As the United States clamors with anti-vax protests, researchers seek to understand what social and behavioral values are keeping patients from electing to vaccinate themselves against the coronavirus disease 2019 (COVID-19) virus. Over the past year, the race to vaccinate has become less about developing working vaccines and more about finding ways to encourage vaccine uptake.This paper examines the question of vaccine hesitancy in rural Chemung County, NY. In identifying various psychosocial barriers to patient vaccination, which we hypothesize will be mostly political, we seek to understand the local mindset in the hopethat our data guidethe way to change it.
The SARS-CoV-2 virus that resulted in the coronavirus disease 2019 (COVID-19) pandemic was first detected in Wuhan, China, in December 2019.This novel coronavirus spread rapidly around the world, and in March 2020, the World Health Organization (WHO) declared COVID-19 a worldwide pandemic [1]. Current statistics show over 520 million cases worldwide, with more than six million deaths as of May2022 [2].
Since the first case of COVID-19 emerged over a year ago, the extent of its consequences has been devastating in many ways. The global health, social, and economic effects of this pandemic will be felt for years to come. Before the production of efficacious vaccines, efforts to prevent the spread of COVID-19 relied heavily on social distancing, self-isolation, hand hygiene, mask mandates, travel restrictions, and widespread testing.
As vaccines became available between December 2020 and March 2021, the next step in preventing the spread of COVID-19 became mass vaccination to reach herd immunity, which is defined as a high enough vaccination percentage within the community to prevent the massive spread ofdisease [3,4]. Vaccines available and deemed effective by the Centers for Disease Control and Prevention (CDC) are Johnson & Johnson, Moderna, and Pfizer [5]. Over 11 billion vaccine doses have been given worldwide; however, in Chemung County, NY, where this study was conducted, the vaccination rate is only 58.99% [6].
Vaccine hesitancy is defined as a motivational state of being conflicted about the effects or safety of a certain vaccine or being opposed to vaccination in general [7]. Vaccine hesitancy is not a single entity; it lies between complete acceptance and refusal of all vaccines. Within the context of this pandemic, the term anti-vaxer may apply only to the COVID-19 vaccine rather than as a blanket term for those who refuse all vaccines. In researching the reasoning of the unvaccinated, our terminology must expand with our understanding of their personal barriers [1,8].
The dilemma of COVID-19 vaccine hesitancy is multifactorial and comprises many barriers. Of primary concern is the politicization of vaccine uptake and a growing sense of distrust in the government and mainstream medias representation of health facts on the news [9]. Additional factors include whether to trust the vaccine or the provider of the vaccine. Dror et al. found that geopolitical concerns over the vaccine's country of origin were likely to impact the uptake of the vaccine globally [10].Moreover, the concerns of Americans include factors such as the speed of the vaccines development, its components, efficacy, the rigor of testing, and its potential for causing long-term adverse effects [9]. Many patients also struggle to understand the value of the vaccineand they lack convenient access to it [11].
Many employers under the guidance of New York State, especially within health care, have introduced vaccination mandates for employees to reduce the burden of COVID-19 among healthcare workers. These mandates were an ultimatum: be vaccinated or be unemployed. In many places, mandates were met with hostility and a mass exodus of healthcare workers who stated similar reasons for vaccine distrust as listed above. In rural New York, where our study was conducted, the medical center lost 80 employees to vaccine mandates. Some employees resigned voluntarily before the deadline due to disagreement with the mandate, and those who refused to be vaccinated by the deadline were terminated. These individuals were willing to risk their financial security rather than receive the vaccine, believing that the act of a mandate inherently violates the principle of their autonomy [12]. New York State was dumbfounded by the negative response to these mandates, namely, severe staffing shortages, and in February 2022, decided that despite the original intent of its mandate, the state would not be enforcing the mandate regarding booster shots [13]. This decision was not based on health data but rather a response to social behaviors that dictated the necessity of removing a mandate to staff hospitals amidst the crisis of a pandemic, further illustrating the complexity of questions and problems regarding the vaccination of American citizens. More data on the consequences of vaccination mandates on the attitudes of employees will be required to understand the impact of the concept on global health and the economy in other democratic states.
Anti-vaccine attitudes and beliefs that pre-date the COVID-19 pandemic pose another significant barrier to vaccine uptake along with a pervasive lack of trust in pharmaceutical companies and government agencies such as the CDC. People with conservative political beliefs, residence in non-metropolitan areas, and recent refusal of the seasonal influenza vaccine are other major factors and obstacles to COVID-19 vaccine uptake [7].
Public health awareness about the risks of COVID-19 and the benefits of vaccination needs to be communicated in ways that are easily accessible and understandable within the community [14]. This study is valuable as a means to decipher which types and routes of communication may be useful in targeting the vaccination rate in rural America.
This study received IRB exemption and was approved by Arnot Healths System Review Board and Privacy Committee.
Conducted in November 2021, this study is cross-sectional in nature. A self-administered electronic SurveyMonkey questionnaire, included in the Appendix, was sent via e-mail three times over the course of a two-week period.Each group of emails was sent to the same 1243 patient body to increase the response rate. All patients utilized for this survey had verified emails in the clinics electronic medical record. No patient identifying information other than age, gender, and race/ethnicity was recorded. The study targeted patients aged 18 years and above who visited the Eastside Primary Care Clinic in Elmira, NY, between 06/01/2021 and 10/01/2021.
The questionnaire was designed and developed specifically for this study, utilizing only questions deemed necessary for establishing the demographics of the patient base and their opinions regarding vaccination. Participants were briefly informed about the objective of the study and the handling of their personal information. Two research experts independently reviewed and validated the questionnaire, and the final version consisted of three domains: socio-demographic variables, beliefs toward COVID-19 vaccination, and potential barriers that may prevent participants from choosing vaccination. Respondents who refused to get the vaccine underwent further analysis within the questionnaire. These questions consisted of both answer choices about their possible reasons for refusal and a free-form response box. Free-form responses were analyzed individually.
Analysis of all responses was conducted with SurveyMonkey (Momentive Inc., San Mateo, CA) and Microsoft Excel (Microsoft Corporation, Redmond, WA).
A total of 118 responses were collected from 1243 patients surveyed, yielding a 10% response rate. Of patients,79% indicated previous acceptance of the vaccine, and 21% indicated that they were not willing to take a COVID-19 vaccine. Of the cohort of 25 individuals indicating they were unwilling to accept a vaccine, 80% were women and 20% were men. Of patients, 60% belonged to the age group of 31-50 years, and 88% were White Americans. A total of 72% had been offered COVID-19 vaccination but refused it, and 28% reported not having been offered vaccination. See Table 1for the breakdown of respondents by demographics.
When asked to explain their reservations about the vaccine, 23% of respondents said that they feared the vaccine was not safe, 18% were concerned about a lack of long-term safety data, 9% feared potential side effects, 32% disagreed with mandating the vaccine, and 18% believed that the vaccine is not effective. This question, shown in Figure 1, was conducted via choosing the most important reason for vaccine refusal, but patients also had the option to leave comments to elaborate on their choices.
