🦘Cacatman's Personal Coronavirus COVID-19 Update Thread

[Tom.]

Good morning Tom,
Forgive me if you already know the below information. I know you run the other COVID thread.
re: your question
What the studies I've seen (as well as the real world observations) seem to show that it is possible for people to get reinfected with COVID-19. There are some slightly different scenarios though.

Last year when COVID-19 was emerging (and there were no vaccines), there were literally only a handful of documented cases (less than 50 cases worldwide) of people being reinfected with the virus. This did include some deaths in that group (if they had other concomitant illnesses e.g. immunocompromised etc).

But this year, there are more documented cases of reinfection. The reason, I believe, is because of variants. The virus has become sufficiently different, so as to reduce the effectiveness of both vaccines (to the original COVID-19), as well as those who have been unvaccinated. This is why in fully vaccinated people, there are cases of "breakthrough" infections.

But there is a big difference between the above two groups. "Breakthrough" infections are not very serious in those who are 2 weeks post their second vaccination ie. there is way less admission to hospital/ICU/endpoint of death in this cohort and they limit spread to others because they don't get the high concentrations of virus in their system and aren't sick for as long as "first-timers".

To use an analogy, having a vaccination is like using a safety belt in a car. Just like vaccinations, safety belts occasionally kill people e.g. if they get jammed and people get stuck in a burning/sinking car. However, overall, safety belts will save more people if used. People dying from a safety belt is not a reason NOT to use it. And of course, the "benefits" of using a safety belt will be more advantageous if you are driving on a freeway (c.f. exposed to more people in a city). Taking the analogy further, safety belts that were made in the 1960s will still save your life in a lot of accidents, but using a current safety belt that has pretensioners and made of better material, will better protect you and give you a better chance of survival.

Stay safe, bro!

Right, so it is possible to get Covid twice, especially now with the mutated variants.

I do wonder when the mutations will stop. Or will we continue to see new variants?
I mean, one would think it will stop at one point?

 

[Oakman1992]

Right, so it is possible to get Covid twice, especially now with the mutated variants.

I do wonder when the mutations will stop. Or will we continue to see new variants?
I mean, one would think it will stop at one point?

Idk look at the flu it’s something new every year. It could just keep evolving like that.

 

[Tom.]

Idk look at the flu it’s something new every year. It could just keep evolving like that.

Exactly as i was thinking, but on the other hand, other dangerous viruses like SARS have almost been eliminated.

or rather i was wrong , according to this, Covid-19 is just another variant of
SARS.

Severe acute respiratory syndrome - Wikipedia

 

[cacatman]

Delta Variant,also known as B. 1.617

Discovered in India, first detected in Maharashtra, India, in December 2020.

Coronavirus Disease 2019 (COVID-19)

CDC provides credible COVID-19 health information to the U.S.

www.cdc.gov

Spreads more easily. Thought to be 50% more easily spread than the alpha variant (UK variant which was 50% more transmissible than the original COVID-19)

Coronavirus Disease 2019 (COVID-19)

CDC provides credible COVID-19 health information to the U.S.

www.cdc.gov

“In a completely unmitigated environment—where no one is vaccinated or wearing masks—it’s estimated that the average person infected with the original coronavirus strain will infect 2.5 other people,” Dr. Wilson says. “In the same environment, Delta would spread from one person to maybe 3.5 or 4 other people.”

Spiral: REACT-1 round 12 report: resurgence of SARS-CoV-2 infections in England associated with increased frequency of the Delta variant

spiral.imperial.ac.uk

Twice as likely to cause hospitalisation

SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness

On May 19, 2021, the Delta Variant of Concern (VOC), formerly known as the Indian VOC or B 1.617.2, became the dominant strain of SARS-CoV-2 in Scotland. The Alpha VOC (formerly known as the Kent VOC, B.1.1.7, or S gene negative) had been the dominant strain previously, but it has rapidly been...

www.thelancet.com

SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness

On May 19, 2021, the Delta Variant of Concern (VOC), formerly known as the Indian VOC or B 1.617.2, became the dominant strain of SARS-CoV-2 in Scotland. The Alpha VOC (formerly known as the Kent VOC, B.1.1.7, or S gene negative) had been the dominant strain previously, but it has rapidly been...

www.thelancet.com

An analysis of 38,805 sequenced cases in England revealed that the Delta variant was associated with a 2.61 times higher risk of hospitalisation within 14 days of specimen date than the Alpha variant. There was a 1.67 times higher risk of A&E care within 14 days.

