Medical team in the operating room, dark background.
(Adobe Stock 332342621 ByGeorgii)
The health care sector is preparing to grapple with a particular challenge this fall and winter: the simultaneous surge of three significant respiratory diseasesInfluenza, RSV (respiratory syncytial virus), and COVID-19. As these diseases collide, they form what experts call a "tripledemic," intensifying the burden on health care providers and institutions. This triple threat becomes particularly concerning in areas like the operating room, where the stakes are high, and the margin for error is low.
At first glance, Influenza, RSV, and COVID-19 might appear similar; they all manifest as respiratory illnesses ranging from mild to severe. [1] https://www.nfid.org/resource/how-to-tell-the-difference-between-flu-rsv-covid-19-and-the-common-cold/ Common symptoms like fever, cough, and shortness of breath overlap among these diseases, adding complexity to diagnosis and treatment.
However, these viruses differ in key ways. For example, influenza generally has a shorter incubation period than COVID-19 and RSV. COVID-19 can manifest with a more diverse range of symptoms, including the loss of taste or smell. RSV, on the other hand, is particularly dangerous for infants and older persons, often resulting in severe respiratory issues like bronchiolitis and pneumonia.
Prevention strategies also vary. Influenza and COVID-19 have regularly updated vaccines, and a new vaccine and monoclonal antibody has just been approved for RSV, mainly intended for vulnerable groups such as infants and older people. While these prophylactic measures can help limit the spread and severity of the viruses, health care providers still must equip themselves with the right tools to forge a strong defense against a potential tripledemic.
The operating room (OR) is an environment where precision, sterility, and expertise converge to save lives. Yet, these life-altering invasive procedures make the OR a hotspot for potential infections. Every incision, every intubation, and every implantation opens up opportunities for viral particles to enter the body's sterile core. Surgical teams go to great lengths to maintain a clean and sterile environment. Still, contagious respiratory viruses like influenza, RSV, and COVID-19 pose an elevated risk that can't be ignored.
Complicating the situation further is the high turnover rate of patients in the operating room. Surgeries are often scheduled back-to-back, each with required instruments, surgical teams, and preparatory procedures. In many health care settings, staff resources are stretched thin, sometimes leading to corner-cutting in cleaning protocols or personal protective equipment (PPE) procedures. Even when unintentional, such oversights can dramatically increase the risk of cross-contamination and disease transmission among patients and health care providers.
The convergence of the tripledemic and the unique environmental factors of the OR creates a complex and challenging landscape. Health care providers' risks are manifold: increased exposure to infected patients, the physical strain of long hours in PPE, and the mental toll of high-stakes decision-making. For patients, the risks include the potential for postoperative complications due to undiagnosed respiratory infections and the possibility of contracting a different respiratory illness while in recovery.
Navigating the tripledemic in the OR requires an all-hands-on-deck approach. It demands rigorous infection control measures, enhanced staff training, and a high level of vigilance from every health care team member. It may appear daunting, but with preparation and awareness, it is manageable.
As mentioned above, vaccines and treatments are intended to limit the impact of these viruses. But their abilities can only go so far, so the importance of rigorous cleaning and disinfection protocols in the OR during this potential tripledemic cannot be overstated.
Proper disinfection is crucial for patient safety and infection control, especially in a high-risk environment like the operating room. Traditional disinfection methods can be labor-intensive and prone to error. However, a solution is available for autonomous UV disinfection robots, which can streamline the process while maintaining the highest levels of efficacy and thoroughness.
One of the most encouraging advancements in infection control has been the advent of autonomous UV disinfection systems. The effectiveness of these systems is not just anecdotal; it is well-supported by scientific studies. Ultraviolet (UV) light effectively kills or deactivates many pathogens, including those causing the tripledemic. For instance, studies have shown that UV-C is effective at inactivating RSV. Other studies have found similar results against influenza and coronavirus.
One of the most appealing aspects of autonomous UV disinfection systems is their ability to operate independently. Once set up, these machines can disinfect an area without a human operator. This is a critical advantage in health care settings where staff can already be stretched thin, and resources are often limited.
In a world where operating rooms and other health care settings are preparing for the challenges of a tripledemic, innovations like autonomous UV disinfection offer a glimpse of hope. Their effectiveness and self-operating ability make them a valuable addition to any infection control toolkit.
