Availability of COVID-19 vaccinations has been an issue for many regions of the world effected by the pandemic.1 Barriers to access and concerns over the vaccination continue to enable the development of viral mutations, whereas overall rates of vaccination have continued to stall.1 The need for safe and effective treatment against the various strains of COVID-19 increase, and investigators continue to assess various pharmacologic options. Antivirals and immunologic therapies that had shown efficacy in trials have continued to diminish in efficacy as mutations emerge.2 Other pharmacologic options studied have failed to show any clinical benefit for patients.3 Finding medications that have clinical efficacy continues to be of the highest importance.
Reis and colleagues evaluated the clinical efficacy of fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) and a -1 receptor agonist, at reducing the progression of COVID-19 to hospitalization.4,5 The appeal of medications in these classes include the widespread availability and affordability of these agents, alongside the well-documented safety profile.4 It is hypothesized that fluvoxamine could prove efficacious because of its anti-inflammatory and possible antiviral effects.4,5 A smaller, randomized, placebo-controlled trial found that higher-dosed fluvoxamine reduced hospitalizations and requirements in supplemental oxygen among mildly symptomatic, outpatient adults.6
The TOGETHER trial (NCT04727424) evaluated several repurposed pharmacologic therapies against COVID-19 in a multiarm, 1-to-1, placebo-controlled, double-blinded, randomized clinical trial among 11 sites in Brazil. Patients met criteria for inclusion if they were older than 18 years of age, had a positive SARS-CoV-2 diagnostic test at screening or within the previous 7 days, and had presented to an outpatient care clinic for COVID-19 symptoms, beginning within the previous 7 days. Patients were required to be unvaccinated and have a high-risk condition, including diabetes, hypertension requiring medication, cardiovascular disease, certain respiratory conditions (including asthma and smoking), a body mass index greater than 30 kg/m2, stage 4 or 5 chronic kidney disease, immunosuppression, or current or recent cancer. Patients were excluded if they required hospitalization for COVID-19, had an illness caused by other viral pathogens, had an inability to use SSRIs, or had dyspnea attributed to another acute or chronic lung disease, such as decompensated chronic obstructive pulmonary disease.4
Patients were randomly assigned to start fluvoxamine 100 mg twice a day for 10 days or matching placebo, along with standard-of-care therapies for symptom management in both arms. The primary outcome of interest was a composite end point of medical admission to a hospital setting for COVID-19, defined as an observation period lasting 6 or more hours in the emergency department or any referral for hospitalization within 28 days of randomization. Secondary end points of interest included associated times of disease progression or resolution, safety and tolerability of the trial medication, and clinical monitoring of disease severity.4
A total of 1497 participants were recruited and randomized to fluvoxamine (n = 741) or placebo (n = 756). Patients were randomized, on average, at 3.8 days of symptoms (standard deviation, 1.87). The studys intention-to-treat analysis found a significant reduction in the primary composite end point, attributed to the need for retention in the emergency setting for at least 6 hours (Table). The calculated number needed to treat (NNT) was 20 patients. All other secondary end points were unchanged compared with placebo. Rates of treatment-emergent adverse events did not differ significantly between fluvoxamine and placebo.4
The authors concluded that fluvoxamine may have a place in therapy for the management of outpatient, unvaccinated adults with COVID-19 infection to reduce the progression to hospitalization.4 The authors also call on subsequent research to establish whether these effects are a SSRI-class effect or related to fluvoxamine alone.4 Although fluvoxamine shows some statistical significance in reducing hospital setting visits, it appears this clinical benefit is limited to unvaccinated patients requiring extended stays in the emergency department, not those admitted to the hospital. Rates of hospitalization and death did not differ in the intention-to-treat population, although there was a statistical decrease in death in the per-protocol population.4 Some retrospective reviews have found reduction in mortality, but the benefit appears modest in this analysis.7 A recent commentary on outpatient therapeutics estimated that at a 5% risk of hospitalization, fluvoxamine had the lowest NNT at 80 patients and lowest total drug cost of $1122.8 There are also differences in the prescribing patterns of antidepressants in different parts of the world that would influence the generalizability of this trial.9,10 SSRIs continue to show promise for partial management of COVID-19, and ongoing clinical trials will help identify its place in therapy.11
References
Researchers, looking to identify potential antiviral therapies that are effective against COVID-19, found that the antibiotic clofoctol may be an effective treatment for SARS-CoV-2 infections in mice.
Study in mice suggests Clofoctol inhibits SARS-CoV-2 replication and reduces lung pathology.
Repurposed drugs often have a speedier path to clinical use because they have already been shown to be safe in people. A research study that was published on May 19th in the open access journal PLOS Pathogens by Sandrine Belouzard and Jean Dubuisson at Pasteur Institute, Lille, France, and colleagues suggests clofoctol may be an effective treatment for SARS-CoV-2 infections in mice.
