Rutgers University students failed to revive a lawsuit raising constitutional challenges to a school policy that required students to be vaccinated against Covid-19 before returning to campus in 2021.
The US Court of Appeals for the Third Circuit on Thursday affirmed a lower courts September 2022 dismissal of the complaint, saying that the students didnt have a fundamental constitutional right to be free from mandatory vaccinations and that Rutgers had a rational basis for adopting its vaccine policy.
The universitys decision to phase in its policy by delaying the vaccine mandate for its staff didnt violate the students equal protection ...
Getting vaccines from manufacturing sites into people's arms is a complex process even in normal conditions. During the biggest pandemic in 100 years, these challenges become magnified, which meant COVAX also had to adapt to ensure the billions of vaccines it procured on behalf of countries across the world could be delivered quickly and effectively.
To mark the publication of Gavi's newanalysis paperon this delivery effort, here are five of the key factors that helped achieve one of the largest global vaccination campaigns ever attempted.
In low- and middle-income countries, one of the hurdles affecting vaccination programmes is inability to ensure a "cold chain", which is where vaccines are stored at low temperatures from the moment shipment arrives to the time they are injected into someone's arm. Unstable electricity supplies or inadequate health system infrastructure can risk vaccines being stored at incorrect temperatures, which can render them useless.
Like many other vaccines, COVID-19 vaccines were distributed by plane, truck, motorcycle and in the most remote places, by foot. The challenge was that the first COVID-19 vaccines needed not just standard vaccine cold storage temperatures of 28C but ultra-cold storage at between -90C and -60C.
During the pandemic, 73 lower-income countries received support to increase their cold and ultra-cold chain. COVAX's response was the largest deployment of ultra-cold chain equipment in history. Although Gavi had supported the installation of cold-chain equipment previously, this new initiative was complex for various reasons. Ultra-cold chain equipment is more complicated to install and requires specialist training to maintain. Moreover, shipping and installation was happening at a time when most of the world had shut down to stop COVID-19 spreading.
Despite these hurdles, COVAX financed, coordinated and delivered 948 ultra-cold chain freezers to nearly 70 countries during 2021 and 2022.
Getting vaccines to those who need them requires an extraordinary amount of logistical planning, which can be challenging in an unfolding pandemic when countries aren't sure how many doses they will need, and may not have the infrastructure to deliver doses even when they do receive them. Sometimes, doses end up being wasted through poor planning or unexpectedly low uptake.
In late April 2021, the Democratic Republic of the Congo (DRC) handed over half a million doses of COVID-19 vaccines that they had received from COVAX the previous month. Those half a million doses were part of a consignment of 1.3 million doses redeployed to other African nations: Angola, Central African Republic, Ghana, Madagascar and Togo.
The DRC government knew it would be unable to administer them before their expiry date, and so it alerted COVAX knowing that the vaccines would be used to protect people elsewhere, and that it could receive its allocation at a later date when it was able to deliver them to people.
Redistribution of doses is not always this smooth, as countries can sometimes hold on to vaccines till they are expired and it's too late to give them away. On the back of this experience, COVAX developed a vaccine redeployment policy, launched in 2021 when supplies of doses were still stretched thin, to support countries wanting to ensure doses they could not use did not go to waste. Almost 2million doses were redeployed in this way. COVAX worked with the African Union to ensure that dose donations were only accepted once a country was ready to take them on.
COVAX was designed to reduce vaccine inequity, and by January 2022, although more than 12 billion doses of COVID-19 vaccines had been delivered worldwide from all sources, it was clear that inequity was still rampant low-income countries (LICs) had only received 0.2 billion doses, a shocking 1.6% of the number of doses delivered. At that time, only 13% of people in LICs had been fully vaccinated with a primary series of two doses, compared to 60% of the global population.
The reasons varied from operational challenges to a lack of health care workers, issues in accessing vaccines, and demand issues, such as a lack of information, vaccine hesitancy and COVID-19 misinformation. To address this inequity, Gavi, WHO and UNICEF created the COVID-19 Vaccine Delivery Partnership (CoVDP) in January 2022 to provide focused support to the 34 countries that were at or below 10% primary series coverage at this time.
