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🦘Cacatman's Personal Coronavirus COVID-19 Update Thread

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.”
 
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.

“Inhaled budesonide improves time to recovery, with a chance of also reducing hospital admissions or deaths (although our results did not meet the superiority threshold), in people with COVID-19 in the community who are at higher risk of complications,” the study authors concluded. They did note that this was an open-label trial and that inhalers have been previously shown to have placebo effects in chronic respiratory conditions, possibly affecting the findings on self-reported recovery time.
 
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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
 
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.

The study of more than 2100 pregnant women enrolled at hospitals in 18 countries found that, compared with uninfected pregnant women, those with COVID-19 are at higher risk for severe illness, death, pregnancy complications, and preterm birth.

Those with COVID-19 had a 76% greater chance of pregnancy-induced high blood pressure, known as preeclampsia or eclampsia. They were three times as likely to have a severe infection and five times as likely to be admitted to an intensive care unit, Papageorghiou’s team reports today in JAMA Pediatrics. Eleven women with COVID-19 died, compared with just one woman in the uninfected group.

The study also linked COVID-19 to a 60% to 97% increased rate of preterm birth, and— in infected women with a fever and shortness of breath—to a fivefold increase in neonatal complications such as immature lungs, brain damage, and eye disorders. About 13% of babies tested positive for the virus, and cesarean delivery was linked to a higher risk of transmission. Breastfeeding didn’t appear to transmit the virus—a small bit of good news.

The risk estimates are roughly in line with what other studies have found, Papageorghiou says, including a recently published study that looked at health records for more than 400,000 U.S. pregnant women, nearly 6400 with COVID-19.

The new study helps makes the case for offering all pregnant women COVID-19 vaccines, Papageorghiou says. “We believe pregnancy itself [puts women into] a sufficiently high-risk group,” he says. In the United States, the Centers for Disease Control and Prevention (CDC) includes pregnancy under high-risk medical conditions with priority for vaccines, but not all states have included pregnancy in priority groups. In the United Kingdom, pregnant women were only recently added to such groups.

Brazil losing >100 pregnant women a month

A study compared 18,715 women who gave birth with COVID-19 to 850,364 without COVID-19 and found significantly higher rates of preterm birth (16.4% vs. 11.5%) and in-hospital mortality (0.1% vs. <0.01%) associated with infection.

We demonstrated that women with COVID-19 diagnosis, compared with those without COVID-19 diagnosis, were at substantially increased risk of severe pregnancy complications, including preeclampsia/eclampsia/HELLP syndrome, ICU admission or referral to higher level of care, and infections requiring antibiotics, as well as preterm birth and low birth weight. The risk of maternal mortality was 1.6%, ie, 22 times higher in the group of women with COVID-19 diagnosis. These deaths were concentrated in institutions from less developed regions, implying that when comprehensive ICU services are not fully available, COVID-19 in pregnancy can be lethal. Reassuringly, we also found that asymptomatic women with COVID-19 diagnosis had similar outcomes to women without COVID-19 diagnosis, except for preeclampsia.

Importantly, women with COVID-19 diagnosis, already at high risk of preeclampsia and COVID-19 because of preexisting overweight, diabetes, hypertension, and cardiac and chronic respiratory diseases,28 had almost 4 times greater risk of developing preeclampsia/eclampsia, which could reflect the known association with these comorbidities and/or the acute kidney damage that can occur in patients with COVID-19.29

Our data support reports of an association between COVID-19 and higher rates of preeclampsia/eclampsia/HELLP syndrome,19,30 but it is still uncertain whether COVID-19 manifests in pregnancy with a preeclampsialike syndrome or infection with SARS-CoV-2 results in an increased risk for preeclampsia. Uncertainty persists because the placentas of women with COVID-19, compared with controls, show vascular changes consistent with preeclampsia,31 but the state of systemic inflammation and hypercoagulability found in nonpregnant patients with severe illness and COVID-19 is also a feature of preeclampsia.32

It is known that in nonpregnant patients, distinct subtypes may be predictive of clinical outcomes.33 We found the presence of any COVID-19 symptoms was associated with increased morbidity and mortality. Specifically, severe pregnancy and neonatal complication rates were highest in women if fever and shortness of breath were present, reflecting systemic disease; their presence for 1 to 4 days was associated with severe maternal and neonatal complications. This observation should influence clinical care and referral strategies.