Investigation of SARS-CoV-2 variants of concern: technical briefings

Technical briefing documents on novel SARS-CoV-2 variants.

www.gov.uk

It accounts for over 50% of new infections in the USA

https://www.washingtonpost.com/health/2021/07/07/delta-variant-covid/

There is little research on this, but some people have reported symptoms such as a headache, sore throat and runny nose, without the hallmark covid-19 signs, such as a loss of taste and smell.

The symptoms of the Delta variant appear to differ from traditional COVID symptoms. Here’s what to look out for

Data from the UK, where the Delta variant is dominant, suggest many people with COVID-19 are experiencing cold-like symptoms such as a runny nose and a sore throat.

theconversation.com

The Pfizer-BioNTech vaccine was 88% effective against symptomatic disease

Vaccines highly effective against B.1.617.2 variant after 2 doses

New study by PHE shows for the first time that 2 doses of the COVID-19 vaccines are highly effective against the B.1.617.2 variant first identified in India.

www.gov.uk

and 96% effective against hospitalizationfrom Delta in the studies

Public library - UKHSA national - Knowledge Hub

khub.net

The Oxford-AstraZeneca (which is not an mRNA vaccine) was 60% effective against symptomatic disease and 93% effective against hospitalization. The studies tracked participants who were fully vaccinated with both recommended doses.

In terms of preventing hospitalizations from delta, another PHE paper suggested that the Pfizer vaccine was 94 percent effective after the first shot and 96 percent effective after the second.

The AstraZeneca vaccine, which was included in the PHE studies and found to be 60 percent effective against symptomatic disease and 92 percent effective against hospitalization after both doses.

https://www.washingtonpost.com/health/2021/07/07/delta-variant-covid/

A small study showed waning vaccine efficacy, which has not yet been published, showed vaccinated people retained protection against severe disease and hospitalization, but had markedly lower protection against infection and symptomatic illness.

https://www.gov.il/en/departments/news/06072021-04

Delta shows higher risk of presymptomatic transmission and has a much higher viral load 4 days prior to symptom onset which means individuals are much more contagious and sooner.

https://elifesciences.org/articles/63537.pdf

https://www.medrxiv.org/content/medrxiv/early/2021/08/13/2021.08.12.21261991.full.pdf

Vaccine effectiveness exceeded 90% from March through June but fell to 65.5% (95% confidence interval [CI], 48.9 to 76.9) in July (Table 1). July case rates were analyzed according to the month in which workers with Covid-19 completed the vaccination series; in workers completing vaccination in January or February, the attack rate was 6.7 per 1000 persons (95% CI, 5.9 to 7.8), whereas the attack rate was 3.7 per 1000 persons (95% CI, 2.5 to 5.7) among those who completed vaccination during the period from March through May. Among unvaccinated persons, the July attack rate was 16.4 per 1000 persons (95% CI, 11.8 to 22.9).

