Category: Corona Virus

A recent study published in theOpen Forum Infectious Diseasesjournal evaluated the impact of the lower severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine dosages in younger populations.

In most age groups, the SARS-CoV-2 messenger ribonucleic acid RNA (mRNA) vaccinations were significantly successful in protecting against the CoV disease 2019 (COVID-19) pandemic. According to the most recent data, vaccine efficacy (VE) of SARS-CoV-2 mRNA vaccines appears to be lower in children aged five to 11 than in adults. Besides, understanding the reason for this phenomenon is essential for creating appropriate vaccination approaches for this population moving forward.

The present work analyzed the VE of COVID-19 mRNA vaccines and the associated mechanisms in adolescents, children, and young adults, given the vaccine doses were lower in these groups compared to adults.

VE of the SARS-CoV-2 BNT162b2 vaccine in five- to 11-year-olds against COVID-19 was 91% during the two-month monitoring period in a clinical experiment before the emergence of the Omicron variant in the United States (US). Following the vaccine's approval on October 29, 2021, children were fully vaccinated by December 13, 2021, just in time with the introduction of Omicron.

However, according to preliminary information from the New York State Department of Health, VE in children aged 5 to 11 decreased from 68 to 12%, and hospitalization rates from 100 to 48%during December 13, 2021, compared to January 24, 2022. On the other hand,VE in those aged12 to 17dropped from 66 to 51%for infections and from 85 to 73%for hospitalization.

During the study period, Omicron infections in New York increased from 19% on December 13, 2021, to above99% onJanuary 24, 2022. The median period following vaccination was 51 days for children aged 5 to 11 and 211 days for thoseaged 12 to 17.

When removing the confounding effect of time after vaccination from an examination of recently vaccinated children from New York, the incidence rate ratio for infection was 1.1 for those aged five to 11 and 2.3 for 12 to 17 years at 28 to 34 days after immunization. When the analysis was limited to the Omicron period, information from the Centers for Disease Control and Prevention (CDC) demonstrated slight variation by age, with aVE of 51% in children aged 5 to 11, compared to 45% and 34%t in children aged 12 to 15 and 16 to 17, respectively.

However, during the pooled Delta- and Omicron-predominant timeframes, two-dose VE towards COVID-19-linked hospitalization for five11, 1215, and 1617 years continued at 73 to 94%. The available results indicate that BNT162b2 was less effective in younger children, yetfurther research is required to corroborate these findings.

One theory holds that the lower dosage of 10 g of BNT162b2 delivered three weeksapart was the cause of the poorefficacy in children aged 5 to 11; however, evidence on neutralizing antibodies suggeststhat this was not the case. The evidence presented at the Vaccines and Related Biological Products Advisory Committee meeting on October 26, 2021; Advisory Committee on Immunization Practices (ACIP) meeting on November 2, 2021; and Food and Drug Administration (FDA) and CDC Advisory Committee meetings posit that adolescents, children, and young adults mightattainanoptimum humoral reactionwith the existing BNT162b2 vaccine doses.

Two 30-g BNT162b2 doses administered in a 21-day interval resulted in geometric mean 50% neutralization titers of SARS-CoV-2 of 1146.5 and 1239.5 in individuals aged 16 to 25 and 12 to 15 years, respectively, one month after the second shot. Almost identical titers, 1197.6, were attained in children aged 5 to 11 years after two 10-g doses administered three weeks apart.

Children aged 9-11, 7-8, and 5-6 years acquired almost identical titers of 1191.5, 1236.1, and 1164.1 when further analyzed by age subgroup. These titers show that children and young adults have significant humoral immune reactions because they were more than threetimes higher than the peak titers attained by adults seven days followingthe second dose. As a result, it wasconceivable that doses below 10 gcould still produce significant levels of neutralizing antibodies in five to 11-year-old children.

Other causes for the decreased VE must be considered because, with the current dose, adolescents, children, and young adults produce noticeably high titers than adults. The Omicron variant reduces the efficacy of the COVID-19 vaccinations in all populations, which most likely explains a large portion of the decreased efficacy among children aged 5 to 11 years. Other possible explanations include the younger cohort's shorter time between vaccination and infection, variations in circulating viral strains among age cohorts, past SARS-CoV-2 exposure, and unidentified lower effectiveness of mRNA vaccines among younger populations.

After vaccination, T- and B-cell responses continue to develop for several months, as does immunity against severeillness. Therefore, the 51-day post-vaccination period for children aged 5 to 11 compared to 211 days for children aged 12 to 17 in New York mighthave attributed to the lower efficacy against hospitalization seen in the younger sample.

