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March 20, 2024
2 min read
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Among patients who died of acute respiratory distress syndrome associated with SARS-CoV-2, the virus that causes COVID-19, heart tissues were damaged even when they were not directly affected by the virus, researchers reported.
For the NHLBI-funded study, the researchers investigated whether COVID-19-related heart damage was caused by direct action on the heart from SARS-CoV-2 or resulted from systemic inflammation caused by the immune systems response to SARS-CoV-2 infection among patients who died of acute respiratory distress syndrome (ARDS) as a result of COVID-19.
What this study shows is that after a COVID infection, the immune system can inflict remote damage on other organs by triggering serious inflammation throughout the body and this is in addition to damage the virus itself has directly inflicted on the lung tissue, Matthias Nahrendorf, MD, PhD, professor of radiology at Harvard Medical School, said in a press release. These findings can also be applied more generally, as our results suggest that any severe infection can send shockwaves through the whole body.
Nahrendorf and colleagues compared autopsy results, focusing on cardiac macrophages, of 21 people who died of ARDS as a result of COVID-19 and 33 people who died of other causes. They also conducted a study in mice determine what happens to cardiac macrophages after SARS-CoV-2 infection or lung injury not related to SARS-CoV-2.
Compared with people who died of other causes, in people who died of ARDS as a result of COVID-19, there were higher counts of total cardiac macrophages and a greater proportion of CCR2+ macrophages, which promote inflammation, Nahrendorf and colleagues found.
In mice, both infection with SARS-CoV-2 and lung injury not related to SARS-CoV-2 were associated with remodeling of cardiac resident macrophages and expansion of CCR2+ macrophages. In mice with lung injury not related to SARS-CoV-2, treatment with a tumor necrosis factor-alpha-inhibiting antibody reduced cardiac monocytes and CCR2+ macrophages and preserved cardiac function, and among those mice, those with preexisting HF were more likely to die, according to the researchers.
Our data suggest that viral ARDS promotes cardiac inflammation by expanding the CCR2+ macrophage subset and that the associated cardiac phenotypes ... can be elicited by activating the host immune system even without viral presence in the heart, the researchers wrote.
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Disclosures: Nahendorf reports receiving funds or material research support from Alnylam, Biotronik, CSL Behring, GlycoMimetics, GlaxoSmithKline, Medtronic, Novartis and Pfizer and consultant fees from Biogen, Eli Lilly, Gimv, IFM Therapeutics, Molecular Imaging, Sigilon and Verseau Therapeutics. The other authors report no relevant financial disclosures.
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Executive summary
This case study describes the experiences of those working in Blackpool Council and its public health team in supporting testing and vaccination among vulnerable groups, as well as some of the local responses implemented to overcome challenges. It also includes the perspectives of the programme director of a third-sector organisation and 3 Blackpool community champions. The case study has been compiled from a series of in-depth interviews. While there may be themes common to other local authorities, findings may not be generalisable: each local area has its own blend of challenges.
The following themes emerged from our in-depth interviews.
According to interviewees, the high rates of transience and temporary accommodation have constituted important barriers to the effective rollout of the testing and vaccination programmes. They have made it difficult to locate residents in temporary housing, efficiently run the local test and trace system, and create a sense of community cohesion.
Houses of multiple occupation (HMOs) have been described as particularly problematic due to the high number of unregistered HMOs and the severe level of deprivation commonly found among occupants.
Widespread apathy and disengagement among disadvantaged groups, and more particularly within those living in HMOs, was a prominent theme in the interviews. Members of the public health team and Community Champions reported that many Blackpool residents were withdrawn from society and completely disengaged from public health initiatives.
Interviewees reported that a lack of awareness or understanding as one of the barriers to increasing uptake of asymptomatic testing in the community. Some residents were reportedly unclear about the purpose of taking regular lateral flow tests (LFTs), and/or where to collect LFTs.
Blackpool public health team reported having worked closely with local employers to promote asymptomatic testing among employees. According to interview participants, they had found the workplace to be an effective setting to engage migrant workers and younger or disengaged groups. However, the local authority had faced some reluctance from large private organisations concerned about identifying positive cases and losing part of their workforce as a result.
The close collaboration between the public health team and Voluntary Community and Faith Sector (VCFS) organisations was described as having been an essential feature of the response in Blackpool to the pandemic. All interviewees emphasised the key role played by the voluntary community and faith sector in delivering the national testing and vaccination schemes. They reported that the 211,690 grant received in January 2021, as part of the Community Champions Programme, had contributed to supporting vulnerable groups with a variety of needs related to testing and self-isolation.
Interviewees emphasised the importance of a localised approach to supporting testing and vaccination in Blackpool. A localised approach involves using local assets including VCFS, police, fire and rescue teams and other organisations in the community; offering pragmatic support to HMO tenants through the local network; and operating a local test and trace system that complements the national scheme.
According to interview data, the local authoritys efforts towards creating tailored communication was driven by 2 principles: simplifying messaging and emphasising the role of local government as a support provider. It was reported that this tailored approach led to many residents being more receptive towards information on coronavirus (COVID-19) testing.