CoVDP focused especially on country engagement, demand planning, providing operational funding, delivery coordination and reaching high-priority groups: health care and other frontline workers, older adults and those livingwithcomorbidities.
By June 2023, just six countries had primary series vaccine coverage below 10%, compared to 34 in January 2022. Four Madagascar, Yemen, Haiti and Burundi were dealing with humanitarian situations.
Delivering vaccines in lower- and middle-income countries (LMICs) often requires getting vaccines to people in settings beset by conflict. By the end of 2022, of the 31 countries classified as having humanitarian emergency response plans, 26 were countries that Gavi supported with COVID-19 vaccine deliveries.
Across these countries, more than 250 million people are estimated to have needed humanitarian assistance. As of the end of 2022, half of all COVID-19 vaccine doses delivered in those 31 countries (411 million doses) were provided to their governments through COVAX, making it the largest source of vaccines in humanitarian contexts.
In 2020 and early 2021, Gavi collaborated with the United Nations' Inter-Agency Standing Committee (IASC) a forum for UN agencies including WHO and UNICEF that are involved in humanitarian work to develop the COVAX Humanitarian Buffer, a safety net of last resort to ensure access to COVID-19 vaccines for the most high-risk and vulnerable populations: those in humanitarian settings, including refugees, migrants, asylum seekers, stateless people and other vulnerable groups.
The pandemic disrupted many routine immunisation programmes, and even as those were being resumed in 2022, it was clear that COVID-19 vaccination would still be needed to be delivered by health systems. Gavi started working on supporting countries in integrating COVID-19 vaccination into regular health service delivery systems.
In July 2022, Gavi announced an additional US$667million in COVID-19 vaccine Delivery Support (CDS) that would, among other things, support the integration of COVID-19 vaccination and routine immunisation. The new funds were also used to tackle gaps in vaccine delivery and strengthen engagement.
For example, US$ 25 million was earmarked for direct support to civil society organisations to help unblock critical delivery, access and uptake bottlenecks, and reach under-served and unserved populations, including high-risk groups and those in humanitarian settings. Another US$ 30 million was reserved for emergency funding to be jointly managed with the CoVDP for immediate needs in the 34 low-coverage countries
This funding provided important health system strengthening benefits in many countries 71% of lower-income countries supported by COVAX reported strengthening of their cold chain infrastructure, while 76% were able to make progress in the digitisation of health data. A further 62% of countries reported integrating COVID-19 vaccination into their routine immunisation programmes.
One country that saw its health system strengthened through COVID-19 vaccine delivery was Somalia. In January 2022, the COVID-19 vaccine coverage rate in Somalia was just 5%. Campaigns enabled 90% of the high-risk and older adult population to be reached, and CDS funding was used to help scale up the country's cold-chain capacity. By May 2023, the country's COVID-19 vaccine coverage rate had reached 41%.
The investments made to boost COVID-19 vaccine delivery have had collateral benefits, including building an online digital system and dashboard to allow real-time vaccination monitoring; training staff in risk communication and community engagement; and procuring and installing four ultra-cold chain units and 25 solar direct drive vaccinerefrigerators that rely on solar energy rather than mains electricity.
Read the new Gavi Analysis Paper, Learning from COVID-19 to support vaccine delivery during future health emergencies, here:https://gavi.org/news-resources/knowledge-products/learning-covid-19-support-vaccine-delivery-during-future-health-emergencies
PORTLAND, Ore. The Oregon Health and Science Universityreleased a groundbreaking study which reveals switching arms for multi-dose COVID-19 vaccinations can boost immune response. The new study could change the way vaccines are handled in the future.
The idea started during the height of the pandemic when the newly formed vaccine was in high demand and in its early stages of research, according to OHSU associate professor of medicine Dr. Marcel Curlin.
Many people came through and there was a big rush to get vaccinated. We saw an opportunity to study something that we didn't know much about, Curlin said. So, we were looking at immune responses to COVID and vaccinations.