While COVID-19 vaccines reduce hospitalizations and death, they do not control virus transmission, and affordable, effective therapies are needed. Previous attempts to repurpose medicines to treat COVID-19 patients have been unsuccessful thus far. In order to identify potential antiviral therapies that are effective against COVID-19, the scientists accessed the Apteeus drug library, a collection of 1,942 approved drugs to identify molecules that exhibit antiviral activity against SARS-CoV-2. The authors selected clofoctol based on its antiviral potency. They tested their hypothesis by measuring clofoctols effects in SARS-CoV-2-infected mice.
Clofoctol was identified as a potential antiviral against SARS-CoV-2 following a cell-based phenotypic screening of approximately 2000 drug compounds that have been used or are still used in the clinics. After in vitro validation of the antiviral activity of clofoctol, this compound was confirmed to decrease viral load and inflammation in a humanized mouse model of COVID-19. Credit: Sandrine Belouzard (CC-BY 4.0)
The researchers found that transgenic mice treated with clofoctol had a decreased viral load, reduced inflammatory gene expression, and lowered pulmonary pathology. Future studies are needed to further understand the drugs therapeutic potential in SARS-CoV-2 patients as the study was limited by the physiological differences between humans and mice. Additionally, the mice were euthanized only two days after treatment, so longer-term effects remain unknown.
According to the authors, The antiviral and anti-inflammatory properties of clofoctol, associated with its safety profile and unique pharmacokinetics make a strong case for proposing clofoctol as an affordable therapeutic candidate for the treatment of COVID-19 patients. Finally, the relatively low cost of this drug suggests that it is a potential clinical option for treatment of COVID-19 patients in resource-poor settings.
Antivirals targeting SARS-CoV-2 are sorely needed, adds Dubuisson. In this study, we screened a library of drug compounds and identified clofoctol as an antiviral against SARS-CoV-2. We further demonstrated that, in vivo, this compound reduces inflammatory gene expression and lowers pulmonary pathology and decreases viral load.
Reference: Clofoctol inhibits SARS-CoV-2 replication and reduces lung pathology in mice by Sandrine Belouzard, Arnaud Machelart, Valentin Sencio, Thibaut Vausselin, Eik Hoffmann, Nathalie Deboosere, Yves Rouill, Lowiese Desmarets, Karin Sron, Adeline Danneels, Cyril Robil, Loic Belloy, Camille Moreau, Catherine Piveteau, Alexandre Biela, Alexandre Vandeputte, Sverine Heumel, Lucie Deruyter, Julie Dumont, Florence Leroux, Ilka Engelmann, Enagnon Kazali Alidjinou, Didier Hober, Priscille Brodin, Terence Beghyn, Franois Trottein, Benoit Deprez and Jean Dubuisson, 19 May 2022, PLOS Pathogens.DOI: 10.1371/journal.ppat.1010498
Funding: This work was supported by the Institut Pasteur de Lille (to JeD and BD), the Fondation pour la Recherche Mdicale (FRM to JeD) and the Agence Nationale de la Recherche (ANR) (Project FRM_ANR Flash 20 ANTICOV to JeD), the Centre National de la Recherche Scientifique (CNRS: COVID and ViroCrib programs to JeD) and the I-SITE ULNE Foundation (I-Site_Covid20_ANTI-SARS2 to JeD) and the Conseil Rgional Hauts-de-France (THERAPIDE grant N20005467 to BD). We also received sponsor support from LVMH (to BD), fondation Rotary (to BD), Vinted (to BD), Crdit Mutuel Nord Europe (to BD), Entreprises et Cits (to BD), AG2R (to BD), DSD Systme (to BD), M comme Mutuelle (to BD), Protecthoms (to BD), RBL Plastiques (to BD), Saverglass (to BD), Brasserie 3 Monts (to BD), Coron Art (to BD). EH received support from the I-SITE ULNE Foundation (ERC Generator Grant). The platform used in this work was supported by the European Union (ERC-STG INTRACELLTB grant 260901), the ANR (ANR-10-EQPX-04-01), the Fonds Europen de Dveloppement Rgional (Feder) (12001407 [D-AL] EquipEx ImagInEx BioMed), CPER-CTRL (Centre Transdisciplinaire de Recherche sur la Longvit) and the Rgion Hauts-de-France (convention 12000080). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Patients being treated for acute myeloid leukemia (AML) who are diagnosed with COVID-19 may be best served by chemotherapy delay until after COVID-19 has run its course.
Patients undergoing treatment for acute myeloid leukemia (AML) are severely immunocompromised due to both their disease and the intensive chemotherapy regimens typically used to treat AML. This puts them at increased risk of infection, including during seasonal epidemics and throughout the COVID-19 pandemic.