Navigating the health care landscape during a tripledemic of Influenza, RSV, and COVID-19 is a daunting task that brings unprecedented challenges, particularly in the operating room. However, with a multi-faceted approach that includes technological innovations like autonomous UV disinfection, we can fortify our defenses against this triple threat. The stakes are high, but with vigilant preparation, thorough understanding, and proactive measures, health care providers can safeguard themselves and their patients during these complex times. Embracing these tools and strategies will be crucial in maintaining the integrity and safety of the operating room.
Testing wastewater for COVID-19 provides a better forecast of new COVID hospital admissions than clinical data, according to a Syracuse University research team led by postdoctoral researcher Dustin Hill.
Department of Public Health postdoctoral researcher Dustin Hill.
The COVID-19 pandemic has been a burden on the U.S. health care system since its arrival in early 2020. COVID remains a threat to our communities, particularly during the winter months when new cases and hospitalizations are likely to surge. The ability to predict where and when new patients will be admitted to hospitals is essential for planning and resource allocation.
Our findings indicate that wastewater surveillance improves prediction models for hospitalizations by 11 percent over models that use case data at the county level and by 15 percent for regional hospitalization estimates, says Hill, an environmental data scientist and epidemiologist who works in the Department of Public Health in the Falk College of Sport and Human Dynamics. When looking at how many beds a hospital has available, those percentages can make a big difference in whether that hospital is going to have space for new patients or not, and this data can help them get ready for changes.
Hill led a project that used wastewater surveillance data in predictive models to improve estimates for new COVID hospital admissions in New York state. The research teams results were published recently in the peer-reviewed journal Infectious Disease Modeling and were gathered in collaboration with State University of New York at Albany, University at Buffalo, State University of New York College of Environmental Science and Forestry, Stony Brook University and the New York State Department of Health.
Throughout the pandemic, hospitalization forecasting models have relied heavily on clinical data collected from polymerase chain reaction (PCR) and antigen tests. But this data can be biased because of a lack of widespread testing and may not be quick enough to indicate a surge.
In their study, the researchers combined wastewater surveillance data (how much SARS-CoV-2 is found in wastewater) with clinical case and comorbidity data to predict the seven-day average of new hospital admissions 10 days after the wastewater sample collection.
Pruthvi Kilaru, who earned his masters of public health in 2020 and is now a third-year medical student at Des Moines University in Iowa, is shown here in 2020 collecting wastewater near the Womens Building for COVID-19 testing.
Wastewater data are being collected across New York state through the New York State Wastewater Surveillance Network, and that data can be used to continuously update forecasting predictions each week. According to the research, the average difference between predicted hospitalizations and observed hospitalizations was 0.013 per 100,000 population, or 1.3 in 10,000,000 population, providing high accuracy.
The New York State Wastewater Surveillance Network is testing for COVID in at least one wastewater treatment plant in each of the states 62 counties, covering a population of more than 15.3 million. The New York State Wastewater Surveillance Network dashboard provides the most recent statistics regarding the network.
The research team is exploring how their methods to predict COVID hospitalizations can be further refined and applied to other infectious diseases such as RSV and influenza as wastewater surveillance expands to cover these public health threats.
Predicting future hospitalizations using wastewater data helps get our public health partners in front of surges before they happen so they are prepared when new patients need to be admitted and can distribute resources accordingly, Hill says. The methods we developed here are going to be instrumental for tracking the diseases we already know about, and perhaps even more important for the diseases that could arise in the future.
LONDON -- LONDON (AP) Boris Johnson, the former British prime minister, struggled to come to grips with much of the science during the coronavirus pandemic, his chief scientific adviser said Monday.
In keenly awaited testimony to the countrys public inquiry into the COVID-19 pandemic, Patrick Vallance said he and others faced repeated problems getting Johnson to understand the science and that he changed his mind on numerous occasions.
I think Im right in saying that the prime minister gave up science at 15," he said. I think hed be the first to admit it wasnt his forte and that he struggled with the concepts and we did need to repeat them often.
Extracts from Vallace's mostly contemporaneous diary of the time were relayed to the inquiry. In them, he wrote that Johnson was often bamboozled by the graphs and data and that watching him get his head round stats is awful."
During the pandemic, Vallance was a highly visible presence in the U.K. He and the chief medical officer, Chris Whitty, regularly flanked Johnson at the daily COVID-19 press briefings given from the prime minister's offices on Downing Street.