Furthermore, given the dramatic rise in Omicron occurrence over the study period, there might have been variations in the variants circulating in high, elementary, and middle schools. Besides, there was a significant SARS-CoV-2 seroprevalence in the US. Beforethe Delta variant increase, the age group of five to 11 had the highest seroprevalence in June 2021 at 42%. Previous SARS-CoV-2 exposure was linked to a decreased risk of catastrophic outcomes, but it was unclear how this may have changed the population's immune reactions.

The team noted that mRNA vaccination was a novel vaccination approach that induces both T- and B-cell responses and shows promise for producing superior vaccines against numerous pathogens, some of which are now under development. Yet, an initial trial of the two-dose BNT162b2 series found the approach was ineffective in children aged two to five. Thus, the experiment was changed to assess a three-dose series.

Factors like prior seasonal CoV exposure might have a part in the notably altered immunological response seen in older people that were not present in younger children not exposed to CoVs as much or at all. Maximizing CoV vaccination in children depends on understanding the mechanism causing BNT162b2's decreased efficacy in children.

Altering the dose intervals was one action tried to enhance immunogenicity in individuals between the ages of 12 and 39. New research has shown that spreading out the initial and second doses of mRNA vaccines increases immunogenicity while reducing adverse reactions.

On February 4, 2022, the ACIP reviewed the new information regarding extended dose intervals and published a recommendation that an eight-week gap could be ideal for some individuals aged 12 and older, particularly for males between the ages of 12 to 39. The ongoing clinical trial for BNT162b2 has been expanded to include formal evaluationof the lower 10-g dose, administered in two doses eight weeks apart for patients aged 12 to 18 and older. The team highlighted the need forstudies examining longer dosing gaps in childrenunder 12 years to see if this tactic can increase the immunogenicity and effectiveness of mRNA vaccines in younger populations.

With the present dose of the mRNA vaccines, adolescents, children, and young adults also face higher side effects in addition to reduced efficacy. The cause of COVID-19 vaccine-associated myocarditis was unknown. However, the prevalence of this uncommon event was lower after vaccination with BNT162b2 (30 g per dose) than mRNA-1273 (100 g per dose), reinforcing the idea that the myocarditis may be dose-related.

COVID-19 vaccine-related myocarditis was also more frequent after the second shot, especially with dosing intervals of four weeks. However, increasing the time between the first and second doses to eight weeks reduced the frequency of myocarditis.

The FDA Brief for October 26, 2021, meeting noted that COVID-19 vaccine-linked myocarditis was probably related to dose number and dosage. Nevertheless, the decreased myocarditis incidence after the third or booster shot relative to the reduced incidence with extended dosing intervals, implies that interval spacing, instead of dose number, might be the strategy to minimize myocarditis.

According to the study findings, the SARS-CoV-2 mRNA vaccinations demonstrated reduced efficacy in children aged 5 to 11. Neutralizing antibody titers induced by the COVID-19 vaccines in adolescents, children, and young adults illustrated that lower dosage was not responsible for the lower VE in these cohorts.

Optimizing COVID-19 vaccination approaches for younger populations in the future requires figuring out whether mRNA vaccination techniques were less effective in younger cohorts and identifying if adolescents, children, and young adults need adjusting the dosage, dosing gaps, and the number of doses.

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What is the impact of lower COVID-19 vaccine doses in younger cohorts? - News-Medical.Net

In a recent study published in Arthritis & Rheumatology, researchers examined immune reactions to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among B cell-depleted autoimmune patients who concomitantly administered glucocorticoids.

B cell depletion is a well-established therapeutic approach in musculoskeletal and rheumatologic disorders, B cell hematologic malignancies, and various autoimmune diseases. Nevertheless, B cells are essential for triggering a protective response after an infection or vaccination. Since the 1970s, it has been established that glucocorticoids decrease T and B cell activation, preventing the development of adaptive immune reactions against infections.

According to a study by Dr. Niu and colleagues, long-term glucocorticoid use reduces the effectiveness of the CoV disease 2019 (COVID-19) vaccine and makes people more susceptible to SARS-CoV-2 infection. In addition, earlier analyses showed that patients with immune-mediated inflammatory disease who use glucocorticoids have a higher risk of COVID-19 and infection-related mortality and morbidity. Additionally, evidence suggests that COVID-19 outcomes are poorer during broad-spectrum immune suppressive therapies such as B-cell depleting medications and glucocorticoids.

In the present work, the investigators sought to determine if concurrent glucocorticoid therapy could impact COVID-19 vaccination responses that were reduced in rituximab-treated individuals with autoimmune illness.

The team observed no significant exposure to glucocorticoid medication in the present group when examining whether baseline glucocorticoid treatment could have augmented decreased immune responses to SARS-CoV-2 vaccines or infections. Consequently, only three patients received concurrent glucocorticoid therapy: one COVID-19 vaccinee and two virus-infected patients. In addition, glucocorticoid doses were modest, averaging 4.63.8 mg of prednisolone per day. Thus, it is unlikely that prior glucocorticoid usage was accountable for the defective immune reactions to SARS-CoV-2 infection and vaccination.