Once the vaccines became available in 2020, many people wondered whether alternating arms would make any difference.
The arm randomization was just sort of an afterthought, Curlin said. We knew that we were vaccinating in random arms, but we didn't know if it mattered. We always assumed that it didn't.
OHSU started measuring the antibody response of 947 people who received two-dose COVID vaccinations.
Curlin said they divided the group roughly in half, randomized them and asked one group to receive the contralateral or a shot in each arm while the other group received the shot in the same arm.
The results found when participants switched arms for each dose, they had 1 1/2 to two times more antibody levels in their blood.
Any small increase of antibody levels like a two-fold increase would translate into a mortality benefit for those that are most vulnerable to COVID or those most likely to experience a bad outcome. said Curlin.
OHSU professor of Pediatrics Dawn Nolt echoed that statement and added that the study could potentially help those who are more reluctant to receive the vaccination.
No promises to parents, but it could be that this increased immune response that we're seeing by alternating the site could mean one or two less doses for their child. said Nolt.
Participants also said the study could encourage more people to get vaccinated.
The more efficient you can make the vaccination process, the fewer times that people have to get vaccinated in order to be effective and the more likely they are to get the vaccine. said participant George Keepers.
Researchers said the improved immune response could be similar for other multidose vaccinations, though a further study would need to be conducted.
The full study from OHSU has been published in The Journal of Clinical Investigation.
By Michael Nguyen, PhD
Lipid nanoparticles (LNPs) have played a crucial role in the advancement of vaccine development, especially in the context of the COVID-19 pandemic. These LNPs have demonstrated their efficacy in delivering mRNA, which has significantly accelerated the vaccine development process. Additionally, LNPs are now being investigated as carriers for a range of therapeutics, offering a flexible and adaptable approach to vaccine creation.
The utilization of mRNA-LNPs has enabled governments to expedite the pharmaceutical development process and ultimately save lives during the ongoing COVID-19 crisis. By encapsulating the mRNA within LNPs, scientists have been able to protect the fragile genetic material from degradation and enhance its delivery to target cells. This has resulted in the successful development and deployment of mRNA-based COVID-19 vaccines, such as the Pfizer-BioNTech and Moderna vaccines.
The benefits of mRNA-LNPs extend beyond their application in COVID-19 vaccines. LNPs can be tailored to encapsulate various types of therapeutic molecules, including proteins, small molecules, and nucleic acids. This versatility makes LNPs a promising platform for the development of vaccines against other infectious diseases, as well as for the delivery of personalized medicine and gene therapies.
Explore how the success of mRNA-LNP vaccines is paving the way for future use in a wide range of therapeutic applications by accessing the full article below.
Newly released mortality figures by the Illinois Department of Public Health show deaths in 2022 were still coming in at a much higher rate than what the state was seeing before the COVID-19 pandemic. Daily Herald File Photo
Newly released mortality data shows Illinois residents still dying at a rate well above pre-pandemic levels.
The most recent figures released last week by the Illinois Department of Public Health show 122,977 residents died in 2022. Thats 17,512 more deaths than what the state was averaging in the 10 years leading up to the COVID-19 pandemic, a 16.6% increase.
The states overall population declined 2% from 2010 to 2022, according to U.S. Census Bureau tracking.
Though COVID-19 deaths are on the decline, the effects from infections may be spurring the spike in other causes of deaths, medical experts and public health officials warn.
COVID-19 accounted directly for 7,149 Illinois residents dying in 2022, the states fourth leading cause of death, IDPH figures show. It was the third leading cause of death for the two years prior.
Health officials note heart disease and stroke deaths remain elevated as well, while deaths from cancer and chronic respiratory ailments have dipped.
We knew people were very much not getting the same access to care that they were used to during the pandemic, IDPH Director Dr. Sameer Vohra said. They missed a lot of appointments and preventive screenings, but we also know theres an increased risk of heart attack and stroke after a COVID infection.
Heart disease remains the states leading cause of death, but it killed 4.9% more Illinois residents between 2020 and 2022 than it did in the three years leading up to the pandemic, IDPH records show. Stroke deaths are up 11.8% during the same time period.
