Coverage From ID Week 2020

A new podcast episode featuring Mei Mei Hu of Covaxx, whose company has made great strides toward a preventive option in mere months.

What It's Like to Make a COVID-19 Vaccine

 of reports comprising almost 1,000 children affected with multisystem inflammatory syndrome (MIS-C) subsequent to SARS-CoV-2 infection details its presentations and finds that aggressive treatment has kept the fatality rate low.

"The initial descriptions exposed important clinical heterogeneity, partially overlapping with features of Kawasaki disease or toxic shock syndrome, but nevertheless distinct from these known inflammatory conditions," observed Levi Hoste, MD, Department of Pediatric Pulmonology, Infectious Diseases and Immunology, Ghent University Hospital, Ghent, Belgium, and colleagues.

Hoste and colleagues found that scattered case reporting had provided insufficient insight into clinical, epidemiological, immunological and prognostic characteristics of this novel pediatric COVID-19-associated phenotype; and so undertook what they describe as the most extensive systematic review of published reports on the syndrome.From an initial 918 publications in their literature search, they identified 68 studies published after May 9, 2020 (their review went to preprint in August), which comprised 953 individual patient cases (8 years median age).

Comorbidities were rare, except for obesity (25.3%).The principle presentations of MIS-C were fever (99.4%), gastrointestinal (85.6%), cardiocirculatory manifestations (79.3%) and increased inflammatory biomarkers.Although MIS-C is not associated with the pulmonary manifestations typical of COVID-19, the reviewers also found respiratory symptoms in 50.3% of these children.

While the condition is relatively rare, the severity is reflected in over half of patients (56.3%) presenting with shock and most (73.3%) requiring intensive care treatment, including extracorporal membrane oxygenation (ECMO) in 3.8%.Prompt, intensive treatment has succeeded in keeping the morality rate to a relatively low 1.9%.

Therapeutic interventions included intravenous immunogloblins (IVIG) in 75.9%; and multiple doses were administered to 73 of the 662 patients (11%).Acetylsalicyic acid was received by 52.3%; with high, anti-inflammatory dosages of 80-100mg/kg/day received in 39/171 (22.8%).Heparin was administered in 46% of cases.

Biopharmaceuticals included IL-1R antagonist (anakinra) 7.6%; IL-6 inhibitors (tocilizumab/siltuximab) 6.7%, and TNFα-inhibitor (infliximab) 2.3%.Remdesivir, which is FDA approved for COVID-19 in hospitalized adult and pediatric patients, was rarely prescribed for MIS-C (2.3%).Inotropics were required by 55.3%.Mechanical and non-invasive ventilation was initiated in 23.6% and 25.8%, respectively.

"It remains challenging to recognize this heterogeneous disease in daily clinical practice,"Hoste and colleagues observed."Prompt recognition is pivotal to insure a good individual prognosis."

 on MIS-C, the American Academy of Pediatrics (AAP) recommends that any child with suspected MIS-C should also be evaluated for infectious and noninfectious etiologies.In that guidance, which is also referred to in a "Partner Update" from the 

, the AAP stresses that any fever that is accompanied by symptoms that are concerning in their severity or coincident with exposure to a person with COVID-19 should raise suspicions.

The AAP indicates that a child sick enough to warrant hospital admission with suspected MIS-C should be cared for in a hospital with tertiary pediatric/cardiac intensive care units.Diagnostic testing is likely to include chest radiography, EKG and troponin.If these or physical examination is abnormal, subsequent diagnostic testing for myocardial injury wouldinclude echocardiogram and/or cardiac MRI by pediatric cardiology.

The CDC urges healthcare providers to report suspected cases to their local, state, or territorial department.After-hours phone numbers for health departments are available at the 

Council of State and Territorial Epidemiologists

Articles

A review of approximately 1000 children with multisystem inflammatory syndrome (MIS-C) from SARS-Cov-2 finds low fatality with aggressive treatment.

MIS-C Review Finds Severe Symptoms, Low Fatality Rate

The US Centers for Disease Control and Prevention (CDC) announced beginning this week it was going to funnel air travelers from the Democratic Republic of Congo (DRC) and Guinea to 6 US airports due to an Ebola outbreak.

While there has been a limited amount of cases in remote areas in these countries, out of an abundance of caution, the CDC acted to ensure it limited the risk to the US.

“Air travel has the potential to transport people, some of whom may have been exposed to a communicable disease, anywhere across the globe in less than 24 hours,” the CDC statement read.

The CDC did not mention which airports they would be using. In addition, the airlines will be sending passenger information to CDC for all those who boarded a flight to the US from the 2 countries within the past 3 weeks.

In recent weeks, a handful of deaths from the disease have been 

. Just months removed from the country’s worst outbreak, the DRC is experiencing this latest outbreak.

As of this past Saturday, In the DRC, there have been 8 cases, 4 deaths, 788 contacts with 88% monitored, and 773 people vaccinated. In Guinea there were 15 cases, 6 deaths, 353 contacts with 99% monitored and 771 people vaccinated. These statistics come for the World Health Organization. 

Beginning this week, the agency is funneling air travelers from 2 African countries to a limited amount of US airports.