The use of glucocorticoids in conjunction with the infusion of rituximab was another possible source of glucocorticoids among the volunteers. This ascribes to a single injection of 25 mg prednisolone combined with the rituximab infusion.

Previous research on patients with shock and asthma episodes, where short-term systemic bolus glucocorticoids were utilized often, has not shown any evidence that such treatment affects how well patients respond to their tetanus and influenza vaccinations. Existing studies also depicted that short-term glucocorticoid therapy did not impact the immune reaction to the SARS-CoV-2 vaccine. Hence, there was no reason to believe that a single glucocorticoid dose substantially contributes to the reported decreased humoral immune reactions to SARS-CoV-2 among patients treated with rituximab.

The finding that T cell responses in rituximab-treated individuals with autoimmune disorders were preserved while B cell responses were significantly repressed indicates a specific impact of B cell depleting drugs instead of a general effect of glucocorticoids that would also affect T cell stimulation. These results and the observations made by Dr. Niu and colleagues, nevertheless, also imply that long-term, higher doses of glucocorticoids might pose a risk to B cell-depleted patients because, in the absence of B cells, immune reactions to infections and vaccinations largely rely on intact T cell reactions.

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The impact of glucocorticoid therapy on immune responses to COVID-19 vaccination or infection in rituximab-treated patients with autoimmune disorders...

The median of the national-level daily search index for Covid-19 related terms was 4, 533 (IQR (Interquartile Range)=1, 301) before theCOVID-19 outbreak (January 1 2017 to December 30 2019), and 314, 718 (IQR=445, 074) after the outbreak (December 31 2019 to March 15 2021). The median of the provincial-level search index, ranged from 63 (IQR=7) in Tibet to 1138 (IQR=302) in Guangdong before COVOD-19, and ranged from 1386 (IQR=983) in Tibet to 38, 061(IQR=45, 784) in Guangdong after the COVID-19 outbreak. The crude relative change in the median of the search index ranged from 2 099% in Tibet and 2 034% in Hainan to 3 872% in Beijing and 4 284% in Liaoning (Table 1). 89, 936 cases of SARS-COV-2 occurred nationwide (ranging from 1 case in Tibet to 68, 021 cases in Hubei) from December 31, 2020 to March 15, 2021. The number of confirmed cases outside Tibet and Hubei ranged from 18 (0.1%) in Qinghai to 2, 245 (10.6%) in Guangdong province. In conjunction with these search patterns, 13%, 76% and 11% of confirmed Covid-19 cases were reported in January 2020, February 2020 and from March 2020 to March 2021 respectively.

As shown in Table 2, there was a 10% (relative risk (RR)=1.10, 95% CI 1.071.13, p<0.0001), 11% (RR=1.11, 95% CI 1.081.14, p<0.0001) and 13% (RR=1.13, 95% CI 1.101.16, p<0.0001) annual increase in the search index before the pandemic among regions with low, middle and high HDI respectively. The difference in pre-Covid-19 trends of the search index among the three HDI groups was not statistically significant (middle vs. low, ratio of RR=1.01, p=0.6188; high vs. low, ratio of RR=1.03, p=0.2239) (Table 2, Fig.1).

Baidu search index by province and number of new confirmed cases over time. (A) Observed daily search index (log transformed) by province and HDI category over time. Aggregated search index by HDI category over time is shown in Fig. S1. (B) Daily new confirmed COVID-19 in China (cases in Hubei provinces are excluded).

During the initial wave, the search index increased by 41%, 62% and 58% on December 31, 2019 among regions with low (RR=1.41, 95% CI 1.341.49, p<0.0001), middle (RR=1.62, 95% CI 1.541.70, p<0.0001) and high (RR=1.58, 95% CI 1.481.68, p<0.0001) HDI, respectively. The immediate increase in middle and high HDI regions was statistically significantly higher than the increase in low HDI regions (middle vs. low, ratio of RR=1.15, p=0.0002; high vs. low, ratio of RR=1.12, p=0.0091).

Similarly, there was a 107-fold, 125-fold and 125-fold increase in search index between January 18 and January 25 2020, the period shortly after the official announcement of human-to-human transmission (HHT), among regions with low (RR=106.8, 95% CI 100.1114.0, p<0.0001), middle (RR=124.6, 95% CI 117.6131.9, p<0.0001) and high (RR=125.3, 95% CI 116.5134.8, p<0.0001) HDI, respectively. The immediate increase in this short period among middle and high HDI regions were statistically significantly higher than the increase in low HDI regions (middle vs. low, ratio of RR=1.16, p=0.0004; high vs. low, ratio of RR=1.17, p=0.0012). From the peak of the search index on January 25 to June 10 2020, a 10%, 11% and 11% decrease per week was observed in the search index among regions with low (RR=0.90, 95% CI 0.890.90, p<0.0001), middle (RR=0.89, 95% CI 0.880.89, p<0.0001) and high (RR=0.89, 95% CI 0.890.90, p<0.0001) HDI, respectively (Table 2).