Vallance, who stepped down from his role as the British government's chief scientific adviser earlier this year, said Johnson's struggles were not unique and that many leaders had problems in understanding the scientific evidence and advice, especially in the first stages of the pandemic in early 2020.
He recalled a meeting of European scientific advisers where one country leader was said to have problems with exponential curves and the telephone call burst into laughter, because it was true in every country.
Johnson was hospitalized with the virus in April 2020 less than two weeks after he put the country into lockdown for the first time. Vallance conceded the prime minister was unable to concentrate on things when he was really unwell but that after his recuperation there was no obvious change between him and what he was like beforehand.
The U.K. has one of the highest COVID-19 death tolls in Europe, with the virus recorded as a cause of death for more than 232,000 people.
Johnson, who was forced to step down as prime minister in September 2022 following revelations of lockdown rule-breaking parties at his Downing Street residence during the pandemic, is due to address the inquiry before Christmas.
The probe, led by retired Judge Heather Hallett, is expected to take three years to complete, though interim assessments are set to be published. Johnson agreed in late 2021 to hold a public inquiry after heavy pressure from bereaved families, who have hit out at the evidence emerging about his actions.
The inquiry is divided into four so-called modules, with the current phase focusing on political decision-making around major developments, such as the timing of lockdowns. The first stage, which concluded in July, looked at the countrys preparedness for the pandemic.
The inquiry is set to hear from current Prime Minister Rishi Sunak, who was Johnson's Treasury chief at the time and as such had a particular focus on the economic impacts of Britain's lockdowns.
When he does appear at the inquiry, Sunak is likely to face questioning about his Eat Out to Help Out initiative, which sought to encourage nervous customers back to restaurants in August 2020 as the first set of lockdown restrictions were being eased and before subsequent lockdowns were enacted.
Vallance said scientists weren't aware of the restaurant program until it was announced and that the messaging around it ran opposite to the need to limit mixing between households.
I think it would have been very obvious to anyone that this inevitably would cause an increase in transmission risk," Vallance said.
Soon after, positive cases started rising and the government came under huge pressure to institute a second national lockdown, something Johnson eventually announced at the end of October 2020.
The inquiry was shown a diary entry Vallance wrote before that lockdown and which referred to Dominic Cummings, Johnson's chief political adviser at the time, saying that Sunak thinks just let people die and thats OK."
When asked about the diary entry, the prime minister's spokesman, Max Blain, said Sunak would set out his position when he gives evidence to the inquiry.
Im sure the public will understand the importance of listening to all the evidence of the inquiry before coming to a conclusion," Blain said.
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Associated Press journalist Jill Lawless contributed to this report.
Health officials are warning Thanksgiving travelers to take precautions as COVID-19 hospitalizations are spiking ahead of the peak holiday travel week.
COVID-19-related hospitalizations have surged by nearly 17% over the past week, with the city averaging one death a day from the respiratory virus, according to the latest city data. Several wastewater treatment facilities in the city have also reported increased detection of the virus, according to the CDC.
With a record number of people expected to go through Illinois airports this week, experts warn that a lack of caution could lead to the spread worsening. About 290,000 travelers are expected to go through airports, an increase of 8% over last year and topping pre-pandemic levels, the Transportation Security Administration said.
Yanina Purim-Shem-Tov, an emergency medicine doctor at Rush Hospital, said the same measures used during the height of the pandemic masking, distancing and hand washing will help to keep people safe through another holiday surge.
All of us have fatigue of COVID, and we may want to relax our precautions, Purim-Shem-Tov said. I cannot recommend enough to keep your vigilance, keep your hands clean, and if you have to be in an enclosed space, were still recommending masks.
She added that although it was previously believed patients could either have COVID-19 or the flu, the hospital has since seen patients with both at the same time, and recommended similar precautions as well as COVID booster and flu shots, especially for the elderly or those with compromised immune systems, such as people undergoing chemotherapy.
The Illinois Department of Public Health said the risk of COVID-19 is lower than it has been the past three years. The Chicago Department of Public Health said about 7.4% of Chicagoans having received the most recent booster.
Purim-Shem-Tov also said Rush has seen an uptick in RSV, or respiratory syncytial virus, in children. Though it hasnt reached the extreme numbers of last year, and will present as cold-like in most healthy adults, she still suggests taking similar precautions as the flu and COVID-19.