The SARS CoV-2 mRNA vaccines, BNT162b2 (Pfizer–BioNTech) and mRNA-1273 (Moderna), have previously shown efficacy rates of 95% and 94.1%,2 respectively, in their initial clinical trials, and for the BNT162b2 vaccine, sustained, albeit slightly decreased effectiveness (84%) 4 months after the second dose.3 In England, where an extended dosing interval of up to 12 weeks was used, Lopez Bernal et al. reported a preserved vaccine effectiveness of 88% against symptomatic disease associated with the delta variant.4 As observed by others in populations that received mRNA vaccines according to standard Emergency Use Authorization intervals,5 our data suggest that vaccine effectiveness against any symptomatic disease is considerably lower against the delta variant and may wane over time since vaccination.

https://www.nejm.org/doi/full/10.1056/NEJMc2112981

 

[cacatman]

Treatment - metoprolol can help
A recent study, which appears in the Journal of the American College of Cardiology, reports that metoprolol can reduce lung inflammation and improve respiratory function in people with COVID-19-induced ARDS. Metoprolol is a common beta-blocker designed to treat high blood pressure, and it may provide an inexpensive treatment for severe COVID-19.

Hypertension drug may help treat severe COVID-19

A study suggests metoprolol, a drug approved for the treatment of hypertension, can reduce lung inflammation and improve outcomes in those with severe COVID-19.

www.medicalnewstoday.com

 

[cacatman]

Vaccination in Teens
US Study shows having COVID-19 triggers myocarditis in young men 6 x more than with the vaccine with a rate of about 450/million infections vs 60/million (in those who have been vaccinated)

https://www.medrxiv.org/content/10.1101/2021.07.23.21260998v1.full.pdf

https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-06/05-COVID-Wallace-508.pdf

 

[cacatman]

A Framework for Coping with Moral Challenges In the COVID-19 Era

Health care workers in all disciplines and venues of care are facing unprecedented challenges as they respond to the COVID-19 pandemic. Many report intense feelings of powerlessness or lack of control, and describe a sense of moral distress as they navigate issues that may conflict with their professional values. These feelings can last long beyond the event(s) that originally caused distress. Ira Bedzow, PhD, Definitions Different words are often used to describe moral challenges. It is helpful to understand distinctions between moral distress, moral anxiety, and moral tension as a first step in addressing a challenging situation. Moral distress is the state of anguish or exhaustion caused by a decision that you have made. It involves looking back on previous actions.  Decisions may be active or passive. For instance, not making a decision is, in and of itself, a decision that can cause distress.  Distress that comes from witnessing something (i.e., an event or behavior) usually results from the perception that you could have acted and/or changed the outcome, but decided not to. This perception may be untrue, but can carry moral weight that causes suffering. Moral anxiety is the state of being worried or afraid over a decision that you may have to make in the future.  Anxiety comes from wondering if a future situation will require you to make a decision, and whether that decision will reflect your values – particularly if the anticipated context limits available options. Moral tension is the state of being stretched between multiple options and feeling unsure about which option to pursue. Moral tension occurs in the present moment.  Tension comes from feeling insecure about the available options and the degree to which you are able to make a decision based on your values. Tips:  Use the language of moral “challenge” rather than “dilemma.” A dilemma is defined as a situation with no satisfactory solution, whereas a challenge can be overcome (even if only partially).  When considering the cause of moral anguish, identify whether the impact exists in the past (causing distress), present (causing tension), or future (causing anxiety). While the tools to alleviate the anguish may be similar, the posture you take may be different.  When facing a moral challenge that seems foreign or unprecedented, look to other situations or experiences in your life that you have successfully navigated, and try to identify similarities. These situations need not be limited to health care.  Recognizing similarities between your current situation and previous experiences prevents compartmentalization and mental discomfort.  This technique also allows you to apply strategies that worked in prior situations and find director of the Biomedical Ethics and Humanities Program at New York Medical College and Senior Scholar at the Aspen Center for Social Values, offers this framework for examining and reducing moral distress. solutions that you may not have otherwise considered.

The Three-Questions Framework
When facing a moral challenge, exploring these three questions can provide clarity:

What am I experiencing?
What do I want to do with it?
How do I approach it?
Ask yourself: What am I experiencing?

