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Outcomes of COVID-19 in Inflammatory Rheumatic Diseases: A Retrospective Cohort Study – Cureus

Posted: June 26, 2022 at 10:18 pm

Background

Similar to coronavirus disease 2019 (COVID-19), the pathogenesis of inflammatory rheumatic diseases includes cytokines dysregulation and increased expression of pro-inflammatory cytokines. Although current data from international studies suggest that rheumatic diseases are associated with a higher risk of COVID-19 infection and worse outcomes, there is limited literature in Saudi Arabia. This study aims to evaluate the outcomes and length of hospital stay of COVID-19 patients with inflammatory rheumatic diseases in Saudi Arabia.

This was a single-center retrospective cohort study that included 122 patients with inflammatory rheumatic diseases and documented coronavirus disease 2019 (COVID-19) infection from 2019 to 2021. Patients with suspected COVID-19 infection, non-inflammatory diseases, such as osteoarthritis, or inflammatory diseases but without or with weak systemic involvement, such as gout, were excluded.

The vast majority (81.1%) of the patients were females. Rheumatoid arthritis was the most common primary rheumatological diagnosis. The admission rate was 34.5% with an overall mortality rate of 11.5%. Number of episodes of COVID-19 infection, mechanical ventilation, cytokine storm syndrome, secondary bacterial infection, number of comorbidities, rituximab, diabetes mellitus, hypertension, chronic kidney disease, and heart failure were significantly associated with a longer hospital stay. Additionally, hypertension, heart failure, rituximab, mechanical ventilation, cytokine storm syndrome, and secondary bacterial infection were significantly associated with higher mortality. Predictors of longer hospitalization were obesity, numberof episodes of COVID-19 infection, mechanical ventilation, number of comorbidities, and chronic kidney disease, whereas, hypertension was the only predictor of mortality.

Obesity, number of episodes of COVID-19 infection, mechanical ventilation, number of comorbidities, and chronic kidney disease were significantly associated with higher odds of longer hospitalization, whereas, hypertension was significantly associated with higher odds of mortality. We recommend that these patients should be prioritized for the COVID-19 vaccine booster doses, and rituximab should be avoided unless its benefit clearly outweighs its risk.

Since the outbreak of coronavirus disease 2019 (COVID-19), in Wuhan, China, many studies have been conducted to investigate the effect of COVID-19 on the course of multiple diseases. Although it is primarily a respiratory disease that manifests as pneumonia, it could potentially affect other organs and systems including the heart, kidney, gastrointestinal tract, nervous and immune systems, and blood [1].

COVID-19 usually manifests as mild-to-moderate self-limiting respiratory symptoms, such as fever, cough, shortness of breath, and loss of taste and smell. On the other hand, in a severe form of the disease, some patients may require hospitalization and intubation with mechanical ventilation [2,3]. Several factors have been associated with poor outcomes in COVID-19, including old age and preexisting comorbidities, such as diabetes mellitus (DM), hypertension (HTN), and chronic pulmonary diseases [4,5]. Current data suggest that rheumatic diseases impose an additional risk of COVID-19 infection and are associated with poorer outcomes. This risk varies based on the underlying rheumatic disease, comorbidities, and treatments [6].

Autoimmune connective tissue diseases are chronic diseases with female predominance. The most common connective tissue diseases aresystemic lupus erythematosus (SLE), scleroderma, myositis, rheumatoid arthritis (RA), and Sjogrens syndrome [7,8]. The pathogenesis of these conditions is highly complicated, and it includes excessive production of pro-inflammatory cytokines, and therefore, high disease activity could result in flares with severe systemic symptoms and increased inflammatory markers. Similarly, COVID-19 has been associated with cytokine dysregulation and increased expression of pro-inflammatory cytokines, which can cause cytokine storm syndrome (CSS) [9,10]. Furthermore,patients who are already on immunosuppressants are more vulnerable to infection [11,12].

Due to the variability of the results among different studies concerning the outcomes of rheumatic patients with COVID-19, and due to limited literature in Saudi Arabia, we aimed to study the impact of autoimmune connective tissue diseases and immunosuppressants on COVID-19 severity, hospitalization, intensive care unit admission rates, and mortality in Saudi Arabia.

We sought to evaluate the outcomes (as mortality/survival) and length of hospital stay (if hospitalization was needed) of polymerase chain reaction (PCR)-positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with known inflammatory rheumatic diseases.

This was a single-center retrospective cohort study that took place in King Abdulaziz Medical City (KAMC), Ministry of National Guard-Health Affairs (MNG-HA), Riyadh, Kingdom of Saudi Arabia.KAMC is an academic government-funded tertiary hospital that combines clinical care, training, academics with research, and state-of-the-art medical technologies.

All adult patients with systemic inflammatory rheumatic diseases and PCR-proven COVID-19 infection, from 2019 to 2021 were included. Initially, 192 patients were identified, but after applying the inclusion and exclusion criteria, only 122 were eligible. Patients with suspected COVID-19 infection, non-inflammatory diseases, such as osteoarthritis and fibromyalgia, or inflammatory diseases but without or with weak systemic involvement, such as gout, were excluded.

The required data were obtained by screening electronic medical records(via the KAMC electronic system - BestCare; Seoul, South Korea: ezCaretech Co.) of allrheumatology patients who were seen in the clinic or admitted to the hospitalfrom 2019 to 2021. The following data were collected: demographics, comorbidities (such as diabetes mellitus, hypertension, and chronic kidney disease), primary rheumatological diagnosis, symptoms of COVID-19, number of episodes of COVID-19 infection (patients with more than one COVID-19 infection after recovery of the first COVID-19), steroid dose, immunosuppressants, length of admission (in weeks), length of ICU admission, mechanical ventilation, cytokine storm syndrome, secondary bacterial infection, and outcomes (as mortality or survival). To know the number of episodes of COVID-19 infection, reinfection was defined as having a positive PCR test for SARS-CoV-2 after having two negative PCR tests in a previously infected patient. Cytokine storm syndrome was defined as a serum ferritin level of at least 10g/L, and secondary bacterial infection was defined as having a positive, respiratory or blood, bacterial culture after COVID-19 diagnosis.

Statistical Package for the Social Sciences (SPSS) version 22 (Armonk, NY: IBM Corp.) was used for data analysis. Categorical variables were presented as frequencies and percentages, whereas, numerical variables were presented as meanstandard deviation. Due to the small sample size, Fisher's exact test was used instead of chi-square to test the association between categorical variables, and independent sample t-test was used to test the association between numerical variables. Multivariate logistic regression analysis was done to assess the predictors of COVID-19 infection mortality and hospitalization by calculating the adjusted odds ratios, and odds ratios were reported with 95% confidence interval. A test was considered significant if two-sided p-value was <0.05.