Figure 2 outlines a question about additional information that could be offered to help patients make the decision to get vaccinated, and within the question, they could select any and all options that they felt applied to their opinion. The box labeled, "no amount of information will change my mind" was selected 16 times. "Long-term safety data" was selected 10 times. "More educational materials" was selected three times, and "further discussion from a health professional" was selected twice.
The free-form responses indicated other lesser reasons for refusing vaccination including pushback against the existence of mandates, concerns that mRNA-based vaccines confront religious beliefs, and personal experiences that they believed to outweigh any clinical data on the subject. One patient responded that she had been hospitalized for COVID-19 and recovered without lasting effects and would like to see a vaccine that lasts longer than a year. Another respondent stated, whether you receive the vaccine or not, you can still catch COVID!
Additionally, five patients refused to fill out the survey but emailed us back instead with their negative responses toward the COVID-19 vaccine.
The most cited reason for not getting vaccinated regarded distrust toward the government andgovernmental policy on COVID-19. In addition, fear about adverse reactions and the rapid vaccination approval process were related to hesitancy regarding vaccination, which is consistent with previous studies. In a report released by the World Health Organization (WHO), congruous, transparent, compassionate, and proactive communication about vaccines was cited to help build trust in COVID-19 vaccines [14]. Avenues such as those discussed in the report may be of benefit to this population of patients with specific fears about the components of the vaccines and their long-term safety.
The key reasons for vaccine refusal in this population were as expected: patients were concerned about the lack of long-term safety data, indignant atmandates, and bothered by the apparent influence of the political sphere on the vaccines creation and distribution, a consistent finding within the literature search [8].
The most striking finding of this study was that 66% of unvaccinated respondents said that no amount of information would change their minds about receiving a vaccine, while the remaining participants suggested that more data about long-term safety and provider recommendations could convince them to get vaccinated. A closer examination of these responses indicated pervasive mistrust of the system, which ultimately thwarts the desired outcome of this study: education and increased vaccination rates. It is much easier to collect data and educate a population about the benefits of vaccination than it is to sway the conviction of an individual firm in the belief that taking a vaccine violates his basic rights to autonomy and beneficence. In community settings where these convicted individuals abound, herd immunity becomes less an attainable reality than it is a "pipe dream" of improbability.
This project contains important limitations. With responses from only 118 individuals, of which just 25 were unvaccinated, the small sample size prevents the extrapolation of the data to a larger population. Additionally, several non-vaccinated patients were offended at the mere mention of COVID-19 and chose not to participate in the survey, further limiting responses within the target demographic. While the questionnaire used was validated by an internal team, it was novel and designed solely for the purpose of this study, which limits theability to compare itto other studies of this type. The questionnaire was also self-administered, and some patients chose to skip questions, which narrows the response rate for portions of the survey and provokes questions about the reliability of self-administered patient surveys.
The data clearly showed that for one-third of patients, education and personal recommendations from physicians may be enough to convince them to vaccinate, but for the remaining two-thirds of patients vehemently committed against vaccination for personal and political reasons, simple education measures may not be enough to change minds. The questions then become, how do we remove the politicalized stigma of the COVID-19 vaccine, and is non-partisan marketing enough? Where appeals to ethos and pathos have failed, what ultimately motivates the individual to set aside his convictions? Given the rates of unemployment and severe understaffing in health institutions, mandates were not the answer to this question; thus, more studies on a sociological-economic level will need to be completed to answer these questions.
Meanwhile, providers should broach the subject of vaccination with their patients armed with the most current research and a willingness to appeal to what motivates patients on an individual basis. This recommendation requires more of a grassroots effort than can be accomplished with wide-reaching advertisements ontelevision or social media marketing, but it may prove to be a local solution to a local problem.
You are invited to participate in a research study about COVID-19 VACCINE barriers. If you have a moment to spare, please fill out this short survey. It will take less than a minute. The goal of this research study is to identify the barriers and the ways to encourage people to get vaccinated. Wed greatly appreciate your feedback.
This study is being conducted by Dr. Richard Terry, Dr. Aeman Asrar, and Samantha Lavertue (medical student).
Patients who had been to Eastside Primary Care Clinic between 06/01/2021 and 10/01/2021 and 18 years or older qualify to participate in the study.
Participation in this study is voluntary. If you agree to participate in this study, you would be asked to answer some simple questions via an online survey (attached below) about your vaccination status. If you chose not to be vaccinated, we would ask you some questions about why you decided not to receive the vaccine.
Participating in this study will help us learn about attitudes toward COVID vaccination in our community. The questions we would ask you about the decisionto not be vaccinated are the sorts of things you might discuss with family or friends.
The information you will share with us if you participate in this study will be kept completely confidential to the full extent of the law. The answers you give to any questions are completely anonymous and will not affect in any way the care you receive.
We will be using SurveyMonkey to administer the surveys. SurveyMonkey will not record your computers IP numbers and no patient identifying information other than age and gender will be recorded. Again, your answers will be kept completely anonymous.
If you have any questions about this study, please contact Dr. Aeman Asrar at [emailprotected]
By completing this survey, you are consenting to participate in this study.
We thank you for devoting one minute of your time.
Gender:
* Male
* Female
Age:
* 18-30 years
* 31-50 years
* 51-64 years
* 65+ years
Ethnicity:
* White American
* African American
* Asian
* Hispanic
* Other
* Prefer not to answer
1. Were you offered COVID-19 vaccination?
a. Yes
b. No
If you answered NO to this question, you have completed the survey and do not need to answer any further questions.
2. Did you receive COVID-19 vaccine?
a. Yes
b. No
If you answered YES to this question, you have completed the survey and do not need to answer any further questions.
3. If you were offered vaccination but decided not to get it, please tell us the reason for this decision.
a. Fear that vaccine is not safe because of its rapid development
b. Lack of long-term safety data
c. Fear of potential side effects
d. Personal reasons (disagree with any mandate)
e. I believe the vaccine is not effective
f. Other (please describe) ___________________________
4. What information would you want to receive to help you make the decision to get vaccinated?
a. Long-term safety data
b. More educational material
c. Further discussion from a health professional
d. No amount of information will change my mind
5. Where have you received information about the COVID vaccine? (Check as many as applicable)
a. Print media
b. Broadcast media (television and radio)
c. Internet
d. Word of mouth
6. Do you believe that approved/authorized vaccines are effective at preventing COVID-19?
a. Yes, in most cases
b. No, I don't believe so
c. Yes, but may dependon general health status
7. What strategies do you follow to protect yourself from COVID-19?
a. Wash your hands often with plain soap and water
b. Cover your mouth and nose with a mask when around others
c. Avoid large gatherings and practice social distancing (stay at least six feet apart from others)
d. Nothing
Deputy head of the National Health Commission (NHC) Zeng Yixin said on Saturday that "all China's incumbent state and party leaders" have been vaccinated against Covid-19 with domestically made shots, referring to top officials at the national and deputy national level -- a category that includes Xi, Premier Li Keqiang, and other senior leaders.