A study published in Haematologica used data from the European Hematology Association (EHA) EPICOVIDEHA survey to characterize the clinical features of COVID-19 in patients with AML and long-term outcomes.
COVID-19 is already known to present severely in AML patients, with estimated mortality higher than 40% in this population before vaccines were available. However, there has been a lack of studies on large cohorts with long-term follow-ups, and there are no clinical guidelines for optimal management of COVID-19 and AML concurrently.
A total of 388 AML patients with a concurrent COVID-19 diagnosis were identified in the registry and included in the study. Of those patients, 196 patients (50.5%) had controlled AML, while 192 (49.5 %) had active AML. The majority of patients (64.6%) were either currently on intensive treatment or had received intensive chemotherapy or transplantation in the 3 months before COVID-19 diagnosis.
As far as treatment management, 174 patients had their chemotherapeutic schedules modified due to COVID-19 diagnosis, 106 patients permanently discontinued treatment, and 68 patients had delayed treatment due to COVID-19 that was resumed after a median of 1 month post-COVID-19 diagnosis.
A total of 82 patients (21.1%) had critical COVID-19, 160 (41.2%) were classified as severe, 69 (17.9%) had mild COVID-19, and the remaining 19.8% were asymptomatic. Overall, 293 patients (75.5%) were hospitalized and 82 (21.1%) were admitted to an intensive care unit. At a median 325-day follow-up, 180 patients (46.4%) had died, with 78 deaths (43.3%) attributed primarily to COVID-19. Forty-seven deaths (26.1%) were attributed to AML, and 48 deaths (26.7%) were attributed to a combination of COVID-19 and AML.
Patients whose chemotherapy was delayed had a lower overall mortality rate than patients whose chemotherapy was not delayed (18.4% and 37.5%, respectively). Treatment discontinuation was also associated with higher mortality rates, as was age and having active AML.
The data presented in our manuscript confirm that AML patients frequently have a severe clinical presentation of COVID-19, mainly with respiratory symptoms, and a high rate of ICU admission, even in patients with low-risk AML, study authors wrote.
Of the treatment approached for concurrent AML and COVID-19, delaying treatment was associated with the lowest mortality rate when compared with therapy discontinuation or no delay of AML treatment. This is in line with findings from a univariable analysis within another study.
Despite study limitations, including a lack of information on COVID-19 vaccinated patients and patient selection bias, considering patients with the ability to delay treatment may have less severe AML.
Our study shows that COVID-19 in AML patients poses a serious challenge, as it adds a layer of complication which can lead to modified therapeutic algorithms, the authors concluded. The mortality rate in this patient group was very high, even when the significant reduction over the pandemic course was considered. According to our results, the best approach to improve the survival of AML patients with COVID-19 seems to delay AML treatment, whenever possible.
Reference
Marchesi F, Salmanton-Garca J, Emarah Z, et al. COVID-19 in adult acute myeloid leukemia patients: a long-term follow-up study from the European Hematology Association survey (EPICOVIDEHA).Haematologica. Published online May 12, 2022. doi:10.3324/haematol.2022.280847
BALTIMORE (WJZ) Baltimore City, Baltimore County, Howard County, and Anne Arundel County are all areas of high community transmission of COVID-19, according to the Centers for Disease Control and Prevention.
New data indicates there are 283 cases per 100,000 people in Baltimore over the last seven days, and the hospitalizations per case rate grew to 11.8 admissions per 100,000 cases.
Howard County Health Department Medical Director Dr. Kelly Russo recommends wearing a mask indoors in public, staying up to date with vaccines, getting tested if you have symptoms and if you are at high risk for severe illness, considering additional precautions, and talking to your doctor.
Despite the higher transmission rate, she said Baltimore County is not reinstating a mask mandate at this time.
We have not been talking about a mask mandate. You know, were in a very different place now, Russo said. Right now, what we are seeing is, yes, there are a lot of cases but the disease seems to be very mild. Fewer hospitalizations. Fewer deaths. We have widely available treatments now which was not true in the past.
Russo also said that another reason why they are not considering a mask mandate is because of the high rate of vaccination in the county. Data shows that 83.6% of county residents are currently vaccinated, according to the countys COVID-19 dashboard.
Baltimore Mayor Brandon Scott says he will consult with City Health Commissioner Dr. Letitia Dzirasa and the citys hospital partners about whether or not a mandate is needed.
Dr. Dzirasa let me know late last night about that, Scott said. Her and I will be meeting and discussing what plan of action we will be taking.
Russo says they might anticipate seeing additional cases after the Memorial Day holiday weekend.