The study was approved by the Institutional Review Board of King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia (#RC20/665/R). Informed consent was waived because of the retrospective nature of this study. Access to the data was restricted to the researchers. The confidentiality of all patients was protected, and no names or medical record numbers were used. Privacy and confidentiality were assured and all the data, both hard and soft copies, were kept in a secure place within the National Guard-Health Affairs premises.

The demographics of the patients are shown in Table 1.There were a total of 192 rheumatology patients with COVID-19, only 122 of whom were eligible for inclusion. The vast majority (n=99, 81.1%) of the patients were females with a mean age of 48.316 years and an average BMI of 30.86.4 kg/m2. RA, SLE, psoriasis, and antineutrophil cytoplasmic antibodies (ANCA)-positive vasculitis were the most common primary rheumatological diagnoses, accounting for 41.8%, 24.6%, 8.2%, and 5.7% cases, respectively (Figure 1).The most notable associated comorbidities were HTN, DM, hypothyroidism, chronic kidney disease (CKD), heart failure (HF), and bronchial asthma, accounting for 32.0%, 27.9%, 11.5%, 10.7%, 6.6%, and 5.7% cases, respectively (Figure 2).

Lower respiratory tract symptoms, such as cough and shortness of breath, were the most prominent COVID-19 symptoms with a percentage of 48.4%. Other common COVID-19 presenting symptoms were upper respiratory tract (45.1%) and gastrointestinal symptoms (10.7%). Only five (4.1%) patients had a history of two COVID-19 infections. The majority (65.6%) of the patients did not require hospitalization. However, 16.4% required admission for 7 days, 11.5% for eight to 30 days, and 6.6% for >30 days.

The overall mortality rate was 11.5%. A small fraction of the patients (n=17) required ICU admission. Of those, 14 required intubation with mechanical ventilation with a mortality rate of 85.7%. Secondary bacterial infection was only identified in eight (6.6%) patients, four of whom have died. None of the patients who developed CSS (n=4) have survived.

On Fisher's exact test, having more than one COVID-19 infection, intubation with mechanical ventilation, CSS, secondary bacterial infection, and having more than one comorbidity were significantly associated with longer hospital stay (p=0.006, <0.001, 0.006, 0.01, and <0.001, respectively) (Table 2).Moreover, patients with DM, HTN, CKD, and HF were significantly more likely to have longer hospital stay (p=0.001, 0.003, 0.003, and 0.011, respectively). However, only HTN and HF were significantly associated with higher mortality (p=0.002 and 0.006, respectively) (Table 3).

As a part of their treatment regimen for an underlying rheumatological disease, 60.7% of the patients were on prednisone, 46.7% were on hydroxychloroquine, 28.7% were on methotrexate, 9.8% were on anti-TNF (infliximab or etanercept), 9.0% were on mycophenolate and azathioprine, and 4.9% were on rituximab and tocilizumab. Of the aforementioned immunosuppressants, only rituximab was significantly associated with longer hospitalization and mortality (p=0.046, 0.001). No significance was found between steroid dose and hospital length of stay (p=0.605) or mortality (p=0.821) (Tables 2, 3).

Females had more favorable survival compared to males (p=0.025). Intubation with mechanical ventilation, CSS, secondary bacterial infection, and hospital length stay were associated with higher mortality rates (p0.001, <0.001, 0.006, and 0.001, respectively). Having a higher number of comorbidities was not associated with higher mortality (p=0.11) (Table 3).

In multivariate regression model, obesity (odds ratio {OR}=60.669, 95% confidence interval {CI} 3.53-1042.413, p=0.005), number of COVID-19 infection (OR=59.08, 95% CI 2.532-1378.362, p=0.011), intubation with mechanical ventilation (OR=23.238, 95% CI 3.15-171.434, p=0.002), number of comorbidities (OR=7.11, 95% CI 1.911-26.454, p=0.003), CKD (OR=6.178, 95% CI 1.706-22.38, p=0.006), and HTN (OR=5.291,95% CI 1.266-22.112, p=0.022) were significantly associated with higher odds of hospitalization (Table 4).The only comorbidity that was significantly associated with higher odds of mortality was HTN (OR=5.291, 95% CI 1.266-22.112, p=0.022) (Table 5).

Autoimmune connective tissue diseases are chronic inflammatory diseases with highly complicated pathogenesis that includes excessive production of pro-inflammatory cytokines. Similarly, COVID-19 has been associated with cytokine dysregulation and increased expression of proinflammatory cytokines [9-11]. Patients who are already on immunosuppressive medications are logically more vulnerable to infections [11,12]. Current data suggest that rheumatic diseases are associated with an additional risk of COVID-19 infection and poorer outcomes [6]. In this study, we explored the impact of autoimmune connective tissue diseases and immunosuppressive medications on COVID-19 severity, hospitalization, intensive care unit admission, and mortality rates in Saudi Arabia.

Our patients had a mean age of 48.316 years with females being predominant (81.1%). This is attributed to the fact that inflammatory autoimmune diseases generally have female predilection [7,8]. This is in accordance with other studies, as DSilva et al. who studied the outcomes of 52 COVID-19-infected patients with rheumatic diseases, also reported female predominance. Compared to previously published studies, our patients had a relatively younger mean age [13,14]. Overall hospital mortality of COVID-19 is generally between 15% and 20% and can reach up to 60% in older patients. However, it highly varies across cohorts, reflecting differences in the completeness of testing and case identification, variable thresholds for hospitalization, and differences in outcomes [15-17]. Hospital mortality ranges from less than 5% in patients younger than 40 years to 35% in 70-79 years and greater than 60% in 80-89 years [18]. In our study, the mortality rate was 11.5%, and the mean age was 48.3 which is in compliance with some of the studies. To clarify, Montero et al. reported a mortality rate of 16% [12]. The two percentages are close, and probably our study would have a higher mortality rate if it was delayed further. In contrast, Sharmeen et al. mentioned a mortality rate of 5.9% [19]. Although both Montero and Sharmeen studies have published their works in August 2020, the mortality rates are utterly different. It is hard to judge whether, for example, patients with low mortality rates have been vaccinated and therefore had a milder form of the disease or specific immunosuppressive regimen could have protected those patients. Another factor that could potentially contribute to the differences in mortality rate is the mean age. In our study, the mean age was 48.3 years, whereas, in Montero and Sharmeen they were 60.9 and 57 years, respectively [12,19]. This could not explain the low mortality rate reported in Sharmeen's study.It is also important to mention that our mortality rate might not reflect the actual percentage due to the small sample size and the following limitations: 1) we do not have a unified database for all patients throughout Saudi Arabia and so we could not include patients from other hospitals. 2) Many patients were non-eligible for follow-up in our institution (MNG-HA, KAMC), and so, they might have died outside our institution. 4) Many patients might have died after we collected the data. 3) Many patients, even if eligible, lives outside Riyadh and so cannot be followed up. In our country,Saudi Arabia, at least 56,707,289 doses of COVID vaccines have been administered so far though the mortality rate in our study is still high [20].

