST) combined with thrombocytopenia were reported in the U.S., all among women ages 18-48, and all within 6-13 days, with a median of 9 days following vaccination with the Johnson & Johnson vaccine, the agencies reported in a statement.


With approximately 6.8 million doses administered in the U.S., it suggests a one-in-a-million risk. Johnson & Johnson said it was halting the product's distribution in Europe, reportedly taking officials there by surprise.
 

cacatman

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Low HDL and high triglycerides predict COVID-19 severity


 

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cacatman

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Ways to Improve Mask Efficacy
1. Double Mask - Surgical mask + tight fitting cloth mask
Surgical masks only block about 40% of particles from a simulated cough test, but tighter fitting masks reduce exposure exposure to potentially infectious particles by more than 90% (according to the CDC).
2. Use a mask with a nose wire
3. Use a mask fitter/brace that can be placed over a disposable/cloth mask to reduce air leakage
4. Check for a snug fit.
5. Knot and tuck the ear loops
6. Don't combine a KN95/N95 with another mask.
7. Don't combine 2 disposable masks.


  • The N95 respirator achieved an FFE of 98.4%. The FFE of the other commercially available masks tested ranged from 79% to 26.5%:
    • 3-layer cotton mask with ear loops = 26.5%
    • Polypropylene mask with fixed ear loops = 28.6%
    • Single-layer polyester gaiter/neck cover (balaclava bandana) = 37.8%
    • Single-layer polyester/nylon mask with ties = 39.3%
    • 2-layer nylon mask with ear loops (without aluminum nose bridge) = 44.7%
    • Cotton bandana worn “bandit style” = 49%
    • Cotton bandana folded in a rectangle per Surgeon General’s recommendation = 49.9%
    • 2-layer nylon mask with ear loops (with aluminum nose bridge) = 56.3%
    • Surgical mask with ties = 71.5%
    • 2-layer nylon mask with ear loops (with aluminum nose bridge and 1 insert) = 74.4%
    • 2-layer nylon mask with ear loops (with aluminum nose bridge and no insert; washed once) = 79%
  • In addition, the FFE for the standard medical procedure mask with ear loops were as follows:
    • No alteration = 38.5%
    • Loops tied and corners tucked back in = 60.3%
    • Secured with ear guard = 61.7%
    • Secured with 23-mm claw-style hair clip = 64.8%
    • Secured with 3 rubber bands to fix the mask = 78.2%
    • Secured with a 10-inch segment of nylon hosiery = 80.2%
The CDC has said that transmission of the virus can be reduced by up to 96.5% if both an infected individual and an uninfected individual wear tightly fitted surgical masks or a cloth-and-surgical-mask combination.

“Multi-layer cloth masks can both block up to 50-70%” of the droplets that carry the virus, a CDC briefing paper released in February said. “Upwards of 80% blockage has been achieved in human experiments that have measured blocking of all respiratory droplets, with cloth masks in some studies performing on par with surgical masks as barriers for source control.”
 

cacatman

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Treatment - Budesonide Reduces Recovery Time
The STOIC study found that inhaled budesonide given to patients with COVID-19 within seven days of the onset of symptoms also reduced recovery time. Budesonide is a corticosteroid used in the long-term management of asthma and chronic obstructive pulmonary disease (COPD).

The upshot is that the inhaled steroid that was studied, called budesonide, appears to have had a favorable effect in treating mild covid-19. But the reality is that this trial had some important methodologic issues that make this declaration a somewhat less definitive than we had hoped.

In the intention-to-treat analysis, 3 percent of participants randomized to receive budesonide needed further medical care compared to 15 percent of patients in the non-budesonide group; the difference was statistically significant. In the per-protocol analysis, however, inhaled budesonide failed to decrease the further need for medical care. Based on these data, the authors determined that the number of patients who would need to be treated in order for one patient to not need further medical care was 8. In medical trials, this is actually quite impressive.

Overall, patients in the inhaled budesonide group recovered on average one day faster, had fewer days with fevers, and were less likely to have symptoms at days 14 and 28 as compared to no inhaled budesonide group. Overall, only 7 percent of the study participants reported self-limited adverse events, suggesting that inhaled budesonide is safe.
 

cacatman

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Skin Manifestations for COVID-19
Skin can be affected in 20% of cases
urticaria (hives), erythemato-papular rash (described as a red bumpy rash) or erythemato-vesicular rash (described as chicken pox-like rash), and chilblains.