It is exceptionally rare for health-related information about Chinese leaders to be made public, but the statement was made amid a recent wave of Covid-19 infections and public concerns about the safety of vaccines.
Zeng didn't specify when the officials had been vaccinated or if they received booster shots. The vaccination status of Xi had not previously been disclosed to the public.
China has repeatedly sought to address questions around the safety of its vaccines and to boost its vaccination rates, especially among the elderly. While nearly 90% of China's vaccine eligible population has been fully vaccinated, only 61% of people over the age of 80 have been fully vaccinated and only 38.4% have received booster shots, according to the NHC.
On Saturday, the NHC addressed online speculation on the safety of the vaccines, including accusations they cause leukemia and diabetes in children, saying statistics show no evidence of these diseases linked to vaccines.
Of the nearly 3.4 billion doses of Covid-19 administered in China, only around 70 people per million have reported side effects -- a percentage far lower than other vaccines like polio, measles, hepatitis B, rabies and Influenza, the NHC said.
China has so far only approved domestically made vaccines to be used in mainland, including those by Sinopharm and Sinovac which use inactivated virus instead of the genetically engineered mRNA vaccines. In trials, these vaccines have shown lower efficacy than their mRNA counterparts -- a criticism dismissed by Beijing as a "bias-motivated ... smear." Beijing has instead pointed to the vaccines' effect in reducing severe cases and deaths as a metric of their success.
Few serious side effects have been reported from the administration of the various new vaccines that were developed during the coronavirus pandemic [1]. However, vaccine-induced thrombotic thrombocytopenia (VITT) is a very rare prothrombotic syndrome that has been reported in some patients after receiving coronavirus vaccination with the adenovirus vector-based vaccines: AstraZeneca (ChAdOx1 nCoV-19) and Johnson and Johnson (Ad26.COV2.S) [2].
VITT is a thrombotic syndrome that involves the development of immunoglobulin G (IgG) antibodies that bind to the Fc portion of the IgG receptor on platelet factor-4 (PF4). Platelet activation occurs upon binding, a phenomenon similar to heparin-induced thrombocytopenia (HIT). The immunopathology of VITT differs from HIT since the antibodies bind to a different epitope on PF4, and VITT is not dependent on exposure to heparin products. The mechanism in which VITT causes antibody formation is still unclear. Some theories suggest vaccine components may generate a neoantigen when bound to PF4 [2]. VITT is a very rare complication of the adenoviral-vector-based COVID-19 vaccines, with the CDC estimating an incidence of 1 in 533,333 [3].
In this report, we present a case of VITT in an adult female with no previous medical issues.
A 37-year-old female with no previous health conditions presented to the ED with an 11-day history of headachez following vaccination with the Johnson and Johnson COVID-19 adenovirus-based vaccine. The headache was localized to the bi-temporal region, was constant in nature, and had been progressively worsening since the time of vaccination. The patient had a past surgical history of cholecystectomy and Cesarean section. She had no known medical conditions and was a current cigarette smoker with a 10-pack-year history. The patient reported a positive history of blood clots in her sister and mother, with no known diagnoses of hereditary coagulopathies. Vital signs on arrival were within the normal limits: temperature of 98.1, heart rate of 72 beats per minute, blood pressure of 114/78 mmHg, and oxygen saturation of 96% on room air. Labs in the ED were significant for thrombocytopenia, with a platelet count of 22,000. Other pertinent lab values include an elevated C-reactive protein (CRP) of 3.19 mg/dL. -HCG was negative, and urinalysis showed no evidence of urinary tract infection. At the time of presentation, the patient had no signs of active internal bleeding, petechiae, purpura, or ecchymosis. Physical examination was unremarkable, although the patient appeared to be in significant distress because of the headache. A non-contrast CT scan of the head was ordered and showed no acute abnormalities. A chest X-ray was also performed and demonstrated no acute cardiopulmonary disease. The COVID-19 rapid antigen test was positive, and a polymerase chain reaction (PCR) test was ordered. A full respiratory serology panel was performed and was negative. The patient received a 500 mL bolus of sodium chloride, 30 mg of IV ketorolac, and 10 mg of IV dexamethasoneand was admitted to the general medical floor for observation and management of thrombocytopenia.
On day 1 of hospitalization, the patient woke up with sudden excruciating right lower extremity pain. At this time, she was diaphoretic, tachycardic, and flushed. The pain was associated with numbness, tingling, and decreased sensation around the right ankle with preserved motor function. The dorsal pedal, posterior tibial, and popliteal pulses were non-palpable and non-Dopplerable. Labs showed a high d-dimer level of 6.01 (normal 0.19-0.5), a low platelet count of 20,000, and an elevated immature platelet fraction of 14.3%. Fibrinogen was normal at 217, and coagulation studies, including prothrombin time (PT), partial thromboplastin time (PTT), and International Normalized Ratio (INR), were within the normal limits. CRP was elevated at 2.67, and procalcitonin was normal at 0.06 ng/mL. Venous duplex ultrasound of the right lower extremity showed no evidence of deep vein thrombosis. A computed tomography angiography (CTA) scan of the abdominal aorta with runoff was ordered and showed a right common femoral artery embolus extending into the origin of the superficial femoral and profunda artery, a left distal popliteal trifurcation embolism with segmental occlusion, a small pulmonary embolism in the right lower lobe, and a mural thrombus of soft plaque in the anterior wall of the infrarenal abdominal aorta (Figures 1-3). The patient was not a candidate for thrombolysis due to thrombocytopenia, so an open thrombectomy of the right common and superficial femoral arteries was done with an embolectomy catheter. Post-operatively, the patient received anticoagulation with argatroban.
Following the procedure, the patients platelet count had decreased to 12,000, the WBC was elevated at 12,400, hemoglobin (Hb) was low at 11.6, and PTT was increased to 39.9. She was admitted to the ICU and was started on 10 mg IV dexamethasone Q6H for four days. The COVID-19 PCR test came back negative, confirming a false-positive rapid antigen test. Pathology was consulted to examine a peripheral blood smear, which showed normal platelet morphology with a decrease in the number of platelets. The pathologist suggested that this may be secondary to peripheral consumption and SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia. The patients serum was tested for heparin-platelet factor 4 (heparin-PF4) antibodies. Heparin-PF4 antibody enzyme-linked immunosorbent assay (ELISA) was positive with 100% heparin-PF4 antibody inhibition and an optical density of 2.265. Hematology was consulted and suggested that thrombosis is related to a HIT-like mechanism, even without known exposure to heparin products. This was concluded by cases in the literature that showed immune-induced thrombocytopenia with vascular thrombotic events after COVID-19 vaccination, mostly after receiving the AstraZeneca vaccine. It was recommended that low-weight molecular heparin and platelet transfusions should be avoided to prevent worsening thrombosis. Hematology requested that the patient be started on IV immunoglobulin (IVIG) for two days if there was worsening thrombocytopenia or any signs of bleeding.
