Emergence of a Deadly Coronavirus

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Sweden has decided against recommending COVID vaccines for kids aged 5-11, the Health Agency said on Thursday, arguing that the benefits did not outweigh the risks.

"With the knowledge we have today, with a low risk for serious disease for kids, we don't see any clear benefit with vaccinating them," Health Agency official Britta Bjorkholm told a news conference.

She added that the decision could be revisited if the research changed or if a new variant changed the pandemic. Kids in high-risk groups can already get the vaccine.

hough considered milder than other coronavirus variants, omicron has infected so many people that it has driven the number of daily deaths beyond where it was last spring, before vaccines were widely available, according to Washington Post data.

Omicron has been particularly lethal to people over 75, the unvaccinated and the medically vulnerable, according to doctors and public health officials. The soaring death toll also illustrates why experts pleaded with the public to beware of the highly contagious variant even though it is less virulent than others.

“That feels quite jarring to people who may have assumed omicron is generally on a per-case level less severe and given the fact we have vaccinated at least some portion of the country,” said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. “Even if on a per-case basis fewer people develop severe illness and die, when you apply a small percentage to a very large number, you get a substantial number.”

Yet the seven-day average of deaths during the omicron surge has reached 2,600 in recent days, climbing past the late September peak of about 2,000 average daily fatalities during the surge of the more dangerous delta variant, according to Post tracking. The ranks of hospitalized patients with covid-19 reached record highs in January. Coronavirus deaths lag hospitalizations.

More than 900,000 Americans have died of covid-19.

The latest victims tend to be older, according to a Post review of federal data. Nearly half of the deaths in January 2022 were among those 75 and older, compared to about a third in September.

Experts theorized hospitalizations and deaths during the delta surge skewed younger because of high rates of vaccination among senior citizens and the delta variant appearing to cause particularly severe illness among middle-aged adults compared to earlier surges. Now the age distribution of deaths resembles the deadliest stage of the pandemic last winter, when more than 3,000 were dying a day.

Advocate Aurora Health, Illinois’ largest health system, has seen an in-hospital mortality rate for covid-19 patients decline from about 20 percent at the start of the pandemic to under 2 percent now.

“You are flooding the system with so many patients that the crude number of deaths is going to be higher, but what we really focus on is the death rate,” said Robert Citronberg, Advocate Aurora Health’s executive medical director of infectious disease and prevention. He noted nearly all the latest deaths have been among the unvaccinated.

“There’s also a big group of patients who are politically motivated and don’t want to be told what to do,” Citronberg said. “They are willing to die from this disease because they don’t want to be told what to do, and it’s basically crazy.”

Public health officials have also stressed death rates barely budged among the vaccinated and boosted while surging for older unvaccinated adults. The city reported an age-adjusted death rate peaking at 14 per 100,000 for the unvaccinated around Jan. 22 compared to about 1 per 100,000 for the boosted.

“It’s been challenging because it goes up against the national narrative that omicron is nothing dangerous,” said Allison Arwady, commissioner of the Chicago Department of Public Health. “I don’t think society wants to be a place where we are talking about 30 deaths a day.”

Public health officials such as Arwady are facing similar challenges in trying to communicate the conflicting nature of omicron: It poses a lower risk to individuals but a greater risk to society when the vulnerable face the highest likelihood yet of contracting the virus during a massive surge.

Other hospitals have been raising alarms about immunocompromised patients, whose systems struggle to generate antibodies to fight off coronavirus even after vaccination. Colin L. Powell, the former U.S. secretary of state, was one of the highest-profile examples when he died of covid-19 complications while also being treated for a blood cancer that severely impairs the immune system.

Andrew Myers, director of inpatient covid care at Tampa General Hospital, said the record levels of patients his hospital has seen in the latest outbreak has included more immunocompromised patients who take the virus seriously but had a harder time dodging omicron.

When a variant such as omicron rapidly spreads through the population at once and requires less exposure time to infect, an immunocompromised person is more likely to get infected when a loved one visits or during routine activities.

“It’s really unfortunate for them when something like this is spreading because if you are unable to have that extra protection, it makes life a whole lot more difficult,” Myers said.