This is the season, Purim-Shem-Tov said.
Editors note: This article was updated to correct the percentage of Chicagoans who have received the most recent COVID-19 vaccine.
A sailor prepares a Moderna COVID-19 vaccine at Naval Air Facility Atsugi, Japan, May 7, 2021. (Akifumi Ishikawa/Stars and Stripes)
YOKOTA AIR BASE, Japan The latest COVID-19 vaccine is now available at a handful of American bases in Japan but still in transit or on order for several others, according to military officials.
Pfizer shots arrived last week at Yokota Air Base, the home of U.S. Forces Japan in western Tokyo, according to 1st Lt. Danny Rangel, spokesman for the 374th Airlift Wing.
The boosters are available for patients older than 5 years old, he said by email Friday. We ask members seeking to receive their vaccine to make an appointment by calling the 374th Medical Group appointment line.
The FDA no longer calls the shot a booster for those already vaccinated, according to Andy Pekosz, a professor of molecular microbiology and immunology at Johns Hopkins University in Maryland.
The change in wording reflects that weve begun treating COVID like we treat influenza, with annual vaccination, he wrote in a Q&A published Sept. 14 on the universitys website.
Experts recommended that everyone who is eligible get the updated vaccine by mid-October, ahead of cooler weather and more indoor gatherings, Pekosz said. Those at higher risk of severe illness should get vaccinated as soon as possible, he said.
U.S. Naval Hospital Okinawa on Camp Foster has the vaccine available for anyone with access to the facility who has already been vaccinated, hospital spokesman Trey Savitz said by email Monday.
The hospital received 600 doses on Nov. 14 and began administering them two days later, he said.
At Marine Corps Air Station Iwakuni near Hiroshima, the vaccine is available at the Naval Family Branch Clinic, the base public affairs office said in an email Tuesday.
Camp Zama, the home of U.S. Army Japan near Tokyo, expects its vaccine shipment this week, command spokesman Maj. Devon Thomas said by email Monday.
Vaccines are in transit to U.S. Naval Hospital Yokosuka, at the home of the U.S. 7th Fleet south of Yokohama, according to hospital spokesman Gabriel Archer.
The hospital is awaiting receipt of the most current Pfizer formulation, he said by email Monday. Moderna is on back order with the company, and they anticipate shipment as soon as it becomes available from the manufacturer.
When the vaccines arrive, they will be made available to everyone who is under the status of forces agreement, Archer said.
Depending on initial demand, prioritization of certain populations may be necessary for the early distribution events to manage crowd size, he said.
Medical staff will confirm vaccine temperature and integrity before they are administered, Archer added.
We expect a smooth and expeditious roll out of this formulation in partnership with the entire SOFA community, he said.
Vaccines are also still on order for Sasebo Naval Base, spokesman Aki Nichols said by email Monday.
No mention of when they will be available to Sasebo community members, he said.
People in northeastern Japan will have to wait until next year, according to 35th Fighter Wing spokesman Tech. Sgt. Chris Jacobs.
Misawa Air Base will have COVID-19 shots available for SOFA status residents in early 2024, he said by email Tuesday.
Its possible your morning cup of coffee can do more than just wake you up. According to a recent study published in BMCs Cell & Bioscience journal, drinking 1 to 2 cups per day could curb COVID-19 infection, offering potential protection against various COVID strains like the Omicron variant.1
Since late 2020, many COVID variants have spread globally, with recent reports revealing the Omicron variant has at least 32 mutations in its spike protein, double that of the Delta variant.
As COVID-19 boosters evolve to address the increasing amount of cases, it's important to note that diet, along with the latest preventive measures, plays a role in combating COVID infection.
Research has suggested that engaging in regular physical activity and maintaining a diet rich in polyphenols can affect the immune system, change immune escape properties and reduce the risk of severe COVID.
However, previous studies have also found that coffee consumption is associated with reduced COVID risk.
Coffee, also rich in polyphenolic compounds like chlorogenic acid (CGA), caffeic acid (CAA), cafestol, melanoidins and trigonelline, has been recognized as a dominant source of CGA in various studies.
Previous studies suggest that CGA in coffee can positively impact blood pressure, lipid profile, glycemia and insulin resistance, contributing to the improvement of metabolic syndrome and enhancing metabolism, inflammation, cardiovascular health and liver function.