Blackpool is a large town and seaside resort in Lancashire. It has a high level of deprivation, an older population and a high level of transience. These characteristics have created a singular set of challenges in managing the COVID-19 pandemic. In this study, we explore the experiences of the Blackpool public health team, a third-sector organisation and Community Champions to develop and promote COVID-19 testing and vaccination. We also describe some of the local initiatives implemented to address some of the reported challenges.
This report sets the research context including Blackpools socio-demographic profile, COVID-19 positivity and death rates, as well as test and vaccine uptake numbers. It describes the barriers to testing and vaccination reported by Blackpool public health team and the Programme Director of a large third-sector organisation. The report then outlines the local responses put in place to address these barriers. Finally, we conclude this paper with some future considerations.
This study draws on semi-structured interviews, which were conducted in May and June 2021, with 8 stakeholders who were:
Each interview was conducted remotely, was audio-recorded and lasted between 50 and 60 minutes. Thematic analysis was applied to all interviews in order to identify prominent themes and findings were submitted to interview participants to maintain quality and minimise interviewer bias. In addition to qualitative data, quantitative evidence from NHS Test and Trace data management systems was used to determine levels of testing in Blackpool and describe the local context.
This study was conducted in line with government social research guidance (1) and research participants provided informed consent before data collection. This report was reviewed and approved by the research participants.
The report was completed in July 2021.
The focus of the qualitative element of this report is community testing, and as such, it does not address testing or vaccination in institutional settings such as care homes and hospitals neither of staff nor residents or patients.
While much can be learned from a case study, the generalisability of findings from one locality is limited (2). This research draws on a small sample of participants who shared their personal experiences of developing and managing testing and vaccination services within their local authority.
This study focuses on barriers to testing and vaccination, as reported by interviewees. It also presents the experiences of Community Champions, who have been supporting vulnerable residents during the pandemic, but does not involve any direct reporting from disadvantaged groups in Blackpool. With these limitations in mind, the purpose of the case study is not to generalise the results to the wider population. Instead, it provides a description of some the challenges faced by local authorities, charity organisations and volunteers during the COVID-19 pandemic.
Finally, another limitation of this study is the lack of data on hidden groups such as occupants of unregistered HMOs or temporary migrant workers. As a result, these groups are not included in some calculations, such as positivity rates.
We would draw your attention to a postscript to this case study, provided in May 2023 by the Director of Public Health for Blackpool. This can be found in the Annex to this report.
Blackpool is a unitary authority in the county of Lancashire, in North West England. It has a population of 140,000 and an area of 35 square kilometres. Table 1 gives the age breakdown of Blackpools population. As in other coastal authorities, older people (those aged over 65 years) account for a greater proportion of Blackpools population than is observed at national level. People aged 17 years and under represent 21% of the population (3).
Source: Lancashire.gov.uk
Table 2 gives the ethnicity of Blackpools population. The majority of Blackpool residents are of White ethnicity, with minority ethnic groups estimated to make up just 3% of the population, compared with 15% for all of England and Wales (4).
Source: 2011 Census.
The total does not equal 100% due to rounding.
Population turnover in Blackpool is high. Transience the movement of people with a high degree of residential mobility, which frequently accompanies a chaotic lifestyle has been recognised in Blackpool for a long time (5). Population statistics (6) show that some areas in Blackpool have extremely high levels of population inflow and outflow. For example, Blackpool South Shore has a population inflow rate of 193 per 1,000 population. The 2011 census revealed that, using commonly accepted criteria, 11% of the population in Blackpool could be classified as transient. Further evidence from housing and benefits data suggests that within the first 6 months of settlement, 55% of Blackpools transient residents are likely to move again (4). The section on barriers that the high level of transience and the socio-economic circumstances of transient residents pose for test and trace services.
Transience in Blackpool is closely related with a high rate of temporary accommodation and HMOs. The market for poor quality private rented sector properties is fuelled by former hotel accommodation reaching the end of its life, when it is then converted with or without permission to privately rented small flats and bedsits. There are approximately 3,000 known HMOs in the authority (7).
As a major tourist destination, Blackpool has a lower than average rate of employee jobs in the manufacturing sector and a much greater reliance on service sector employment. It is well-represented in the employment sector of arts, entertainment, recreation and other services (3). As a result, Blackpool has a high proportion of seasonal workers employed in the tourism and hospitality industries. The number of Eastern Europeans, mostly Polish immigrants, working in the resort and surrounding area has grown in recent years (8).
The 2019 Indices of Multiple Deprivation revealed that Blackpool was ranked the most deprived area out of 317 districts and unitary authorities in England (9). Forty-two percent of its lower layer super output areas (LSOAs) were among the 10% most deprived in the country, and 8 of these were also in the top 10 (3). The unitary authority also has a high rate of child poverty with 35% of children in Blackpool living in poverty (nearly half in wards with the worst rates of deprivation), compared with 21% of all children in England.