The outbreak in Beijing was associated with a 91%, 34% and 112% increase in the search index among regions with low (RR=1.91, 95% CI 1.792.03, p<0.0001), middle (RR=1.34, 95% CI 1.261.42, p<0.0001) and high (RR=2.12, 95% CI 1.982.27, p<0.0001) HDI, respectively, in the first week (June 1117 2020) of the outbreak. Additionally, the Beijing outbreak was associated with an increase in the monthly change rate of the search index. From June 17 to October 11 2020, a 4% decrease, 2% increase and 6% decrease per month in the search index was observed among regions with low (RR=0.96, 95% CI 0.950.96, p<0.0001), middle (RR=1.02, 95% CI 1.011.02, p<0.0001) and high (RR=0.94, 95% CI 0.930.94, p<0.0001) HDI, respectively (Table 2).

The Qingdao outbreak was associated with a comparable 31%, 34% and 41% immediate increase in the search index among regions with low (RR=1.31, 95% CI 1.231.40, p<0.0001), middle (RR=1.34, 95% CI 1.261.42, p<0.0001) and high (RR=1.41, 95% CI 1.311.52, p<0.0001) HDI, respectively. In the winter wave after the Qingdao outbreak, search index increased by 1%, 2% and 2% per week among regions with low (RR=1.01, 95% CI 1.001.01, p=0.0647), middle (RR=1.02, 95% CI 1.011.02, p<0.0001) and high (RR=1.02, 95% CI 1.011.03, p=0.0002) HDI, respectively.

The Shijiazhuang outbreak in January 2021 was associated with a 100%, 167% and 145% immediate increase in search index among regions with low (RR=2.00, 95% CI 1.852.16, p<0.0001), middle (RR=2.67, 95% CI 2.502.86, p<0.0001) and high (RR=2.45, 95% CI 2.242.67, p<0.0001) HDI. In regions with low HDI (middle vs. low, ratio of RR=1.34, p<0.0001; high vs. low, the ratio of RR=1.22, p=0.0007). However, the 20% and 22% weekly decrease in search index after the Shijiazhuang outbreak among regions with middle (RR=0.80, 95% CI 0.790.80, p<0.0001) and high (RR=0.78, 95% CI 0.770.79, p<0.0001) HDI, respectively, was statistically significantly greater (p<0.0001) than the 17% monthly decrease in the region with low HDI (RR=0.83, 95% CI 0.820.84, p<0.0001). Figure2 illustrated the heterogeneity in the immediate relative change in the search index following each pre-specified exposure across the country.

Immediate relative change in search index at different exposure period (A) December 31 2019, the estimated start of the first Covid-19 wave. (B) 18 January 18 2020 (official announcement of human-to-human transmission) to Jan 25 January 2020 (shortly after the lockdown and the estimated peak of daily search index in the initial Covid-19 wave). (C) Outbreak in Beijing starting on June 11 2020. (D) Outbreak in Shijiazhuang starting on January 3 2021. Specific point estimate for relative change and the corresponding 95% CIs are provided in the supplemental materials.

The results from models where HDI or its component was coded as a continuous variable were consistent with findings from our main analysis. As shown in Table S1, the pre-pandemic trends in two provinces differing in HDI, GNPPP (Gross national product per person), education year or life expectancy by one standard deviation were similar (p>0.1). The immediate relative increase in the search index in a province with one standard higher HDI was statistically higher (initial wave: ratio of RR=1.09, p<0.0001; HHT announcement: ratio of RR=1.04 p=0.0395; Beijing outbreak: ratio of RR=1.06, p=0.0090; Qingdao outbreak: ratio of RR=1.04, p=0.0324; Shijiazhuang outbreak: ratio of RR=1.11, p<0.0001). In contrast, the gradual decrease in the search index in a province with one standarddeviation higher HDI after each exposure was either similar or greater. For each exposure, the difference associated with GNPPP, education year or life expectancy in the directions and magnitudes of both immediate and gradual effect across provinces was similar to the difference associated with HDI.

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Geographic social inequalities in information-seeking response to the COVID-19 pandemic in China: longitudinal analysis of Baidu Index | Scientific...

Since the coronavirus pandemic began, public schools have been promised a windfall of federal funding.

In Oklahoma schools have been budgeted $2.1 billion total. And that money has been scheduled to go to a wide array of programs like summer school, mental health resources and construction projects.

But more than half of the money offered by the federal government remains.

The reasons are numerous per the Oklahoma State Department of Education: supply chain issues and construction delays have delayed spending, which is given to districts through reimbursements.