Though, further studies have yet to demonstrate the exact mechanism that coffee stops the binding of COVID to host cells.
In the BMC human trial study, researchers observed data from the UK Biobank to find that coffee can be a new strategy to reduce COVID infection by blocking spike protein ACE2 interaction, slowing down TMPRSS2 and CTSL activity and ridding the protein level of TMPRSS2 and ACE2.
Using the HRMS-exploring-recombination-examining method, researchers discovered that isochlorogenic acid A, B, and C in coffee restrict COVID infection (4354% efficiency), as well as decaffeinated coffee.
In the trial of 64 people, consuming 12 cups of coffee per day proved effective in stopping entry for multiple COVID variants.
However, for the Omicron variant, previous articles pointed out that this variant has more mutations and a higher ability of immune escape than other variants. This results in many strategies potentially being ineffective or having poor responses to stop the infection from the Omicron variant.
Despite that, authors of the BMC study discovered that consuming coffee within 6 hours is crucial, with a recommendation to have another cup after this period for better chances to stop the infection.
Authors propose a strategic coffee-drinking plan as a preventive measure for individuals in the post-COVID era.
This article originally appeared in Managed Healthcare Executive.
Nov. 20, 2023 -- About three-quarters of people dont have great worries about getting COVID-19 over the winter holidays, according to a survey of about 1,400 adults conducted by KFF.
The survey showed that 74% of respondents are not too worried or not at all worried about getting COVID-19 over the holidays. About 69% are not too worried or not at all worried about spreading the virus to other people.
About 54% answered that way when asked how they felt aboutan increase in cases and hospitalizations this winter. Over the past three years, cases and hospitalizations have gone up over the holidays because of family gatherings and cold weather forcing people inside.
Other key takeaways from the survey, which was conducted between Oct. 31 and Nov. 7:
The CDC says COVID indicators are trending upward a little.
In a report released Friday, the CDC said more than 16,000 people were hospitalized for COVID-related reasons last week, up 8.6% compared to the previous week. COVID-related deaths went up 9.1% compared to the previous week, with COVID responsible for 2.4% of all deaths.
With the holiday season upon us, health officials warn cases of COVID-19 will increase and say medical professionals must do more to guard public health.
Between Oct. 15 and Nov. 11, there were 243 confirmed COVID-19 cases in Springfield higher than the number of cases in any other city or town in Franklin, Hampden and Hampshire counties and the second highest in the state after Boston, according to Massachusetts COVID dashboard.
There were 6,943 confirmed cases in the state during that period.
Doctors and other health advocates are expecting these numbers to spike over the next few weeks. They say there are ways to combat the spread.
Wastewater data shows COVID cases are increasing, Lara Jirmanus, a primary care physician and instructor at Harvard Medical School, said at a Massachusetts Coalition for Health Equity briefing Monday.
In May 2021, former Gov. Charlie Baker lifted the mask mandate for vaccinated people in Massachusetts, in line with the Centers for Disease Control and Prevention guidance.
Since then, the state has ended universal admission screening and free community testing for the virus. And it has reduced the frequency of mandates about if and when to get the booster vaccines.
Seasonal masking makes care safer during higher virus transmission periods, Jirmanus said.
Dr. David Alpern, a Northampton physician, said testing remains a way to avoid transmission.
Discontinuing universal admission testing for COVID-19 has been shown to result in a significant rise in hospital-acquired COVID-19, which carries a significant mortality rate, Alpern said.
Others Monday pointed to health consequences of not requiring masks.
Due to the lack of a mask mandate in the state, hospital-acquired COVID-19 is under-reported and under-appreciated, said Dr. Ted Pak, a hospital epidemiologist at Massachusetts General Hospital.
While some major hospitals in the state have reinstated mask mandates, like Baystate Health, others like Mass General Brigham dont require screening or masking of patients for the virus.
With COVID-19 on the rise in hospitals, Pak said four in 10 patients with undetected COVID-19 may transmit it to their hospital roommate.
Testing and masking is needed because its our ethical responsibility to protect our patients, Pak said.
The state Department of Public Health did not respond Monday to a request for comment about whether universal testing or a mask mandate will be reinstated. But the departments website provides an updated resource list for how residents can stay safe.