The need for admission of COVID-19 patients in the general population depends mainly on their age and preexisting comorbidities, such as chronic respiratory diseases and DM [21,22]. The likelihood of hospitalization increases with age up to a maximum of 18.4% in patients 80 years old [23].In our study, the admission rate was 35%, which is much higher than the global admission rate of the general population. This high percentage could partially be explained by the fact that we included all rheumatology patients with documented COVID-19 from 2019 to 2021. At the beginning of the pandemic, with the lack of clear guidelines, institutions tended to admit COVID-19 positive patients till their swaps came negative. This is a possible explanation for the high admission rate seen in our study. Previously published studies are in agreement with our high admission rate. To emphasize, Gianfrancesco et al. reported an admission rate of 46% [15]. Similarly, Montero et al. also mentioned a high admission rate that is 68% [12]. In addition to what we mentioned above, another explanation could be disease-specific factors as patients with inflammatory diseases might need more medical attention. This is not only limited to rheumatology patients, it is also seen with other autoimmune diseases. To clarify, Sahraianet al. reported a hospitalization rate of 25% in multiple sclerosis patients infected with COVID-19, which is also much higher than the admission rate of the general population in the age group associated with multiple sclerosis patients [24].

In our study, number of COVID infections, CSS, secondary bacterial infection, number of comorbidities, DM, HTN, CKD, and HF were significantly associated with a longer hospital stay. A lot of these factors are in agreement with other studies. For example, DSilva et al. reported several factors that have been significantly associated with longer hospital stay including older age, number of comorbidities, and DM [14]. Moreover, Stradner et al. also reported the same thing. They found that old age and comorbidities, such as HTN, DM, cardiovascular and pulmonary diseases, and end-stage kidney disease were significantly associated with longer hospitalization [25].

Some reports found that rituximab use is not associated with worse outcomes or course of disease in patients with COVID-19. In our study, the only medication that was significantly associated with longer hospitalization and higher mortality was rituximab. Similarly, Tepasse et al., Stradner et al., and Alpizar-Rodriguez et al., in their studies, concluded that rituximab is associated with a higher risk of severe disease and/or mortality in patients with COVID-19 infection [25-27]. Ideally, immunoglobulin levels should be obtained in all patients prior to rituximab prescription. Unfortunately, to the best of our knowledge, our institution does not mandate immunoglobulin levels prior to rituximab prescription, which could explain the high mortality rate and hospitalization in our study. Though it is crucial to keep in mind that our findings are consistent with the literature [25-27]. Possibly due to the small sample size, we have not found any significance with steroid use nor with other immunosuppressants. However, in Gianfrancesco's study, prednisone 10 mg/day was associated with a higher hospitalization rate. Conversely, it has been found that TNF- inhibitoruse was associated with less hospitalization rate [15].

The susceptibility to and severity of COVID-19 is highly influenced by patients comorbidities, such as hypertension, and dysregulated innate immune response as in patients with inflammatory autoimmune diseases [9,11,12,28,29]. This might be due to enhanced expression of angiotensin-converting enzyme 2 (ACE2) receptors on the surface of several organs and epithelial cells. COVID-19 infects epithelial cells through binding with ACE2 and initiates inflammation, endothelial activation, tissue damage, and disordered cytokine release [29,30]. Although, in our study, all the included patients were known to have inflammatory rheumatologic diseases, according to literature, those patients are more likely to be infected with and to develop severe COVID-19. To emphasize, DSilva et al. reported that in COVID-19 patients, the need for intubation with mechanical ventilation was more common in patients with known rheumatologic diseases compared to the general population. Patients with autoimmune inflammatory diseases already have high cytokines and immune dysregulation [14]. The high levels of cytokines intensify the destructive progression that leads to additional epithelial cells dysfunction and inflammation [29,31,32]. Altogether, these disorders ultimately lead to multi-organ failure and death. Comorbidities and suppressed immunity have been found as primary reasons for the exacerbated rate of infection and mortality of COVID-19 [29,30,33]. This is another explanation for the high mortality rate as a lot of those patients are chronically on immunosuppressants. In COVID-19 patients, cellular immunity fails to provide adequate protection due to the viruss ability to escape the innate immunity and induce a functional decline in T-cell counts [29]. The literature identifies TNF- and IL-6 receptor inhibitors to be effective in treating COVID-19 among patients with rheumatic diseases as during recovery of COVID-19, decreased levels of IL-6 and TNF- increase the total T-cell counts [34,35]. In our study, we have not found any protective role for TNF- and IL-6 receptor inhibitors, probably due to the small sample size.

The studied population should be prioritized for the booster dose of COVID-19 vaccine. Those patients are particularly at increased risk of severe infection, and so they should have more precautions. Rituximab should be avoided unless it is the only option with the benefit clearly outweighing the risk. Prompt seeking medical attention is also recommended to prevent morbidity and mortality.

This study is mainly affected by its single-centered retrospective design and the small sample size. The small sample size limited our statistical analysis as we could not perform Kaplan-Meier survival curve. The results could have been affected by the fact that vaccination-related data were not available and so the effect of vaccination on patients outcomes was neglected in the study. We plan to do a follow-up study to assess the effect of vaccination on the outcomes of inflammatory rheumatic diseases.

Over a third (34.5%) of the patients required hospital admission. Predictors of longer hospitalization were obesity, number of COVID-19 infections, mechanical ventilation, number of comorbidities, HTN, and CKD, whereas, HTN was the only predictor for mortality. Furthermore, rituximab was significantly associated with longer hospitalization and higher mortality. Based on what we found, we recommend that patients with inflammatory rheumatic diseases should be prioritized for the COVID-19 vaccine booster dose, and rituximab should be avoided unless its benefit clearly outweighs its risk.

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Pfizer says tweaked COVID-19 shots boost omicron protection – Boston Herald

Posted: at 10:18 pm

Pfizer announced that tweaking its COVID-19 vaccine to better target the omicron variant is safe and works just days before regulators debate whether to offer Americans updated booster shots this fall.

The vaccines currently used in the U.S. still offer strong protection against severe COVID-19 disease and death especially if people have gotten a booster dose. But those vaccines target the original coronavirus strain and their effectiveness against any infection dropped markedly when the super-contagious omicron mutant emerged.

Now with omicrons even more transmissible relatives spreading widely, the Food and Drug Administration is considering ordering a recipe change for the vaccines made by both Pfizer and rival Moderna in hopes that modified boosters could better protect against another COVID-19 surge expected this fall and winter.

Pfizer and its partner BioNTech studied two different ways of updating their shots targeting just omicron, or a combination booster that adds omicron protection to the original vaccine. They also tested whether to keep todays standard dosage 30 micrograms or to double the shots strength.