(The Conversation) COVID-19 case numbers are rising again in the U.S. includingamong children. In mid-May 2022, the Food and Drug Administration authorized a booster shot of the COVID-19 vaccine forU.S. children ages 5 to 11, and the Centers for Disease Control and Prevention followed byrecommending a booster shotfor this age group.
Naturally, many parents are wondering about the importance and safety of a booster shot for their school-age children.Debbie-Ann Shirley, apediatric infectious disease specialistat the University of Virginia, answers some common questions about COVID-19 and booster shots in kids that she hears in her practice and explains the research behind why booster shots are recommended for children ages 5 to 11.
COVID-19 is generally milder in children than adults, but severe disease can occur. As of late May 2022, more than 15,000 children ages 5 to 11have been hospitalizedwith COVID-19 and180 childrenhave died. During the height of the recent winter surge ofthe highly transmissible omicron variant, 87% of the children in the 5-to-11 age groupwho became hospitalized with COVID-19 were unvaccinated.
In addition, the rare but serious condition that can follow in the weeks after COVID-19 infection, known asMultisystem Inflammatory Syndrome in Children, or MIS-C, most commonly occurs among children ages 5 to 11. Over3,800 cases of MIS-C have been reportedin that 5-to-11 age group, and93% of the childrenwho developed this complication were unvaccinated.
For some vaccines including those for COVID-19 effectiveness wanes over time.Booster shotshelp to bolster the immune response. Severalchildhood vaccines, such as the tetanus and diphtheria vaccines, require booster shots.
COVID-19 boosters have been shown to improve waning protectionin adolescentsandadults. Side effects are similar to those reported with the initial series. The risk of myocarditis, or heart inflammation a rare side effect that can occur following COVID-19 vaccination seems to be less after a third dose thanafter the second.
When administered to children 5 to 11 years old, the Pfizer-BioNTech vaccine generated levels of antibody response similar to that in 16-to-25-year-olds ina clinical trial, which was the basis for theFDAs initial authorization of the shotsin October 2021. Butstudies after the shots were authorizedfound thatvaccine effectiveness rapidly wanedin the 5-to-11 age group during the omicron surge. Despite that, the shots continued to beprotective against severe disease and hospitalization.
Vaccination has alsobeen shown to be be highly protectiveagainst Multisystem Inflammatory Syndrome in Children.How to talk to kids about getting vaccinated.
In a clinical trial, researchers tested the Pfizer vaccine in children 5 to 11 using a 10-microgram booster dose, which is the same dose children received for the primary series and is one-third the dose used for adolescents and adults. When tested among 401 children,no new safety concerns arose, and in the smaller subset of children in which the immune response was tested, the third shotsignificantly increased antibody responses, including against the omicron variant. Hence, a third dose seems beneficial for boosting immunity in this age group, similar to older age groups.
The booster dose can be givenfive months or moreafter the second shot. But as of late May 2022, fewer thanone-thirdof children ages 5 to 11 had received two shots, meaning that onlyabout 8 millionschool-age children were eligible to start receiving the booster. This could prove an important layer of protection for them andhelp limit disruptionson schooling and summer activities, particularly asmask mandates have gone by the wayside.
Children withweakened immune systemswho were at first authorized to receive three initial doses of COVID-19 vaccine may now also receive a booster shot or a fourth dose as soon as three monthsafter their third dose.
As of late May 2022, more than18.5 milliondoses of the COVID-19 vaccine had been administered to children in the 5-to-11 age group. MostCOVID-19 vaccine side effects such as pain at the injection site have been mild and short-lived in children. Fatigue, headache and muscle aches are other common side effects.
Reports suggest that most cases of myocarditis that follow vaccination typicallyimprove quickly with medicine and rest. Rates of myocarditishave been lowerin children ages 5 to 11 than in teens. In any age group, myocarditis is more likely to occurafter infectionthan vaccination.
For parents of kids ages 6 months to 5 years, COVID-19 vaccines are also finally within sight. On May 23, 2022, Pfizerreleased new data for this age group, stating that three shots generated strong antibody responses, were well tolerated with no new safety concerns and, based on preliminary data, the series was 80% effective at preventing COVID-19 infection. In late April 2022,Modernareleased similar data showing that two doses of its vaccine stimulated good antibody responses and were tolerated well by kids under age 6.
The FDA isset to meet in June 2022to discuss new low-dose formulations of theModernaandPfizervaccines for this group.
If it is authorized by the FDA, the CDC will then provide recommendations on its use for the more than 20 million children ages 6 months to 5 years in the U.S.
COVID-19 cases have crept up once again in the Lehigh Valley, and the cause this time is the BA.2.12.1 variant.
Dr. Alex Benjamin, Lehigh Valley Health Networks chief infection control and prevention officer, said BA.2.12.1 has been in the region for only weeks, but it didnt take long for it to gain a foothold.