Lots of different skin manifestations. Has a broad spectrum of manifestations e.g. mild end - chillblains/covid toes - red or purple toes about 1-4 weeks AFTER COVID-19. 15% will be positive for PCR testing.
Severe - e.g. retiform purpura - clotting/thrombus event. 100% will be hospitalised and significant number will be sent to ICU.
Some get urticarial/mobilliform rashes
 

cacatman

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Improve Home Ventilation
Install CO2 sensors - 800 ppm shows inadequate ventilation
Install better filters
Open windows


Risk of infection could be three times higher in a poorly ventilated room as opposed to one that underwent 10 air changes per hour.
https://www.bmj.com/lookup/external-ref?access_num=10.1098/rspa.2020.0584&link_type=DOI
 

cacatman

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Pregnancy - A Risk for COVID-19
Originally, pregnancy was not thought to be a risk for COVID infection. A recent study showed they were significantly more likely to require intensive care, to be connected to a specialized heart-lung bypass machine, and to require mechanical ventilation than nonpregnant women of the same age who had Covid symptoms. Most importantly, the pregnant women faced a 70 percent increased risk of death, when compared to nonpregnant women who were symptomatic.


An interim report from the UK Obstetric Surveillance System (UKOSS) on pregnant women admitted to hospital with confirmed COVID-19 in the UK was published on 8 June 2020. This reported on 427 pregnant women admitted to UK hospitals with confirmed SARS-CoV-2 infection between 1 March and 14 April 2020. During this time, public health recommendations were to test only individuals admitted to hospital with symptoms of COVID-19. Of the 427 pregnant women, 38 women (9%) required level 3 critical care; four women (less than 1%) received extracorporeal membrane oxygenation (ECMO).These data are expected to be updated in the future.
Knight M, Bunch K,Vousden N, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020;369:m2107.

Severe illness appears to be more common in later pregnancy. In the UKOSS study, most women were hospitalised in their third trimester or peripartum (n = 342, 81%).The median gestational age at hospital admission was 34+0 weeks of gestation (interquartile range [IQR] 29–38 weeks of gestation).11 Similarly, an analysis of women in French hospitals showed that those in the second half of pregnancy, from 20 weeks of gestation, were five times more likely to be admitted to ICU than those in the first half of pregnancy.
Badr DA, Mattern J, Carlin A, et al. Are clinical outcomes worse for pregnant women at >/=20 weeks’ gestation infected with coronavirus disease 2019? A multicenter case-control study with propensity score matching. Am J Obstet Gynecol 2020 Jul 27 [Epub ahead of print]

Maternal COVID-19 is associated with an approximately three times greater risk of preterm birth.A systematic review estimated the risk at approximately 17%.8 Most of these preterm births (94%) were iatrogenic. In the UKOSS study, 58% of women gave birth during the data collection period; the median gestational age at birth was 38 weeks (IQR 36–39 weeks).

While none of the initial Phase 3 Covid-19 vaccine trials specifically included pregnant or lactating women, the limited data with regard to safety and efficacy in this demographic were promising. Over 20 women enrolled in the initial adult Pfizer/BioNTech vaccine trial became pregnant during the study period, and none suffered pregnancy loss or perinatal complications. A recent study reported in Forbes demonstrated that breastfed infants of vaccinated women mount Covid-19 antibodies via consumed breast milk. As reported in Forbes by Victoria Forster, pregnant women who had been infected with SARS-CoV-2 during New York City’s coronavirus surge between March and May 2020 delivered babies who tested positive for Covid-19 antibodies. Women who had more demonstrable symptoms when infected with Covid-19 had higher levels of antibodies, as did their newborns.

Of the women who gave birth, 27% had preterm births: 47% of these were iatrogenic for maternal compromise and 15% were iatrogenic for fetal compromise.

