There were 102,371 respondents to the Smoking Toolkit Study between June 2017 and August 2022. We excluded 411 people (0.4%) who did not report their smoking status, leaving a sample of 101,960 for analysis. Of these, 55,349 were surveyed before the start of the pandemic (June 2017February 2020) and 46,611 were surveyed during the pandemic (April 2020August 2022). There was a small proportion of missing cases on quitting outcomes (4.1% for quit attempts; 0% for cessation, number of quit attempts, and use of support). Table 1 presents weighted descriptive statistics for the sample as a whole and as a function of the timing of the pandemic (unweighted characteristics are shown in Additional File 5: Table S1).
Table 2 summarises the GAM results. Figure1 shows trends in current smoking over the study period.
Current smoking, overall and by age and social grade. Panels show trends in the prevalence of current smoking among A adults in England (unweighted n: overall=101,960, ABC1=64,088, C2DE=37,872), B 1824-year-olds (unweighted n: overall=12,455, ABC1=7766, C2DE=4689), and C 4565-year-olds (unweighted n: overall=34,332, ABC1=22,401, C2DE=11,931), June 2017 to August 2022. Lines represent modelled weighted prevalence over the study period, adjusted for covariates. Points represent unadjusted weighted prevalence by month. The vertical dashed line indicates the timing of the start of the COVID-19 pandemic in England (March 2020). ABC1, managerial/professional/intermediate; C2DE, small employers/lower supervisory/technical/semi-routine/routine/never workers/long-term unemployed
Overall, among adults in England, the onset of the COVID-19 pandemic was associated with a negligible step-level change in current smoking (Fig.1A). However, there was a notable change in trend. Before the pandemic, smoking prevalence fell by 5.2% per year (relative risk, trend [RRtrend]=0.948; note this percentage represents the relative rather than absolute percentage point reduction, i.e. a 5.2% decrease compared to the previous year [(1-RR)*100], rather than a decrease of 5.2 percentage points within a given year). After the onset of the pandemic, this rate of decline slowed to 0.3% per year (RRtrendRRtrend=0.9481.052=0.997; Fig.1A). The change in trend from pre- to post-onset of the pandemic was significant (relative risk, change in trend [RRtrend]=1.052, 95% confidence interval [CI]=1.014,1.090). In June 2017, smoking prevalence was estimated at 16.2%. At the start of the pandemic (March 2020), it was 15.1%. In August 2022, it was virtually unchanged, at 15.0%.
Stratified analyses showed a 20.1% (95% CI=10.1, 31.0%) step-level increase in smoking prevalence among adults from more advantaged social grades (ABC1) at the start of the pandemic, followed by a slowing in the pre-pandemic decline to the point where progress in reducing smoking reversed (+3.6% per year compared with9.5% per year before the pandemic, RRtrend=1.145, 95% CI=1.083,1.211; Fig.1A). By contrast, there was no increase in smoking prevalence among those from less advantaged social grades (C2DE), and it appeared the modest (~3% per year) pre-pandemic decline continued (Fig.1A).
When we looked at current smoking in different age groups, we saw divergent changes associated with the pandemic: a 34.9% (95% CI=17.7,54.7%) step-level increase among 1824-year-olds (Fig.1B) but a 13.6% (95% CI=4.4, 21.9%) step-level decrease among 4565-year-olds (Fig.1C). While the rise in smoking among young adults was similar across social grades, the fall among middle-aged adults was limited to those from less advantaged social grades (22.4%, 95% CI=10.7,32.6%). As we observed overall, progress in reducing smoking stopped among more advantaged social grades during the pandemic (from12.4% to0.3% per year among 1824-year-olds, RRtrend=1.138, 95% CI=1.004, 1.290; and from11.7% to+3.4% per year among 4565-year-olds, RRtrend=1.171, 95% CI=1.0551.300) but was similar to pre-pandemic rates within less advantaged social grades (Fig.1B and C).
The data indicated these changes were sustained over time (Fig.1), rather than short-lived pulse effects during the early months of the pandemic (Additional File 5: Table S3).
Data on cessation were available for all of the 17,964 past-year smokers in our sample. There were 741 (4.1%) with missing data on quit attempts and, among those eligible, 0 with missing data on the number of quit attempts. Table 2 summarises the GAM results. Figure2 shows trends in quitting activity over the study period.