An October 2023 report by the National Institutes of Health indicates research has shown a likely link between COVID-19 infections and greater risk for heart attack or stroke.
The findings suggest that (COVID-19) may increase the risk of heart attacks and stroke by infecting artery wall tissue, the report stated. This provokes inflammation in atherosclerotic plaques, which could lead to heart attack or stroke.
People may survive a COVID-19 infection, but not survive the effects of the infection.
We have to consider that COVID is going to have an ongoing culling effect on the population, and not just the old, said Dr. Emily Landon, head of the University of Chicago's infectious disease prevention and control program. It definitely results in increased risk of other conditions that cause death.
As for cancer and chronic respiratory disease deaths declining, thats a population that is most at risk from the worst outcomes of a COVID-19 infection. Individuals with those ailments likely make up the majority of those who succumbed to COVID-19, medical experts said. That was especially true in 2022 when vaccines and antiviral medications were more accessible to the general population.
The bottom line is were just not as healthy as we were before COVID for whatever reason, Landon said. Our life span has decreased.
In 2022, life expectancy for the average American climbed to 77.5 years. But thats still more than a year below pre-pandemic levels, according to research by the U.S. Centers for Disease Control and Prevention.
Accidental deaths also remained above pre-pandemic levels in 2022 and were the third-leading cause of death in Illinois that year, records show.
Between 2020 and 2022, accidental deaths were 22.9% higher than in the three years prior. These include drug overdoses and motor vehicle crashes.
A lot of these continued excess mortalities are for younger adults, and that can have just huge distorting effects in many ways on the country, said Mary Pat Campbell, an insurance industry actuary who has written extensively about the pandemic-related mortality trends. With people under the age of 50 that are getting hit, these death rates may be much lower, but the percentage impact is so much higher. It could have some effect on economic stability.
Homicides declined year over year as well, but remain above pre-pandemic levels. IDPH reported 1,312 Illinois residents were murdered in 2022. While thats down from the previous two years, its significantly higher than any year from 2010 to 2019.
Most alarmingly, the data shows more female residents were murdered in 2022 than in any year since at least 2010. From 2010 to 2019, the state averaged 139 female murder victims a year. The 241 female homicide victims in 2022 represents a 73.3% increase from that pre-pandemic 10-year average.
Evidence shows that domestic violence help calls have been increasing in many countries during the COVID-19 pandemic, a 2021 report published by Science Direct titled The effect of COVID-19 on female homicides stated. Gender-based violence is a global phenomenon threatening women irrespective of race, nationality, education or socioeconomic status.
IDPH figures also show a skyrocketing number of injury-related deaths among Illinois residents 65 and older. The number of injury-related deaths among that population has nearly doubled since 2010 from 1,574 to 2,958 in 2022.
Vohra is worried that has to do with a breakdown in the social safety net, particularly during the pandemic.
The community structures that often support our aging population are not what they used to be, he said. During the pandemic, there was almost no access to community and personal social networks.
Among the other top 10 leading causes of deaths for Illinois residents, Alzheimers disease deaths have remained relatively stable through the pandemic, with a slight bump in 2022, records show. Deaths attributed to diabetes were up 20.5% between 2020 and 2022 when compared to the three previous years. Flu and pneumonia deaths are down 14% during that time frame as well, which is largely attributed to fewer gatherings during the pandemic.
The 2023 mortality data isnt expected until January 2025.
As we near the fourth anniversary of COVID-19's arrival in New Zealand one thing is clear - the virus isn't going anywhere.
Professor Michael Baker says if anything, the pandemic has become more intense in the last few months, with this latest wave larger than the previous one.
Today, face masks are few and far between. We may still be experiencing a fifth wave of COVID-19, but experts are worried Kiwis are becoming complacent.
"I think it's really old news to be honest," one person told Newshub.
"I'm not super worried about it, it's kind of everyday life," another said.
It's become part of everyday life, unlike previous pandemics that were gone within a year.
"We didn't expect this pandemic to last for four years and if anything it's become more intense in the last three or four months with this fifth wave being bigger than the fourth wave," said Otago Uni Professor of public health Michael Baker.