Unemployment (those actively seeking employment but currently not in a job) is around 8% in Blackpool. This is higher than England (6%) and the North West (6%). The Blackpool working-age population claiming employment and support allowance or incapacity benefit is 13%, compared to 8% for the North West region, and 6% for England (10). Blackpool also has more residents with no qualifications (31%) than the national average (22%) (4)
The high level of poverty in Blackpool is reflected in the public health of this authority. According to the Office for Health Improvement and Disparities annual Local Authority Health Profiles (11), residents in Blackpool have a lower life expectancy than the national average. In the poorest parts, life expectancy is 12.3 years lower than the average for men and 10.1 years lower for women.
Behavioural risk factors for Blackpool (2018 Local Authority Health Profile) include high rates of alcohol-related harm hospital admissions. In Blackpool alone, the hospital admission rate for alcohol-related conditions is 1,015 per 100,000 per year, compared with 663 for England (3). In addition, estimated levels of excess weight in adults (aged 18 and over), smoking prevalence in adults (aged 18 and over) and physically active adults (aged 19 and over) are worse than the England average. In 2019, the suicide rate in Blackpool was well above the country average, with 14 per 100,000 compared to 10 per 100,000 for England (12).
As of 28 June 2021, Blackpool achieved good vaccination uptake, with 95,534 people having received one dose and 77,279 people having received 2 doses. Figure 1 below shows the percentage of people, by age group, who have received at least one dose of vaccination in Blackpool and in Lancashire and South Cumbria. The figure is a column chart, the X-axis representing 13 different age ranges and the Y-axis representing the percentage range from 0 to 100. The green columns represent data derived from people living in Lancashire and South Cumbria and the blue columns represent data derived from people living in Blackpool. Vaccine uptake in both areas is about 55% in the 18 to 24 age range and steadily increases to mid to high 90% in the 55 to 59 age range and remains high for all later age groups.
Source: NHS England
As table 3 illustrates, the proportion of people who had taken a polymerase chain reaction (PCR) test in Blackpool from April 2020 until 26 May 2021 was slightly lower than the test uptake for the North West region (42% versus 47% of the population).
Source: NHS Test and Trace Data Management System
Source: NHS Test and Trace Data Management System
Although the uptake in PCR testing in both regions was much reduced between 1 January to 26 May 2021 (Table 4), the number of tests administered per capita was higher in Blackpool (Table 5). This indicates a higher rate of multiple testing of some Blackpool residents.
Source: NHS Test and Trace Data Management System
Similar to PCR uptake, lateral flow test (LFT) rates show that, while the number of individuals tested is at the same level in Blackpool and North West (Table 6), the number of tests administered is higher in Blackpool (Table 7). This, again, indicates a higher rate of repeated testing in Blackpool.
Source: NHS Test and Trace Data Management System
Source: NHS Test and Trace Data Management System
Note: the provision for asymptomatic testing of staff at Blackpool Teaching Hospitals NHS Trust was via a technology called Loop Mediated Isothermal Amplification (LAMP) which would not have been included in either LFT or PCR testing numbers via NHS Test and Trace Data Management System. At the time of the study, the Universal Testing Offer was in place and NHS staff using LFTs may have been accessing testing via this route. The implications of this are that when comparing testing rates between geographies there may have been an impact on the calculation of testing rates (both proportion of individuals participating in testing and number of tests per person). Given the intensity of testing in care homes, and the relatively low number of care homes in the Blackpool local authority area, this may also explain why slightly lower rates of testing were observed via the NHS Test and Trace testing programme.
Blackpool has a substantial transient population, with approximately 8,000 people moving into and out of the area over the course of 2015 (13). These include people moving from other parts of the country to access low-cost housing, seasonal workers, especially from Eastern Europe, and an estimated 500 Gypsy families, according to Blackpool public health officials.
The high rate of transience results in high levels of movement between properties within Blackpool, especially in the private rented sector. The local authority has a large proportion of poor quality privately rented housing, often converted from former guest houses. These have led to intense concentrations of deprivation, and an environment that contributes to lack of opportunity and poor health. Participant B described the severity of the housing situation as follows:
We have the largest tourist economy in the country. Huge stock of ex-holiday homes, ex-bed and breakfasts, converted into very poor accommodations. Its really shocking. It was never built to house people all year round. We have this problem. Bigger here than anywhere else in the country.
Interviewees reported that the high level of low-quality temporary accommodation has been one of the main challenges of rolling out testing and vaccination programmes in Blackpool. They explained that a high level of transience not only makes it extremely difficult to create a sense of community cohesion, but also hinders their ability to locate residents in temporary housing and run the local test and trace system as efficiently as they could.
Interviewees reported that problems associated with inadequate and poor-quality HMOs were identified before the pandemic but that they have since been exacerbated.
Regarding HMOs, that was recognised way before COVID. Weve looked at the uptake in these areas, we know the uptake falls by age, we know its lower for males. Its not a feeling. We know theres a problem in HMOs.
(Participant B)
According to interviewees, one of the main challenges of reaching residents living in HMOs has been the high proportion of unlicensed HMOs and unregistered HMO residents. As 2 interviewees said:
We have a lot of people not registered and living in HMOs. We cant know what our rates are if we dont know the actual numbers. Landlords have been using terms such as students accommodations, but theyre not.
(Participant C)
Theres a lot of sofa surfing and things like that. Informal arrangements. About demographics, we actually dont know since many people arent registered with GP practices. Were suspecting its more than in other places.