The risks of severe neonatal complications, including NICU stay for 7 days or longer, as well as the summary index of severe neonatal morbidity and its individual components, were also substantially higher in the group of women with COVID-19 diagnosis. The increased neonatal risk remained after adjusting for previous preterm birth and preterm birth in the index pregnancy; thus, a direct effect on the newborn from COVID-19 is likely.

Overall, our results were consistent across morbidities and mostly at an RR near or greater than 2 for maternal and neonatal outcomes, with narrow CIs excluding unity, and above 3 to 4 in several estimates. Sensitivity and stratified analyses confirmed the observed results. They are probably conservative because overall, 41% of women with COVID-19 diagnosis were asymptomatic, a subgroup with a low risk of complications. Hence, higher morbidity and mortality risk should be expected for the general pregnant population, especially in low- to middle-income countries.

We found 12.1% of neonates born to test-positive women also tested positive, a higher figure than in a recent systematic review.34 We speculate whether contamination at the time of cesarean delivery was responsible because the rate in this mother/neonate positive subgroup was 72.2%. Reassuringly, as SARS-CoV-2 has not been isolated from breast milk,35 breastfeeding was not associated with any increase in the rate of test-positive neonates.

Our results mostly reflect COVID-19 diagnosed in the third trimester. Thus, women with COVID-19 diagnosis or whose pregnancy ended earlier in pregnancy are underrepresented either because our study was exclusively hospital based or earlier infection may manifest with mild symptoms, which are either ignored or managed in primary care. Alternatively, most women might have avoided the hospital until late in pregnancy or when in labor. Clearly, the effect of COVID-19 early in pregnancy needs urgently to be studied.

Increased risk of Stillbirth

Unvaccinated, coronavirus-infected women were far more likely than the general pregnant population to have a stillborn infant or one that dies in the first month of life. Among the infected women in the study, every one of the perinatal deaths occurred in the pregnancy of someone who was unvaccinated.

The unvaccinated mothers themselves were also more endangered: Nearly every pregnant person with a SARS-CoV-2 infection who required critical care was unvaccinated. Unvaccinated women also had a far higher rate of hospitalization than their vaccinated counterparts in the study of nearly 88,000 pregnant women.

A mother’s COVID-19 infection also increased the risk of premature births, confirming earlier work. Scots infected at any point in pregnancy were likelier than the general pregnant population, surveyed from March 2020 through October 2021, to have premature babies: 10.2% versus 8%. Those who delivered their babies within 28 days of being infected saw the rate jump to 16.6%.

The pregnancy study also highlighted risks to the unvaccinated women’s own health: 98% of critical care admissions that occurred during the study and 91% of hospitalizations were in unvaccinated women.

Risk of even mild COVID-19 infection to pregnancy outcomes. After controlling for factors likely to infect birth outcomes, like maternal age, race, ethnicity, and smoking status, the study found infected women were significantly more likely to have preterm births or stillborn infants.

The scientists also found that time of the infection was a very strong predictor of how close to term a woman would carry her pregnancy: the earlier in pregnancy a mother was infected with SARS-CoV-2, the earlier a baby was likely to be born. Perhaps surprisingly, the severity of COVID-19 symptoms didn’t worsen the outcome. “Even mild COVID-19 infections put pregnant people at increased risk for preterm delivery,” says Samantha Piekos, a systems biologist at ISB who is the paper’s first author.
 
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Blood Cancers with COVID-19 Vaccines
Vaccines tend to be less effective in patients with cancers or those receiving immunosuppressive treatments, as well as patients who receive more aggressive chemotherapy treatments.
Likely to have lower antibody responses. The more aggressive the chemotherapy, the lower the function of lymphocytes.
 
COVID-19 Probably Causes Antibodies to be Made for Life
People who recover from mild COVID-19 have bone-marrow cells that can churn out antibodies for decades, although viral variants could dampen some of the protection they offer.


Immunity may last years 2 according to 2 studies
"People who were infected and get vaccinated really have a terrific response, a terrific set of antibodies, because they continue to evolve their antibodies," explained Michel Nussenzweig, MD, PhD, lead author of the bioRxiv study and immunologist at New York City-based Rockefeller University. "I expect that they will last for a long time"
 
Unvaccinated Are Still at Risk
Dropping numbers amongst vaccinated populations shouldn't lull unvaccinated people into a false sense of security.

 
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