The virus is also evolving.
"JN.1 is more than 90 percent of cases being detected. We haven't seen that dominance by a subvariant since omicron," he warned.
Prof Baker said in the future we could experience two major waves of COVID-19 each year. And we need to beef up our strategy to deal with them.
"It's getting ahead of our immune system and we need a different way of working," he said.
In the last year, COVID-19 has caused more than 1000 deaths here in New Zealand, and more than 12,000 hospitalisations. With free rapid antigen tests now extended until the end of June, Te Whatu Ora is urging people to have a supply at home and at the ready.
"We need to get on top of this ongoing pandemic. It's not going away, if anything it's getting worse," Prof Baker warned.
Right now Canterbury has the most active cases of COVID-19, with a recorded total of 694.
Earlier this week, Rangiora High School had to close its doors after nearly 40 teachers contracted the virus.
"The big thing is we have a really vulnerable health population, we don't have the health professionals that we have had and that's a scary thing. People need to treat them with respect and not put our small health workforce at risk," said Unichem Cashel pharmacist Annabel Turley.
By isolating if you're unwell, wearing a mask when visiting the doctor and staying up to date with your COVID boosters.
In a recent study published in the journalDiagnostics,researchers investigate the relationship between olfactory dysfunction associated with the coronavirus disease 2019 (COVID-19) and subsequent neurocognitive disorders.
Study:A Comprehensive Review of COVID-19-Related Olfactory Deficiency: Unraveling Associations with Neurocognitive Disorders and Magnetic Resonance Imaging Findings. Image Credit:Mariia Boiko/ Shutterstock.com
Acute olfactory dysfunction is one of the earliest and most common symptoms associated with COVID-19, with an incidence rate of up to 75%. The manifestation of both olfactory and gustative dysfunction in COVID-19 can range from reduced or distorted perception to a complete loss of smell and/or taste.
In the context of COVID-19, acute olfactory dysfunction is defined as the altered sense of smell that persists for 14 days or less. Typically, olfactory dysfunction arises around the third day following initial infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with complete resolution of smell perception occurring within four to six weeks. However, up to 27% of COVID-19 patients will continue to experience altered olfactory perception for up to four months, with 21.3% of patients reporting an altered sense of smell for up to one year.
In addition to COVID-19, various other viral infections can lead to olfactory dysfunction, in addition to traumas, neurodegenerative pathological processes, and the secondary effects of sinus diseases. Despite the high prevalence of COVID-19-related olfactory dysfunction, few studies have discussed neuroimaging abnormalities associated with this symptom, including those that may affect the olfactory bulb (OB), olfactory sulcus (OS), olfactory cleft, and olfactory tract (OT).
In the present study, researchers performed a literature review on OB changes observed in patients with clinically confirmed olfactory dysfunction following a diagnosis of COVID-19. They also discussed current treatments for olfactory dysfunction associated with COVID-19.
To this end, the researchers searched multiple databases including PubMed, Scopus, and Google Scholar until December 5, 2023, using keywords including COVID-19, olfactory deficit, anosmia, imaging, SARS-CoV-2, magnetic resonance imaging (MRI), olfactory bulbs, neurocognitive deficits, mood disorders, neuropsychiatric sequelae, and treatments. This search led to a total of 12 observational studies and one case report included in the analysis.
SARS-CoV-2 is considered neurotropic, neuroinvasive, and neurovirulent, with some viral variants associated with a greater affinity for the central nervous system (CNS) than others. In particular, the ancestral D614G strain, followed by the Gamma, Delta, and Omicron BA1 variants, have been associated with the greatest neurotropism in descending order.
Despite several studies evaluating the impact of SARS-CoV-2 infection on olfaction, the precise pathogenesis and molecular mechanisms responsible for this dysfunction remain unclear. Some proposed hypotheses include mechanical obstruction due to congestion and rhinitis, which can compromise airflow and the transportation of odorants for smell perception. However, this hypothesis has been disproven, as several studies have found that olfactory dysfunction often persists for longer durations than respiratory symptoms, with many COVID-19 patients experiencing olfactory dysfunction without the associated nasal congestion needed to support this theory.