The new variant is a subvariant of the BA.2 variant, which is itself a subvariant of the omicron strain of the coronavirus. Continuing the trend set by previous variants, BA.2.12.1 is the most infectious yet.
Omicron and its variants have been noted for being less likely to result in serious illness and BA.2.12.1 continues this trend, with some of the most common early symptoms including scratchy or sore throat, sneezing or runny nose, easily confused with allergies.
Benjamin said because of this, it is important people dont brush off what might otherwise seem like allergies or a sinus infection, even though the Lehigh Valley is one of the worst places to live in the U.S. for allergy sufferers and those with asthma, according to the annual Asthma Capitals report, published by the nonprofit Asthma and Allergy Foundation of America.
I think its been really confusing because the air quality has been so bad, Benjamin said. A lot of people attributed their symptoms to allergies and some people did not think to test.
BA.2.12.1 now accounts for the majority of cases nationally and locally, about 60%, and is leading a new surge in cases. The Pennsylvania Department of Health, which had started updating its COVID-19 dashboard on a weekly basis while cases were low, recently resumed updating it daily. New York City is already well into its fifth surge of the pandemic and officials put the city under high COVID-19 alert, according to the New York Times.
There were 1,739 cases reported in Lehigh and Northampton counties in the past seven days. There were an average of 248 cases per day in that time period, down 6.3% from the previous week, but up 130% from where they were.
Hospitalizations are also up compared to where they were a month or so ago. Lehigh Valley totals were 111 COVID-19 positive patients on Thursday, with all seven ICU patients on ventilators. Local hospitalizations are up 7.8% from last week and up 145% from 30 days ago. Lehigh Valley Health Network had 97 COVID-19 patients hospitalized network-wide on Monday when in early April hospitalizations were in the low 20s.
Robert Shipp, vice president for population health and clinical affairs with the Hospital & Healthsystem Association of Pennsylvania, and a practicing nurse, said on a slightly more positive note, hospitals are seeing proportionally fewer people who need intensive care after being hospitalized for COVID-19.
Thats a good sign, but there are still twice as many people in the hospital and in the ICU as there were as close as a month ago, Shipp said.
He said other good news is that schools will let out soon, creating fewer opportunities for the disease to spread and with warmer weather coming.
Unlike the last COVID-19 surge, at-home tests are not hard to find and getting a lab test doesnt require waiting in long lines or ending up on a waiting list. President Joe Bidens administration last week announced it would allow Americans to order a third round of free COVID-19 tests through the U.S. Postal Service.
And fortunately, there is no evidence that this variant is more likely to evade tests. But Benjamin said it is possible to test too early in a COVID-19 infection, resulting in a false negative. He said during the earliest stages of infection there may not be a large enough concentration of virus throughout the body for tests to detect anything.
The CDC guideline is to test as soon as you find out that youre exposed and for some people, they find out so quickly that they may be testing earlier than the test can capture any virus in your system, Benjamin said. It may take a couple of days for you to have enough virus in your system for a test to turn positive.
He said this is why some people may test negative early on, only to get sick a few days later, retest themselves and find out they actually did have COVID-19.
But testing is as important as ever, especially since infections by BA.2.12.1 are more likely to result in symptoms similar to those associated with seasonal allergies or the common cold.
Benjamin said if test results are negative, he suggests those results be treated with a good deal of suspicion. The CDC recommends retesting five days after the first test, but Benjamin said if even mild symptoms develop before then, it might be a good idea to test sooner.
Besides getting tested when you arent feeling well or have reason to believe you were exposed to COVID-19, experts are also suggesting people start taking personal actions to reduce the risk of catching COVID-19. This includes getting caught up on shots and choosing to mask while indoors.
Though a vaccine still hasnt been approved for the youngest children, as of last week boosters were authorized for use on children ages 5 to 11 by the U.S. Food and Drug Administration.
Morning Call reporter Leif Greiss can be reached at 610-679-4028 or lgreiss@mcall.com.
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Taiwans worst Covid outbreak has left the islands insurers bracing for more than $1 billion in claims that the financial regulator is urging them to honor.
The head of the Financial Supervisory Commission, Huang Tien-mu, has ordered insurers to pay out on valid Covid-related insurance policies after they faced criticism from lawmakers for dismissing claims, canceling policies and delaying payouts.
Insurers are looking to limit their losses on policies after underestimating the extent of the disease. There are currently more than 6.3 million still-active Covid-related policies and another million waiting for approval, according to the FSC. This year, insurers have already paid out more to customers -- NT$2.6 billion ($89 million) -- than the NT$2.1 billion in revenue they have received from premiums.