•  Giving something a name allows you to categorize it in a familiar way. This can provide a sense of control and remove some fear of the unknown.
•  Taking big experiences and examining their component parts makes it easier to comprehend and manage.
•  Finding what aspects of the experience are similar to and different than others will allow for familiarity.
  “It may feel as if the COVID-19 pandemic is wholly new and different from anything you have experienced. But breaking it down and identifying how the different components relate to previous challenges can anchor your experience to something more familiar. An analogy is the color green. It is not the same as the colors that form it – blue and yellow – but one can understand where green fits on the color spectrum by considering how it relates to blue and yellow.”
  Ask yourself: What do I want to do with it?
•  This is a personal question, rather than an abstract one. Values entail choices. Instead of framing your response to the situation as an obligation based on social or environmental norms, examine how your values intersect with those norms. Inserting your perspective provides a choice to act based on what you want to do, rather than what you should do.
•  This is an empowering question: It’s actionable; the choice you make will be one you can and want to do.
•  This is an individualized question: Your plan will need to account for your own strengths and limitations.
  “Throwing yourself into the question allows you to put yourself into the answer. Your response to the challenge will come out of who you are, instead of being imposed on who you are.”
  Ask yourself: How do I approach it?
•  This is a question based on where you are and what you can accomplish. Exploring how to approach the moral challenge helps you understand how best to implement your choices.
•  Your approach should reflect the idea that each experience or situation will demand specific skills, tools, or frames of reference based on what it is and what you want to do with it (questions 1 and 2 in the three-question framework). For example, your approach will differ if the distressing situation demands one major decision or a series of decisions over time.
  “Make sure your approach to addressing the moral challenge aligns with the “what I want to do with it” question, and that you have tools in your toolbox that are appropriate to your strategy.”
  This three-question approach relieves moral distress by:

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•  Making you aware of realistic expectations: What you are experiencing during the COVID-19 pandemic differs from prior situations; therefore, previous expectations about behaviors and outcomes may be unrealistic for now. Recognizing this can reduce distress by allowing you to focus on more achievable decisions and/or outcomes – preventing the feeling that you are falling short.
•  Making you aware of more and better options: You are no longer stuck in a dilemma of choosing two bad choices or an “all or nothing” approach. You can identify many different options for what might be possible. This provides hope and an opportunity to act on your values, rather than feeling locked in an untenable situation.
  “Before COVID-19, health care providers had certain expectations about the quality and outcomes of the care they provided. COVID-19 has changed the environment. If clinicians and administrators do not change their expectations to match the realities of the current environment, they will automatically feel as if they have failed. This feeling of failure will stick with them longer than any sense of success that they have had.”
  Avoid Rationalizations
  When faced with a moral challenge that causes tension, it may seem easier to ask, “What should be done?” rather than “What do I want to do?”. However, avoiding the question that probes what you want to do risks allowing you to rationalize (i.e., creating reasons for not acting or justifying conclusions that you have already made about your role). Common rationalizations include, “Nothing can be done about this,” “This is too big an issue for me to impact,” or “It is not my job to do this.” By jumping to these foregone conclusions, you lose the opportunity to name the issue, break it down to its smaller components, and determine what you might be able to do – and what you choose to do. Challenging yourself to recognize and confront these rationalizations will empower you to act on your values.
  Use the worksheet on the following pages to think through your own source of moral distress.

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A Worksheet to Address Moral Challenges
Step 1: Tell your story: Describe the moral challenge
Briefly describe the presenting problem – without analysis, simply lay out the issue in a few sentences.
Step 2: Determine the temporal aspect of your challenge: past, future, or present

•  Moral Distress: a state of anguish or exhaustion brought on by a decision already made (passive or active decision)
•  Moral Anxiety: a state of being worried or afraid of a decision that you may have to make in the future
•  MoralTension:astateofbeingconflictedbydifferentoptionsinthepresentandnotknowingwhich to pursue
  Step 3: Use the three-questions framework: address the challenge
  1. What am I experiencing?
  2. What do I want to do with it?
  3. Depending on whether the experience is tied to the past, present, or future, consider if you want to change is a) your actions, b) the results of previous actions, or c) how you think or feel your actions/options.
     