In a study of more than 1,200 middle-aged and older adults whod already had three vaccine doses, Pfizer said over the weekend that both booster approaches spurred a substantial jump in omicron-fighting antibodies.

Based on these data, we believe we have two very strong omicron-adapted candidates, Pfizer CEO Albert Bourla said in a statement.

Pfizers omicron-only booster sparked the strongest immune response against that variant.

But many experts say combination shots may be the best approach because they would retain the proven benefits of the original COVID-19 vaccine while adding new protection against omicron.

And Pfizer said a month after people received its combo shot, they had a 9- to 11-fold increase in omicron-fighting antibodies. Thats more than 1.5 times better than another dose of the original vaccine.

And importantly, preliminary lab studies show the tweaked shots also produce antibodies capable of fighting omicrons genetically distinct relatives named BA.4 and BA.5, although those levels werent nearly as high.

Moderna recently announced similar results from tests of its combination shot, what scientists call a bivalent vaccine.

The studies werent designed to track how well updated boosters prevented COVID-19 cases. Nor is it clear how long any added protection would last.

But the FDAs scientific advisers will publicly debate the data on Tuesday, as they grapple with whether to recommend a change to the vaccines recipes ahead of similar decisions by other countries.

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Study: Many adolescents reported worsened or new-onset headaches during the COVID-19 pandemic – News-Medical.Net

Posted: at 10:18 pm

Over one-third of schoolchildren who received online lessons during the COVID-19 pandemic reported a worsening of headache symptoms or new-onset headaches, a study presented today at the European Academy of Neurology (EAN) Congress 2022 has found.

Prolonged exposure time to computer screens, a lack of suitable conditions for online learning from home, school exams and anxieties about COVID-19 were all found to be risk factors for the worsening of headache symptoms or triggering new-onset headaches.

The multicenter study analyzed 851 adolescents aged between 10 and 18, with 756 (89%) of children reporting headaches over the study period. Among these children, 10% reported new-onset headaches over the pandemic home-schooling period. Over a quarter (27%) of children said their headaches had worsened, 61% said their headaches had remained stable and 3% said their headaches had improved.

Those who reported worsened or new-onset headaches suffered from headaches an average of 8-9 times per month. Over half of children within this group (43%) used painkillers at least once a month compared to a third (33%) in the stable group.

Lead researcher Dr Aye Nur zdag Acarli from Ermenek State Hospital, Karaman, Turkey, said that in contrast to previous reports, the team's analysis didn't support a tendency towards reduction in headache and severity during the pandemic.

Although earlier studies reported that young people were having fewer headaches due to the closure of schools in the early weeks and months of COVID-19, this longer-term study has found the stresses and pressures of the pandemic eventually took their toll."

Dr Aye Nur zdag Acarli from Ermenek State Hospital, Karaman, Turkey

The study found that headaches had a big impact on mental health and school achievements. Depression and anxiety scores, including anxiety about catching COVID-19, were significantly higher in the worsened and new-onset headache groups. These respondents also acknowledged that they had made less effort with their schoolwork and their academic achievements had fallen.

Exams, living in a city, weight gain and depression were also linked to more frequent headache occurrences within the study.

Dr Acarli commented, "Young people had concerns about the quality and sufficiency of online education and 62% of respondents said they were dissatisfied with it, while 21% were indecisive. Headache severity and frequency showed significant correlation with age, depression, and anxiety."

Headache is the most common neurological issue in children and adolescents. A complex mix of factors can contribute to headaches, including sleep, use of electronic devices and socioeconomic factors.

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Devi Sridhar’s ‘Preventable’ Review: The Countries That Handled COVID-19 Best – Foreign Policy

Posted: at 10:18 pm

During a recent trip to London, I saw almost no one wearing a maskexcept for American tourists, who were easily identifiable because they wore them even when they were outside. Restaurants have recovered and are packed; reservations are down only 13 percent from before the pandemic, compared with 40 percent in New York. For me, a visiting American comparing London to his homeland, the impression is that the cityand the countryhas moved on from COVID-19.

But England has not moved on from its failed initial response to COVID-19 and the decisions surrounding it, which remain controversial. Starting in February 2020, the country pursued a libertarian strategy of trying to reach herd immunity, before lurching to a severe lockdown in late March. England cycled through lockdowns of varying severity over roughly the next year. People were ordered to stay at home, and nonessential businesses were closed; at times, it was an offense to leave your home without a reasonable excuse. The National Health Service (NHS) attempted an effort at test and trace from May 2020 to January 2021, but this proved to be completely useless.

I happened to be marooned in London throughout most of 2020, having arrived only days before the initial lockdown was imposed on March 23. I remember how empty Londons streets were during that period, except for the speeding ambulances. While I never caught COVID-19, my doctor didperhaps because of the NHSs lack of personal protective equipment and overall lack of preparedness for a pandemic. Prime Minister Boris Johnson nearly died from the virus. And it was recently revealed, in a scandal known as Partygate, that during lockdown, when group gatherings were forbidden, Johnson hosted parties in the prime ministers residence at No. 10 Downing St. Wine was wheeled in from a nearby shop in a suitcase. Johnson survived a recent no-confidence vote by his own Conservative Party but so narrowly that his premiership remains threatened.

The debate in England about these COVID-19 policies is immensely sensitivegiven the staggering number of deathsand highly politicized, with the Labour press arguing the government did not do enough during COVID-19 and some of the Tory press arguing the government did too much by enacting lockdowns.

Devi Sridhars Preventable: How a Pandemic Changed the World & How to Stop the Next One is a notable contribution to the still-raging debate. Sridhar, a professor of global public health at the University of Edinburgh, is broadly associated with the Labour-aligned stancethat is, the need to suppress the virus even if this was achieved through the curtailment of individual liberties such as freedom of movement. She has advised Scottish First Minister Nicola Sturgeon, as well as the World Health Organization, on COVID-19 and is a divisive figure in the U.K. because of these associations and her support for strict border closures.

Preventable itself is a wide-ranging book. It is in part a work of advocacy for a more muscular response by governments to pandemics and a work of analysis, comparing different countries methods of trying to control the spread of COVID-19.

Because these different responses come not only from state capacity but also ideology, reaction to Sridhars book has been accordingly split. The U.K. progressive, anti-populist press is mostly supportive. The Guardian, where she is a contributor, was glowing. The Financial Times, which seems to advocate trusting the expertsparticularly one as establishment as Sridhar (she co-wrote a book with Chelsea Clinton)as an almost moral duty, was even more positive, getting straight to the political point in its review: Preventable argues that the poor leadership skills of populist leaders (such as Johnson, Donald Trump and Brasils Jair Bolsonaro) condemned some of the countries best equipped to fight the pandemic to failure in 2020.