And with only around 2% of policies subject to claims so far and Taiwans outbreak showing no sign of abating, insurers are facing a wave of further claims in June and July. Speaking to lawmakers last Monday, Huang said payouts will likely be higher than the NT$41 billion estimate mentioned by lawmakers.
While that is just a tiny fraction of the NT$2 trillion in net assets held by Taiwans insurance industry, the majority of those are held by the large life insurers. The potential claims represent around 25% of the assets held by property insurance companies, which were among the most active in selling Covid policies.
Risk Models
Property insurers, which focus primarily on car protection, have struggled to find growth in recent years and saw Covid as a great opportunity, according to Andy Chang, director of Taiwan Ratings Corp. When working out their risk models, many miscalculated the potential number of cases by a factor of almost 100. They also didnt adequately estimate the necessary capital buffer.
They shouldnt have just said, how much are our competitors selling? We want to sell that much too, Chang said in a phone interview.
Even Taiwans largest insurers are likely to take a hit. Claims at Fubon Life Insurance Co. and Cathay Life Insurance Co. could reach NT$5 billion, equivalent to about 2% of their net income this year, Bloomberg Intelligence analyst Steven Lam wrote in a May 13 note.
The generosity of the policies insurers sold is a major part of the problem. Since the beginning of the pandemic, many companies have offered policies protecting customers against negative health impacts of Covid and the associated costs.
Quarantine insurance is among the most popular. For as little as NT$666 a year, the insurers guarantee to pay out NT$50,000 if the customer is required by the government to isolate. If the client later tests positive for Covid, they can get another NT$50,000.
Blow Up
Until recently, Taiwan had managed to keep the pandemic broadly under control, making Covid-related policies a solid source of revenue. But cases began surging in late April as the omicron variant breached the islands border controls.
Taiwan reported more than 76,000 local cases and a record-high 145 deaths on Sunday, according to data from the Centers for Disease Control. The health minister has said around 15% of the population -- about 3.5 million people -- could end up getting Covid.
Siang Lin, a financial industry professional working in Taiwan, bought a Covid insurance policy that he renewed once it expired.
I thought, sooner or later its going to blow up here, he said. Were all going to end up getting it -- thats why I extended my policy.
Lin was right. He got Covid in early May and is currently awaiting his NT$50,000 payout.
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ITHACA, N.Y.Its no secret that Ithaca is a tourism hot spot, especially during the summer when the sun is shining, the waterfalls are rushing and everything is in bloom.
With the Finger Lakes towns and their respective gorges making many of the what to do in New York State and best summer activities lists, Ithaca draws thousands of visitors every year, starting with the bang of graduation weekend and this year, the return of the Ithaca Festival.
But, like the rest of the world, Ithaca saw far fewer tourists during the summer of 2020 due to COVID-19 as people stayed home and didnt travel internationally or even domestically for much of the year, particularly during the normally busy spring and summer months.
Gary Ferguson of the Downtown Ithaca Alliance (DIA) said that the organization receives constant feedback from downtown retail and restaurant businesses and that it had quickly become apparent that tourism had regained its speed after the summer of 2020 The bottom line is weve seen a pretty strong bounce back in visitor traffic from our peak of the pandemic.
In its Strategic Tourism Plan for 2021 through 2027, the Tompkins County Tourism Department highlighted goals and focus topics with the purpose of increasing the amount of time visitors spend during trips to the area. Some of the more prominent goals listed are to increase the average trip length to three to four nights; increase average visitor spending by 5% (from $366 to $384); add year-round indoor and outdoor programming; and increase collaboration between local tourism partners and businesses.
Room tax, of particular note as it is the main funding method for tourism programs locally, has a 5% rate charged with every hotel room and Airbnb booked. In the first quarter of 2022, $383,989 was collected more than twice what the same timeframe in 2021 yielded ($167,311). Brett Bossard, chair of the Strategic Tourism Planning Board said that 2022s room tax thus far wasnt expected to that extent, but that it shows a volume increase in tourism returning.
We benefit from a lot of different factors being where we are located, he said. Were a relatively easy drive from a number of large metropolitan areas, [] and up until very recently, other forms of travel, like air travel, were not as appealing because of the health concerns.
Projected room tax for the entirety of 2022 is $2.4 million, even with occupancy being assumed in the budget at 20% of what it was in 2019. In 2019, Tompkins County collected $2.9 million in room tax, dropping to $1.2 million for the entire 2020 year.
In its annual report from 2020, Visit Ithaca found that visitors spent $229.8 million in 2019. Similarly, in 2020, $230 million was spent, though the total for 2021 is not yet reported.
A 2019 visitor profile report from Visit Ithaca and the Tompkins County tourism found that 76% of visitors are repeaters, primarily traveling as a couple or with children. Seventy-eight percent stayed overnight with 22% visiting for a day trip, and the overnight visitors stayed on average between two and three nights, mostly at hotels or inns.