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3. How can I approach it?
It can be helpful to consider all the options available, starting with extremes and then working towards more balanced approaches. Then assess how these options fit with your personal and professional capabilities and limitations, as well as organizational or environmental factors.
For More Information
Learn more about resiliency and coping with the stress of COVID-19:

•  Visit CAPC’s COVID-19 Rapid Response Resources Toolkit https://www.capc.org/toolkits/covid-19-
  response-resources/
•  Listen to Dr. Ira Bedzow discuss his practical framework for addressing moral challenges experienced by the healthcare workforce during the pandemic https://www.capc.org/events/recorded-webinars/how-am-i-supposed-to-feel-about-this-addressing- moral-distress-caused-by-covid-19/
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A Framework for Coping with Moral Challenges In the COVID-19 Era

www.capc.org

 

[cacatman]

Booster Shots Post Vaccination Expected to be at 8 months post 2nd shot
U.S. experts are expected to recommend COVID-19 vaccine boosters for all Americans, regardless of age, eight months after they received their second dose of the shot, to ensure lasting protection against the coronavirus as the delta variant spreads across the country.

https://www.cbc.ca/news/world/us-booster-vaccine-covid-19-1.6143312

Among Israelis 60 and older who received a booster, the risk of infection fell 11-fold in August and the risk of severe disease 20-fold compared with their twice-vaccinated peers.

https://www.nejm.org/doi/full/10.1056/NEJMoa2114255

22nd Sept - The U.S. Food and Drug Administration amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine to allow for use of a single booster dose, to be administered at least six months after completion of the primary series in:

• individuals 65 years of age and older;
• individuals 18 through 64 years of age at high risk of severe COVID-19; and
• individuals 18 through 64 years of age whose frequent institutional or occupational exposure to SARS-CoV-2 puts them at high risk of serious complications of COVID-19 including severe COVID-19.

Today’s authorization applies only to the Pfizer-BioNTech COVID-19 Vaccine.

FDA Authorizes Booster Dose of Pfizer-BioNTech COVID-19 Vaccine for Certain Populations

FDA amended the EUA for the Pfizer-BioNTech COVID-19 Vaccine to allow for the use of a single booster dose in certain populations.

www.fda.gov

 

[cacatman]

MIS-C/MISC (Multi-inflammatory syndrome in children)
Starts about 4 weeks after infection - fatigue, weakness, rash, abdominal pain, vomiting & diarrhoea, cracked lips, red eyes and swollen hands/feet. Affects 2-15 yo. Rx with immunoglobulin, steroids and other anti-inflammatories.

MIS-C and COVID-19: Uncommon but Serious Inflammatory Syndrome in Kids and Teens

The U.S. Centers for Disease Control and Prevention (CDC) recently recognized a new syndrome in children and teens ages 2–15 that is associated with the coronavirus that causes COVID-19.

www.hopkinsmedicine.org

Autoimmune & Inflammatory Diseases Following COVID-19
Emerging reports show that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection precedes the appearance of various autoimmune and autoinflammatory diseases, including paediatric inflammatory multisystemic syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C), thus adding to the growing mystery of this virus and raising questions about the nature of its link with autoimmune and autoinflammatory sequelae.

Autoimmune and inflammatory diseases following COVID-19 - Nature Reviews Rheumatology

Emerging reports show that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection precedes the appearance of various autoimmune and autoinflammatory diseases, including paediatric inflammatory multisystemic syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C)...

www.nature.com

If kids have fever, abdominal pain, vomiting, diarrhoea, neck pain, rash, bloodshot eyes or extra tiredness, contact your doctor straight away.

COVID-19 and Your Health

Symptoms, testing, what to do if sick, daily activities, and more.

www.cdc.gov

Treatment includes 12 hour infusion of immunoglobulins/steroids. Most are children 1-14 y.o.