Quitting activity, overall and by social grade. Panels show trends in the prevalence of A) cessation and B making at least one quit attempt in the past year among past-year smokers (unweighted n: overall=17,964, ABC1=8802, C2DE=9162), and C the weighted geometric mean number of past-year quit attempts among past-year smokers who made at least one quit attempt (unweighted n: overall=5754, ABC1=2908, C2DE=2846), June 2017 to August 2022. Lines represent modelled weighted prevalence (or means) over the study period, adjusted for covariates. Points represent unadjusted weighted prevalence (or means) by month. The vertical dashed line indicates the timing of the start of the COVID-19 pandemic in England (March 2020). Corresponding data without adjustment for dependence are shown in Additional File 5: Fig.1 and Additional File 5: Table 4. ABC1, managerial/professional/intermediate; C2DE, small employers/lower supervisory/technical/semi-routine/routine/never workers/long-term unemployed
Among past-year smokers, the pandemic was associated with a 120.4% (95% CI=79.4170.9%) step-level increase in cessation (Fig.2A). This increase was similar at 154.4% (95% CI=104.8216.1%) when cigarette dependence was not adjusted for (Additional File 5: Table S4; Additional File 5: Fig. S1A) despite mean cigarette dependence only decreasing very slightly during the pandemic (Additional File 5: Table S5; Additional File 5: Fig. S3). There was also a change in trend: the prevalence of cessation was reducing before the pandemic at a rate of 16.1% per year (RRtrend=0.839); this rate of decline slowed during the pandemic (RRtrend=1.219, 95% CI=1.0791.379) to 2.3% (Fig.2A). The change in trend was driven by the less advantaged social grades, among whom the rate of cessation was reversed from24.5% per year before the pandemic to+9.8% per year during the pandemic (RRtrend=1.454, 95% CI=1.2001.762; Fig.2A). By contrast, the more modest (7.4%) pre-pandemic decline in cessation among those from more advantaged social grades appeared to continue (Fig.2A). This pattern of results was largely replicated when we analysed data separately for smokers aged25years (Additional File 5: Table S6; Additional File 5: Fig. S4). However, among the much smaller group aged 1824years, while we observed a significant step-level increase in cessation, there was uncertainty in all the other results with the confidence intervals crossing zero and including the point estimate from the overall analyses for the trend in cessation before the pandemic, the change in trend, and the patterning of the socio-economic results (Additional File 5: Table S6; Additional File 5: Fig. S4).
The pandemic was also associated with a 41.7% (95% CI=29.754.7%) step-level increase in the proportion of past-year smokers who made1 quit attempt (Fig.2B). This increase occurred across ages but was larger among smokers aged 1824 (90.8% [95% CI=57.0131.9%]) than those aged25 (31.5% [95% CI=19.145.2%]) (Additional File 5: Table S6; Additional File 5: Fig. S4). The rate of decline in quit attempts slowed from 8.2 to 1.4% per year (RRtrend=1.074, 95% CI=1.0161.136; Fig.2B); again, this was driven by those from less advantaged social grades, with no significant change in trend among the more advantaged social grades (Fig.2B), and was only observed among those aged25 (Additional File 5: Table S6; Additional File 5: Fig. S4). Among those who tried to quit, there was little change in the mean number of attempts made (Fig.2C).
While analyses of pulse effects showed increases in quitting activity in the first 23months of the pandemic (Additional File 5: Table S3), it is clear from visual inspection of the data in Fig.2 and the change in trend results (Table 2) that these increases were sustained through to August 2022.
Table 2 summarises the GAM results. Figure3 shows trends in use of cessation support over the study period.
Use of support by smokers in quit attempts, overall and by social grade. Panels show trends in the prevalence of use of A prescription medication, B behavioural support, and C e-cigarettes in the most recent quit attempt among past-year smokers who made a least one quit attempt (unweighted n: overall=5754, ABC1=2908, C2DE=2846), June 2017 to August 2022. Lines represent modelled weighted prevalence over the study period, adjusted for covariates. Points represent unadjusted weighted prevalence by month. The vertical dashed line indicates the timing of the start of the COVID-19 pandemic in England (March 2020). Corresponding data without adjustment for dependence are shown in Additional File 5: Fig.2 and Additional File 5: Table 4. ABC1, managerial/professional/intermediate; C2DE, small employers/lower supervisory/technical/semi-routine/routine/never workers/long-term unemployed
Among past-year smokers who made a quit attempt, the onset of the COVID-19 pandemic was associated with little change in the use of prescription medication (Fig.3A). Point estimates for a step-level change were in opposite directions for those from more and less advantaged social grades, but neither group had a statistically significant change. This finding was robust to the exclusion of varenicline from this variable (Additional File 5: Table 7).
However, the pandemic was associated with changes in the use of behavioural support and e-cigarettes for quitting smoking. There was a 133.0% (95% CI=55.3249.6%) step-level increase in use of behavioural support, followed by a continuation of the modest pre-pandemic decline (Fig.3B). By contrast, there was a 21.2% (95% CI=6.833.4%) step-level decrease in use of e-cigarettes (Fig.3C). This change was short-lived (Additional File 5: Table 3) because there was also a change in trend, reversing this step-level decline: before the pandemic, the proportion of smokers using e-cigarettes in a quit attempt fell by 4.1% per year; during the pandemic, it increased by 18.1% per year (RRtrend=1.232, 95% CI=1.1111.365, Fig.3C). These changes were similar across social grades.
Changes in the use of cessation support were similar when cigarette dependence was not adjusted for (Additional File 5: Table 4; Additional File 5: Fig.2).
FOR MEDICAL AUDIENCES ONLY
Novavaxs Updated COVID-19 Vaccine Now Available in Sweden
December 14, 2023
Novavaxs updated protein-based non-mRNA COVID-19 vaccine is now available for order by healthcare professionals and use in Sweden. The Public Health Agency in Sweden has recommended the vaccine for the prevention of COVID-19 in individuals aged 30 and older.