Of the visitors surveyed in the 2019 report, the Commons, Ithaca Farmers Market, Buttermilk Falls, Robert H. Treman and Taughannock Falls state parks were among the most visited locations in town.
According to the Downtown Ithaca Alliances pedestrian counters for foot traffic, the Commons saw 1.6 million visits between May 2019 and 2020 keep in mind that this timeframe is skewed as New York went on pause and shut down non-essential businesses from March 22 to May 26, 2020 991.6 thousand visits between May 2020 and 2021, and the beginning of recovery between May 2021 and 2022 with 1.637 million visits. During those timeframes, visitors to the Commons came back three to four times on average, so while that data does count overall visits, unique visitors are not distinguished.
Trips to the area (particularly the state parks listed above) help paint another partial picture of the number of visitors Ithaca sees. The 2020 data sticks out as a slightly abnormal trend likely because of individuals and families seeking things to do outdoors during that COVID summer as they were considered the safest activities.
As a baseline, in 2019, Buttermilk Falls saw 326,156, Treman saw 369,121 and Taughannock Falls saw 577,391 visitors. In 2020 (keep in mind the outdoor activities sentence from the above paragraph), Buttermilk saw 441,386, Treman had 444,124 and Taughannock had 606,202 visitors, according to the New York State parks website.
Last year, 2021, Buttermilk and Treman both had numbers similar to 2019: 378,350, and 358,536, respectively, but Taughannock saw a large bump from its 2019 number and an increase still from 2020 with 618,162 visitors throughout the year.
Visit Ithaca, one of the tourism bureaus in town, also reported that website traffic numbers in 2020 were down 14% for the year but tracked almost identically for the months of July through October, even with case numbers fluctuating seeming to show that interest was there, even if actual visitation remained down.
If you arefully vaccinated, you may be excited about gathering with family and friends again. You might even be planning a winter vacation. But there are still nagging questions about how long protection from thecoronavirus vaccineswill last. For instance, will your shot wear off gradually or suddenly? Will you need abooster? "We can only say that a vaccine is protective as long as we are measuring it," says Yale Medicine infectious diseases specialistJaimie Meyer, MD, MS.Read on to find out moreand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.
Vaccine longevity became a hot topic in August, when some studies began to suggest vaccine effectiveness was waning, although data also showed the vaccines were still highly effective against hospitalization. Inone studyreported by the Centers for Disease Control and Prevention (CDC), data from the state of New York showed vaccine effectiveness dropping from 91.8 to 75% against infection.
Data about the vaccines waning contributed to a decision in the fall of 2021 to make booster shots availablethe CDC says all adults 18 or older should get a booster six months after completing their primary vaccination series if they started with Pfizer-BioNTech or Moderna, or two months after getting the J&J single-shot vaccine Teenagers ages 16 or 17 may also get the Pfizer-BioNTech booster, which the FDA authorized for that age group in December 2021. A mix-and-match policy allows people to take any of the three COVID-19 vaccines available in the U.S. as a booster shot, regardless of which vaccine a person had for their primary vaccination.
Pfizer and Moderna have been monitoring immunity in people who were given their vaccines in the initial clinical trialsboth companies had reported strong overall efficacy at the six-month mark. (Pfizer reported on its efficacy in apreprintthat has not been reviewed by outside scientists; Moderna released acompany statement.)
One thing researchers are monitoring in vaccine recipients is levels of antibodies, which are proteins produced by the body's immune system when it detects harmful substances, and that are easily measured from blood samples. "Antibodies are a really good marker for protection against infection, so we will be monitoring those levels for as long as we can measure them," saysAkiko Iwasaki, PhD, a professor of immunobiology at Yale School of Medicine.
A report inThe New England Journal of Medicine(NEJM) in April showed that 33 participants who had received the Moderna vaccine during the Phase I trial had a gradual decline in antibody protectionand, based on the slope, Iwasaki says, that is hopeful news. "If antibodies are going down very quickly, you would expect that to last for a short time." The slow decline raises hopes that the mRNA vaccines will be protective for at least a year, if not longer, she says. (It should be noted that the trial occurred prior to when Delta became the predominant virus variant in the U.S. last summer; as of mid-December 2021,Omicronis the predominant virus in the U.S.)
Another measure is T cells, which scientists are still studying for their ability to kill virus-infected cells in the context of COVID-19, and which may also provide important protection. T cells are more difficult to measure, Iwasaki says. But they may be importantlast year,a study inNatureshowed that people who were infected with severe acute respiratory syndrome (SARS), a different coronavirus outbreak that killed almost 800 people in 2003, maintained T-cell immunity 17 years after they recovered.