Also discussed at the press conference was long COVID, its effects, and the demographic it impacts.
Long COVID has become more of a concern, especially for those whove had [the virus] more than once and those among the 18-64 year-old age group, Jirmanus said.
Since 2021, nearly 1 million people in Massachusetts, or 16% of the population, have reported experiencing long COVID, Jirmanus said.
Long COVID poses a particular threat to the disabled community and those who are immunocompromised.
Disabled people dont have a choice as to the number of times they have to go to the hospital, so lives are at stake when hospitals dont have a mask mandate, said Colin Kilick, executive director at the Disability Policy Consortium.
This is a civil rights and equity issue, he said.
Disabled people are being discouraged from asking questions and there is an increase in medical distrust, said Jayda Jones, a disability advocate. The end of the public health emergency does not mean an end to affordable and safe healthcare.
The coalition wants the state to provide safe and accessible healthcare, free public access to testing, better communication about the risks of long COVID and a stronger defense of disability rights.
Novavaxs shot, a vaccine that is based on proteins rather than mRNA and has been used since early 2022 in other countries.
Erin Kissane, a co-founder of the COVID Tracking Project, rolled up her sleeve for the Novavax covid-19 vaccine in mid-October soon after it was finally recommended in the United States. Like many people with autoimmune diseases, she wants to protect herself from a potentially devastating covid infection.
Kissanes autoimmune arthritis seems to make her susceptible to unusual vaccine side effects. After getting an mRNA booster last year, her joints ached so painfully that her doctor prescribed steroids to dampen the inflammation. She still considers the mRNA vaccines miraculous, knowing covid could be far worse than temporary aches.
Nonetheless, when the pain subsided, she pored through studies on Novavaxs shot, a vaccine that is based on proteins rather than mRNA and has been used since early 2022 in other countries. Data from the United Kingdom found that people more frequently reported temporary reactions like low fevers, fatigue, and pain as their immune system ramped up in the days following booster vaccination with Modernas mRNA vaccine versus the one by Pfizer. And those boosted with Novavaxs had fewer complaints than either of those. That finding was corroborated in an analysis of international data published last year.
Such studies have driven people with long covid and chronic fatigue syndrome (also known as myalgic encephalomyelitis, or ME/CFS) to seek out Novavax, too, since the FDA and the Centers for Disease Control and Prevention greenlighted Novavaxs vaccine updated to protect against recent omicron coronavirus variants about three weeks after recommending updated mRNA vaccines in September.
Waiting paid off for Kissane, whose arm was briefly sore. It was a dramatically different experience for me, she said. I hope that plays out for others.
Another group who waited on Novavax are biologists who geek out over its technology. When asked why he opted for Novavax, Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai, replied on X, formerly known as Twitter: Because I am [a] vaccine nerd, I like insect cell produced vaccines.
Whereas mRNA vaccines direct the body to produce spike proteins from the coronavirus SARS-CoV-2, which then train a persons immune system to recognize and fight the virus, Novavax simply injects the proteins. These proteins are grown within moth cells in a laboratory, while other protein-based shots use cells from mammals. And Novavax has said that a special ingredient derived from the bark of Chilean soapbark trees enhances the vaccines power.
Research suggests that the Novavax vaccine is about as safe and effective as the mRNA shots. Its main disadvantage is arriving late to the scene. Vaccine uptake has plummeted since the first shots became widely available in 2021. Nearly 70% of people got the primary vaccines, compared with fewer than 20% opting for the mRNA covid boosters released last year. Numbers have dwindled further: As of Oct. 17, only 5% of people in the United States had gotten the latest covid vaccines, according to the Department of Health and Human Services.
Daniel Park, an epidemiologist at George Washington University, said low rates might improve if people who felt lousy after their last mRNA shots gave Novavax a try. It protects against severe illness, but researchers struggle to specify just how effective this and other vaccines are, at this point, because studies have gotten tricky to conduct: New coronavirus variants continuously emerge, and people have fluctuating levels of immunity from previous vaccines and infections.
Still, a recent study in Italy suggests that Novavax is comparable to mRNA vaccines. It remained more than 50% effective at preventing symptomatic covid four months after vaccination. Some data suggests that mixing and matching different types of vaccines confers stronger protection although other studies have found no benefit.