The story in the Tory press, which tends to be skeptical of COVID-19 lockdown measuresand Sturgeonwas very different. The Spectator, in an article titled Please dont do a hit job: An interview with Devi Sridhar, proceeded to do exactly that and was personal in its conclusion: Now virtually the whole worldwith the exception of hermit kingdom Chinais living with Covid, being a former pin-up for Zero Covid is no longer quite such good box office. A pre-publication article in the Spectator was even nastier, listing the book in a guide to all the titles which wont be flying off the bookshelves in the forthcoming months. (It actually was a bestseller.) The article concluded: With such an avalanche of epidemiological musing remember the words of Christopher Hitchens: Everyone has a book in them and that, in most cases, is where it should stay.

The truth however is that Sridhars book is highly nuanced and the author too intellectually heterodox and empirically oriented to be constrained by a single ideological perspective. There is no doubt she felt countries should have developed a COVID-19 control strategy. But unlike lockdown true believers, Sridhar is very candid that containment policies such as school closures involve trade-offs and can cause harm. As she writes, School closures have far reaching and detrimental effects. Many children, especially in poorer countries, will never return to formal schooling again.

It is tempting to now relitigate COVID-19 policy decisions made then by citing recent academic research questioning the efficacy of lockdowns. Both pro- and anti-lockdown camps have become amateur epidemiologists. Though they argue endlessly about science, neither side acknowledges the glaring political contradictions in each of their approaches: Zero-COVID adherents tend to be globalists who dream of a borderless world (for people, goods, services, and finance)except when it comes to COVID-19, where free movement and activity must be tightly prescribed. Anti-lockdown populists pretty much feel the opposite in every respect.

One could read and critique Sridhars initial policy advicefavoring a more aggressive response to the pandemic, including tight border controls, social distancing, and the banning of nonessential travelwith the benefit of hindsight, but this would not be a very fruitful approach or a good use of the readers time. For one, Sridhar changes her thinking in response to changing evidence. As an example, she updated her analysis of the cost and benefits of school closures as more data came in showing the developmental harm closures caused to children and the limited risk of COVID-19 transmissions from schools.

More broadly, it is a fact that countries differed in the efficacy of their initial policy response to COVID-19 even if these policies didnt always work in the long term. Some, like Taiwan, were able to contain the virus and had low early death rates. Others, such as the United States, which devotes more resources to health care than any other country in the world, could not mount an effective response at all.

Indeed, the core of Preventable, and what I believe will be its lasting contribution, is how and why countries responded to COVID-19 differently. Rich countries did not necessarily handle the pandemic better than poor ones, showing that something else is at work besides money. The specifics are complex, which is why the book exceeds 400 pages.

Sridhars framework is essentially political. [W]ith the right politics and leadership, much of the suffering and death [from COVID-19] was largely preventable, she writes. It is worth looking more closely at the initial policy successes of some countries and failures of others, as detailed in Preventable.

South Korea. South Koreas response to COVID-19 was informed by its recent experiences with another virus: MERS (Middle East respiratory syndrome) in 2015. That experience did not go well: South Korea had the largest outbreak outside of the Middle East. As a result of MERS, South Korea put policies and planning in place for pandemics that proved critical when COVID-19 hit.

South Koreas plans did not rely on a national lockdown, and schools were largely kept open, though social distancing was deployed. Instead, Sridhar writes, the core of the South Korean response has been the test/trace/isolate system and by March 2020 it had the highest per capita test rate in the world with results back within twenty-four hours. In comparison, she notes, during this period the U.K. was only offering testing in hospitals.

If someone tested positive, South Korean public health teams traced that persons activity over the previous week using phone and credit card data and closed-circuit TV. They were then asked to isolate at home or in specialized isolation centers, where their symptoms were continuously monitored to see if they required hospitalization. South Korea, according to Sridhar, attributed its low death rate to this monitoring system. The low oxygen levels stemming from COVID-19 may not be detectable by patients themselves, and so often in the United States patients showed up at hospitals when they were already gravely ill.

Sridhar terms the South Korean model, which is based on testing rather than lockdowns, reasonably effective. But, as she points out, it also involved something else: trust in the government and that it wouldnt misuse the personal data it had gathered.

Senegal. Senegal is another one of the books case studies of success and one barely known in the global north. As of March 2021, it ranked second, right after New Zealand, in FP Analytics COVID-19 Global Response Index.

President [Macky] Sall knew to go early, go hard and keep it simple, Sridhar writes. Once COVID-19 was confirmed in the county, Sall closed schools and air travel and shut down large gatherings. This applied to mosques, with many choosing to worship from home.

Sridhar praises the countrys messaging efforts, including the use of religious leaders and musicians who released a single about beating the virus, Daan Corona. Senegals success also built on a more traditional disease management and surveillance infrastructure developed for infectious diseases such as Ebola.

As Sridhar writes, What Senegals story shows is that even in the context of limited resources and scientific uncertainty, certain countries reacted quickly and effectively to prevent a crisis. Senegals success rested on leadership, messaging, testing, but also financial support for those who were impacted by COVID-19 restrictions and had no way to earn a living, allowing them to isolate.Italy. Two regions in Italy, Lombardy and Veneto, make for a clear case study within the same country of differing COVID-19 policy responses and their impact. Veneto took a strict containment approach accompanied by mass testing. Lombardys focus was on treating cases once they occurred rather than trying to prevent them. The results of these different strategies: Lombardys case fatality rate was three times that of Veneto, as of April 2020.

In Sridhars telling, these outcomes were not surprising, and what happened next in Lombardy was almost inevitable: As the pandemic worsened and Lombardy became a death zone, it implemented almost medieval extreme lockdown measures. There was almost no exit from or entry into afflicted areas. She was not surprised by this turn of events: Around the world, before vaccines became widely available, mitigation strategies [allowing the virus to spread] have always resulted in lockdown measures.

New Zealand. New Zealand was distinctive in the Anglophone world for successfully pursuing a COVID-19 elimination strategyof trying to eliminate the virus altogether rather than just flattening the curve through containment. (Australia attempted this, too.) To accomplish this, New Zealand closed its borders to everyone but citizens and long-term residents, who themselves were forced to quarantine in hotels if they chose to enter the country. In March 2020, the country entered a state of emergency with a stay-at-home lockdown.

The elimination strategy was successful: The country went 102 days without cases. But Sridhar also points out that it was not without its challenges, which she itemizes: Not everyone cooperated with lockdown and test and trace; lockdown took a psychological toll; and the closed border ruined tourism and separated families. Despite these misgivings, Sridhar titles her section on the country, The Paradise of New Zealand.

Sweden. Sridhar contrasts New Zealands approach with that of Sweden, which is typically held up as the poster child for the success of a laissez-faire or anti-lockdown approach. Underlying its hands-off approach to COVID-19 was the public health authorities belief that the only sustainable way to deal with this kind of respiratory pathogen would be to let it flow through the population and avoid the economic and social costs of lockdown.