Researchers have also hypothesized that SARS-CoV-2 causes direct damage to olfactory neurons, which subsequently leads to olfactory dysfunction. Despite the absence of both the angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) on olfactory neurons, both of which are crucial for viral entry into cells, SARS-CoV-2 may use other pathways such as Basigin (BSG), neuropilin-1 (NRP1), TMPRSS11A, and furin receptors to infect the olfactory system and cause dysfunction.
The reviewed studies included several descriptions of MRI findings in patients with COVID-19, such as volumetric abnormalities and altered signal intensity of OBs, altered depth of OS, abnormalities within the olfactory cortex, as well as irregularities of neuron filia.
Measuring OB volume (OBV) and OS depth is the most common approach to evaluating the olfactory system. To this end, reduced OBV and OS depth in both the right and left side of hospitalized COVID-19 patients has been observed in several studies, thus suggesting that SARS-CoV-2 causes direct damage to olfactory neuronal pathways.
Up to one-third of patients who have recovered from COVID-19 report neurological symptoms, some of which include brain fog, insomnia, headache, depression, anxiety, and mental fatigue. In COVID-19, prolonged olfactory dysfunction has been associated with severe cognitive consequences, which may be attributed to inflammation, altered neurogenesis of the olfactory system, and functional changes within the brain structures.
Although olfactory dysfunction often spontaneously resolves in COVID-19 patients, a significant proportion of these individuals experience chronic olfactory dysfunction. Thus, a wide range of treatment approaches have been proposed for the treatment of COVID-19-related olfactory dysfunction, some of which include corticosteroids and intranasal insulin, dietary intake of various supplements, and olfactory training.
Future studies are needed to determine the efficacy of combining these treatment strategies to restore olfactory function.
Journal reference:
Reported coronavirus cases decreased statewide and locally in the week ending Feb. 3.
Statewide, the number of reported cases went down to 2,792 from 3,192, a decrease of 400 cases. Thats a percentage decrease of 12.53%.
Locally, the number of reported cases went down to 66 from 87 in the week ending Jan. 27. Thats a decrease of 21, or 24.13%.
Overall, cases have dropped four consecutive weeks statewide, from 4,999 to 2,207 cases, which is a percentage drop of 44.14%.
Locally, the cases have fallen for four consecutive weeks, from 125 to 66, or a drop or 59 cases, which is a percentage decrease of 47.20%.
There were 552 coronavirus tests administered by health officials in the 10 communities covered by The Sun Chronicle with 66 positives, which is a percentage rate of 11.49%. Thats a decrease of 58 tests, which equals 9.5%
The communities covered are: Attleboro, Foxboro, Mansfield, Norfolk, North Attleboro, Norton, Plainville, Rehoboth, Seekonk and Wrentham.
The number of reported COVID-19 cases is not accurate, however, and the figure is surely higher because of the prevalence of home-testing kits. Not all the positive cases found through home-testing are reported to health officials. Also, many people who become ill dont bother testing as the virus has weakened and the symptoms caused by the virus are less severe.
For context, the highest number of new cases statewide for one week was recorded on Jan. 14, 2022, at 132,557.
The highest number locally for one week was 3,463, recorded on Jan. 13, 2022.
All told, since the beginning of the pandemic in March 2020, the area has recorded 50,493 cases.
In the week ending Feb. 3 the case counts in the communities were:
Statewide, the number was 2,792 confirmed cases with 695 probable cases for a total statewide of 2,136,756 confirmed and probable cases since the pandemic began in March 2020.
The number of confirmed deaths statewide increased to 37, from the 29 recorded in the week ending Jan. 27, and the number of probable deaths fell to 0 from the two recorded in the week ending Jan. 27.
The number of confirmed deaths statewide since the beginning of the pandemic in March 2020 is 23,329, and the number of confirmed and probable deaths is 27,888.
A poll for the area was taken recently and the death total, with nine communities reporting, was 518.