Oklahoma public school district leaders are being prudent and thinking long-term strategically with how relief funds are being utilized to best serve the educational and environmental needs of Oklahoma students and educators, Oklahoma State Department of Education spokesman Rob Crissinger wrote in an email.

Uneven spending of funds is reflected across the country, per a national analysis put together by Georgetown University. A district-by-district breakdown of spending is available via Georgetowns Edunomics Lab.

Overall, it is clear that districts are making very different choices with their money, and the pace of spending appears to be slow, wrote in a national analysis earlier this year.

The deadline for spending federal money isnt for two years. School districts must spend down their CARES money by September 2024.

StateImpact Oklahoma is a partnership of Oklahomas public radio stations which relies on contributions from readers and listeners to fulfill its mission of public service to Oklahoma and beyond. Donateonline.

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Oklahoma school districts were promised billions for coronavirus relief. Here's how much they've spent - KGOU

In Sherman Oaks, Julia Irzyk tries to gauge how rampant the coronavirus is in her community, turning to a constellation of data points to guide her.

I have very little confidence that I would survive COVID, said Irzyk, who is more vulnerable to the coronavirus because she has lupus and other health conditions.

So Irzyk keeps track of hospitalizations and deaths. She checks data from wastewater monitoring that predicts spikes in the coronavirus. Recently, troubled by what she was seeing in the numbers, she told employees at her talent agency to stop coming to work in the office.

But she puts little stock in one of the simplest numbers regularly shared by health officials: How many COVID-19 cases are being reported.

Those official figures are relatively worthless at this point, said Irzyk, who authored a book on disability and the law. Positive tests are being discovered through home testing and theyre not reported to anyone.

The boom in home testing for the coronavirus has meant that health officials never hear about many COVID cases, deflating official counts.

Federal funding to test uninsured patients also dried up this spring, pinching the availability of free testing for some Americans. California has sought to continue providing testing for uninsured people through its own programs, and in Los Angeles County, the Department of Health Services said the number of its own sites which offer COVID testing without out-of-pocket charges to L.A. County residents has remained stable since the beginning of this year.

But official testing has nonetheless fallen off even as California reckons with the rapid spread of the BA.5 subvariant.

In L.A. County, an average of more than 222,000 tests were being recorded daily in January; in June, that figure had dropped to around 77,000 tests a day. Those figures do not include tests taken at home; the public health department said it currently has no system in place for people to report such results to L.A. County.

At the University of Washington, researchers who test blood to assess the true level of infections have estimated that only 14% of cases are being reported across the United States. Testing has never captured the full spread of the coronavirus, but the figure is much lower than in some earlier points in the pandemic, when more than 40% of cases were once estimated to be detected.

Even the cases that are being detected are not being reported as frequently as they used to be, said Ali H. Mokdad, professor of health metrics sciences at the universitys Institute for Health Metrics and Evaluation. In many states, many counties, its only once a week.

Between the rise in home testing that goes unreported, budgetary reductions in testing services, and mild or asymptomatic infections going unnoticed, we dont really know how many cases we have, said Dr. David Dowdy, an infectious-diseases epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

Public health officials can still piece together what is happening with other data, but the challenge is that you want your public health systems to develop responses that are based on these sorts of metrics, Dowdy said. As these metrics become less reliable ... youre left with going back to what it was before, which is just kind of a general sense of where things are headed.

As the pandemic has persisted, experts have turned to a range of metrics to assess how the virus is spreading and what toll it is taking. During the Omicron wave this past winter, some health officials argued that the sheer number of cases was less important than how many of them led to severe illness, as reflected in hospitalizations and deaths.

But infections remain an important metric for anyone trying to avoid them. If government officials are trying to prevent hospitals from being overwhelmed, it makes sense to focus on hospitalizations, Dowdy said.

Gauging personal risk, however, can be very different. Even if hospitalizations are not especially high, for those people who are at risk, those who are older, those who have compromised immune systems, the risk now is very high because of the high level of transmission thats out there, Dowdy said.

L.A. County Public Health Director Barbara Ferrer. She has said that if current trends of rising hospitalizations continue, the county could reinstate a mask mandate for indoor spaces by the end of July.

(Al Seib / Los Angeles Times)

When COVID cases go uncounted, people think that it is safer to do activities that are not as safe to do, for people who are still trying to avoid infection, said Dr. Abraar Karan, a fellow in the Division of Infectious Diseases and Geographic Medicine at Stanford University.

As they try to calculate the costs and benefits of different activities, when people dont realize how much spread there is, they dont know what the true potential cost is, Karan said. People now may be doing things that they dont realize are going to put them at high risk of getting infected and infecting others.