Hence, Sweden did not pursue lockdowns or test and trace for that matter. Schools and restaurants stayed open and so did the border. These policies were in stark contrast to the containment measures deployed by other Scandinavian countries.

Did the Swedish lax approach work? Sridhar writes: The debate is polarized. In her analysis, Swedens gamble did not pay off. Swedes paid a heavy price in that lives were lost unnecessarily. And, as the year progressed, Sweden went the same way as its Scandinavian neighborsinto suppression, she writes.

Among the analyses in Preventable of COVID-19 responses across countries and regions, one consistent finding is that poorer countries that took the approach of aggressively trying to contain the pandemicsuch as Greece or the Czech Republicfared better than richer countries, such as France, that were more hands-off, at least initially.

It is true that many of the countries that handled the first wave well, such as South Korea, New Zealand, and Senegal, struggled as time went on. But their strategies bought time until vaccines were available. And their economies were not as devastated as those of countries with laxer policies, according to Sridhar: [T]hose countries that responded effectively and controlled the virus, like Taiwan, South Korea, Denmark and Norway, had faster economic recovery compared with countries like Britain, Spain and Sweden.

But there is a puzzle in these overall patterns of response. It is clear from Sridhars telling that countries that undertook a coordinated national response involving test and trace and isolation handled the initial outbreak much better than the disorganized response of the United States and the U.K. Yet it is the latter two countries that were first able to develop effective vaccines.

Is this just a coincidence?

There is a reason to think not. The answer to this puzzle is found outside of Preventable, or even epidemiology writ large, and instead is provided by a niche area of political science studying economic development and varieties of capitalism.

Chalmers Johnson in his book MITI and the Japanese Miracle describes two economic systems, plan-rational vs. market-rational economies, a distinction common in the literature on the varieties of capitalism. Plan-rational economies are characterized by their governments focus on planning, with economic growth the overarching goal. (The Soviet Union was plan ideological, according to Johnson, so not part of this grouping.) In plan-rational economies, the state has a developmental orientation, and there is a great deal of state intrusion into the economy. Market-rational economies, in contrast, are centered on market efficiency, with the government playing primarily a regulatory rather than a planning role.

For Johnson, Japan was the exemplifier of the plan-rational system, with the United States the standard-bearer of the market-rational system. There are strengths and weaknesses in each system.

When there is a crisis where there is no consensus about what the long-term goal should be, and therefore how to plan for it, the plan-rational system stumbles. The market-rational system is better at coming up with new answers. Johnson writes that the great strength of the market-rational system lies in its effectiveness with dealing with critical problems. [Its approach] helps to promote action when problems of an unfamiliar or unknown magnitude arise.

Johnson doesnt discuss pandemics, but his dual-system typology, which is found elsewhere in political science, applies in this case. Plan-rational economies were distinguished by their planning and state effectiveness at controlling the pandemicbut only initially. In contrast, the more flexible market-rational U.S. and U.K. systems came through when it came to developing vaccines.

This typology of plan rational vs. market rational doesnt map precisely to countries responses to the pandemic, but it roughly does, with COVID-19 control standouts of Taiwan and South Korea falling into the camp of plan rational.

The typology can be seen again in countries behavior once vaccines were developed. The United States and U.K. reverted to typeor rather, continued as typewith no planning for the next crisis. There were to be no more Operation Warp Speeds in the United States. In alignment with market efficiency, the U.K. made aggressive moves to rapidly sell off its vaccine manufacturing and innovation center, which had proved so useful in vaccine development. (Kate Bingham, who led the U.K. vaccine task force, denounced the governments overall approach.)

And China, too, continues on its pre-chosen path. Even though vaccines are now readily available, it insists on pursuing a zero-COVID strategy, an authoritarian policy imposed at great cost.

The question is whether the United States can broaden its market-efficient economic approach, which has many strengths, to include planning capabilities, too. As Preventable demonstrates, planning was critical for early pandemic control, though in the long run it was not sufficient. Both approaches are needed. If the United States had added a bit more planning to the mix, many lives could have been saved during the initial outbreak.

The risks facing the United States going forward go well beyond just pandemics. Coronaviruses arent the only threat emanating from China. China poses unprecedented economic and military challenges to the United States. It is moving to a new economic model, one that combines state planning with market forces. By expanding its own economic model, the United States can respond more effectively to these new threats. Losing this competition is preventable.

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Many Tourists Around the World Now Unconcerned About COVID-19 – TravelPulse

Posted: at 10:18 pm

COVID-19 has affected pretty much everyone on the planet and generally overshadowed the past two-plus years of our lives.

So many of our decisions and actions over the past 26 months have been determined by the fickle nature of the virus, and shared anxieties about it have dominated our thoughts for so long.

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But, now, those widespread COVID concerns appear to be on their way out, as vaccination rates rise, the Omicron variant seems to have peaked, and countries around the world have eased or entirely dropped their international travel restrictions.

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In a recent live poll conducted by leading data and analytics company GlobalData, 57 percent of respondents said that they are not concerned or not very concerned about the spread of COVID-19. This affirms the attitude the world seems to have adopted toward the pandemic at this point, which is that we must treat the virus as endemic and learn to live with it.

The outlook for tourism in many countries is brighter than at any time in the past two years, said Hannah Free, Travel and Tourism Analyst at GlobalData. However, the turbulence and uncertainty of COVID-19 has created several challenges which are likely to further complicate recovery. Rising demand, coupled with mass layoffs and competition for talent with other sectors, has resulted in widespread labour shortages in several tourism economies, such as the UK, the Netherlands, and Spain.

With tourism now returning in earnest to many parts of the world, destinations and businesses will need to continue prioritizing hygiene and health safety measures in order to further boost travelers confidence and keep it high. GlobalData posited that coordinated health protocols designed to protect workers, communities and travelers alike, as well as support companies and their workforces, must be firmly established in order to build and maintain tourists trust.

The global travel and tourism industrys post-pandemic recovery is gaining traction as pent-up demand for international travel rekindles, Free added. According to GlobalDatas latest forecasts, on a global scale, international departures will reach 68% of pre-COVID levels in 2022. This is expected to improve to 82% in 2023, and 97% in 2024, before fully recovering by 2025 at 101% of 2019 levels. There is reason to be cautiously optimistic for the return of travel demand as growth in international travel is finally expected in 2022.

For the latest insight on travel around the world, check out this interactive guide.

For the latest travel news, updates and deals, subscribe to the daily TravelPulse newsletter here.

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Long-Term Care After COVID-19 – The Regulatory Review

Posted: at 10:18 pm

Experts recommend regulatory policies to improve long-term care in the wake of COVID-19.