We are pleased that our updated protein-based vaccine is now available for healthcare providers to start vaccinating people before the holiday season in Sweden. A diverse vaccine portfolio with both mRNA and non-mRNA options is critical to helping to protect those most at risk against COVID-19.
Non-clinical datashowed that Novavax's updated COVID-19 vaccine induced functional immune responses against XBB.1.5, XBB.1.16 and XBB.2.3 variants. Additional non-clinical data demonstrated that Novavax's vaccine induced neutralizing antibody responses to subvariants BA.2.86, EG.5.1, FL.1.5.1 and XBB.1.16.6 as well as CD4+ polyfunctional cellular (T-cell) responses against EG.5.1 and XBB.1.16.6. These data indicate Novavax's vaccine can stimulate both arms of the immune system and may induce a broad response against currently circulating variants.1,2
Forward-Looking Statements
Statements herein relating to the future of Novavax, its operating plans and prospects, including the availability of its updated XBB version of its Novavax COVID-19 Vaccine, Adjuvanted (2023-2024 Formula) (NVX-CoV2601) and the timing of delivery and distribution of its vaccine in Sweden are forward-looking statements. Novavax cautions that these forward-looking statements are subject to numerous risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. These risks and uncertainties include, without limitation, challenges satisfying, alone or together with partners, various safety, efficacy, and product characterization requirements, including those related to process qualification and assay validation, necessary to satisfy applicable regulatory authorities; difficulty obtaining scarce raw materials and supplies; resource constraints, including human capital and manufacturing capacity, on the ability of Novavax to pursue planned regulatory pathways; challenges or delays in obtaining regulatory authorization for its product candidates, including its updated XBB version of its COVID-19 vaccine in time for the fall 2023 vaccination season or for future COVID-19 variant strain changes; challenges or delays in clinical trials; manufacturing, distribution or export delays or challenges; Novavax's exclusive dependence on Serum Institute of India Pvt. Ltd. for co-formulation and filling and the impact of any delays or disruptions in their operations on the delivery of customer orders; challenges meeting contractual requirements under agreements with multiple commercial, governmental, and other entities; and those other risk factors identified in the "Risk Factors" and "Management's Discussion and Analysis of Financial Condition and Results of Operations" sections of Novavax's Annual Report on Form 10-K for the year ended December 31, 2022 and subsequent Quarterly Reports on Form 10-Q, as filed with the Securities and Exchange Commission (SEC). We caution investors not to place considerable reliance on forward-looking statements contained in this press release. You are encouraged to read our filings with the SEC, available at www.sec.gov and www.novavax.com, for a discussion of these and other risks and uncertainties. The forward-looking statements in this press release speak only as of the date of this document, and we undertake no obligation to update or revise any of the statements. Our business is subject to substantial risks and uncertainties, including those referenced above. Investors, potential investors, and others should give careful consideration to these risks and uncertainties.
References:
image:
Ioannis Katsoularis
Credit: Klas Sjberg
Individuals infected with COVID-19 are also at an increased risk of suffering from heart rhythm disturbances, such as atrial fibrillation. This is shown in a new study at Ume University, Sweden, which is one of the largest studies of its kind in the world.
"The results underline the importance of both being vaccinated against COVID-19 and that the healthcare system identifies people at increased risk of this type of complications, so that the correct diagnosis is made and appropriate treatment is started in time," says Ioannis Katsoularis, first author of the study and cardiologist at University Hospital of Northern Sweden in Ume.
The researchers were able to show that those who had been ill with COVID-19 could also suffer from heart rhythm disturbances, both in the form of so-called tachycardias, when the heart ha rate is high, and bradyarrhythmias, when the heart is slow so that a pacemaker is sometimes needed.
The study shows that the risk of atrial fibrillation and flutter was increased up to two months after infection. In the first month, the risk was twelve times greater than for people who did not suffer from COVID-19infection.
Even the risk of a specific subset of tachycardias, paroxysmal supraventricular tachycardiaswas elevated up to 6 months after the infection and was five times greater in the first month. For the bradyarrhythmias, the risk was increased up to 14 days after the infection and was three times greater in the first month compared to subjects without COVID-19. Previous research in this area had not focused as much on which individuals are most at risk.
We found that the risks were higher in older individuals, individuals with severe COVID-19 and during the first wave of the pandemic. We could also see that unvaccinated people were at higher risk than vaccinated people. Overall, the severity of the infection was the strongest risk factor," says Anne-Marie Fors Connolly, who leads the research group at Ume University that is behind the study.
In the study, information from large national registers was cross-checked. All people who tested positive for the virus in Sweden from the start of the pandemic until May 2021 were included, but also a comparison group of individuals without a positive test for the virus. Over one million individuals with COVID-19 and over four million control individuals were included in this nationwide study, which is one of the largest of its kind in the world. Researchers at Ume University have previously shown that COVID-19 leads to an increased risk of blood clots, myocardial infarction and stroke.
Observational study
People
Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study
21-Nov-2023
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.
Representative Image
The COVID-19 saga is far from over, as recent discoveries of four new sub-variants in the US remind us. While vaccines have significantly reduced case numbers, these new strains pose fresh challenges in our ongoing fight against the virus.