Another concern is the risk of long COVID, in which symptoms can persist for months or years even after an initial illness that was relatively mild. Scientists have differing estimates of how common the condition is, but if massive numbers of people are infected, even estimates in the lower range would result in high numbers of patients with enduring symptoms.

Despite concerns about many COVID cases not being reported, L.A. County Public Health Director Barbara Ferrer said that because we triangulate data from wastewater, emergency departments and reported test results, we feel confident that we have a decent grasp on the level of spread across the county.

Ferrer has said that if current trends of rising hospitalizations continue, the county could reinstate a mask mandate for indoor spaces by the end of July.

We dont have to count every case to understand whats happening in our communities, said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Whats important is to understand the general trend of how cases are changing.

You have to assume right now that COVID particularly BA.5 is widespread in our communities everywhere. The bottom line is, extensive transmission is going on right now. Osterholm likened it to assessing the speed of a car as it passes. I couldnt tell you the difference between 80 and 120 miles per hour I just know its going really fast.

The virus is spreading rapidly as U.S. residents have expressed decreasing concern about getting seriously ill or infecting others: As of May, the percentage of Americans who said they were concerned about being hospitalized for COVID had fallen to its lowest level since the Pew Research Center began asking the question early in the pandemic. So had the share of people worried about unknowingly infecting someone else.

The fact that we dont have mask mandates also makes people think, Well, its not that serious, because otherwise we would have mask mandates the danger must be less, said Dr. Sherrill Brown, medical director of infection prevention at AltaMed Health Services.

L.A. County public health officials have continued to strongly recommend wearing masks, especially well-fitting respirators such as N95s and KN95s, in indoor settings. But when we made it a strong recommendation, virtually nobody did it, County Supervisor Sheila Kuehl said at a meeting this week.

Irzyk said that right now, its not like I could be a lot more cautious than Im being. The 44-year-old is not eating in restaurants or gathering in groups. Her husband gets their groceries by curbside pickup. She hasnt been on an airplane since before the pandemic and cant imagine doing so anytime soon.

Because few other people are wearing masks in her office building, she gets anxious about taking the elevator up to her office, where she still goes twice a week to issue paychecks to her employees. Even a neighbor in the office building who was made aware of her medical condition has stopped bothering to wear a mask around her, she said.

Brilliant people, experts in their fields, are emailing me asking what my dad says they should do on COVID, because they dont trust anybody else, said Irzyk, whose father, Mark Rothstein, is a public health and bioethics expert. We are just doing a terrible job at messaging.

Rothstein, who in the past served as public health ethics editor for the American Journal of Public Health, argued that unless the rate of new infections is slowed, were always going to be on this treadmill of new variants.

And as more cases have gone unreported, its harder for public health officials to make decisions about masking and other protective measures that can be justified with such data, where you can say, Look, weve gone from Point A to Point B and weve crossed a line that is very important, Rothstein said.

Osterholm, in turn, contended that the number of unreported cases has little consequence for whether such government actions are embraced by the public, because the public has come to the conclusion that theyre done with the pandemic, even if the virus isnt done with them.

Karan said that with a constantly evolving pandemic, its hard even for experts to synthesize the many factors that have shifted in assessing the reach and risk of the coronavirus over time, including the emergence of new variants and subvariants. I dont think that people in the general public are going to have any idea how to analyze a lot of this, he said.

Telling people to make these risk assessments is not going to work for many reasons, Karan said, including that theres too much data thats coming out all the time.

Instead, Karan argued that health officials need to be pursuing community mitigation measures such as upgrading ventilation and air filtration in public spaces to reduce the spread of the virus. Individual efforts will only get you so far, he said, when you have something thats spreading this fast.

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Just how big is this COVID surge? It's gotten harder to say - Los Angeles Times

Patients with asthma hospitalized with COVID-19 in Michigan in 2020 had more severe outcomes after taking certain factors into account, according to a recent study.

What is known and unknown about the relationship between asthma and COVID-19 has been inconsistent during the pandemic. Some prior research has found that individuals with asthma do not have an increased risk for worse COVID-19 outcomes, but a study published this month said that outcomes may appear to be dependent on the type of asthma one has, as well as the factors of sex and age.

The patients with asthma in this single-center study, conducted in Michigan, did have more severe COVID-19, after considering these other factors.

Additional research is needed to fully understand which aspects of the chronic lung disease might be linked with increased risk from the virus, said the authors, who wrote in the Annals of Allergy, Asthma & Immunology that data suggest that it is premature to conclude that asthma is not associated with an increased risk of poor outcomes with COVID-19.

Their research compared hospitalized patients with COVID-19 (confirmed through polymerase chain reaction testing) with asthma (n = 183) and without asthma (n = 1319).

To identify asthma severity level, the researchers looked at asthma maintenance medications, Global Initiative for Asthma classification, pulmonary function tests, immunoglobulin E level, and the highest historical absolute eosinophil count to determine if the patient had eosinophilic vs non-eosinophilic asthma.