Nursing homes and other long-term care facilities have been devastated by the COVID-19 pandemic. Nearly one-third of coronavirus deaths in the United States have been residents and employees of these facilities. As of May 2021, confirmed cases in these facilities have reached over one million. The leading explanation for these high rates is that residents advanced age and comorbidities make them particularly at risk for severe illness and death from the virus. This risk is compounded by the communal nature of long-term facilities, which increases the likelihood of residents and staff spreading COVID-19. Still, some experts argue that regulatory failures and chronic underfunding are partly to blame for such tragic outcomes in one of Americas most vulnerable populations.

Although the challenges of the COVID-19 pandemic are new, the crisis in long-term care is not. Long-term care facilities have a long history of low-quality care. In 1986, a study by the Institute of Medicine found that nursing home residents were routinely given inadequate care, neglected, or abused. In response, Congress passed the Nursing Home Reform Act, which set new care standards, upgraded staffing requirements, and established an enforcement mechanism for noncompliant facilities. Today, states enforce these standards through unannounced surveys conducted every 9 to 15 months, with variable penalties depending on the severity of the violation.

Most nursing home quality measures have improved over time under this law, but the majority of facilities still fall short of federal standards. In recent years, over 90 percent of nursing homes have received at least one citation per year for violating federal regulations. The pandemic only exposed and amplified these issues. Numerous nursing home residents have reported instances of severe neglect during lockdowns, including extreme weight loss and untreated bedsores.

Neglect for long-term care is also visible in its patchwork funding regime. The majority of long-term care is paid for by Medicaid, which only becomes available once individuals have exhausted their personal assets. Medicaid funding for long-term care also varies dramatically by state and is frequently under threat of budget cuts, especially during economic downturns. For individuals who look to private insurance to cover costs, they often find prohibitively high premiums. Fewer than 1 in 30 Americans own a long-term care insurance plan. Medicare, the primary insurer of Americans over 65 years old, does not cover long-term care beyond 100 days.

As a result of this patchwork system, nursing homes are chronically underfunded. The majority of nursing homes in the U.S. operate at a net loss, and hundreds of nursing homes have been forced to close in recent years. Thin or negative profit margins prompt facilities to cut corners in care quality and staffing levels, perpetuating low quality care. During the pandemic, increased costs have placed nursing homes on the brink of collapse, prompting billions of dollars of federal aid.

Today, approximately 12 million people in the U.S. need long-term care. By 2050, that number is expected to more than double. The challenges of the pandemic present a unique opportunity for policymakers to evaluate how the long-term care system is failing, so as to better prepare for increased demand going forward.

In this weeks Saturday Seminar, scholars explore how regulatory failures contributed to COVID-19 outbreaks in nursing homes and provide potential avenues for reform.

The Saturday Seminar is a weekly feature that aims to put into written form the kind of content that would be conveyed in a live seminar involving regulatory experts. Each week,The Regulatory Reviewpublishes a brief overview of a selected regulatory topic and then distills recent research and scholarly writing on that topic.

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Global impact of the first year of COVID-19 vaccination: a mathematical modelling study – The Lancet

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Global impact of the first year of COVID-19 vaccination: a mathematical modelling study  The Lancet

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COVID-19 reinfections are on the rise in Nueces County – KIIITV.com

Posted: at 10:18 pm

Despite the progress that's been made to prevent the spread of COVID-19, more people are finding themselves re-infected, regardless of vaccination status.

CORPUS CHRISTI, Texas Although precautions and vaccinations are in place, more people are finding themselves re-infected, regardless of vaccination status.

Pulmonologist Dr. Salim Surani said people taking precautions, like wearing a mask, is a good thing.

Dr. Surani told 3NEWS, "even as of yesterday, if you look at it, we had more than 100,000 people who had an infection. Even in Nueces County, it's almost 175 people who were infected, many of those were reinfection."

The challenge with the number of reinfection cases is that these can be an underestimation, because people have the option of at-home testing.

"I think people are recognizing that there is a higher incidence of infection, and a lot of the folks who have already received the vaccine, or they've had COVID in the past, they're getting the infection again," Dr. Surani shared.

The vaccine is doing its job to prevent serious illness and hospitalizations, but the vaccine immunity wears off after a certain amount of time. That may be the reason why people are seeing more reinfections lately. Boosters, along with vaccinations, are crucial.

"I think we have to go beyond that," Dr. Surani said. "We have to have a constant state of vigilance. In other words, if you see an increased number of cases in your community, then you need to make sure that you avoid large public gatherings."

Social distancing and hand washing are practices that we've been doing for the past few years. These precautions work hand-in-hand with vaccinations and boosters, like the vaccinations that were recently approved for those six-months and up.

"If you look at the bigger states like California and New York, they have more than 200 cases of reinfection," Dr. Surani said. "So the reinfection is going to happen, depending on your community prevalence or incidence of the disease. The higher number of cases that are in the community, the more chances you may get infected."

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Where’s the next generation of COVID-19 shots? – The Verge

Posted: at 10:18 pm

Over a year after the US authorized its first vaccines, COVID cases continue to pile up, leaving many vaccinated people wondering: Do I need a vaccine upgrade? People who are fully vaccinated and boosted have been testing positive in huge numbers, particularly since the omicron-triggered wave started its relentless burn across the United States in December. Vaccines that once caused experts to declare COVID-19 a pandemic of the unvaccinated dont protect as well against illness, even as they continued to protect against the most severe disease. Breakthrough infections are so common that the near-miraculous protection the vaccine promised a year ago feels very far away.

Part of the problem is that the virus that the vaccines target the first version of the coronavirus that started spreading in early 2020 doesnt exist anymore. Now, regulators, researchers, and vaccine companies are turning to the next phase of the vaccine development process: finding a way to protect against the virus thats spreading now and finding a way to protect people against future variations of the virus.

On June 28th, an FDA committee will meet to discuss whether and how future booster doses of vaccines might specifically target emerging variants of the virus. Like the seasonal flu shot, the next vaccines may at some point protect against whatever version of the virus is going to be circulating in a particular year. At the same time, other scientists are looking into ways of making the protection from any booster shot last longer. Longer-term, COVID-19 vaccines might be very different from current shots, using different technology and protecting against viruses that dont even exist yet. Some might not be shots but nasal sprays, which might be able to prevent even mild infections.

Preventing severe disease was the original goal, and I understand that. At the beginning of the pandemic, that made sense, said Akiko Iwasaki, a professor of immunobiology at Yale University School of Medicine. But now we understand the virus better and the fact that the variants are here I think we need to shift our thinking.

The first step for the future of COVID-19 vaccines is to play catch-up with the recent past. After over two years, the version of the virus that was first detected in Wuhan, China, has been replaced by its more contagious and immune-evading variants. Several vaccine manufacturers have already started testing vaccines tailored to the omicron variant. An early analysis of Modernas omicron-specific shot showed that it generated more antibodies against the omicron virus than the original vaccine, the company announced earlier this month. The vaccine is bivalent its made to protect against both the original flavor coronavirus and omicron.