Deaths caused by the virus, per community covered by The Sun Chronicle, are:
Most of the deaths were suffered by the elderly.
The average age of death caused by the virus is about 80, according to the states Department of Public Health.
Theres a new variant which is causing many of the cases known as JN.1. As of Feb. 3, JN.1 is estimated to account for approximately 91% to 94% of all currently circulating coronavirus variants, an increase from the estimated prevalence of 83% to 88% two weeks ago, according to the CDC.
JN.1 remains at high prevalence among variants in international travelers and wastewater viral levels, as well as in most regions around the globe. At this time, there is no evidence that JN.1 causes more severe disease.
Approximately 12.5% of all emergencydepartment visits in Massachusetts were due to acute respiratory disease including coronavirus, flu and respiratory syntactical virus (RSV).
There have been 100 deaths due to the flu this season 2023-2024.
Most hospitals and health clinics in Massachusetts and Rhode Island including Sturdy Memorial Hospital and all Sturdy Health facilities have re-instituted mask mandates in an effort to help keep the spread of COVID-19, the flu and other winter respiratory illnesses, down.
George W. Rhodes can be reached at 508-236-0432.
Credit: Miguel Martinez
Credit: Miguel Martinez
Two years ago in early 2022, when The Atlanta Journal-Constitution visited Northeast Georgia Medical Center, 18 of the 24 beds in the intensive care unit (ICU) were filled with COVID patients. Under a maze of machines, tubes, and wires, patients wrestled with everything from dangerously low oxygen levels to heart problems to organ failure. Some were on the brink of death.
Today, far fewer people are dying or becoming seriously ill because vaccines and prior infections have bolstered their immunity and reduced the severity of illnesses. At a visit to the hospital on Feb 5, only three of the ICU beds were filled with COVID. And many of the hospitalized COVID patients only tested positive after being admitted for other reasons such as cancer surgery or appendicitis.
The latest preliminary data on weekly COVID deaths in Georgia show 14 COVID deaths for the week ending Feb. 3. Data from January, which is considered more reliable, shows around 50 COVID deaths a week in Georgia.
The number of new COVID hospitalizations in Georgia for the week ending Feb. 3 totaled 740, down from 834 the week before, marking an 11% drop.
Back in September 2021, shortly after vaccines became available and a more contagious variant, delta, was circulating, there were a staggering 995 deaths during the week ending Sept. 4, 2021. And the peak of new COVID hospitalizations for Georgia was 5,600 for the week ending Jan. 9, 2021.
There are more treatment options today. And while the current omicron variants are considerably more contagious than prior variants, Northeast Georgia Medical Center doctors said they do not attack the lungs as aggressively as those earlier strains. But COVID remains a threat, especially for those who are older and who have weakened immune systems.
Credit: Miguel Martinez
Credit: Miguel Martinez
The AJC recently returned to the ICU and interviewed Glass and infectious disease physician Dr. Supriya Mannepalli about how the coronavirus has changed and how sick patients are managed now. The following is a Q and A with Mannepalli. Some of her comments were edited for length and clarity.
Q: Whats it like to be hospitalized with COVID now?
Mannepalli: I think from the earlier days to now, what we have seen is a change in the severity overall and less severity overall. But there are still patients who have other risk factors chronic medical conditions, immunosuppressive conditions who who not up to date with their vaccines, who do get sick enough to need to be hospitalized. But that number is much less compared to earlier surges we have seen in 2020, 2021.
Q: How many COVID patients are currently hospitalized at the Northeast Georgia Medical System?
Mannepalli: COVID patients in the entire health system are between 40 and 50 and this includes all of the hospitals and long-term care as well (the system includes five hospitals). This doesnt mean that theyre specifically here for COVID. Most of them are here for something else and test positive for COVID. But there are the ones who are here truly for COVID-related respiratory infections. Those are the patients with low immunity and other medical conditions, and not up to date with their vaccinations.
There are also those patients who are here for another issue and if they have comorbidities, the COVID diagnosis on top of what they are already dealing with can make a patient very ill and in need of ICU level of care.