Primary outcomes included death, mechanical ventilation, intensive care unit (ICU) admission, and how long the patient was hospitalized in either the ICU or the hospital.

Results were adjusted to include demographics, comorbidities, smoking status, and timing of illness in 2020, with the year split from March, 2020 to June 14, 2020, and from June 15, 2020 to December, 2020.

There were 140 encounters in the first half of the year and 127 encounters in the second half.

The median age of patients with asthma was significantly lower (56 years, P < .001) compared with those without asthma (62 years). In addition, most of the patients with asthma were female (65%) compared with those without asthma (41%, P < .001).

There were 104 patients with mild asthma, 29 patients with moderate asthma, and 49 patients with severe asthma. In addition, just over a third (33%) had eosinophilic asthma and 58% had non-eosinophilic asthma.

Unadjusted analyses showed no difference between patients with asthma and patients without asthma in terms of outcomes. There was no statistically significant difference in looking at inhaled corticosteroid use and eosinophilic phenotype.

However, in adjusted analyses, patients with asthma, when compared with those without asthma, were more likely to have:

Patients with moderate asthma had worse outcomes than those with mild asthma, with higher odds of:

Patients with severe asthma had shorter hospital stays (RR, 0.80; 95% CI, 0.65-1.00; P < .04).

In addition, patients who were female and of older age also tended to have worse outcomes, in line with what is already known about sex disparities in asthma. But the finding is also the opposite of what has been shown when examining COVID-19 illness alone, where being male is a risk factor for more severe disease or death.

However, the authors noted that since the sample size of patients with moderate asthma was smaller, confidence intervals were larger, making the findings more challenging to interpret.

Noting that their findings differ from other research, the authors said prior studies had smaller sample sizes of patients with asthma, and primary outcomes differed. Larger cohort studies did show longer periods of intubation and worse outcomes, they said.

Reference

Ludwig A, Brehm CA, Fung C, et al. Asthma and coronavirus disease 2019related outcomes in hospitalized patients: a single-center experience. Ann Allergy Asthma Immunol. 2022;129(1);79-87. doi:10.1016/j.anai.2022.03.017.

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What Influences COVID-19 Severity in Patients With Asthma? - AJMC.com Managed Markets Network

With the coronavirus resurgent and cases and hospitalizations on the rise, Los Angeles is poised to become the first Southern California county to reinstate mandatory public indoor masking.

If the situation sounds familiar, its because it is. Almost exactly one year ago, the county took the same step to combat a surge fueled by the Delta variant of the coronavirus. It was the first, but it wasnt the last. Officials in at least 20 counties including Ventura, Santa Barbara, Santa Cruz, Sacramento and a large swath of the San Francisco Bay Area would eventually follow suit.

Unless conditions improve, Los Angeles County will by the end of the month find itself in an identical position: issuing a face covering order even though no other county currently appears ready to do the same.

But as California grapples with another summertime wave this one driven by the highly infectious family of Omicron subvariants, namely BA.5 will L.A. County prove to be ahead of the curve or, as some critics maintain, behind the times?

The U.S. Centers for Disease Control and Prevention recommends universal indoor public masking for those 2 and older when a county enters the high COVID-19 community level a designation signifying both that coronavirus transmission is elevated and that the spread is starting to affect hospitals.

L.A. County officially entered the high community level Thursday. Should it remain there for the next two weeks, the county will reissue an indoor mask mandate with an effective date of July 29.

No other California county has publicly tied its placement on the CDCs community level scale to a renewal of masking orders. Along with L.A., 41 other counties are in the high level as of this week.

Most places recommend, but do not require, masking indoors while in public.

We are seeing a summer wave in cases and hospitalizations, and this move to the high transmission level confirms that, Dr. Clayton Chau, director of the OC Health Care Agency, said in a statement. To protect those at high risk, we are recommending that OC residents continue masking in public, indoor settings, especially those who are at high risk or living with loved ones who have comorbidities, are immunocompromised or are prone to getting sick.

Alameda County was the first California county to issue a mandatory indoor masking order following the winter Omicron surge. Issued on June 3, it was rescinded three weeks later on June 25.

L.A. is like no other county in the United States. With some 10 million residents, it is far and away the most populous county in the nation home to more residents than most states.

Overcrowded housing, a risk factor for the spread of the coronavirus, is worse in L.A. County than many other parts of the country, including the Bay Area.

Of all of Southern Californias coastal counties, L.A. has the highest rate of poverty and lowest median household income. People living in lower income areas are more likely to be hospitalized or die from COVID-19 than those living in wealthier areas even when vaccination status is the same.

Lower-income people in L.A. County power substantial sectors of the local economy, including food production, hospitality and tourism.