33 children have died from 2,617 MIS-C cases in the USA

Some children's hospitals see a surge in rare Covid-19 complication MIS-C

Katharine Dunn's son, Nolan had been running a low grade fever for about a week, when it started getting higher, she took him to the doctor who said it was likely a regular virus, but she found out it was much worse.

edition.cnn.com

The best treatment strategy for COVID-linked multisystem inflammatory syndrome in children (MIS-C) remains unclear after dueling observational studies came to disparate conclusions.

Starting treatment off with both IV immunoglobulin (IVIG) and glucocorticoids was associated with a lower risk of cardiovascular dysfunction on or after day 2 compared with initial IVIG alone (17% vs 31%; risk ratio [RR] 0.56, 95% CI 0.34-0.94).

Best MIS-C Treatment? Murky Picture Emerges

Large U.S. and international surveillance data series come to conflicting conclusions

www.medpagetoday.com

The risk of MIS-C is 5.1 per 1 million person-months. ie. it is pretty rare.

The risk of MIS-C is 5.1 per 1 million person-months. ie. it is pretty rare.

Incidence of Multisystem Inflammatory Syndrome in Children Among US Persons Infected With SARS-CoV-2

This cohort study examines the incidence of multisystem inflammatory syndrome in children among persons in the US with SARS-CoV-2 infection.

jamanetwork.com

@Dbninc

 

[cacatman]

Treatment - First Oral Molnupiravir Drug from Merck
At the interim analysis, molnupiravir reduced the risk of hospitalization or death by approximately 50%; 7.3% of patients who received molnupiravir were either hospitalized or died through Day 29 following randomization (28/385), compared with 14.1% of placebo-treated patients (53/377); p=0.0012. Through Day 29, no deaths were reported in patients who received molnupiravir, as compared to 8 deaths in patients who received placebo. At the recommendation of an independent Data Monitoring Committee and in consultation with the U.S. Food and Drug Administration (FDA), recruitment into the study is being stopped early due to these positive results. Merck plans to submit an application for Emergency Use Authorization (EUA) to the U.S. FDA as soon as possible based on these findings and plans to submit marketing applications to other regulatory bodies worldwide.

Merck and Ridgeback’s Investigational Oral Antiviral Molnupiravir Reduced the Risk of Hospitalization or Death by Approximately 50 Percent Compared to Placebo for Patients with Mild or Moderate COVID-19 in Positive Interim Analysis of Phase 3 Study -

At the Interim Analysis, 7.3 Percent of Patients Who Received Molnupiravir Were Hospitalized Through Day 29, Compared With 14.1 Percent of Placebo-Treated Patients Who were Hospitalized or Died Merck Plans to Seek Emergency Use Authorization in the U.S. as Soon as Possible and to Submit...

www.merck.com

Merck announced last week that an antiviral pill it’s developing can cut hospitalizations and deaths among people with COVID-19 by half. The results haven’t yet been peer reviewed. But if the drug candidate, molnupiravir, is authorized by regulators, it would be the first oral antiviral treatment for COVID-19. By contrast, the other currently authorized drugs must be delivered intravenously or injected.

How antiviral pill molnupiravir shot ahead in the COVID drug hunt

The Merck pill, which could become the first oral antiviral COVID treatment, forces the SARS-CoV-2 coronavirus to mutate itself to death.

www.nature.com

Merck said on Friday that in a final analysis of a clinical trial, its antiviral pill reduced the risk of hospitalization and death among high-risk Covid patients by 30 percent, down from an earlier estimate of 50 percent.

Merck and Ridgeback Biotherapeutics Provide Update on Results from MOVe-OUT Study of Molnupiravir, an Investigational Oral Antiviral Medicine, in At Risk Adults With Mild-to-Moderate COVID-19 - Merck.com

Merck (NYSE: MRK), known as MSD outside the United States and Canada, and Ridgeback Biotherapeutics today provided an update on the MOVe-OUT study of molnupiravir (MK-4482, EIDD-2801), an investigational oral antiviral medicine for COVID-19. Data are now available from all enrolled participants...

www.merck.com