CDC to Begin Public Health Measures to Respond to Ebola in Africa

On Monday, the Philippines began its inoculation campaign despite a deep public distrust in foreign-made vaccines after a scare in 2017 of severe disease linked to French drug maker Sanofi shots. The country, one of the last in Southeast Asia to receive them, secured 25 million doses the of the Sinovac vaccine, with another expected shipment of 500,000 doses of AstraZeneca being delayed.

In New Zealand, after discovering a single case of 

, the country’s largest city of Auckland began its second lockdown in a month on Sunday. The lockdown is set to last for 7 days, and follows a 3 day stay-at-home order that occurred in mid-February. New Zealand has been largely praised for the way it has handled the ongoing pandemic, as the population of 5 million people has only experienced a little over 2,000 cases and just 26 deaths.

Additionally, on Saturday, the US Food and Drug Administration (FDA) approved the pharmaceutical company 

 for an Emergency Use Authorization (EUA). The approval comes a few months after the FDA approved both the Pfizer and Moderna vaccines for use in the prevention of the disease. The company expects to supply 100 million doses through the first half of 2021.

Data Table per Our World in Data (March 1, 2021, 12 AM EST)

In the United States, the numbers of COVID-19 tests have been plummeting from a high in January. Experts have cited a number of reasons why this may be occurring, including fewer exposures, less travel, bad weather, vaccine rollout and pandemic fatigue.

Data Table per CDC COVID-19 Tracker (Feb 28, 2021, 6 AM EST)

For more information on COVID-19 vaccination research, distribution, and assessment, check out some of these recent Contagion stories:

Canada Authorizes AstraZeneca’s COVID-19 Vaccine

FDA VRBPAC Votes in Favor to Recommend EUA of Janssen’s COVID-19 Vaccine

FDA Eases Temperature Requirements for Pfizer, BioNTech's COVID-19 Vaccine

Prime Minister Narendra Modi of India receives vaccine as country begins next phase of program.

The Philippines Begins Vaccination Program Amid Public Distrust

Following the cancellation of the American Academy of Allergy, Asthma & Immunology (AAAAI) 2020 Annual Meeting last March due to the recently-begun COVID-19 pandemic, the respiratory and allergy meeting returned this last weekend in a virtual capacity to again lead conversation on a litany of matters pertaining to the lung.

No matter has greater pertinence in such a current meeting than COVID-19 itself.

shared a triplet of new studies and insights gathered on COVID-19 research as it related to other matters of respiratory health.

Here's a recap of new AAAAI research into COVID-19:

MMR Vaccine Shows Some COVID-19 Protection

New research shows the Mumps-Measles-Rubella (MMR) vaccine could provide a degree of protection against severe COVID-19 outcomes.

Led by Desiree E.S. Larenas Linnemann, MD, FAAAAI, Médica Sur Clinical Foundation and hospital, the international team of investigators administered the MMR vaccine with 3 live-attenuated viruses to allergic patients and seemingly healthy close-contact of COVID-19 patients during the measles-outbreak between February and March 2020.

Of the 587 patients to receive MMR vaccine, 79 tested positive for COVID-19. Of them, 12% were between 50-59 years old and 12% were between 60-75 years old. Another 40.5% had 1 or more risks factors, including morbid-obesity, diabetes, or hypertension. Ten patients had asthma.

All of the COVID-19 positive patients had mild or moderate symptoms, with 2 requiring supplementary oxygen at home. In addition, 2 patients older than 70 were hospitalized and died, likely due to a pre-existing interstitial lung condition with a previous 2016 hospitalization for pneumonia and erroneously 2 administrations of the DTP vaccine 1-2 months prior to the MMR-II vaccine in another center.

“The here presented cases show a possible beneficial effect in the context of a COVID-19 infections,” investigators wrote. “Very recently another publication actually showed an inverse relationship between level of IgG against measles and COVID-19 outcome, with the mildest outcome in those with most antibodies.”

Breathing Difficulty Still Common in Hospitalized COVID-19 Patients After 6 Months

A team of investigators from Oklahoma State University Center for Health Sciences conducted a six-month discharge survey of patients treated for RT-PCR-confirmed COVID-19 at a local tertiary center from March - August 2020.

They observed significant prevalence of fatigue (52.4%), changes in daily activities due to breathing (52.4%), shortness of breath (47.6%), change in taste and smell (42.9%) and increased much production (38.1%).

More than 25% of all surveyed patients also reported continued issues with rhinorrhea, nasal congestion, and cough.

 regarding the findings, study author Ben Rossavik, DO, discussed  shared perspectives collected from survey respondents, including frequent failures of memory on their COVID-19 treatment in the hospital, and experiences in physical therapy and rehabilitation.

“A lot of times, the way our model is run, people go there for a period of time, then they’re done and they go home,” Rossavik said. “But then they still complain about this inability to just walk around their house.”

The US Centers for Disease Control and Prevention (CDC) currently recommends masks be worn in public settings and around members of different households for individuals 2 years and older, including asthma patients.