(Participant B)
Interviewees description of a sizeable hidden population in Blackpool indicates that the number of positive cases in the authority may be higher than the official figures. Another reported obstacle of engaging HMO occupants was that many are vulnerable individuals living in precarious conditions.
Its not a student population in HMOs. Theyre older than that. People who have been around, theyve got drug problems, drifted around, ended up in Blackpool because its cheap accommodation here, just go to the pub and live on the social security.
(Participant C)
Members of the local public health team concurred that the greatest constraint to rolling out COVID-19 vaccination in HMOs has been the imposition of an age limit. They believed that promoting the vaccine among HMO tenants, while only a proportion of occupants may be in the relevant age bracket, would be ineffective.
The biggest barrier is the vaccine age limit. Were going to get in there once we get in there, we need to be able to offer it to everybody. The message go get the vaccine if youre the right age is too complicated for our population. Its either get the vaccine or dont get the vaccine.
(Participant C)
Theres no point going to an HMO where 6 people live and say Three of you, you can get it, and the rest of you cant have it.
(Participant B)
A prominent theme in interview data was reported apathy and disengagement around COVID-19 testing and vaccination commonly found within some disadvantaged groups, and more specifically among HMO occupants. Interviewees described some Blackpool residents as showing low levels of either health literacy or engagement. One of the interviewees described the phenomenon as follows:
Weve done segmentation work before. We know we have a really large population that are just not engaged with their own health and well-being in general. If they fell ill, they wouldnt do anything about it.
(Participant B)
Furthermore, members of the public health team highlighted that the town includes a large number of residents who are withdrawn from society and, as a result, disengaged from public health initiatives.
The fatalistic and disengaged are a large chunk of people who come to Blackpool and live in HMOs, arent really interested in the wider world. It doesnt matter what the message is, they arent interested.
(Participant C)
One of the barriers to asymptomatic testing described in the interviews is a lack of awareness, as well as some level of confusion, about regular symptomatic testing. Some residents are reportedly unclear about the purpose of taking regular LFTs and/or where to collect LFTs.
The comms to get tested twice a week hasnt really reached anyone anywhere. Theres a large part of the community that seems unaware that they can get tests from the chemist, et ceteraThere seems to be a void in the comms.
(Participant B)
Members of the public health team said that they had detailed data on polymerase chain reaction (PCR) uptake, but were not well sighted on asymptomatic home testing.
For some things we have a huge amount of details. Because we do our own contact tracing. Weve got good information on the symptomatic PCR testing going on. In terms of positive and negative tests. The bit were unsure is the LFT routine, we dont have as much detail there.
(Participant B)
Interviewees described 2 reasons for lack of traceability of LFTs being a barrier to promoting regular asymptomatic testing. First, the local authority is unable to identify the final recipients of collected LFTs unless self-tests are associated with a given official structure such as a school, a workplace or medical setting.
Whether it goes to all the right places and engaging all the right peopleWe dont have that level of detail. Especially with the testing at home. When its attached to a certain setting: school, NHS centre, et cetera, we do have this data. Otherwise, we dont know
(Participant A)
Secondly, although the Blackpool public health team was able keep track of the number of LFTs collected from the various available outlets, they reported a gap in the data where residents do not register their results online.
We know how many packs theyre taking from us but other than that we dont know the results.
(Participant C)
Interviewees expected that many Blackpool residents would not register negative LFT results due to the perceived complexity of the online registration process, which they described as too difficult and very long-winded. On the other hand, they believed that positive LFTs do get reported and are followed by a confirmatory PCR test.
Interviewees described large private organisations reluctance to support testing in the workplace as a missed opportunity (Participant A). While local employers had reportedly embraced the local authoritys campaign for regular testing of asymptomatic employees, national companies in Blackpool had not engaged. According to interviewees, large companies disengagement was due to trade unions opposition to workplace testing schemes, as well as employers concerns about identifying positive asymptomatic cases and losing part of their workforce as a result.
In the workplace, we have an issue with the largest national employers. We cant get it in supermarkets, we couldnt get it in [organisation name redacted] where we have 3,500 people in Blackpool. Because of the trade unions and this not being part of their policy.
(Participant C)
In response to COVID-19, Blackpool public health team reported having established close collaboration with the voluntary community and faith sector (VCFS) which were already providing services to the community pre-pandemic. One aspect of the cooperation between the local authority and VCFS consisted of fortnightly briefings during which the council, Blackpool public health and third-sector organisations discussed the latest official guidance, local priorities and barriers or concerns experienced by the community. Interviewees spoke positively about the collaboration:
The councils approach was key. They very quickly created the infrastructure to bring together the third sector. Council pulled together the infrastructure of the third sector and did it on a geographical basis, so it is accessible equally. The relationship between third sector and local authority is much better than before the pandemic. Having access to the [director of public health] on a regular basis has made a great difference.
(Participant E)
There has traditionally been a third sector-local authority split. Because local authorities used to provide funding. In working together, weve proven that we could achieve so much more.