Moderna says its booster may be available by late summer in some markets, wrote Elise Meyer, senior director of communications at Moderna, in an email to The Verge.

Pfizer and BioNTech are also running a clinical trial to update their shots against omicron, examining standard booster shots of the original vaccine, a version targeting only omicron, and a bivalent shot like Modernas. At a press briefing in April, Pfizer CEO Albert Bourla said an omicron shot might be available in the fall.

Novavax, whose vaccine might be approved soon in the US, is working on its own omicron booster. Its clinical trial testing both omicron-targeted shot and a bivalent vaccine started on May 31st. The vaccine, which has been under review by the FDA since January, seems to have less severe side effects than the other vaccines, making it potentially ideal to use as a non-disruptive booster.

But its still unclear if the omicron shots will work much better than the original vaccine against omicron and other variants. In one study on mice, the original vaccine actually worked quite well, at least in the short-term, said Larissa Thackray, an associate professor of infectious disease at the Washington University School of Medicine in St. Louis.

If omicron-specific vaccines dont have a major benefit over the existing vaccines, they could be a hard sell to be authorized by the FDA. Yet despite the uncertainty, Thackray said she thinks an omicron booster is overdue. A vaccine targeting a current or at least recent variant makes more sense than one targeting a much different virus the original strain of SARS-CoV-2, which doesnt exist anymore.

At some point, omicron might not be circulating anymore either. Its already evolved into several sublineages, and the virus will only keep evolving. Figuring out a way to continuously update the shots is one way to keep on top of it. But other researchers are working on universal vaccines which could theoretically protect against any new form of the virus.

Vaccines like this take advantage of the immune systems ability to respond to the parts of viruses that stay the same as they evolve, said David Martinez, an immunologist at the University of North Carolina at Chapel Hill and an author of a 2021 study examining a proposed universal coronavirus vaccine.

Martinez and other researchers made their vaccine by combining genetic material from a handful of different coronaviruses. Their goal was to make a shot that could generate an immune response against current and future variants, as well as other coronaviruses that could cause another pandemic. Its still preliminary that particular universal vaccine has only been tested in animals but its a first step toward broad protection.

This kind of vaccine might still work even if the virus substantially changes, said Martinez. But it will be a long time before we know if this is true its likely that this kind of vaccine will take years for scientists to develop, test, and get approved, he said.

Universal vaccines arent the only next-gen products in development. Researchers are also working on vaccines that arent shots at all theyre nasal sprays.

Intranasal vaccines could protect against the virus right where it enters the body, said Iwasaki, the immunobiologist at Yale University School of Medicine.

It makes sense to establish immune defense right at these mucosal sites, she said, referring to the inside of the nose. It can prevent the infection of these tissues altogether. Without infection, people wouldnt transmit the virus, and theyd be protected from long COVID.

There is one intranasal vaccine given now FluMist but it uses a weak version of the live flu virus, which is not safe for immunocompromised people. Iwasaki and her colleagues are working on a strategy to get around that issue: using a nasal spray containing a version of the COVID-19 virus spike protein as a booster after an initial mRNA shot. Because its used as a booster, the spray doesnt need to contain a live virus to trigger a strong enough immune response immunity from the initial shot is enough to drive a strong response to the protein in the spray.

So far, the technique is experimental and only has been tested in mice. But Iwasaki co-founded a company, Xanadu Bio, to make these vaccines, though she says they are still raising money to start clinical trials and working on testing the vaccine in nonhuman primates. And Xanadu is far from the only one looking at nasal spray vaccines. There are more than a dozen clinical trials of intranasal vaccines already in progress in the US and globally.

There are still a lot of challenges ahead before the next set of COVID-19 vaccines are available to the public. Theres still a lot experts dont know about the current vaccines like why they lose their efficacy over time, regardless of new variants, says Deepta Bhattacharya, a professor of immunobiology at the University of Arizona College of Medicine. He says it can be hard to know exactly what it is about a vaccine that makes it work well for a long time.

When youre comparing one vaccine to another, theres a lot of things that are different, he said. And so trying to extract which of those differences are really important is almost as much guesswork as it is science.

There are also practical limitations. The FDA meeting next week to discuss vaccinating against COVID-19 variants could have a big impact on the direction that future vaccine development will take. Funding, both for new research and to make shots available to people for free, will also probably be an issue. Unless Congress can agree on more pandemic funding, free future vaccines might be limited to only the most vulnerable people.

Despite everything, Bhattacharya is optimistic about the future of COVID-19 vaccines. Research seems to show that combining and refining the next-generation vaccine techniques like intranasal, vaccine-targeted, and universal vaccines could have great success, he said.

I think the science is there for sure to have better vaccines in the coming years, he said.

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Casino hub Macau launches third round of COVID testing as infections rise – Reuters

Posted: at 10:18 pm

People queue for COVID-19 testing in Macau, China, June 20, 2022. REUTERS/John Mak

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HONG KONG, June 27 (Reuters) - Macau launched a third round of mandatory COVID-19 testing for its more than 600,000 residents on Monday, in a push to curb a rise in infections in the world's biggest gambling hub.

Authorities in Macau have locked down multiple buildings and put more than 5,000 people in quarantine in the past few days, the city's government said. Health authorities said 38 new COVID cases were recorded on Sunday, taking the total number of infections to 299 in the latest outbreak.

Two rounds of COVID tests were conducted in Macau in the past week. The latest round is expected to end on Tuesday.

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Authorities have asked people to remain at home as much as possible with most of the city effectively closed, including bars, hair salons and outdoor parks. Only takeaway is allowed from dining facilities. read more

Casinos, while mostly deserted, are allowed to stay open, the city's government said, in a move to protect local jobs.

The stringent measures come after the Chinese special administrative region has been largely COVID-free since an outbreak in October 2021. It has not previously had to deal with the highly transmissible Omicron variant.

Macau adheres to China's "zero COVID" policy which aims to eradicate all outbreaks, at just about any cost, running counter to a global trend of trying to co-exist with the virus.

Macau's cases are still far below daily infections in other places, including neighbouring Hong Kong where cases have jumped to close to 2,000 a day this month.

Hong Kong's outbreak this year saw more than 1 million confirmed infections, and more than 9,000 deaths, swamping hospitals and public services. Officials there are looking to ease some restrictions.

Macau only has one public hospital with its services already stretched on a daily basis. The territory's swift plan to test its population comes as it keeps open the border with mainland China, with many residents living and working in the adjoining city of Zhuhai.

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Reporting by Farah Master; Editing by Himani Sarkar

Our Standards: The Thomson Reuters Trust Principles.

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