A new University of Michigan study included 223 adult and pediatric patients attending appointments at the Michigan Medicine Allergy clinic between September 10, 2020 and October 23, 2020, 46% (n = 102) of which reported having asthma. Each patient voluntarily completed a survey reflecting their demographics, asthma diagnosis and perceived control, and mask type worn.

Investigators performed a pulse oximetry reading on masked patients, with respondents reporting their continuous duration of ask use prior to the measurement. They completed a descriptive analysis of frequencies and proportions to examine the data.

Oxygen saturation (SpO2) ranged between 93-100% among the patient subgroup with asthma—unchanged from the SpO2 range for patients without asthma.

After adjusting for gender, race, mask type used, or duration of mask use, the oxygen saturation did not change, with asthma patients who reported their perceived level of control (n = 100) having a similar mean SpO2 across all groups.

“Mask use at rest did not decrease SpO2 levels in patients with or without asthma, regardless of mask type worn, duration of mask use, or demographics,” the authors wrote. ”SpO2 levels did not differ between those with perceived well-controlled and somewhat-controlled asthma.”

Courtesy of HCPLive, here's a look at 3 new pandemic talking points covered at the annual allergy and asthma meeting.

COVID-19 Research Contributions from AAAAI 2021

 Makeshift COVID-19 data-sharing networks


 Interpreting SARS-CoV-2 sequence changes


The communication networks connecting major US laboratories conducting 

 sequencing may not be any greater than a Slack channel established by the US Centers for Disease Control and Prevention (CDC).

But it’s proven to be more than enough for teams including Cooper, Kamil, and Domman, a trio of microbiology investigators

 into a lineage B.1.2 variant with a Spike protein Q677P substitute in a growing proportion of cases in the South and Southwest regions earlier this year.

In the second segment of an interview with 

, the team discussed the intricacies of SARS-CoV-2 sequencing and reporting—a matter which, given the urgent nature of the COVID-19 pandemic, conflicted against the scientific instincts of raised patience and scrutiny. Kamil and colleagues faced such conflict when observing the prevalent lineage.

“It’s so easy to get stuck in the hyper-cautious, ‘Wait, we need more proof’,” Kamil said. “It’s such a balance in science where you don’t want to want to be irresponsible but you also don’t want to sit on a story that’s real.”

For reference, Kamil discussed the caution placed around D614G mutation, nicknamed ‘Doug,’ by the scientific community in the late spring of 2020.

“We were all kind of too cautious about Doug,” Kamil explained. “It now is 98% of all the viruses in the world. It became a signal in June, and it probably popped up in maybe April or March—and it probably occurred first maybe February, January, or December (2019). It came from almost nothing to overtake all the population.”

But the opportunity to observe and share virus evolution first-hand is almost unprecedented in the modern history of sequencing, regardless of the means by which it’s being collected.

“I think it’s really valuable for everyone to know how quickly we were able to put this data together because of data-sharing, and because of scientific networks that we basically put together ad hoc,” Cooper said

It does speak to the benefit of improved resourcing for such monitoring—for COVID-19 and beyond.

“Sequencing is cheaper than it has ever been,” Kamil said. “Why are we not sequencing more? We have not updated our public health surveillance on any respiratory pathogens.”

Videos

How observed changes in SARS-CoV-2 lineage have warranted heightened priority, and why sequencing deserves better resourcing beyond the pandemic.

SARS-CoV-2 Sequence Reporting: Changing Mindsets

The variant, B.1.526, was first found in samples dating back to November.

New COVID-19 Variant Identified in New York

Symptoms of COVID-19 can persist for months in about a third of cases, including among those with mild illness, a new study confirms.

A Third of COVID-19 Patients Report Persistent Symptoms 6 Months After Illness 

The VRBPAC voted 22-0 with no abstentions to support the benefit-risk profile associated with Ad26.COV2.S on Friday night.

FDA Authorizes Janssen COVID-19 Vaccine in the US

Vitamin B6 is a water-soluble vitamin found in various foods such as fish, whole grains, and bananas.

Vitamin B6 May Help With COVID-19 Cytokine Storm

The US Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) recommendation paves the way for the authorization.

FDA VRBPAC Votes in Favor to Recommend EUA of Janssen’s COVID-19 Vaccine 

Patients with cardiometabolic conditions have a high risk of poor outcomes.

Over Half of COVID-19 Hospitalizations Due to 4 Conditions

The country has no domestic production, and the government has been accused of not acquiring doses quickly enough.

A team of cross-country investigators discuss their coordinated tracking of a new variant in the US earlier this year.

SARS-CoV-2 Sequencing in the US: The Need for Collaboration

Multiple observational and ex-vivo laboratory studies have demonstrated that IL-6 is an important cytokine associated with disease severity and mortality.

Interleukin-6 Receptor Antagonists Improve Outcomes in Severe COVID-19

If approved, the decision could have a significant impact on the mass vaccination programs.

Top Medical News

MIS-C Review Finds Severe Symptoms, Low Fatality Rate

CDC to Begin Public Health Measures to Respond to Ebola in Africa

The Philippines Begins Vaccination Program Amid Public Distrust

COVID-19 Research Contributions from AAAAI 2021

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