On hospital day two, morning labs showed that the platelet count dropped to 8000. The patient received her first day of IVIG. WBC count at this time increased to 14,300. Immature platelet fraction had increased to 19.6%, and PTT increased to 41.4. At this time, hematology suggested that platelet transfusions should be withheld unless active bleeding is present. Venous duplex ultrasound of the unaffected left leg was taken and showed no evidence ofdeep vein thrombosis (DVT). Venous duplex ultrasounds of the bilateral upper extremities showed acute DVT in the left brachial vein. MRI of the brain showed no evidence of acute infarct, parenchymal hemorrhage, cerebral edema, or cerebellar tonsillar ectopia. Magnetic resonance angiogram (MRA) showed no significant stenosis of the major intracranial arteries and did not identify any medium or large-sized aneurysms. Magnetic resonance venography (MRV) showed no evidence of dural venous thrombosis. CT scan of the brain and head with contrast showed no evidence of dural venous sinus or cavernous sinus thrombosis and no acute intracranial hemorrhage or mass effect. Repeat afternoon labs showed some improvement in platelet count, rising to 14,000. WBC count at this time continued to trend upward to 16,200. Immature platelet fraction increased to 21.6%. Coagulation studies showed prolonged PT of 16.3 and PTT of 45. Other lab abnormalities include low fibrinogen of 135 and an elevated aspartate aminotransferase (AST) of 123.
On hospital day three, the platelet count continued to trend upwards to 20,000, WBC count remained stable at 14,500, Hb was low at 10.3, immature platelet fraction remained stable at 22.3%, PTT remained stable at 44.5, and AST was high but trending downwards to 105. The head CT scan showed no evidence of dural venous sinus or cavernous sinus thrombosis and no acute intracranial hemorrhage. The patient received day two of IVIG.
On hospital day four, the platelet count increased to 47,000. The WBC count trended downwards to 13,100. Hb remained low but stable at 10, PT remained elevated but stable at 24.3, PTT was high but stable at 50, and AST continued to trend down to 69.
On hospital day five, the platelet count improved to 101,000. WBCs trended down to 12,200, Hb was 10.4, PTT was 48.4, and AST was 42, trending towards normal. The patient was discontinued on argatroban and started on oral apixaban 10 mg two times a day (BID) every 12 hours (Q12H) for seven days. The dexamethasone changed from IV to 10 mg per os (PO) today, and she was transferred from the ICU to the medical floor. Pathology confirmed that the content analyzed from the femoral arteries was consistent with a thrombus.
On hospital day six, the platelet count improved to 143,000. WBC count was elevated at 17,500, Hb increased to 11.7, and AST trended down to 52. Dexamethasone was tapered to 10 mg BID, then discontinued upon discharge. The patient was told to decrease the apixaban dose to 5 mg BID after seven days.
Lab values recorded during the hospital stay are summarized in Table 1.
VITT is an uncommon but potentially life-threatening complication that has developed after vaccination with AstraZeneca and Johnson and Johnson COVID-19 adenoviral-based vaccines. This led to safety concerns as several individuals received these vaccinations during the COVID-19 pandemic. However, studies reveal that there is no association between the development of VITT and the BioNTech Pfizer vaccine [4]. One case report has also been published on fatal thrombotic events following vaccination with Moderna. However, it is unknown if this was a direct result of VITT or was related to a prior illness [5].
We reported a case of VITT following the Janssen (Johnson and Johnson) COVID-19 vaccination. A case report in the UK that included 220 cases of definite or probable VITT stated that the median time of diagnosis post-vaccination is 14 days, ranging from 5 to 48 days [6]. This study showed a female predominance among cases, with 55% of patients being female, making this a significant risk factor for VITT [6]. Over half of the patients studied had multiple thrombi present in different locations. The patient in our case report had similar demographics to this study as she presented to the hospital with symptoms 11 days post-vaccination, is female in gender, and had four different thrombotic sites. In systematic reviews, the headache was shown to be the most common presenting symptom in patients with VITT and cerebral venous sinus thrombosis (CVST) [7]. Despite our patients presentation of an unremitting headache, no signs of CVST or neurological abnormalities were found on imaging.
Sites of venous thrombosis in VITT can vary but are more commonly seen as deep vein thrombosis of the lower extremities and thromboembolism to the lungs [1,8]. Some rare but observed sites of thrombosis in VITT include the splenic, portal, mesenteric, adrenal, cerebral, and ophthalmic veins [1,8]. CVST is an uncommon but serious complication of VITT, where thrombosis of the cerebral sinuses occurs, leading to intracranial hypertension [9]. Thrombosis in the presence of VITT can be diagnosed through MRI with venography or CT venography. This was done after our patient developed thrombosis in the setting of thrombocytopenia, thus ruling out dural sinus thrombosis as a cause of the headache [1,9].
Arterial thrombosis caused by VITT has been displayed through reports of middle cerebral artery stroke and occlusion of peripheral arteries [10]. Our patients sites of thrombosis are consistent with these locations as they include the femoral arteries, popliteal artery, pulmonary vasculature, and abdominal aorta. The median platelet count for patients with VITT is 20,000-25,000 [2]. In this report, the patients platelet count dropped as low as 8000 but mostly remained within the 10,000-20,000 range.
VITT is diagnosed by using PF4 antibody tests [11]. A diagnosis is based on a positive PF4 antibody assay and the presence of thrombocytopenia or thrombosis. The test used on our patient was the ELISA, which is the recommended screening test [11]. Other screening tests include serotonin release assay, which can be used in patients with suspected VITT with a negative or equivocal ELISA [12]. Patients diagnosed with VITT from case reports in the UK had high optical densities on ELISA, ranging between a density of 2 and 3 [2]. The patient in our report had an optical density of 2.265.
Our patient was treated for two days with IVIG infusions, one of the mainstays of treatment in VITT, as it substantially improves the patients platelet count while stabilizing coagulative events [13]. IVIG interferes with the ability of PF4 to activate platelets by blocking FcRyIIA receptors, as seen in HIT [14]. Plasma exchange is another potential treatment that temporarily reduces the PF4 antibodies, thus decreasing coagulability [7]. It is important to note that platelet infusions should be avoided in the case of VITT to prevent further antibody formation and thrombosis [14]. The long-term complications of PF4 antibodies have not yet been established [13]. An observational study showed that VITT patients had a negative platelet functional assay within a median time of 15.5 weeks [15]. However, 7.5% of subjects showed persistently high levels of antibodies and optical densities, and two out of these five patients had a recurrent episode of thrombocytopenia [15]. Due to the new emergence of this condition, the prolonged implications of VITT and PF4 antibodies will be an essential topic for research in the coming years.