Given all this, Park held out for the Novavax vaccine on account of its potentially milder side effects. Between a demanding full-time job and two young kids at home, I wanted to stay operational, he said. His arm was sore, but he didnt have the 24-hour malaise accompanying his last mRNA shot.
Most people dont strike a fever after mRNA shots. Even when they do, it is brief and therefore far less detrimental than many cases of covid. In fact, most reactions are so minor that theyre hard to interpret. During clinical trials on mRNA vaccines, for example, up to a third of people in the placebo group reported fatigue and headaches after injection.
People with ME/CFS and long covid a potentially debilitating condition that persists months after a covid infection have responded to covid vaccinations in a wide variety of ways. Most participants with long covid in an 83-person Canadian study said their levels of fatigue, concentration, and shortness of breath improved following vaccination. Inflammatory proteins that have been linked to long covid dropped as well.
However, larger studies have yet to corroborate the hopeful finding. Jennifer Curtin, a doctor who co-founded a telehealth clinic focused on long covid and ME/CFS, called RTHM, said vaccines seem to temporarily aggravate some patients conditions. To learn how Novavax compares, she posted polls on X in late October asking if people with long covid or ME/CFS felt that their symptoms worsened, improved, or stayed the same after Novavax. Most replied: unchanged.
Its not scientific, but we need to figure it out since these folks dont want to get covid, Curtin said. My patients are all wondering about what vaccine to get right now.
Adding to the uncertainty, the rollout of Novavax and mRNA vaccines has been bumpy as pharmacies struggle to predict demand and insurance companies figure out how to reimburse providers for the shots. Unlike previous vaccine offerings, these options are no longer fully covered by the federal government. A testament to this seasons struggle to get vaccinated is that at least one do-gooder has created an online tool to find open appointments for Novavax.
Buoyed by anecdotes of relief from others with long covid, Hayley Brown, a researcher at the Center for Economic and Policy Research who has the condition, opted for Novavax recently. Unfortunately, her symptoms have flared. She said a temporary discomfort will still be preferable to risking another infection. As someone with long covid, the idea of getting covid again is terrifying.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFFan independent source of health policy research, polling, and journalism.
The official worldwide deaths from COVID-19 pandemic surpassed 6 million, and it is still far from over3. The restrictions and global full or partial lockdowns have been initiated to slow down the spread of the virus and flatten the curve of the pandemic14,15. However, these measures had negative impacts in different strata of life, including the changes in accessibility and structure of health care delivery. From the time of early pandemic declared by WHO on March 2020, a moratorium on every kind of elective surgeries was placed to preserve the critical care resources. Since the high influx of patients with severe disease after the outbreak made the available medical staff and equipments insufficient to meet the needs of all patients, admission decisions to ICUs become more important. Therefore, the effects of COVID-19 outbreak on case volumes and ICU bed utilization have changed the traditional indications for admissions, disease control methods, demographics and overall outcomes in both COVID-19 and non-COVID-19 patients16,17. Health care utilization was affected by this major public health emergency, with elective high risk procedures and treatment for non-urgent conditions significantly cancelled or postponed18,19. The largest decrease was seen in preventive and primary care visits for common chronic conditions18. Furthermore, previous investigations have shown that even patients with life-threatening conditions may have avoided hospital admissions, possibly due to concerns regarding the exposure to SARS-CoV-220. Substantial reductions in admissions and treatments for carcinoma, stroke and myocardial infarction were also reported21,22. A prolonged pandemic may also continue to exacerbate growing gender, social and economic inequalities with devastating consequences for those most at risk, since it has disproportionately impacted women, from reduced economic opportunities and decreased access to reproductive and maternal health care, especially in developing countries.
Although there are many post-pandemic publications on the change in demographics, treatment algorithms and outcomes of surgical patients admitted to both COVID and non-COVID wards and ICUs, our knowledge on OGAs only consists of clinical experience since OG patients constitute only 5 to 10% of general ICU population12,16,17. These studies reveal that there is over 90% reduction from baseline in the number of elective surgeries performed allowing 70 to 80% of surgical ICU beds to be available for COVID-19 positive patients23,24. In the present study, we analysed the patients admitted to ICU for non-COVID-19 OG pathologies as our hospital was not announced as a COVID-hospital in metropolitan Istanbul area, but we still had to be careful in reserving bed capacity in case of other COVID hospitals may overflow with patients. To our knowledge, this is the first study investigating the impact of COVID-19 outbreak on non-COVID-19 OGAs to ICUs, and according to our findings, our ICU admitted 38% fewer OG inpatients after March 2020.