“Even if you feel fine as a 25-year-old or 35-year-old, one, you are taking a chance, a small chance,” he added. “But two, you don’t know who else you can infect. You don’t know if that lady sitting next to you outside or the lady you work with at the store are immunocompromised or if they have someone at home who is immunocompromised. It’s a butterfly effect.”

So far, despite an endless supply of shots and months of easy access, barely a quarter of the U.S. population (27 percent) has received a booster — less than half the Danish (61 percent) or British (55 percent) rate.

Even among Americans who’ve already received their initial vaccine doses and are eligible for another, nearly 50 percent have yet to get a booster, which offers much greater protection against serious or critical COVID-19 illness than what continues to count for full vaccination (two doses of the mRNA vaccines manufactured by Pfizer or Moderna, or a single Johnson & Johnson shot).

A new CDC study of the Omicron surge in Los Angeles found that while vaccinated people were 5.3 times less likely to end up in the hospital than the unvaccinated, boosted people were 23 times less likely to do so, meaning that boosters afforded four times more protection against hospitalization than a first-series vaccination alone.

The result is practically unique to America, where vaccination rates are solid but booster rates are low: “A pandemic of the unboosted,” as Dr. Peter Hotez, an infectious-disease expert at Baylor College of Medicine, recently told the Financial Times.

Since Dec. 1, when health officials announced the first Omicron case in the U.S., the share of Americans who have been killed by the coronavirus is “at least 63 percent higher” than in any other large, wealthy nation, according to a New York Times analysis published earlier this week.

“The only large European countries to exceed America’s COVID death rates this winter have been Russia, Ukraine, Poland, Greece and the Czech Republic, poorer nations where the best COVID treatments are relatively scarce,” the Times reported.

Experts say fading vaccine protection — along with higher numbers of unvaccinated and overweight residents — is a major reason why.

Why is America so bad at boosters? The country’s initial vaccination effort was more or less successful, with 74.2 percent of all adults — and 88.4 percent of seniors — now considered “fully” inoculated, according to the Centers for Disease Control and Prevention.

But its subsequent booster effort has been hampered by regulatory disagreement, confusing public health messaging and the spread of misinformation, not to mention two new waves of the coronavirus since the fall, when the booster effort was just beginning.

“The White House COVID-19 team was correct back in August 2021 when they said that most Americans would need boosters and that the effort would begin in September,” Dr. Leana Wen, a former Baltimore public health commissioner, told Yahoo News. “But then the messaging became very convoluted from the CDC. The American public generally understood this back-and-forth to mean that boosters were a nice-to-have luxury instead of essential.”

The contrast with peer countries is stark. In a Twitter thread explaining Denmark’s decision, political scientist Michael Bang Petersen, who advises the Danish government and leads the country’s largest study of pandemic behavior, rattled off several key differences with the U.S. that have allowed his homeland to return to normal first.

But one data point in particular stood out. “Sixty-one percent of the [Danish] population,” Petersen wrote, has “received a booster vaccine.”

In Europe, that figure is hardly an outlier. More than half of Germans, Italians and Belgians have received an additional dose, and France, Spain, Canada and the Netherlands will soon clear the 50 percent mark themselves.

Yet Americans trail far behind — and that, more than anything else, is what’s holding the U.S. back from declaring an end to its own state of emergency, experts say. Some of the U.S. states with the lowest booster rates have already returned to something approaching normal, while more cautious blue states continue to wait, even as booster uptake remains anemic nationwide.

Only 8 percent of people age 65 and over who were hospitalized for COVID-19 had been boosted.

A booster, on the other hand, is twice as effective as two shots against infection (50 percent) and almost completely effective against hospitalization (90 percent) and death (95 percent), even after three months.

Clearly, booster shots are the surest way of keeping vulnerable people out of hospitals. And keeping people out of hospitals, in turn, is the surest way to return to normal, as Walensky said on Wednesday.

Yet the U.S. has botched its booster rollout. Although America got off to a much faster start than Europe in the initial drive to vaccinate its population, Europe caught up by August.