Our patient presented with a case of vaccine-induced thrombotic thrombocytopenia, a recent illness that arose with the development of vaccines produced in light of the COVID-19 pandemic. VITT can be life-threatening if not recognized quickly and treated adequately.
In this case, the patient was treated surgically and medically for multiple thrombotic events in the presence of thrombocytopenia, leading to a full recovery prior to discharge. VITT is a very rare complication of the adenoviral-vector-based COVID-19 vaccines, and although it can result in serious medical issues, the benefits of protection against COVID-19 heavily outweigh any associated risks.
One of the former U.S. officials who led the COVID-19 response during the Trump administration said July 22 that COVID-19 vaccines were not expected to protect against infection.
I knew these vaccines were not going to protect against infection. And I think we overplayed the vaccines. And it made people then worry that its not going to protect against severe disease and hospitalization,Deborah Birx, the White House COVID-19 response coordinator under former President Donald Trump, said during an appearance on Fox News.
The Moderna and Pfizer COVID-19 vaccines were granted emergency use authorization in late 2020 to prevent symptomatic COVID-19, and were promoted by many health officials, including Birx.
This is one of the most highly-effective vaccines we have in our infectious disease arsenal. And so thats why Im very enthusiastic about the vaccine, Birx said on an ABC podcast at the time.
She made no mention of concerns the vaccines might not protect against infection.
Data shows the vaccines did prevent infection from early strains oftheCCP (Chinese Communist Party) virus, which causes COVID-19, but that the protection waned over time. The vaccines have proven increasingly unable to shield even shortly after administration, and provide little protection against the Omicron virus variant and its subvariants.
The vaccines continue to protect against severe disease and hospitalization, Birx said on Friday. But lets be very clear50 percent of the people who died from the Omicron surge were older, vaccinated, she said.
So, thats why Im saying, even if youre vaccinated and boosted if youre unvaccinated, right now, the key is testing and Paxlovid, she added.
Paxlovid is a COVID-19 pill produced by Pfizer that has had uneven results in clinical trials and studies, but is recommended by U.S. health authorities for both unvaccinated and vaccinated COVID-19 patients to prevent progression to severe disease.
President Joe Biden, who tested positive this week, was prescribed Paxlovid by his doctor.
There are signs the protection from vaccines against severe illness is also dropping quickly as new strains emerge.
That protection was just 51 percent against emergency department or urgent care visits, and dropped to just 12 percent after five months, according to a recent study. Against hospitalization, protection went from 57 percent to 24 percent. A booster increased protection but the shielding quickly dropped to substandard levels.
Dr. Anthony Fauci also helped lead the U.S. pandemic response along with Birx and once said that vaccinated people would not get infected.
What was true two years ago, a year and a half ago, changes because the original ancestral strain did not at all have the transmission capability that were dealing with with the omicron sublineages, particularly BA. 5. So the vaccine does protect some people, not 95 percent, from getting infected, from getting symptoms, and getting severe disease. It does a much better job at protecting a high percentage of people from progressing from severe disease, Fauci said on Fox.
He said that vaccines with updated compilations, which are expected to debut in the fall, are necessary.
We need vaccines that are better. That are better because of the breadth and the durability, because we know that immunity wanes over several months. And thats the reason why we have boosters, he said. But also, we need vaccines that protect against infection.
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Zachary Stieber covers U.S. and world news. He is based in Maryland.
WASHINGTON One after another, President Biden hugged and kissed them.
At a packed ceremony in the East Room of the White House on July 7, Mr. Biden bestowed the Presidential Medal of Freedom, the nations highest civilian honor, on 16 Americans, some in their 80s or 90s. After reaching around to hang the medal on their necks, the president embraced most of them, shook hands with a few and gave three a smooch on the cheek.
It is highly unlikely that Mr. Biden who tested positive for Covid-19 on Thursday became infected with the coronavirus during that event. But the fact that the celebration happened at all underscores how much the White House has dropped most of the extraordinary measures it once employed to protect the commander in chief from a disease that has killed more than one million Americans.
In the early days, Mr. Biden was a president in a bubble, governing the country mostly by Zoom inside the Oval Office. He rarely traveled. He held few in-person meetings. And most of the ceremonial trappings of the office like the medal ceremony were canceled or postponed, victims of the lockdowns that were deemed necessary to stop the spread.
But like many other Americans, Mr. Biden has loosened up in recent months. Protected by multiple doses of the vaccine, the president and his aides have changed their risk assessments and have begun to live with the coronavirus.
Whatever your thing is whether its being the president of the United States, going to school, going to work, doing the things you enjoy, being with who we love it cant be put off forever, said Andy Slavitt, who advised the White House on its Covid-19 response early in the Biden administration.
Mr. Slavitt said Covid-19 has become a disease that comes around as frequently as a common cold but with much more severe consequences. Its a much more uncomfortable middle state for people to adjust to.
Inside the West Wing, there was never much doubt that Mr. Biden would eventually contract the disease. By this week, many of the people around him already had: Vice President Kamala Harris; Jen OMalley Dillon, his deputy chief of staff; Karine Jean-Pierre, his press secretary; several cabinet members, including the attorney general; Doug Emhoff, the second gentleman; and Jen Psaki, his former press secretary twice.
On Friday, Mr. Bidens physician said his symptoms had improved. The president had a temperature of 99.4 degrees late Thursday evening, according to Dr. Kevin OConnor, in a letter released on Friday. He wrote that Mr. Biden was still experiencing a runny nose and fatigue, and that he had an occasional nonproductive, now loose cough.
His voice is deeper this morning, Dr. OConnor wrote. His pulse, blood pressure, respiratory rate, and oxygen saturation remain entirely normal, on room air.
The deeper tone in Mr. Bidens voice was noticeable on Friday, when he participated by video in a briefing on declining gas prices. Mr. Biden cleared his throat multiple times during his remarks and could be heard coughing.
Dr. Ashish K. Jha, the coordinator for the administrations Covid-19 response, said that Mr. Bidens temperature of 99.4 on Thursday was not considered a low-grade fever by the White House and that it fell within the normal range. He added, however, that he was unaware of Mr. Bidens temperature recorded Friday morning. The White House referred to guidance from the Centers for Disease Control and Prevention that states a person is considered to have a fever when he or she has a measured temperature of 100.4 degrees or feels warm to touch.
But in his letter, Dr. OConnor indicated that he did not feel that the presidents temperature of 99.4 was normal until after it responded to Mr. Biden taking Tylenol. Dr. Jha said later on Friday that it was routine for doctors to report the highest temperature of their patients, even if it was not a fever.
He did mount a temperature yesterday evening to 99.4F, which responded favorably to acetaminophen (Tylenol), Dr. OConnor wrote. His temperature has remained normal since then.
Dr. Jha said Dr. OConnor did not prescribe the Tylenol for the temperature, but rather for Mr. Bidens discomfort. Dr. Jha declined to say what discomfort the president was experiencing. Officials have said he does not have a sore throat or a headache, and have not indicated he has other aches and pains.