Credit: Miguel Martinez
Credit: Miguel Martinez
Q: What appears to make the biggest difference?
Mannepalli: I think the one thing I keep stressing is the importance of staying up to date with the COVID vaccines, and last I checked the uptake of the new vaccine is very, very low. Overall, maybe 20% across the U.S. So thats very low numbers, and especially those who are elderly, at high risk of developing severe COVID, its so important to stay up to date on your vaccinations.
(In Georgia, the vaccination rate is even lower. Only about 7% of Georgians have had the updated COVID-19 vaccine, according to the most recent figures from the state Department of Public Health.)
When it comes to oral treatments (such as the anti-viral Paxlovid, which can be taken at home) for those who are high risk in the outpatient setting, start it early so it doesnt progress to severe infection later on.
If they are here and admitted, our treatments are still primarily the antiviral remdesivir and steroids; if they require oxygen, that as well.
Credit: Miguel Martinez
Credit: Miguel Martinez
Q: Is COVID now one of the multiple viruses you are dealing with along with the flu? What has that been like?
Mannepalli: One thing we are noticing is a severe flu season this year. Weve seen some patients with severe influenza infection and some with a secondary bacterial infection. Weve seen some very, very sick flu patients this season even some who needed to be intubated (to assist their breathing mechanically).
Most of those who are hospitalized for the flu were not vaccinated against influenza.
Vaccines can help. Even when they are not the perfect match (to circulating strains), they help prevent the disease.
A National Institutes of Health (NIH) study has found that 5.8 million children have experienced long COVIDsymptoms of COVID-19 that have persisted long after the initial infection. The Nationwide research effort called the Researching COVID to Enhance Recovery (RECOVER) Initiative involved 10 pediatric hospital in the U.S., sought to provide vital information for doctors on the difficulty of diagnosing and treating post-acute sequelae of SARS-CoV-2 (PASC) and to better understanding its trajectoryand persistencein these patients over time.
Results of the study are published in the journal Pediatrics.
At our Long COVID Recovery Care clinic, some patients have symptoms for two months and there are others whose symptoms have still not gone away two years later, said study co-author Sindhu Mohandas, MD, co-director, Immunocompromised Infectious Diseases Program at the Childrens Hospital Los Angeles.
For this research, the RECOVER collaborators scoured the existing literature across a number of different areas of expertise to provide a comprehensive view of how long COVID has affected children and youth. Our goal was to summarize all available knowledge from those smaller articles, case reports and clinic-based studies on the full range of long COVID symptoms that we are seeing across the U.S., Mohandas stated.
The team found some common factors of long COVID risk among this population: 45% of long COVID patients experienced symptoms of the infection versus only 15% who were asymptomatic. Other factors increasing risk included older age, severity of initial infection, the number of organs initially affected, other underlying medical conditions, and higher weight.
Similar to findings of long COVID in adults, the most common symptoms in younger people include fatigue, persistent headaches, weakness, musculoskeletal pain, shortness of breath, loss of taste and smell, and dizziness.
Further, between two percent and 44 percent of children experience brain fog after physical of mental effort, the well documented difficulties some long COVID sufferers have concentrating. The researchers note that brain fog and fatigue symptoms from long COVID are very similar to the symptoms myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which can last for six months or more.
Additional complications related to long COVID include the development of type 1 and type 2 diabetes a month after initial infection and multisystem inflammatory syndrome in children (MIS-C). This condition is likely related to an abnormally strong activation of the immune system in combating the initial infection and can result is heart damage and other cardiovascular health issues.
Long COVID has also been shown to worsen pre-existing health issues in children, notably chronic respiratory conditions such as asthma, which several studies have shown does not worsen during the initial infection, but often did worsen in the ensuing six months.
In general, the report noted that pediatricians are underdiagnosing long COVID. Some believe children dont get long COVID and others just dont know the signs and symptoms. I think the big added value to this published study is that it provides some of the characteristic fingerprints that pediatricians can use to recognize long COVID, noted co-author John C. Wood, MD, PhD, a cardiologist and investigator at the Childrens Hospital Los Angeles.