Right around that time, regulators at the CDC and Food and Drug Administration entered an acrimonious debate over whether boosters were even necessary. Some top FDA experts argued that a first series offered sufficient protection even against the Delta strain for most people and that the U.S. should focus instead on getting first shots to unvaccinated populations abroad.

Two officials at the FDA even resigned over what they saw as Biden’s own advocacy for boosters, which they and others regarded as political interference of the kind his administration had vowed to avoid.

The legitimate scientific debate over boosters was joined with a rising Republican resistance to vaccines.

By the time boosters were broadly approved, many Americans had absorbed the message that they were optional — even overkill. Then Omicron surged, and vaccine appointments were suddenly hard to come by.

Some Americans started to voice concerns about when inoculations would end, or if they would end at all. Israel has been experimenting with a fourth shot, with results suggesting a marginal benefit. In the end, many Americans seem to have resigned themselves to simply contracting the coronavirus, concluding that natural immunity will suffice in place of getting boosted.

But whatever the causes of America’s booster deficit, the cost is now being measured in lives. According to a Financial Times analysis published Monday, 30 percent of U.S. seniors had gone six months since receiving a second dose as of Dec. 20 — when Omicron was taking off — compared with just 7 percent in Denmark. As a result of this weaker coverage among those most susceptible to serious disease — another 12 percent of U.S. seniors remain entirely unvaccinated — the FT calculated that the U.S. was twice as exposed to COVID hospitalization as Denmark during the Omicron wave.

Going forward, vulnerable Americans will continue to be exposed. A recent Omicron infection offers some initial protection, but it is likely to be short-lived and eventually ineffective against new variants; boosters provide a stronger, broader shield. Yet even now, more than 35 percent of “fully” vaccinated U.S. seniors remain unboosted. That’s 17 million Americans. By comparison, just 9 percent of Britons over 65 are unboosted.

Feb 11 (Reuters) - The European Medicines Agency's safety committee said on Friday it was reviewing reports of heavy menstrual bleeding and absence of menstruation from women who had received COVID vaccines from Pfizer (PFE.N)/BioNTech (22UAy.DE)and Moderna (MRNA.O).

The assessment was in view of reports of menstrual disorders after receiving either of the two vaccines, both based on messenger RNA technology, and it was not yet clear whether there was a causal link, the agency said.

[...]

After reviewing the available evidence, the EMA's Pharmacovigilance Risk Assessment Committee (PRAC) said it decided to request an evaluation of all available data, including reports from patients and healthcare professionals, clinical trials and the published literature.

The agency on Friday added that there was also no evidence to suggest that COVID-19 vaccines affected fertility.

Source: https://www.reuters.com/business/healthcare-pharmaceuticals/eu-investigates-reports-menstrual-disorders-after-mrna-covid-shots-2022-02-11/

The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that has yet to be certified by peer review.

Risk of new heart problems much higher after COVID recovery

Long after recovery from COVID-19, people face significantly higher risks for new heart problems, a large study has found.

Researchers at the U.S. Department of Veterans Affairs compared rates of new cardiovascular problems in 153,760 individuals infected with the coronavirus before vaccines were available, 5.6 million people who did not catch the virus, and another 5.9 million people whose data was collected before the pandemic. An average of one year after their recovery from the acute phase of the infection, the COVID-19 survivors had a 63% higher risk for heart attack, a 69% higher risk for problematic irregular heart rhythm, a 52% higher risk of stroke, a 72% higher risk of heart failure, and a nearly three times higher risk of a potentially fatal blood clot in the lungs compared with the other two groups, according to a report published on Monday in Nature Medicine. The elevated risks among former COVID-19 patients were evident in young and old, Blacks and whites, males and females, people with and without diabetes and with and without kidney disease, as well as smokers and nonsmokers, said Ziyad Al-Aly of the VA St. Louis Health Care System and Washington University in St. Louis.

The risks were high even in people who had mild COVID-19 and did not need to be hospitalized for it, he noted in a Twitter thread. "It really spared no one," Al-Aly told Reuters. "People with COVID-19 should pay attention to their health and seek medical care if they experience symptoms like chest pain, chest pressure, palpitation, swelling in the legs, etc."