(Participant D)
In January 2021, Blackpool Council received a 211,690 grant from central Government through the Community Champions Programme. This funding has contributed to supporting the work of volunteers who have offered vulnerable groups assistance with a variety of needs related to testing and self-isolation. Interviewees reported that Community Champions funding was split among 9 organisations in key areas and has made a significant difference (Participant E). Community Champions funds were used to provide VCFS organisations with physical resources, including food parcels, to support vulnerable residents.
Community Champions activities have also been supported by the creation of the Corona Kindness Hub whose goal has been to provide a single point of contact for residents in need of assistance during the pandemic. The hub is staffed with over 100 approved volunteers who have intimate knowledge of their community and how to engage it. In order to minimise negative socio-economic impacts of self-isolation, the Corona Kindness Hub has helped disadvantaged Blackpool residents by providing a wide breadth of support, including help to obtain food, health care and medication; with welfare, mental health and loneliness; help for someone they care for; with utilities and bills, and around debt or benefits (including claiming Statutory Sick Pay).
According to interview data, another important role of VCFS and Community Champions has been to disseminate public health messages and tackle any misinformation from the early stage of the pandemic.
Misinformation isnt really an issue because it was addressed by third sector organisations very early on. Digital comms have been useful to address that.
(Participant E)
Members of the public health team described VCFS as an invaluable asset to support vulnerable groups with testing, self-isolation and vaccination. They also explained that close collaboration with VCFS is aligned with the local authoritys effort to adopt a localised approach drawing on community resources.
A prominent theme that emerged from interviews was the importance of a localised or geographical (Participant E) approach to supporting testing and vaccination in Blackpool.
We have close neighbourhoods in Blackpool. It is not diverse in terms of its population. People identify with the estate or the area they live in. We look at the geographical split and trusted organisations within those geographies.
SK Bioscience's cell-cultured flu vaccine, SKYCellflu (SK Bioscience)
South Korean pharmaceuticals firm SK Bioscience said Thursday that it exported its cell-cultured flu vaccine, SKYCellflu, to Thailand, marking its first entry into a market with southern hemisphere requirements.
The company shipped out approximately 440,000 doses of SKYCellflu to its Thai partner Biogenetech from its vaccine manufacturing facility in Andong, North Gyeongsang Province.
SKYCellflu, the world's first cell-cultured flu vaccine endorsed by the World Health Organization, aligns with the WHO's 2024 southern hemisphere flu vaccine recommendation and is safe for egg-allergic individuals unlike traditional vaccines.
Thailand holds strategic importance for SKYCellflu due to its elongated geography, necessitating year-round flu vaccination that follows both the northern and southern hemisphere vaccine guidelines despite being entirely in the northern hemisphere.
Furthermore, SK Bioscience has honed its focus on the southern hemisphere market, leveraging potential cost savings and shorter supply delays through continuous production if flu strains are shared between hemispheres.
Starting with Thailand, SK Bioscience aims to extend its reach across southern hemisphere markets and beyond. With marketing authorizations secured in 12 countries and pending approval in ten more, the company is poised for further expansion.
Additionally, it seeks to strengthen its global presence through procurement contracts with organizations like the United Nations Children's Fund and the Pan American Health Organization.
"The export of SKYCellflu to Thailand marks a significant milestone in our expansion into the southern hemisphere and global markets," said Ahn Jae-yong, CEO of SK Bioscience.
"In line with our commitment to diversifying product markets, we are dedicated to developing vaccines with high potential, such as our upcoming pneumococcal conjugate vaccine candidate, slated for phase three clinical trials this year," Ahn added.
By Heo Yu-jeong (yjheo@heraldcorp.com)
Key Takeaways
The COVID-19 pandemic put a fresh eye on infectious diseases, including the consequences that can come from having a virus. While long COVID is now a well-known condition, researchers have discovered that people can develop lingering illness from the flu, too.
A recent study of more than 92,000 people compared the health outcomes of those who were admitted to the hospital with COVID versus people admitted with the flu. The researchers found that both viruses caused people to have lingering health problems that can last for months to years.
Were learning that these respiratory viruses can have long-term effects, William Schaffner, MD,an infectious disease specialist and professor at the Vanderbilt University School of Medicine, told Verywell. It seems like that was always the case. Were just becoming much more aware of it now.
Research into long flu is in its infancy.
Were learning now that a variety of infections result in symptoms after the acute phase as consequences of infection, Thomas Russo, MD, professor and chief of infectious disease at the University at Buffalo in New York, told Verywell. Long flu can cause respiratory symptoms like shortness of breath and a cough with activity, he said.
Its unclear why someone might develop long flu.
Its probably due to a continuing inflammatory response, Schaffner said. This is your bodys way of fighting off the infection. Youve gotten over the acute infection, but its as though the army that is your immune system keeps fighting.
There are a few options to treat long flu at home. Schaffner recommends taking warm showers once or twice a day to get moisture into your lungs and running a humidifier at night.
Clean the humidifier after every use, dry it off, and, when you use it again, put in a new supply of water, he said. If you dont, bacteria can grow, and you can inhale the bacteria, making you sicker.
If youre experiencing pain or body aches, acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help, Schaffner said.
Taking any medication long-term without consulting a doctor first isnt advised, Russo said. If youre considering taking a medication like acetaminophen or NSAIDs long-term or find that youve been taking them consistently for more than a few weeks, Russo said its time to consult a doctor.