Some of these new strains, while mostly harmless, have begun raising eyebrows among the healthcare community worldwide, with notable outbreaks in the US and the UK. India, too, is witnessing a spike in recorded COVID-19 cases, with Kerala and a concerningly new sub-variant at the centre of the surge.
Keep reading to learn more about the recent sub-variants that have begun making global rounds recently.
Experts reckon that the EG.5, or Eris, may be a descendant of the XBB.1.9.2 Omicron subtype that originated in China earlier this year. Transcending one step further, the HV.1 evolved from the EG.5, sporting additional mutations that make it superior to its predecessor.
While both EG.5 and HV.1 are currently found in nearly half of all COVID-19 cases in the US, experts note that these do not pose a major threat compared to other variants. EG.5 initially peaked at 25% of total record US COVID-19 cases in September, but has since declined to 13% in December.
HV.1, on the other hand, rapidly rose to prominence after emerging in late summer and now accounts for over 30% of cases in the country. New vaccines that counter XBB also appear to work against both these strains.
The situation becomes more worrisome with the remaining two sub-variants: BA.2.86 and JN.1.
BA.2.86, nicknamed Pirola, carries a concerning number of mutations in its spike protein, the key to infecting human cells and evading our immune system. This initially sparked fears that new vaccines might not be effective against it.
Fortunately, newer data has shown that we appear to be exhibiting sufficient antibodies against the BA.2.86, suggesting that existing vaccines should continue to work. So far, the strain has been detected in 38 countries.
The newly emerged JN.1, a child of BA.2.86, adds another layer of complexity. While JN.1 readily evades immune defences, preprint studies show that new vaccines do generate antibodies against it, albeit at lower levels than for other sub-variants. This raises concerns about JN.1's potential to cause breakthrough infections despite vaccination protection.
Notably, the JN.1 sub-variant was recently detected in Kerala for the first time, the latest data from the Indian SARS-CoV-2 Genomics Consortium (INSACOG) showed. Experts have noted that this could be a factor behind the states surging COVID-19 cases, but assured that they do not deem it a risk to India yet.
The emergence of these new variants underscores the constant evolution of the COVID-19-causing novel coronavirus. Continued vigilance and monitoring are crucial in staying ahead of the curve. While existing vaccines remain our primary defence, researchers are actively developing updated versions to tackle new threats like JN.1.
Individual precautions like masking, social distancing and staying up-to-date on vaccinations continue to be essential in protecting ourselves and our communities. By staying informed and taking necessary measures, we can navigate this evolving landscape and emerge stronger from the pandemic.
**
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FOR MEDICAL AUDIENCES ONLY
Novavaxs updated protein-based adjuvanted non-mRNA COVID-19 vaccine is now available for use in Italy for the prevention of COVID-19 in individuals aged 12 and older. Doses have been distributed by the Italian Ministry of Health across all regions and are now available for this season's vaccination campaign.
We are pleased that our updated protein-based adjuvanted non-mRNA vaccine is now available for pharmacists and general practitioners to start vaccinating people across Italy before Christmas. A diverse vaccine portfolio with both mRNA and protein-based adjuvanted options is critical to helping to protect those most at risk against COVID-19.
Non-clinical datashowed that Novavax's updated COVID-19 vaccine induced functional immune responses against XBB.1.5, XBB.1.16 and XBB.2.3 variants. Additional non-clinical data demonstrated that Novavax's vaccine induced neutralizing antibody responses to subvariants BA.2.86, EG.5.1, FL.1.5.1 and XBB.1.16.6 as well as CD4+ polyfunctional cellular (T-cell) responses against EG.5.1 and XBB.1.16.6. These data indicate Novavax's vaccine can stimulate both arms of the immune system and may induce a broad response against currently circulating variants.1,2
Forward-Looking Statements
Statements herein relating to the future of Novavax, its operating plans and prospects, including the availability of its updated XBB version of its Novavax COVID-19 Vaccine, Adjuvanted (2023-2024 Formula) (NVX-CoV2601) and the timing of delivery and distribution of its vaccine in Italy are forward-looking statements. Novavax cautions that these forward-looking statements are subject to numerous risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. These risks and uncertainties include, without limitation, challenges satisfying, alone or together with partners, various safety, efficacy, and product characterization requirements, including those related to process qualification and assay validation, necessary to satisfy applicable regulatory authorities; difficulty obtaining scarce raw materials and supplies; resource constraints, including human capital and manufacturing capacity, on the ability of Novavax to pursue planned regulatory pathways; challenges or delays in obtaining regulatory authorization for its product candidates, including its updated XBB version of its COVID-19 vaccine in time for the fall 2023 vaccination season or for future COVID-19 variant strain changes; challenges or delays in clinical trials; manufacturing, distribution or export delays or challenges; Novavax's exclusive dependence on Serum Institute of India Pvt. Ltd. for co-formulation and filling and the impact of any delays or disruptions in their operations on the delivery of customer orders; challenges meeting contractual requirements under agreements with multiple commercial, governmental, and other entities; and those other risk factors identified in the "Risk Factors" and "Management's Discussion and Analysis of Financial Condition and Results of Operations" sections of Novavax's Annual Report on Form 10-K for the year ended December 31, 2022 and subsequent Quarterly Reports on Form 10-Q, as filed with the Securities and Exchange Commission (SEC). We caution investors not to place considerable reliance on forward-looking statements contained in this press release. You are encouraged to read our filings with the SEC, available at www.sec.gov and www.novavax.com, for a discussion of these and other risks and uncertainties. The forward-looking statements in this press release speak only as of the date of this document, and we undertake no obligation to update or revise any of the statements. Our business is subject to substantial risks and uncertainties, including those referenced above. Investors, potential investors, and others should give careful consideration to these risks and uncertainties.