COVID-19 vaccines using mRNA technology do not produce any extra short-term side effects in cancer patients, a new study suggests.

Researchers surveyed 1,753 recipients of two doses of the Pfizer (PFE.N)/BioNTech vaccine, about two-thirds of whom had a history of cancer and about 12% of whom were receiving chemotherapy, immunotherapy, radiation therapy or surgery for their disease. More than 90% of the cancers involved solid tumors. The Pfizer vaccine has been shown to work well in such cases. People with and without cancer reported similar rates of pain at the injection site, muscle pain, joint pain, fever, chills, headache, nausea, and fatigue, the research team reported in the Journal of the National Comprehensive Cancer Network. Overall, post-vaccination symptoms were reported by roughly 73% of patients regardless of whether they had cancer, with pain at the injection site being the most common adverse event.

Earlier studies have found vaccine hesitancy among cancer patients, the researchers noted. The harms of COVID-19 are "compounded for patients with cancer who have refused vaccination," they said. "Our data, in combination with those from other sources, show that the mRNA COVID-19 vaccine is well tolerated by patients with a history of cancer, including those receiving active treatment."

When Natalie Hollabaugh tested positive for Covid-19 in March 2020, her recovery felt extremely slow. Eighteen months later, she was still suffering from a litany of symptoms, including fatigue, shortness of breath, headaches and joint pain. She saw a cardiologist and a pulmonologist, who both ruled out other health problems, she said. And they advised her to start exercising, suggesting that some of her symptoms may have been a result of being out of shape. So Ms. Hollabaugh dutifully began using an exercise bike, speed walking on a treadmill and walking her dogs several miles a day.

But instead of helping, her new exercise regimen only exacerbated her symptoms. “I had never felt worse,” said Ms. Hollabaugh, 31, a lawyer who lives in Portland, Ore. She found she had to start taking daily naps, that her heart rate would skyrocket even when she was at rest and that she was so tired she couldn’t concentrate.

As one of the many Americans suffering from long Covid, a condition characterized by new or lingering symptoms that can be felt for months after a coronavirus infection, Ms. Hollabaugh is not alone in experiencing setbacks with exercise. Natalie Lambert, a biostatistician and health data scientist at the Indiana University School of Medicine, has collected self-reported data from more than a million long Covid patients through a collaboration with Survivor Corps, a Facebook support group for Covid survivors. Patients frequently report that their doctors have advised them to exercise, she said — but many say that when they do, they feel worse afterward.

“The research that I’ve done has shown that inability to exercise is one of the most common long-term symptoms,” Dr. Lambert said. Some people are simply too tired to exercise, she said, while others experience debilitating symptom relapses like increases in fatigue, brain fog or muscle pain. This worsening of symptoms after engaging in even just a little bit of physical activity — what is sometimes called “post-exertional malaise” — seems to be common among long Covid patients. When researchers performed an online survey of 3,762 people with long Covid, as part of a study published in August, they found that 89 percent reported post-exertional malaise.

These exercise-induced problems are not, however, merely the byproduct of becoming out of shape. The effects “are very, very different from normal and simple detraining,” said Dr. David Systrom, a pulmonary and critical care physician at Brigham and Women’s Hospital in Boston. They also don’t seem to be the result of lung or heart injury.

In one small study published in January, for example, Dr. Systrom and his colleagues compared 10 long Covid patients who had trouble exercising with 10 people who had never tested positive for Covid-19, but who had unexplained shortness of breath after exercise. The researchers found that nobody in the study had abnormal chest CT scans, anemia or problems with lung or heart function, suggesting that organ injury wasn’t to blame for their symptoms. Yet when the long Covid patients exercised on a stationary bicycle, Dr. Systrom found that some veins and arteries were not working properly, preventing oxygen from being delivered efficiently to their muscles.

Nobody knows why these blood vessel problems occur, Dr. Systrom said, but another one of his recent studies suggested that long Covid patients experience damage to a certain kind of nerve fiber involved in how organs and blood vessel function.