For coughs, Schaffner said that consuming a spoonful of honey or mixing it with warm water or tea may temporarily help.
Its not very useful to take an over-the-counter cough suppressantthey dont work very well, he said.
A lingering cough is usually a good indicator to make a doctors appointment, Schaffner said.
If you suspect that you have long flu, Russo said its best to see a healthcare provider for an evaluation to make sure youre not dealing with another health issue. Long flu is a diagnosis of exclusionmeaning doctors want to rule out other health issues firstand its important to be checked for other illnesses as well.
If you have symptoms that last more than a few weeks after flu recovery that affect your daily activities, you should reach out to a healthcare provider to see if there is any sort of systemic treatment that could be beneficial, Russo said.
You should contact your doctor if you find that you feel better after having the flu and then get worse within a week or two.
You could have a secondary infection like bronchitis or pneumonia, Russo said.
More research is needed on how to effectively treat long flu. But Russo said that bronchodilators like albuterol and salmeterol, as well as pulmonary rehabilitation, might work for long flu. These interventions are also recommended for respiratory symptoms of long COVID.
Youre more likely to develop long flu if you have a serious course of influenza, which doctors said makes the case for getting an annual flu vaccine.
We certainly know that vaccination seems to be the most important measure to minimize acute consequences with long COVID, Russo said. We dont have as much data for long flu, but theres no question it would help, too.
Like long COVID, long flu is a real illness. If you have symptoms of long flu, including shortness of breath and a lingering cough, and they last for more than two weeks after you recover from the flu, its time to consult a doctor.
By Korin Miller Korin Miller is a health and lifestyle journalist who has been published in The Washington Post, Prevention, SELF, Women's Health, The Bump, and Yahoo, among other outlets.
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March 18, 2024
4 min read
Why People Aged 65 and Older Should Get a Spring COVID Vaccine
Older people are particularly vulnerable to COVID and should get another vaccine against the disease this spring, doctors say
By Laurie Archbald-Pannone & The Conversation US
Even if you got a COVID-19 shot last fall, the spring shot is still essential for the 65 and up age group.
Jasmin Merdan/Getty Images
The following essay is reprinted with permission from The Conversation, an online publication covering the latest research.
In my mind, the spring season will always be associated with COVID-19.
In spring 2020, the federal government declared a nationwide emergency, and life drastically changed. Schools and businesses closed, and masks and social distancing were mandated across much of the nation.
If you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.
In spring 2021, after the vaccine rollout, the Centers for Disease Control and Prevention said those who were fully vaccinated against COVID-19 could safely gather with others who were vaccinated without masks or social distancing.
In spring 2022, with the increased rates of vaccination across the U.S., the universal indoor mask mandate came to an end.
In spring 2023, the federal declaration of COVID-19 as a public health emergency ended.
Now, as spring 2024 fast approaches, the CDC reminds Americans that even though the public health emergency is over, the risks associated with COVID-19 are not. But those risks are higher in some groups than others. Therefore, the agency recommends that adults age 65 and older receive an additional COVID-19 vaccine, which is updated to protect against a recently dominant variantand is effective against the current dominant strain.
The shot is covered by Medicare. But do you really need yet another COVID-19 shot?
As a geriatrician who exclusively cares for people over 65 years of age, this is a question Ive been asked many times over the past few years.
In early 2024, the short answer is yes.
Compared with other age groups, older adults have the worst outcomeswith a COVID-19 infection. Increased age is, simply put, a major risk factor.
In January 2024, the average death rate from COVID-19 for all ages was just under 3 in 100,000 people. But for those ages 65 to 74, it was higher about 5 for every 100,000. And for people 75 and older, the rate jumped to nearly 30 in 100,000.
Even now, four years after the start of the pandemic, people 65 years old and up are about twice as likely to die from COVID-19 than the rest of the population. People 75 years old and up are 10 times more likely to die from COVID-19.
These numbers are scary. But the No. 1 action people can take to decrease their risk is to get vaccinated and keep up to date on vaccinations to ensure top immune response. Being appropriately vaccinated is as critical in 2024 as it was in 2021 to help prevent infection, hospitalization and death from COVID-19.
The updated COVID-19 vaccinehas been shown to be safe and effective, with the benefits of vaccination continuing to outweigh the potential risks of infection.
The CDC has been observing side effects on the more than 230 million Americans who are considered fully vaccinated with what it calls the most intense safety monitoring in U.S. history. Common side effects soon after receiving the vaccine include discomfort at the injection site, transient muscle or joint aches, and fever.
These symptoms can be alleviated with over-the-counter pain medicines or a cold compress to the site after receiving the vaccine. Side effects are less likely if you are well hydrated when you get your vaccine.
Repeat infections carry increased risk, not just from the infection itself, but also for developing long COVID as well as other illnesses. Recent evidence shows that even mild to moderate COVID-19 infection can negatively affect cognition, with changes similar to seven years of brain aging. But being up to date with COVID-19 immunization has a fourfold decrease in risk of developing long COVID symptomsif you do get infected.