References:
Wednesday 13 December 2023 5:00 am
By: Paul Ormerod
Paul Ormerod is an economist at Volterra Partners LLP, author and an Honorary Professor at the Alliance Business School at the University of Manchester
The pandemic-era lockdowns had crushing social and economic impacts, but the inquiry is flat out ignoring it, writes Paul Ormerod
The liberal establishment appears to remain wedded to a narrow and blinkered view of the Covid pandemic and its consequences.
It has been on full display during the Covid inquiry, especially during the cross-examination of Boris Johnson. Hugo Keith KC, the lead barrister at the inquiry, made a great effort to establish that the UK had a very high rate of excess deaths. In other words, a death rate which was higher than in the years immediately before the pandemic.
Measuring the excess death rate is not as straightforward as it may seem though, with a number of technical subtleties involved. But we can refer to a paper which has a very prestigious pedigree indeed in these matters. The article, entitled Excess mortality associated with the Covid-19 pandemic was written by leading academics for the World Health Organisation. It was published in Nature, one of the two top scientific journals in the world.
There is a specific discussion about the situation in the UK. The authors state that in terms of the excess rate, the UK was in the middle of the pack. But there is an interesting qualification. They show that in the opening months of the pandemic, essentially until early 2021, the excess death rate in the UK was definitely high. By implication after that date it was low by international standards, otherwise we would not be in the middle in terms of the overall outcome.
It is this initial period which has clearly shaped perceptions about what happened in the UK. But it is the outcome over the full length of the pandemic which matters in terms of assessing excess deaths.
A great deal of effort has been expended at the inquiry in trying to establish that Britain was too slow to introduce the initial lockdown. The idea that it was not needed and that we should instead rely upon herd immunity, a view apparently held in March 2020 by Prime Minister Johnson, has come in for scathing criticism.
In fact, the policy of herd immunity is one which is now followed, and has been followed for some time, by every Western country. The odd zealot still demands restrictions, but almost everyone now accepts that the virus can be allowed to circulate. In this way, we develop resistance by exposure to it.
Of course, vaccines mitigate the severity of the illness though not the number of cases. But if they had not been invented, we would have had no option but to rely on herd immunity. A more or less permanent state of lockdown would otherwise have bankrupted the country.
Study after study sets out the appalling social and economic costs of the policy of lockdown. Only this week a report from the Centre for Social Justice found that the pandemic has left Britain with a massive social divide that mirrors the Two Nations of the Victorian era.
The families and friends of some of those who died early in the pandemic have been prominent at the inquiry. It is impossible not to feel human sympathy for them. But we do not see anyone representing the large numbers who have died from having vital operations postponed or from their fatal illnesses not being identified early enough to be cured. These are all a direct result of lockdown and the policy of concentrating health resources on dealing with Covid.
Will Hugo Keith KC be raising questions about these deaths and pinning the blame on the lockdown enthusiasts? In a balanced and fair inquiry these and the other broader social and economic issues would feature prominently. It remains to be seen whether they will.
Novaxx
Novavaxs updated protein-based non-mRNA COVID-19 vaccine is now available for use in Poland for the prevention of COVID-19 in individuals aged 12 and older. Doses have been distributed by the appropriate Polish authorities and made available for this seasons vaccination campaign. The Novavax vaccine is currently the only updated COVID-19 vaccine option available in Poland.
We are pleased that our updated vaccine is available in time for the upcoming Christmas and winter holiday season. We are honored to support both the Polish government and the countrys healthcare workers to help protect Polish citizens and their loved ones against COVID-19. Starting today, individuals across the country can receive an updated vaccine.
Non-clinical datashowed that Novavaxs updated COVID-19 vaccine induced functional immune responses against XBB.1.5, XBB.1.16 and XBB.2.3 variants. Additional non-clinical data demonstrated that Novavaxs vaccine induced neutralizing antibody responses to subvariants BA.2.86, EG.5.1, FL.1.5.1 and XBB.1.16.6 as well as CD4+ polyfunctional cellular (T-cell) responses against EG.5.1 and XBB.1.16.6. These data indicate Novavaxs vaccine can stimulate both arms of the immune system and may induce a broad response against currently circulating variants.1,2
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by Timothy McQuiston, Vermont Business Magazine COVID-19 cases rose and hospitalizations fell last week. There were also 8 fatalities reported by the Vermont Department of Health, for a pandemic total of 1,075. Fatalities had been running at about five per week during the fall, mostly among the very elderly.
The VDH reported December 6, 2023, that COVID-19 hospitalizations were down 6 last week to a statewide total of 41. COVID-19 activity remains in the "Low" range, according to the VDH. Reported cases last week were 353, up 63 for the week.