Hemorrhage, hypertensive disorders of pregnancy, sepsis and malignancy are among the most common indications for the OGAs to ICUs8,9. However, preexisting medical conditions, cardiac diseases, respiratory disorders, and complicated operations are usually followed up in ICUs, as well. In a pre-pandemic study of Heinonen et al.25, published in 2002, the authors report that the most common diagnoses at ICU admission for the gynecological patients were postoperative haemorrhage (43%), infection (39%) and cardiovascular disease (30%). The mean duration of their stay in the ICU was 4.97days and the mortality in the ICU was 0%.Other pre-pandemic studies of Sailaja et al.26 and Richa et al.27, published in 2019 and 2008, respectively, confirmed hypertensive disorders (24.2% vs 26%) and obstetric hemorrhage (23.1% vs 20%) as the most common obstetric admissions. In Richa et al. s 27 study, sepsis (26.7%) and preexisting medical problems (6.65%) were also ranked among the indications. According to our pre-pandemic admission indications; hemorrhage, hypertension and placental pathology in obstetric (60% vs 41% vs 29%, respectively), and postoperative complications and hemorrhage (57% vs 19%, respectively) in gynecological patients were detected as the leading causes. Sepsis and cardiopulmonary diseases (4.5% vs 2.7%, respectively) were also among the indications of OGAs to ICU, and the main disease groups were similar to the pre-pandemic literature, even the percentages differ probably due to regional population factors.
Since there is no similar study in our PubMed research of the English-written literature, we could compare the post-COVID-19 results with our own pre-outbreak data. The most important findings in the present study were the change in indications after outbreak as significant increases in admission ratios of pregnancy-induced hypertension and placental pathologies (36% and 58%, respectively) in obstetric, and postoperative complications and sepsis (69% and 12%, respectively) in gynecological patients. Significant decrease in admissions for hemorrhage in obstetric patients (from 60 to 36%) was also another interesting finding in the present study. In our opinion, priority given to oncological operations might explain the increase in postoperative complications seen in gynecologic patients. Since oncology patients were older, their APACHE-II scores were also higher. However, there were no important changes in their acute physiology scores and chronic health points. Similarly, we explain the decrease in hemorrhage in obstetric patients and in obstetric admissions to ICU partly by a result of the improvement in maternal and fetal care lately. Another contributing factor can be the effective use of postanesthesia care unit (PACU) and secondary care units located in the surgical wards, since most of the patients formerly admitted to ICUs were followed up in these units. Most importantly, the procedure of selecting priority patients by gynecologists and intensive care specialists in cooperation, and meticulous implementation of the rule of only accepting patients with strict indications may help to interpret the changes in OGAs during the outbreak. This has been achieved by changes in triage with denying ICU admissions to less-ill patients in order to accomodate those with postoperative complications and sepsis. This may also explain why bleeding patients are less well-represented since bleeding can typically be dealt with outside the ICU, but sepsis or ventilator dependency cannot.
The primary goal in ICU is to resuscitate patients and save their lives, and one of the most important secondary goals is to decrease the length of stay in order to improve the quality of medical care and reduce cost. However, prolongation of hospital stay in ICUs due to life-threatening diseases are increasing in the world28. According to literature, the mean length of stay in ICUs ranges from 1 to 28days for most of the diseases including gynecological pathologies29,30. However, it is well known that elderly oncology patients with multiple comorbidities stay longer in ICUs31,32. In our study, comparatively shorter duration of stay in ICU was remarkable. It was on average only 3days, even most of them underwent oncologic surgery. Because they were transferred to their OG wards as soon as their intensive care treatment ends.
The major limitation of our study is its retrospective design, which may cause difficulties in controlling for potential confounding bias. Moreover, we could not compare our single-center data with the literature since there was no similar articles in our web search. However, the present study investigating the impact of COVID-19 pandemic on the indications of non-COVID-19 OGAs to ICU will contribute to the current literature, since these findings remind the health professionals of the primary role of ICUs; admitting patients who really needs to be there. We also believe that our findings will question the accuracy of wider indications for OGAs to ICUs in pre-pandemic period, and help in planning the policy for future post-pandemic days.