Known as immunosenescence, this puts people at higher risk of infection, including severe infection, and decreased ability to maintain immune response to vaccination as they get older. The older one gets over 75, or over 65 with other medical conditions the more immunosenescence takes effect.
All this is why, if youre in this age group, even if you received your last COVID-19 vaccine in fall 2023, the spring 2024 shot is still essential to boost your immune system so it can act quickly if you are exposed to the virus.
The bottom line: If youre 65 or older, its time for another COVID-19 shot.
This article was originally published on The Conversation. Read the original article.
The Washington State Department of Health released updated guidance Monday for how to protect against COVID-19, influenza and respiratory syncytial virus, also known as RSV.
The recommendations come in addition to the guidance provided by the Centers for Disease Control and Prevention, which include how to prevent the spread of respiratory illness after infection and protect community members with weakened immune systems.
The most significant change is the length of time someone should stay home after showing symptoms. Previous guidance recommended people stay home for at least five full days after symptoms begin. But now, the department of health says people may return to normal activities once their symptoms get better overall, and they have not had a fever for at least 24 hours.
However, people can still be contagious even when their symptoms have improved, according to the health department. It recommends taking extra precautions, such as frequent hand-washing, physical distancing and regular cleaning.
Raechel Sims, a health department spokeswoman, said although there is no set frequency for updating the guidelines, the agency is continually looking at scientific developments and changes in disease patterns.
COVID-19, influenza, and RSV emergency department visits, hospitalizations and reported positive tests have all declined over the last several weeks, Sims said. Its important to remember that though COVID-19 activity is decreasing, more than a dozen people in Washington lose their lives to COVID-19 each week.
Last week, 1 percent of hospitalizations in Clark County were COVID-19 related and 1 percent were influenza related, according to Clark County Public Health. There were no hospitalizations related to RSV last week.
People at higher risk of getting sick, such as older adults and those with weakened immune systems, should try their best to stay away from sick people for at least 10 days after their symptoms start or until they receive a negative COVID-19 or antigen test result.
The health departments new COVID-19 and respiratory illness guidance is meant to provide recommendations, but Washington residents should follow their local health jurisdiction, workplace, business or school policies that may be more specific to that setting.
The new guidance does not apply to health care settings; people in health care settings should follow the guidance at the COVID-19 Infection Prevention in Health Care Settings webpage.
While life is returning to normal in many ways, we must remember that for many in our community with chronic conditions and weakened immune systems, respiratory virus infections such as COVID-19, flu and RSV remain a deadly threat, Dr. Tao Sheng Kwan-Gett, chief science officer, said in a news release.
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In this study we have characterized the demographic, clinical and laboratory aspects of COVID-19 among a population that experienced a disproportionate impact of the pandemic. Among the patients admitted with COVID-19, approximately 1 in 2 received supplemental oxygen, 1 in 3 received high-flow oxygen, and 1 in 10 died during their hospitalization. Our analysis is consistent with other reports of substantial early impact of COVID-19 in Louisiana. Together with evidence from other studies, our findings suggest that several factors may have been important in explaining the high case-severity in this cohort.
We found that patients with COVID-19 requiring high-flow oxygen were more likely to be older, which is consistent with other studies7. Nevertheless, approximately 66% of patients hospitalized with severe COVID-19 were younger than age 65, indicating that other factors were also important. Among all patients included in our analysis, 95% had underlying health conditions, and 80% had multiple comorbidities. Patients most frequently had cardiac disease, obesity, and diabetes mellitus, each of which are risk factors for severe outcomes from COVID-1912. Notably, we found that comorbidity was reflected in hospitalized cases, whether or not they received high-flow supplemental oxygen. Since we conditioned the analysis on hospital admission, comorbidity among non-severe cases might reflect an increased likelihood of admission, leading to potential collider bias20. A lower threshold for admission with underlying health conditions among patients without severe COVID-19 might explain why we did not find overall differences in underlying conditions by illness severity. Our finding that patients with more than two underlying conditions tended to be admitted more rapidly than other patients is suggestive of this. In view of these considerations, the lack of an overall difference in comorbidity by severity does not negate the importance of comorbidities in driving case-severity. Instead, the high prevalence of known risk factors suggests these factors were important drivers of adverse outcomes.
Among patients included in our analysis, 60.5% had Black non-Hispanic race and ethnicity. This proportion is slightly higher than that of inpatients documented to have COVID-19 in the participating hospitals (approximately 50%), and is similar to the proportion reported for New Orleans in the U.S. census (58%)21. Consistent with previous analyses, we did not find a difference in case-severity by race and ethnicity among hospitalized patients5,22. However, Black race was associated with an increased risk of hospitalization with COVID-19 in Louisiana after adjusting for comorbidity and socioeconomic status5, and this elevated risk might reflect an array of other factors, including those related to accessing care6.