VDH reported 15 COVID-related deaths in March, 20 in April, 10 in May, 10 in June (these are fewest since the summer of 2021), 11 in July, 15 in August, 17 in September, 25 in October, 19 in November and 1 so far December (there were 33 in October 2022 and 47 in October 2021 and zero in October 2020, which was the last month since the beginning of the pandemic to record no COVID-related fatalities).
Of the total deaths to date, 864 have been of Vermonters 70 or older. There have been 3 deaths of Vermonters under 30 since the beginning of the pandemic, as of December 2 (the most recent data available).
CDC states that already an estimated 97% of Americans have some level of immunity, from either vaccination or infection or both, which they said will help keep down new transmission and lessen serious outcomes.
(see data below)
Report Timeframe: November 26 to December 2, 2023
The hospitalizations dataset contains day-level data reported from all Vermont hospitals each Tuesday. Reported numbers are subject to correction.
The number of reportable COVID-19 cases is still available in this report, below. Laboratory-confirmed and diagnosed COVID-19 cases and COVID-19 outbreaks must still be reported to the Vermont Department of Health.
There were 8 outbreaks last week, 1 at schools, and 7 at long-term care facilities (LTC).
Vermont Department of Health recommendations: Preventing COVID-19 (healthvermont.gov)
Vermont has the second lowest fatality rate in the US (124.2 per 100K; Hawaii 101.6/100K). Mississippi (434.9/100K) and Oklahoma (431.8/100K) have the highest rates. The US average is 289.9/100K (CDC data).
There has been a total of 1,158,185 COVID-related deaths to date in the US (CDC) and 6,985,964 globally (WHO).
Following an analysis of COVID-19 data, the VDH reported in January 2023 a cumulative 86 additional COVID-associated deaths that occurred over the course of the pandemic but had not been previously reported. Most of those deaths occurred in 2022.
COVID-19 Update for the United States
Early Indicators
Test Positivity
% Test Positivity
11.5%
(November 26 to December 2, 2023)
Trend in % Test Positivity
+0.9% in most recent week
Emergency Department Visits
% Diagnosed as COVID-19
1.9%
(November 26 to December 2, 2023)
Trend in % Emergency Department Visits
+4% in most recent week
These early indicators represent a portion of national COVID-19 tests and emergency department visits. Wastewater information also provides early indicators of spread.
Severity Indicators
Hospitalizations
Hospital Admissions
22,513
(November 26 to December 2, 2023)
Trend in Hospital Admissions
+17.6% in most recent week
Deaths
% of All Deaths in U.S. Due to COVID-19
3.0%
(November 26 to December 2, 2023)
Trend in % COVID-19 Deaths
+25% in most recent week
Total Hospitalizations
6,544,614
CDC | Test Positivity data through: December 2, 2023; Emergency Department Visit data through: December 2, 2023; Hospitalization data through: December 2, 2023; Death data through: December 2, 2023. Posted: December 11, 2023 3:38 PM ET
The Delta variant took off in August 2021, which resulted in the heaviest number of deaths before vaccines and their boosters helped alleviate serious COVID cases. Multiple Omicron variants are now circulating and appear more virulent than previous variants, but perhaps not more dangerous, according to the CDC.
AP April 5, 2023: WHO downgrades COVID pandemic, says it's no longer a global health emergency
Walk-in vaccination clinics run by the state closed on January 31, 2023. Learn more
Vermonters are reminded that all state COVID testing sites were closed as of June 25, 2022. PCR and take-home tests are available through doctors' offices, pharmacies and via mail from the federal government. The federal government officially ended its pandemic response as of May 11, 2023. See more information BELOW or here: https://www.healthvermont.gov/covid-19/testing.
Starting May 11, 2023, the CDC and Vermont Department of Health will no longer use the COVID-19 Community Level to measure COVID-19 activity in the U.S. and Vermont. Instead, Vermont's statewide COVID-19 level will be measured by the rate of COVID-19 in people being admitted to the hospital, per 100,000 residents.
Focusing on hospitalization data is a better estimate of how COVID-19 is impacting the community now that reported COVID-19 cases represent a smaller proportion of actual infections. This also allows us to compare Vermonts hospitalization levels with other parts of the country.
The Delta variant caused a surge in COVID-related fatalities last fall and into the winter.
The highest concentration of deaths was from September 2021 through February 2022. Overall, December 2020 and January 2022 were the worst months with 72 fatalities each.
The US confirmed its first case of COVID-19 on January 20, 2020.
Vermonters ages 6 months and older are eligible for COVID-19 vaccines. Getting vaccinated against COVID-19 is the safer way to build protection from serious illnesseven for those who have already had COVID-19. Learn more about COVID-19 vaccines (CDC)
COVID-19 vaccines are free and widely available. Anyone can get vaccinated in Vermont, including those who live in another state, are non-U.S. citizens, or who have no insurance. See Vermont's current vaccine rates
Know your rights when getting free vaccines.
You are considered up-to-date if you are over the age of 6 years old and have received a bivalent (updated) COVID-19 vaccine.Learn more about kid vaccines
If you are unable or choose not to get a recommended bivalent mRNA vaccine, you will be up to date if you received the Novavax COVID-19 vaccine doses approved for your age group.