Other research on exercise intolerance implicates problems with how the heart rate responds to exercise.

Dr. Lambert pointed out that some patients with long Covid are also diagnosed with postural orthostatic tachycardia syndrome (or POTS), a disorder that affects blood flow. In people who have POTS, “the nervous system can’t regulate the things that it’s supposed to automatically control, like heart rate, blood pressure, sweating and body temperature,” she said. Yet “those are all things that when you’re exercising need to be regulated properly.”

n 2021, Dr. Systrom and his team studied 160 chronic fatigue syndrome patients, and found that when they exercised, they experienced many of the same blood vessel problems observed in long Covid patients, while control subjects did not. “We’re essentially finding the exact same thing” when it comes to potential mechanisms, he said.

This all leads to one question: Should Covid patients who are having trouble with exercise continue to ramp up their physical activity? Nobody knows — and opinions differ. “There are both patients and doctors who are vehemently against any exercise” because of these issues, Dr. Systrom said. But he also said that exercise can be possible, and even beneficial, after long Covid patients receive proper treatment.

She added that long Covid can manifest in different ways, so doctors and patients may need to tailor their recommendations to patients’ needs.

“That’s really the story of Covid — that for every patient, long Covid is different,” she said. “There’s probably never going to be a one-size-fits-all recommendation for exercise.”

Many symptoms of Post-COVID-19 syndrome could be caused by lasting damage sustained to one of the most important nerves in the human body during initial infection with coronavirus, new research has suggested.

The vagus nerve is the 10th cranial nerve and is the longest and most complex of all of them. It runs from the brain throughout the entirety of the face and chest, reaching the abdomen. The vagus nerve serves as the main connection between the brain and the gastrointestinal tract, sending back information about the state of the inner organs.

As well as being crucial to the gastrointestinal system as it controls the transfer of food from the mouth to the stomach and moves food through the intestines, the vagus nerve is also responsible for multiple other processes such as controlling the heart rate, sweat production and the gag reflex, as well as certain muscle movements in the mouth, including those necessary for speech.

New research set to be presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) investigates the connection between Post-COVID-19 syndrome, also known as long COVID, and the vagus nerve.

The pilot study was authored by Dr. Gemma Lladós and Dr. Lourdes Mateu of the Germans Trias i Pujol University Hospital Badalona, Spain, and its findings will be presented at the congress, taking place between April 23-26 in Lisbon, Portugal.

The study suggests that SARS-CoV-2-mediated vagus nerve dysfunction (VND) could be responsible for many of the symptoms of long COVID, including persistent voice problems, difficulty swallowing, dizziness, abnormally high heart rate (tachycardia), low blood pressure and digestive issues.

Out of the 348 patients taking part in the study, two-thirds (228) had at least one symptom of VND among their long COVID symptoms. After the initial assessments were completed, further evaluations were conducted on a test group of 22 patients, all presenting VND symptoms.

Of the 22 subjects analyzed, 20 were women with a median age of 44, and on average the symptoms had been present in the participants for 14 months.

The most frequent VND symptoms presented were diarrhea (73% of subjects), tachycardia (59%),and dizziness, difficulty swallowing, and voice problems (45% each). An additional 14% of patients suffered from low blood pressure.

All in all, 86% of the patients assessed had at least three different VND-related symptoms.

Furthermore, in six of the 22 patients, there were visible changes in the vagus nerve in the neck which could be seen in ultrasounds, including thickening and the indication of mild inflammatory reactive changes.

10 of the patients in the study showed abnormal breathing patterns and reduced maximum inspiration pressures, indicating weakness in the breathing muscles, which are also connected with the vagus nerve.

Multiple patients also showed changes in digestive function, with 13 of 18 assessed (72%) also having a positive screening for oropharyngeal dysphagia, or trouble swallowing, which can affect the digestive process. Eight patients showed signs of reduced or impaired ability to deliver food to the stomach via the esophagus, with others suffering from acid reflux.

“Our findings so far thus point at vagus nerve dysfunction as a central pathophysiological feature of long COVID.”