Compared with non-severe hospitalized patients, we found that those requiring high-flow supplemental oxygen were more likely to be admitted greater than five days after symptom onset. This suggests that delayed access to healthcare might have contributed to adverse outcomes. In our analysis, patients received high-flow oxygen a median of 8days after symptom onset, and inpatient deaths occurred a median of 24days after illness onset. Severe COVID-19 typically progresses over 12weeks23, and patients who were admitted more than five days after illness onset were likely to have more severe illness by the time of presentation. We also found that patients with severe illness were more likely to have received treatment with remdesivir, dexamethasone, or other non-antiviral treatment (baricitinib or convalescent plasma). Since patients who met criteria for severe illness were likely to have been unwell at presentation, this is likely to reflect more treatment for patients presenting with more advanced disease, rather than any effect of treatment on severity; such an interpretation is supported by other evidence from other studies24.
Only 5% of hospitalized patients had completed a primary COVID-19 vaccine series during the period of analysis. This low proportion is likely to reflect both low vaccine coverage early in the pandemic, and an increased risk of COVID-19 if unvaccinated25. Similarly, approximately 20% of the U.S. population were estimated to have had prior infection during the period of analysis26. Since infection-induced immunity confers substantial protection against severe illness, patients admitted with COVID-19 would be expected to have a lower prevalence of prior infection during the period of analysis27. Although we did not have baseline serology results, low antibody titers during 07days is consistent with a low prevalence of prior infection in the cohort.
Our finding that 43% of patients did not have a positive anti-nucleocapsid result within 14days of illness onset is consistent with other evidence that it can take up to 14days or longer for new antibodies to develop28. Since a similar proportion of patients with severe and non-severe disease had evidence of seroconversion, we did not find evidence that severe disease reflected inadequate immune responses. However, our modeled estimates were limited by sparse data.
Among patients with available SARS-CoV-2 RT-PCR results, we found that severe COVID-19 was associated with a lower cycle threshold value in saliva specimens that were collected before any antiviral treatment was started. Cycle threshold values reflect the number of RT-PCR amplification cycles needed to detect viral RNA in a specimen, and are inversely related to the level of viral RNA; lower Ct values therefore imply the presence of higher RNA levels. Higher cycle threshold values over time are likely to reflect declining viral load after initial infection29,30. Lower cycle threshold values among patients with severe disease is broadly consistent with evidence of higher viral load in severe illness, after adjusting for other characteristics15,17,19. Detection of SARS-CoV-2 in saliva may reflect involvement of the oral cavity31. Previous studies have found similar detection of SARS-CoV-2 RNA in nasal and saliva specimens early after symptom onset32,33, although with differences in cycle threshold that may reflect differences in specimen collection33,34. Our findings were similar when restricted to patients with paired saliva and nasal specimens on the same day. However, data were sparse for paired specimens, and reasons for an association with saliva but not nasal specimens is unknown. Our findings of an association between case-severity and lower Ct value in saliva are consistent with those of others, who have reported that abundance of SARS-CoV-2 RNA in saliva was significantly higher in patients with risk factors for severe COVID-19, correlated with more severe COVID-19, and was superior to nasopharyngeal viral load as a predictor of mortality35. We did not find an association between lower cycle threshold and severity after treatment that might lower the viral load36,37, possibly because patients with severe illness were also more likely to received such medications, thereby masking differences in viral load.
Before considering implications of our analysis, several strengths and limitations need to be considered, in addition to those listed above. First, although we provided a detailed description of more than 500 patients with severe COVID-19, for some analyses we were limited by sparse data, resulting in wide confidence intervals. Second, our capture of potential confounding factors was incomplete, which might lead to residual or unmeasured confounding in multivariable analyses. Third, although we found a relatively high mortality among hospitalized patients, we may have underestimated deaths that occurred in the community or that did not meet our definition of severe illness. For example, two patients who died without meeting this definition might have had extrapulmonary manifestations of infection2. Fourth, for analysis purposes we used a relatively low threshold (6L/min) to determine severity based on oxygen level, limiting comparability with some other studies that have used 1015L/min as a threshold, and with guidelines that define severe illness based on oxygen saturation rather than supplemental flow38,39. Lastly, generalizability of our findings to other populations may be limited. Patients included in the analysis had similar overall demographic characteristics to other patients with COVID-19 in participating hospitals, but might have differed from patients admitted to other hospitals in the New Orleans area. Similarly, although overall patient characteristics were similar by availability of laboratory results, patients with laboratory data might be considered as a convenience sample within the main cohort. Overall, our scope was limited to analysis of patients who were hospitalized before widespread transmission of the Omicron SARS-CoV-2 variant and its subvariants.
Since predominance of the Omicron variant, average case-severity of SARS-CoV-2 infection has become milder3, both because of increased immunity from vaccination and infection40, and because of lower virulence compared with the Delta SARS-CoV-2 variant and ancestral variants13. Nevertheless, severe infections and deaths have continued to occur, both in individuals with and without clear risk factors. In our analysis, substantial comorbidity coupled with late presentation in an unvaccinated population are likely to have contributed to the high case-severity. Our study is relevant both in highlighting a patient population who experienced a disproportionate burden of COVID-19, and in describing severe COVID-19 in this group. Our findings of a correlation between severe illness and low cycle threshold in saliva may support the use of saliva PCR tests as a potential alternative to nasal PCR in the inpatient setting, though more work is needed to explore this association. To prepare for future epidemic and pandemic threats, our findings support broader efforts to address underlying inequalities and strengthen access to healthcare access and resilience of health systems6,41.