Maternal COVID-19 is also associated with an increased rate of caesarean birth.Again,from the UKOSS study, 59% of women had caesarean births; approximately half of these were because of maternal or fetal compromise.The remainder were for obstetric reasons (e.g. progress in labour, previous caesarean birth) or maternal request (6%). Of the women having a caesarean birth, 20% required general anaesthesia (GA) because of severe COVID-19 symptoms or urgency of birth.



The below advice applies to a normal pregnancy. With twins, there are more risks involved.

If she gets COVID, she has a 3 times greater risk of preterm birth and also has a higher risk for Caesarian birth.

Severe illness is more common in later pregnancy. Those > 20 weeks into their pregnancy were 5 times more likely to be admitted to ICU than those in the first half of pregnancy.

It's thought that they are more likely to be admitted to ICU than non-pregnant women (but this is based on a single study).

She is more at risk if she has any of these risk factors:-

1. Black, Asian and minority ethnic (BAME) background
2. Being overweight (BMI 25–29 kg/m2) or obese (BMI 30 kg/m2 or more)
3. Pre-pregnancy co-morbidity, such as pre-existing diabetes and chronic hypertension
4. Maternal age 35 years or older
5. Living in areas or households of increased socioeconomic deprivation.

re: the foetus - There's no increase of stillbirth or neonatal death among women with COVID-19, but there isn't enough information concerning miscarriage.

There is a theoretical risk that foetal growth restriction can occur (because 2/3 of pregnancies with SARS 1 were affected by FGR).

There haven't been any reported cases of mothers transmitting the virus to the baby during birth. The virus has not been found in amniotic fluid.

Babies can be breastfed even if mother is COVID positive and even though breast milk can contain viral particles.

Babies under 2 yo SHOULD NOT be given masks or faceshields due to the risk of sudden infant death syndrome (SIDS).

In a recent CDC report, symptomatic nonpregnant women with COVID-19 reported higher frequencies of headache, muscle aches, fever, chills and diarrhea than symptomatic pregnant women with COVID-19. Both groups had relatively similar frequencies of cough and shortness of breath. The severity of some symptoms appears to be higher in pregnant women with COVID-19 than the nonpregnant cohort, as 31.5% of pregnant women with COVID-19 were hospitalized compared with 5.8% of nonpregnant women.

“The risk of acquiring COVID-19 is the same, and there is no difference in the risk for death between pregnant and non-pregnant women. However, now we know that when you compare pregnant women with non-pregnant women in their reproductive years, those who are pregnant are more likely to be hospitalized, be admitted to the ICU, and to be placed on a ventilator,” says Dr. Goje.

Pregnant women with COVID-19 were 5.4x more likely to be hospitalized, 1.5x more likely to be admitted to the ICU and 1.7x more likely to receive mechanical ventilation.

“At this point, we don’t have enough data to determine a causal link with pregnancy, as there may be other comorbidities at play, including diabetes, respiratory and cardiovascular problems. Among COVID-19 cases in female patients with known pregnancy status, the data on race, ethnicity, symptoms, underlying conditions and outcomes were missing for a large proportion of cases. Further research on this is desperately needed,” Dr. Goje explains.

Breast Milk Carries Antibodies

240 participants who had a confirmed infection with the SARS-CoV-2 virus found that pregnant women were 3.5 times more likely to be hospitalized because of the disease and had a 13 times higher rate of mortality in comparison to those of a similar age.

Pregnancy Conferred a 70% Higher Rate of Infection
Pregnant women in Washington state were infected with COVID-19 at a 70% higher rate than others of similar ages, with nonwhite women shouldering a disproportionate burden.

Preterm delivery a risk in pregnant patients with ARDS
More at risk for severe illness if pregnant

Mothers who have the vaccine can pass on antibodies to their newborns while in utero

"The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) are aware of the World Health Organization's (WHO) recommendation to withhold COVID-19 vaccines from pregnant individuals unless they are at high risk of exposure. ACOG and SMFM continue to stress that COVID-19 vaccines currently authorized by the US Food and Drug Administration should not be withheld from pregnant individuals who choose to receive the vaccine."

Mothers can pass antibodies acquired from the Pfizer/BioNTech vaccine to their children through breast milk. This implies that mothers who get infected before or after birth, but who are breastfeeding, can supply their own infants with immunologic protection gained from vaccination.
 

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