The White House went to great lengths this week to show that Mr. Bidens work life had not been dramatically affected by his diagnosis.
The White House Twitter account posted three photos of the president working at a desk in the White House residence. In one, he can be seen talking on the phone. In another, he is signing a law designed to give people more access to baby formula.
Mr. Biden was elected in no small measure because he persuaded voters to trust that he could bring the pandemic under control and reopen the country.
In the last 18 months, Mr. Biden has achieved much of that goal. Because of the widespread availability of vaccines and treatments, most communities have reopened stores, bars, sporting venues and schools. There are few mask mandates still in place.
Mr. Biden now travels abroad (he shook hands with numerous world leaders during a trip last week to Israel and Saudi Arabia). He holds political events around the country, flying on Air Force One and riding in the motorcade. And in-person events at the White House are a weekly occurrence again.
But the pandemic is not over.
According to the C.D.C., most of the country is now classified as areas with high community transmission. The latest Omicron subvariant to become dominant, BA.5, is vastly more contagious than the original coronavirus, though doctors say the vaccines remain effective at preventing hospitalization and death.
So Mr. Biden has to walk a careful line, demonstrating that he is just like every other American eager to be done with Covid-19, even as he keeps his eye on the possibility that the pandemic could come roaring back.
The White House tried to do that on Friday by using the presidents diagnosis as a case study for why Americans should get vaccinated and boosted.
Were in a much, much better place than where we were 18 months ago, when the president took office, Dr. Jha said, adding that the current level of about 400 Covid-19 deaths per day was unacceptable. He also added a grim warning.
This virus, he said, is going to be with us forever.
We regularly answer frequently asked questions about life during the coronavirus crisis. If you have a question you'd like us to consider for a future post, email us at goatsandsoda@npr.org with the subject line: "Weekly Coronavirus Questions." See an archive of our FAQs here.
I'm on a family vacation and I'm the only one who tested positive for COVID. How do I protect everyone else?
Yeah, it's exactly what you don't want to have happen. You're on a family vacation, maybe your first in a couple of years because of the pandemic. It could be just immediate family or maybe grandparents, aunts, uncles, cousins and others have come along.
Then a couple days in, you get that scratchy throat feeling. Your COVID self-test delivers the bad news. Yup, you've got it. It happened to a colleague who was away with their partner and young kids. She felt like crying and then wondered: Are my tears going to spread my COVID?
We talked to experts for advice on how to prepare ahead of time for a possible COVID infection while on vacation and what to do if it does strike.
The big question of course: Will everyone get it?
"Part of me thinks: we're doomed!" says Linsey Marr, professor of civil and environmental engineering at Virginia Tech. "But the other part of me knows there are many things we can do to reduce the risk and many, many cases where one person gets it [in a household] and not everyone else does. So it's not inevitable." Including her own family her son had COVID and no one else got it.
Various studies estimate what's known as the "secondary attack rate in households" other household members who catch COVID from an infected individual. "It does look like the secondary attack rate is over 50%," says Marr. "It is quite high but it is not 100%." Studies of earlier variants suggest that vaccination is a good way to keep down the infection rate in a household and that if lots of people are packed into tight quarters, rates of infection are, as you'd expect, higher.
Tip 1: Preplan
Just like you pack suntan lotion and bug spray, you need to take a good supply of good quality masks (N95 or KN95), self-tests and maybe a few helpful medical tools, like a thermometer and pulse oximeter ... just in case. Also ask if folks in your vacation group are all vaccinated and boosted (if eligible for boosters). The shot might not keep you from becoming infected with the highly infectious and currently dominant omicron BA.5 variant, but it could lessen the severity of disease or shorten the span of your contagiousness.
Tip 2: Figure out the best way to isolate the person with the virus
"You need to remove them from the mix," says Dr. Preeti Malani, an infectious diseases physician and a professor of medicine at the University of Michigan. That's the ideal. But it may not be possible depending on your budget and your lodging options.
If you can book a separate hotel room or put the COVID vacationer in their own room in a rental property, that's ideal. If you're renting a house or staying with family or friends, see if you can assign the COVID case to their own room.
Tip 3: Mask up!
They've been politicized, people are tired of them, they're not exactly fun to wear in a heat wave. But masks are still the front line of protection. The patient should wear a mask when anyone is in proximity and so should the rest of the vacation party if they're in the same space as the patient. I know we just said this a few paragraphs above, but our experts stress that you want N95s or KN95s for maximum protection and a mask that fits well. So it shouldn't slide down off your nose and should also be comfortable. Some N95s have over-the-head straps that won't pinch the ears, notes Abraar Karan, an infectious disease physician at Stanford University.
Tip 4: Open windows
The overall goal is "harm reduction," says Malani. And opening windows is a helpful step for any space where the infected person might hang out or pass through. The airflow can help disperse pathogens exhaled by a sick person.
Hotel room windows cannot always be opened, so if your only option is to stay in the same room as the infected person, you might look for an alternative hotel with openable windows or balconies.
Tip 5: Fans are your friend
If the person with COVID will be sharing common space with others, fans are another harm reduction measure. See if you can get a box fan hotels may have them or you may be able to buy one. Put the fan in the window, pointing outward to suck air (which could contain pathogens exhaled by the patient) out of the room. This is especially helpful if you can't find a separate bedroom for the contagious vacationer. See if you can push their bed near the window with the fan.
Tip 6: Distance makes the pathogen less risky
It's been drummed into the public mind that 6 feet of distance from a sick person is a way to reduce the risk of infection. That's true, but it's not an ironclad guarantee. Pathogen-packed aerosols exhaled by the sick person can travel beyond 6 feet but "there's far less risk if the sick person is 6 feet away from others," says Karan, who adds, "the more feet the better."
Tip 7: Be bathroom-conscious.
Let's say the sick person is isolated in their own room but the vacationers are sharing a bathroom. If the patient takes off their mask for various bathroom activities, like showering or oral hygiene, they can exhale aerosols (containing viral pathogens), which will linger in the air. So someone who walks in immediately after the sick person is done is going to "walk into a big cloud" of SARS-CoV-2 pathogens, says Karan.
"Stay out of the bathroom for half an hour to an hour," suggests Marr.
Tip 7: Stay outdoors whenever possible
Outdoor airflow doesn't mean no chance of infection, but it does help disperse pathogens. So if you want to have a meal and include the patient dine al fresco and keep some distance. If the patient is feeling well enough to take a walk and others want to go along, "the safest thing is to wear a mask," says Malani. And make sure that the other walkers are not downwind from the patient, especially if it's a breezy day. If the patient takes a solo walk and no one else is around, "you don't need to have a mask," says Malani. "It's cumbersome to wear a mask all the time."
Tip 8: Be honest with little kids
Our colleague with COVID said her greatest frustration was not being able to hug or share ice cream with her kids, ages 4 and 7.