Find more on recommended doses from CDC
COVID Vaccine Information for Health Care Professionals
More on COVID-19 Vaccines (CDC)
Recommended COVID Vaccine Doses (CDC)
Find a COVID-19 vaccine near you.
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Use Vaccines.gov to find a location near you, then call or visit the location's website to make an appointment.
Vaccines.gov
Everyone 6 months of age and older is eligible to get a COVID-19 vaccination.Most children are also now eligible for a bivalent dose that offers increased protection against the original strain and omicron variants.
See more on recommended vaccine doses by age group (CDC)
Resources for parents and caregivers
https://www.vermontfamilynetwork.org/ccfk/
Tips for Helping Kids Feel Ready for Any Vaccine (Vermont Family Network)
#factsheet
What Families with Children Should Know About COVID-19 Vaccines (translated)
https://www.youtube.com/watch?v=lWcqHOgQIVg&t=5s
Conversations About COVID-19 Vaccines for Children with Vermont Pediatricians (American Academy of Pediatrics)
If you cannot get vaccines through any of the options above, our local health offices
offer immunization clinics by appointment.
Need a ride? If you do not have transportation to get a free COVID-19 vaccine or booster, please contact your local public transportation provider or callVermont Public Transportation Association (VPTA)
at 833-387-7200.
English language learners, or immigrant or refugee community members, who would like to learn about more about vaccine clinics can contact theAssociation of Africans Living in Vermont
(AALV) at 802-985-3106.
If you lost your vaccine card or your information is wrong:
Recommendations for keeping your vaccination card and record up to date
Find more COVID-19 translations
COVID-19 resources for people who are deaf and hard of hearing
Report your COVID-19 test results
Most data are from analysis of data are from the Centers for Medicare & Medicaid Services (CMS) Nursing Home COVID-19 Public File (downloaded most recently on 12/8/2023). These data are self-reported by facilities to the Centers for Disease Control and Prevention (CDC) weekly.
Vaccine data for Q4 2023 are from the CDC Nursing Home COVID-19 Vaccination Data Dashboard (https://www.cdc.gov/nhsn/covid19/ltc-vaccination-dashboard.html; accessed 12/8/2023).
Several data points in the state fact sheets include general population state data (that is, not limited to nursing homes) as a denominator or stand-alone measure. These data are from CDC (downloaded most recently on 12/6/2023).
Data were analyzed by Scripps Gerontology Center at Miami University in Ohio, additional analysis and preparation of the dashboard by the AARP Public Policy Institute.
Key Definitions
CDC has issued detailed instructions to nursing homes for reporting these data:
Inclusion Criteria
For the four-week measures, nursing homes were included only if the facility reported to CDC for all four weeks (nationally, 98% of facilities for the most recent four-week period, for states ranging from 94% to 100%). If a nursing facility reported but had missing data for a specific measure, that facility is excluded from the calculation of that measure for the dashboard.
Most nursing facilities with missing data are only missing the most recent week (ending 11/19/2023). That is, most missing data are due to late responses, not skipped entirely. To have the most current data possible, we must exclude those facilities that were late in reporting the most recent week of data as well as those with one or more weeks of non-response in earlier weeks.
Vaccination data points are based on the most current week of data for each facility, as long as it is within the last four weeks. Facilities do not need to report for all four weeks to be included. The Dashboards use of multiple weeks of data and definition of booster rate and up to date rate as a percentage of all residents/staff means that rates may be systematically different than what is reported elsewhere.
Aggregate counts of deaths and cases may be an undercount if there are facilities that are not reporting. Percentages or rates might be slightly biased if the average of non-reporting facilities differs significantly from the average of reporting facilities.
For the measures of cases and deaths since 6/1/2020 and since January 2020, all nursing homes reporting at least one week of data are included. The national response rate is typically greater than 99% for both measures.
Comparability to Other Data Sources
The first reporting date for the CMS Nursing Home COVID-19 data was May 24, 2020, and includes all cases and deaths that were reported since the beginning of the year; however, retroactive reporting is not mandatory, and the accuracy of reporting at the state level is unknown. Vaccination data were first reported for the week ending May 30, 2021, and are mandated as of the week ending June 13, 2021.
Data points that go back prior to the first reporting date, including the since January 2020 counts of resident cases and deaths in the state fact sheets, may significantly undercount the total number of cases and deaths. At the national level, the CMS data source gives a significant undercount of the number of cases and deaths before June 2020, compared to other sources that were reporting in real-time.
Since June 2020, the CMS data are much more reliable and at the national level track well against data reported by the states (comparisons to individual states are difficult because each state categorizes and reports the data differently).
The state fact sheets include several measures of the percentage of total state deaths and cases that occurred among nursing home residents and nursing home staff. Because the denominator data is from a different source, the reported data may result in a percentage less than 0% or greater than 100%, which is impossible. The value of each such measure is capped at 100%, and values of less than 0% are marked as NA. These measures should not be used to compute the number of cases or deaths occurring outside of nursing homes.