Still another way to predict how long protection might last is by looking at natural immunity, says Dr. Meyer. This means studying immunity people developed after infection with COVID-19. "We know for at least the first few months after symptomatic diseaseand even longerthat people are unlikely to become reinfected," she says.
But it's important to know that immunity induced by the mRNA vaccines is stronger and more reliable than natural immunity, says Iwasaki. That's because levels of natural immunity tend to differ from person to person. "Vaccines normalize the response to a very high level, where it uniformly uplifts everybody," she says. "If you are starting with the high level, even if you start to decline from that level, it will take much longer before you need a booster."
This is a reason why the CDC recommends vaccinations for people who have had a COVID-19 infection as well as for those who have not.
No one knows for sure whether one vaccine will last longer than another. Instead, one question to ask might be whether Pfizer and Moderna's mRNA vaccines, which had an especially robust response, also have potential to be the longest lasting, Dr. Meyer says.
The two mRNA vaccines use a relatively new technology that delivers a tiny piece of genetic code from the SARS CoV-2 virus into the body to provide instructions for making copies of spike proteins that will stimulate an immune response. The Johnson & Johnson vaccine takes a more traditional approach that involves an inactive adenovirus (a common virus that can cause colds and other illnesses when it's active).
"The mRNA vaccines are a novel tool that hasn't been widely rolled out with any other virus, and so far in clinical trials they have had a much more robust immune response," Dr. Meyer says. Whatever the answer to the question of which will last the longest, the Pfizer and Moderna mRNA vaccines work similarly, so it seems likely that they will have a similar impact on immunity, she says.
However, while both vaccines still are considered highly effective, some recent studies showed Moderna to be more protective. A study published inTheNew England Journal of Medicinefound the Moderna vaccine to be 96.3% effective in preventing symptomatic illness in health care workers compared to 88.8% for Pfizer. Another study, from the CDC, found Moderna's effectiveness against hospitalization held steady over a four-month period, while Pfizer's fell from 91% to 77%. But scientists say more data is needed to fully understand the differences between the two vaccines.
"It's also possible that the length of immunity is somewhat dependent on the patient," Dr. Meyer adds. While more research is needed, there could be variations in immune responses from person to person based on such factors as age, medical conditions, and medications they may be taking. Overall, though, the mRNA vaccines appear to be so effective that they level the playing field in terms of achieving protection from infection, says Dr. Meyer.
It's critical that as many people as possible get their primary vaccination shots, Dr. Meyer says. In December 2021, the CDC endorsed a recommendation to choose the Pfizer-BioNTech or Moderna vaccines, in response to concerns over rare blood clots associated with Johnson & Johnson's shot.6254a4d1642c605c54bf1cab17d50f1e
"The good news is that Pfizer and Moderna made their mRNA vaccines easy to update," Dr. Meyer says. "It just has to be tweaked a little bit, like having a computer code that needs a couple of minor edits. It's relatively easy to build."It's also important to follow the CDC's recommendations onbooster shots.
"The hope is that the case rate will go down and more people will be less likely to be exposed." That advice is especially important with the Delta and Omicron variants, which have proven to be more contagious than previous variants, prompting the CDC to issuestricter guidelinescalling for everyonevaccinated or nottowear masksindoors in areas of high transmission.
Even if Delta and Omicron go away, "I think those preventive measures will become even more important as the year passes, because potentially your immunity is going to wane over time," Dr. Meyer says.
Meanwhile, people need consider the amount of virus activity in their area, and what they need to do to protect the immunocompromised, and children and others who can't get the vaccine. "I tell my family, 'It's great that you're vaccinated. That's wonderful, and you will have a lot more freedom and flexibility. But even the vaccines don't have 100% guarantees, so whatever you do, you want to keep weighing the risks.'" she says. And to protect your life and the lives of others, don't visit any of these 35 Places You're Most Likely to Catch COVID.
This article has been published in Yale Medcine.
By this time, we already know about COVID and its long term effects. We also know about the various common signs and symptoms COVID; however there are certain symptoms which are so unusual that it is beyond anyone's knowledge to associate it with COVID.
These unusual symptoms are an indication that COVID is not just a respiratory illness, it is far more worse than that. In the aftermath of a coronavirus attack, 10-20% of the patients (as per the estimates of the World Health Organisation) are likely to develop long term complications which usually start 2-3 months after the infection and mostly linger for a few months.
As per a research study, "Long COVID is a term used to describe presence of various symptoms, even weeks or months after acquiring SARS-CoV-2 infection irrespective of the viral status. It is also called post-COVID syndrome. It can be continuous or relapsing and remitting in nature. There can be the persistence of one or more symptoms of acute COVID, or appearance of new symptoms."
The super effective way to deal with long COVID conditions is to understand the symptoms, both common and uncommon ones.