So how do you explain it all to a kid?
"Young children are very smart, very conscious of wanting to make sure people stay healthy," says Dr. Jill Weatherhead, assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine. "Be honest: Explain you don't want others getting sick and [the person with COVID needs to] stay separate for a few days to make sure nobody else gets sick."
Or you might ask them questions instead of telling them what's up, suggests Junlei Li, the co-chair of the human development and education program at the Harvard Graduate School of Education. That way, you won't just be lecturing, you'll be discovering how much they do (and don't) know and what their concerns are. Li says you might say:
Whatever you tell your children, says Li, the main message you want to convey is: "I want to keep you (and other people) safe too. You know a lot about what to do and what not to do. And we can still be together. We just need to find new ways."
Tip 9: Self-tests can only tell you so much
The great hope, of course, is that the person with COVID will get to a negative test fairly soon and be able to socialize without putting others at risk of infection. Many people ask if a faint "positive" line on a COVID test after a few days means there's a lower load of virus and less chance of transmitting it. In theory it might, our experts say, but it's not a sure thing. "There's no data to suggest that," says Weatherhead. A self-test "is not a quantitative test, it's qualitative. If there's a line, even if it's faint, it's positive."
Tip 10: Don't feel guilty
"Guilt is not helpful," says Malani. "Understand that you're doing your best and this wasn't your fault. This happens."
Tip 11: Don't fret about tears and COVID transmission.
"You don't need to worry about tears" being a major risk for spreading SARS-CoV-2, says Marr. Malani agrees: "There may be some virus in tears, but that's not really how this is spread. It's spread through respiration."
I am on a mission to preserve the most valuable item in my home: my fianc, who has never had COVID. Through sheer luck and a healthy dose of terror, he made it through the first pandemic year without getting sick. Shielded by the J&J vaccine and a Moderna booster, he dodged infection when I fell ill last November and coughed up the coronavirus all over our cramped New York City apartment. Somehow, he ducked the Omicron wave over the winter, when it seemed as though everyone was getting sick. And in the past few months, he has emerged unscathed from crowded weddings, indoor dinners, and flights across the country.
At this point, I worry about how much longer its going to last. People like himI think of them as COVID virginsare becoming a rare breed. Just yesterday, President Joe Biden thinned their ranks by one more person. The Institute of Health Metrics and Evaluation suggests that as of earlier this month, 82 percent of Americans have been infected with the coronavirus at least once. Some of those people might still think theyre never had the virus: Asymptomatic infections happen, and mild symptoms are sometimes brushed off as allergies or a cold. Now that were battling BA.5, the most contagious and vaccine-dodging Omicron offshoot yet, many people are facing their second, third, or even fourth infections. That reality can make it feel like the stragglers who have evaded infection for two and a half years are destined to fall sick sooner rather than later. At this point, are COVID virgins nothing more than sitting ducks?
Read: Of course Biden has COVID
The basic math admittedly doesnt look promising. Most of the people getting infected right now seem to be coming down with the illness for the first time, even though they are a distinct minority. Nationally, we dont have good data on who is getting COVID, though in New York, first infections seem to be happening at five times the rate of reinfections. Part of why those who havent gotten COVID seem to be at a higher risk of infection is that taking into account all other factorsvaccination, age, behaviorsthey lack the immunity bump conferred by a bout with the virus, no matter how fleeting that bump may be. On its own, this would suggest that these people are in fact sitting ducks who cant avoid infection short of hunkering down in total isolation.
The experts I talked with agreed that the risk of infection is currently high. We are finding now that with the more transmissible variants, its becoming more and more difficult to avoid infections, Robert Kim-Farley, an epidemiologist at UCLA, told me. However, its not inevitable. Rick Bright, the CEO of the Rockefeller Foundations Pandemic Prevention Institute, was less certain. Honestly, it might be inevitable, the way the virus has continued to change, he said.
Still, they reiterated that we still dont quite know just how at risk those who havent had COVID areespecially when BA.5 seems to be reinfecting so many people. I dont know if I would call them sitting ducks, necessarily, Bright said, but I would say every one of us is more vulnerable. The unvaccinated are still the most vulnerable by far, especially to more severe outcomes. But even this far into the pandemic, its hard to know exactly why some vaccinated and boosted people have gotten sick while others haventgood pandemic behaviors might come into play, along with luck. Scientists are still investigating the role of other factors, including whether genetics might be protecting the immune systems of people who havent gotten COVID.
Read: Is BA.5 the reinfection wave?
Nevertheless, all of the experts argued that COVID virgins should still try to avoid infection. Above all, they should get up-to-date on vaccination and boosters. Once those layers of protection are in place, they should continue to be prudentespecially in crowded, indoor settingsbut unless they are medically vulnerable, they dont have to take more precautions than anyone else, Kim-Farley said.
The guidance for this group is the same as it is for everybody else largely because immunity by infection is protective, but only to an extent. BA.5, for one, seems to be able to reinfect people who were previously sick, sometimes even those who just a few months ago had an earlier version of Omicron. At this point, an infection from a year ago, let alone two, might not mean much immunologically. People shouldnt rely on prior infection, because it just is not as effective as prior vaccination, Kim-Farley said. And though hybrid immunitywhich results when a person gets sick and is then vaccinated, or vice versais thought to confer a good amount of protection, that kind of assertion may be challenged now that so many reinfections are occurring, the Yale epidemiologist Albert Ko told me.
The ultimate problem with people viewing themselves as sitting ducks is that this is the exact attitude epidemiologists do not want us to have. It can foster a why bother? demeanor, negating all public-health efforts to stop transmission and discouraging personal efforts to protect oneself. In other words, it promotes COVID fatalism, which is appealing because it offers relief from the daily anxiety and behavioral compromises of pandemic life by assuming that an infection is a question of when, not if. This notion can be liberating for those who have never gotten infectedand presumably it is part of the reason so few are left: Many people have already adopted a meh attitude toward COVID, not letting the fear of an infection get in the way of living their lives.
Even this late in the game, you should really try to avoid getting COVID if you can. Having to take precautions can be frustrating after so many months of pandemic life, but getting sick can be extremely unpleasant, even if you are vaccinated and boosted. Theres the risk of long COVID, yes, but those who escape it can still feel terrible for several days, if not weeks, Bright said. These infections dont usually lead to hospitalization or death, but theyre no walk in the park either, especially for the elderly and the immunocompromised. And as COVID continues to mutate, you definitely want to forestall a second infection, or a third down the line. The consequences of repeated infections and their potential to cause long COVID or other health issues are not yet known. And, of course, the tenets of COVID 101 are still true: Even if your infection is mild, you can still spread it to someone who could have it much worse.