In a cohort study published in Nature Communications, researchers from the United States of America investigated the role of type-2 interferon (IFN) in antiviral immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in murine models.
They found that an IFN response pre-established within the lungs may protect against SARS-CoV-2 infection, indicating the potential use of IFN as a prophylactic agent in managing coronavirus disease 2019 (COVID-19).
Study:Bacterial-induced or passively administered interferon gamma conditions the lung for early control of SARS-CoV-2. Image Credit:PrinceJoy/Shutterstock.com
COVID-19, caused by SARS-CoV-2, primarily infects lung epithelial cells expressing angiotensin-converting enzyme 2 (ACE2). While interferons (IFNs) of types 1 and 3 are known for their role in antiviral response, the role of type-2 IFN (IFN), especially in SARS-CoV-2 infection, is poorly understood. IFN is a cytokine immune cells produce in response to bacterial infection to combat intracellular pathogens.
Although IFN is not typically required for pulmonary viral resistance, studies in mice and immunocompromised patients indicate that recombinant IFN treatment may be useful against viral infections, including that of SARS-CoV-2.
Evidence on therapies acting through IFNs has highlighted that timing of treatment relative to viral exposure is critical, often requiring pre- or early post-exposure administration.
Interestingly, an ongoing IFN response to existing or recent infection, such as lung infection with Mycobacterium bovis BCG (short for Bacillus Calmette-Gurin), has shown protection against SARS-CoV-2 in animal models.
Therefore, researchers in the present study explored the mechanisms underlying the protection offered by a concurrent bacterial infection against SARS-CoV-2 while shedding light on the potential role of IFN in the process.
In the present study, wild-type (WT) B6 mice were inoculated intravenously (iv) with BCG or phosphate-buffered saline (PBS, control) 4045 days before they were intranasally challenged with SARS-CoV-2 strain B.1.351. On day 3, lungs were isolated, and viral titer was measured in the homogenate using TCID50(short for 50% tissue culture infectious dose) assay.
Additionally, single-cell RNA sequencing (scRNAseq) was performed on the isolated lung cells. Cell clusters were analyzed using Seurat clustering and flow cytometry.
After 28 days of BCG vaccination, cytokine staining was performed on lung cell suspensions. Similar experiments were performed in Ifngr1/mice to understand the effect of IFN signaling on protection.
Additionally, to understand whether IFN signaling in the non-hematopoietic compartment is enough forBCG-driven protection, Ifngr1/mice were irradiated, and their bone marrow was reconstituted with WT cells.
Actively infected cells were identified by staining lung tissue for the SARS-COV-2 nucleocapsid and using in situ hybridization (ISH). Recombinant IFN was administered intranasally to WT orIfngr1/animals two days before and one day after the SARS-CoV-2 challenge, and their lungs were analyzed on day 3.
Statistical analysis involved the determination of p-values using Studentst-test, Mann-Whitney test, one-way analysis of variance (ANOVA) with Tukeys post-test, or Kruskal-Wallis test with Dunns post-test.
Three days after the SARS-CoV-2 challenge, the lungs of WTBCG animals showed a significantly reduced viral load compared to controls. While the lungs of BCG-treated animals were enriched in T-cells, those of control PBS-treated animals were enriched in fibroblasts.
scRNAseq datashowed that the lungs of BCG-treated animals had more differentially expressed genes (related to inflammation, antiviral immunity, and IFN signaling) in macrophages and dendritic cells compared to controls.
While levels of other IFNs did not vary between the two groups, IFN and IFN were significantly higher in BCG-treated animal samples than controls. T-cells and natural killer cells were the major sources of IFN.
No reduction in viral load was observed inIfngr1/mice (without IFN receptor), suggesting that IFN signaling is required for BCG-induced protection against SARS-CoV-2. Also, BCG was found to protect severe-disease mice models from the virus, but animals treated with anti-IFN did not receive significant protection, confirming the role of IFN.
BCG-treated WT mice also showed a reduced inflammatory cytokine response irrespective of the presence of IFN. The study shows BCG-induced IFN present during the viral challenge controls viral load rather than SARS-CoV-2-related inflammation.
Studies conducted on irradiated and reconstituted Ifngr1/mice showed that IFN signaling in non-hematopoietic cells is sufficient forBCG-induced protection against SARS-CoV-2.
Bronchiolar epithelial cells, macrophages, and pneumocytes were most immunoreactive to the SARS-CoV-2 nucleocapsid. Findings suggest that BCG-induced IFN controls SARS-CoV-2 infectivity and/or replication within the epithelial cells. Data showed that IFN induced the expression of IFN-regulated proteins by pulmonary epithelial cells, including a viral restriction factor.
Notably, WT mice administered with recombinant IFN showed reduced or no viral load, suggesting that pre-existing IFN responses can control SARS-CoV-2 infection and/or replication across epithelial cells, thereby protecting the host from related tissue damage and immunopathology.
The present study's findings suggest that bacterial infections, particularly intravenous administration of BCG, which specifically elicit IFN responses in the lung, could limit SARS-CoV-2 infection.
They highlight the prophylactic potential of intranasally administered recombinant IFN in offering protection against SARS-CoV-2 infection for improved outcomes in COVID-19 management and encourage further research.