The grim reality is that as long as the virus shows no signs of abating, the number of COVID virgins will continue to shrink. Grappling with this reality will be a lot less stressful if we reframe the way we talk about getting COVID. Instead of fretting about the virus as something that could come for you, focus on what to do when it does. Those who are vaccinated and boosted may still be ducks sitting in the crosshairs of infection, but in all likelihood they wont die or get severely ill, especially if they are young and healthy. Thats what we care most about, Ko said. The people who havent gotten sick should remember that they have already wonvaccines, in tandem with the treatments that are now available, mean that its far better to get sick now than it was a year or two ago.
When I told my fianc that he would probably get COVID but should definitely still try not to get COVID, he described the situation as Kafkaesque. Indeed, these are absurd and illogical times. But at the very least, focusing on what is within our control can help us regain a modicum of sense. Short of total isolation, people may not be able to do much to avoid the coronavirus forever, but theres still plenty they can do to escape the worst when it does come for them.
Coronavirus cases are on the rise again, Mohamed Awad Tag Eddin, Advisor to the President of the Republic for Health and Prevention Affairs, said.
The symptoms of the current coronavirus mutant are simple and similar to colds, despite the increase in the rate of infections, Tag Eddin told Al-Hayat Al-Youm program broadcast on the Al-Hayat channel on Thursday evening.
A large part of the severe cases in the world are due to the lack of respirators and medical monitoring, he continued.
Patients must take the necessary treatment and follow the doctors advice in case of infection, Tag Eddin said.
Most cases of infection with the virus and its variants range between mild and moderate at about 90 percent or 95 percent of the total infections, according to Tag Eddin.
Only 5 percent or 8 percent of cases need hospitalization, he explained.
Coronavirus cases are on the rise again, Mohamed Awad Tag Eddin, Advisor to the President of the Republic for Health and Prevention Affairs, said.
The symptoms of the current coronavirus mutant are simple and similar to colds, despite the increase in the rate of infections, Tag Eddin told Al-Hayat Al-Youm program broadcast on the Al-Hayat channel on Thursday evening.
A large part of the severe cases in the world are due to the lack of respirators and medical monitoring, he continued.
Patients must take the necessary treatment and follow the doctors advice in case of infection, Tag Eddin said.
Most cases of infection with the virus and its variants range between mild and moderate at about 90 percent or 95 percent of the total infections, according to Tag Eddin.
Only 5 percent or 8 percent of cases need hospitalization, he explained.
Edited translation from Al-Masry Al-Youm
Coronavirus, Egypt, symptoms, infections, pandemic,
The average number of deaths from the coronavirus is between four and five cases per day, Acting Minister of Health and Population, Khaled Abdel Ghaffar, said in a statement on the official page of the ministry, on Monday, adding that the cases infected with the virus and are isolated do not need more than six days of home isolation before recovering.
He said that 97 percent of the cases of infection is with the new mutant.
The statement said that the coronavirus affects many parts of the body, such as the brain, heart, lungs and muscles, and also affects mental health.
The ministry advised citizens to receive the vaccine to strengthen their immunity and reduce the chance of infection with the virus by registering on the official website of the coronavirus vaccination.
Egypt started giving the fourth booster dose to those who got the three doses without the need for prior reservation to receive the vaccine, he added.
The number of deaths of the virus is stable, according to the statement.
Patient deaths: 1,021,306
Total vaccine doses distributed: 784,110,065
Patients whove received the first dose: 261,204,035
Patients whove received the second dose: 222,950,194
% of population fully vaccinated (both doses, not including boosters): 67.2%
% tied to Omicron variant: 100%
% tied to Other: 0%
The coronavirus SARS-CoV-2 is quite versatile, with a large number of variants and subvariants.The omicron variant alonehas more than 130 sublineages.
In Europe, the omicron subvariantsBA.4 and BA.5 are currentlyon the rise. Why are they spreading so fast, despite the fact that many people have already beenvaccinated?
"New variants are traditionally defined as a new set of mutations that is believed to change how the virus functions. Typically, these variants have increased infection rates and increased disease severity," Krishna Mallela, professor in the department of pharmaceutical sciences at the University of Colorado in theUS, told DW.
Now scientists are beginning to understand why specific mutations cause variants to be more infectious, like omicron, or more deadly, like delta and it comes down to how the coronavirus enters cells, and how our immune system fights it off.
A recent study from the USshowedthat omicron is more infectious because it can better evade our immune system.
After vaccination or a prior infection, antibodies circulate in your body and hunt for viruses. They detect coronavirus via its spike protein, which then signals for the virus to be neutralized.
The study showsthat the mutations in omicron subvariants BA.1 and BA.2 change the structure of the spike protein.
"The mutations are at the spots where antibodies bind to the spike protein. The mutations cause a different binding surface, which is less recognized by the antibodies. This leads to the evasion of antibody protection," Kamal Singh, an immunologist from University of Missouri in theUS,told DW.
Essentially, your immune system is less good at hunting down and destroying omicron virus particles. This evasiveness is what caused the huge rise in infections around the world since omicron was first identified in South Arica in November 2021.
With all the omicron news lately, it's easy to forget the variants that came before like delta. Delta is the most virulent coronavirus variant, leading to more severe symptoms and increased mortality among infected patients. UK statistics show that risk of death with omicron is 67% lower than delta infection.
Research has shownthat delta is particularly deadly because of mutations on the spike protein, protuberances on the surface of the virus. A new US-based study found that two mutations cause increased expression of the spike protein on the delta variant of the virus.
That's important becauseSARS-CoV-2 is like a thief trying to sneak into your house, or rather your cells and it does this via spike proteins.
Its system of breaking into cells is via a protein expressed on the surface of cells in your body, called ACE2. Thisprotein is like a door into your cells. Normally it's closed and requires a key to open it.
SARS-CoV-2 has managed to trick ACE2 into thinking it should be let into your cells. In essence, it's duplicated the keys to your house.
In biological terms, the keys are the spike proteins, which bind to ACE2. Once inside, the virus then replicates and spreads.
Coronavirus enters human cells via its spike proteins
For delta, more spike proteins mean greater ability to enter cells and reproduce, leading to higher quantitiesof coronavirus in the body.
Mallela, the study's lead author,explained how the mutations also affects the immune system's ability to neutralize the virus.
"Our study found deltareducesthe spike protein binding to an important class of antibodies [in the human body]. This causes higher infectivity rates and worse symptoms," he said.
Coronavirus vaccines have been hugely successful, reducing mortality and severe symptoms worldwide. However, new variants are likely to appear in the coming years, and they could be more transmissible and deadly.
Scientists are working hard to be one step ahead, developing new coronavirus vaccines that train the immune system to deal with new variants.
"There are about 220 vaccine candidates in clinical trials around the world," said Mallela."These updated vaccines will allow usto generate an immune response that is better suited to tackle the variants that are in circulation at the time of vaccinating."
And there's reason to be optimistic. For example, UK-based scientists recently showcased a promising new vaccine that better protects against newer coronavirus variants like omicron. The study authors used new nanoparticle technology to create a vaccine that can easily be adapted to target future variants.
Edited by: Carla Bleiker