All this means that, when a new wave hits, a place like L.A. County may be hit disproportionately harder than neighboring places.

Families with fewer resources are more likely to have more exposures at work, live in crowded conditions and have one or more chronic health conditions compared to those with more resources, county Public Health Director Barbara Ferrer said during a briefing Thursday. This places individuals at higher risk of suffering the severe effects from COVID. Since vaccination alone is not sufficient to erase the troubling inequities we see, additional efforts are needed to protect those at greatest risk.

Masking has been the subject of heated debate and at times fervent opposition throughout the pandemic. But officials and experts are largely in agreement that wearing a high-quality, well-fitting face covering provides additional protection especially in indoor or crowded spaces.

There is broad consensus in the scientific community that wearing a high-quality mask in indoor public spaces is an important tool to control the spread of COVID-19. [It] prevents you from getting infected, and it prevents you from spreading it to others, Dr. Ashish Jha, the White House COVID-19 response coordinator, said during a recent briefing.

Masking, Ferrer said, protects all of us.

When people who are infected wear a mask, they exhale far less virus into the air than infected people who do not mask, she said. Masks also provide protection to the individual thats wearing a mask by filtering virus from the air as theyre breathing. When everyone in the room is masked, safety is enhanced as theres less virus circulating and less likelihood that any virus that is circulating will penetrate the physical barrier.

Ferrer said the rationale for a mask order during a time of high hospitalization rates is similar to the sensible collective actions taken to reduce other public safety risks, such as rules limiting drivers alcohol consumption and requiring seat belts.

The reality is that because were living with a mutating SARS-CoV-2 virus, there remains uncertainty around the trajectory of this pandemic, Ferrer said. We should not settle for the existing high rates of morbidity and mortality that disproportionately affect those most vulnerable.

Although its true that the versions of the coronavirus currently in circulation tend to cause less severe symptoms, theyre not harmless. As Ferrer noted, You cannot predict with any degree of certainty whether, if you get infected, youre going to be one of the luckier ones that ends up with mild illness or one of those that ends up with severe illness.

And just as no one can guarantee they wont suffer long-term risk, they also cant predict the potential health effects should they spread the virus to others especially those at higher risk.

I think we kind of owe it to each other to do whatever we can to reduce that burden, and to really acknowledge that it has disproportionately affected people who are either older, have serious underlying health conditions, or have more exposures, which tends to be people who are our essential workers, Ferrer said.

As of Thursday, L.A. County hospitals were caring for 1,223 coronavirus-positive patients double the number recorded a month ago.

Hospital inpatient units are not reporting being overwhelmed, and the overall patient count remains well shy of the figures reported during the pandemics earlier waves. But other facilities, including emergency departments, urgent care centers and community clinics are telling us that theyre feeling very strapped, Ferrer said.

They have staffing shortages because lots of their staff are sick with COVID and out, and they also have lots of their patients that while they dont need to go to the hospital they do need medical care, and that creates some stress as well.

Vaccinations and anti-COVID drugs have made it less likely that large numbers of patients will need intensive care during this surge, Ferrer said. But, she added, we also have a lot of unknown with BA.5, and anything else that comes our way. Whats going on in our hospitals could change.

Waiting until hospitals are overwhelmed is way too late to try to do much about slowing transmission, she said. The time to slow transmission is actually when you start seeing indicators that youre having more utilization at your hospitals.

Weekly COVID-19 deaths in L.A. County have doubled in the last month, with officials reporting 100 deaths a week. The weekly peak during the initial Omicron surge last fall and winter was more than 500.

The most effective masks are N95, KN95 and KF94 respirators. You should not double-mask with a respirator.

Another type, though with a lower degree of effectiveness, is a surgical mask, also known as medical masks, which are looser fitting and sometimes called blue masks for their tinted color. They can be made more effective by placing a cloth mask over the surgical mask.

This helps hold the edges of the medical mask to your face and creates a better seal, Ferrer said.

When higher-quality masks were in short supply, cloth masks with at least three layers were seen as a better option than thinner cloth masks. But its now clear that even three-layer cloth masks provide minimal protection, according to Ferrer. Bandannas, gators and thin cloth masks are not effective at filtering out the virus.

While [cloth masks are] better than wearing no mask, given that we have a highly transmissible set of variants circulating, upgrading your mask makes a big difference in the level of protection, Ferrer said.

Masks should be worn over both the nose and mouth, and disposable masks and respirators should be thrown away when they become wet or dirty.

For people who cannot wear a mask due to a disability or medical condition, face shields with drapes that go under the chin and are attached at the bottom edge can provide additional protection, Ferrer said.

Read more from the original source:

L.A. headed for new COVID mask mandate. Will others join? - Los Angeles Times

Research has shown that mouthwash may help to break down the viral envelope around viruses such as SARS-CoV-2, which causes COVID-19. The viral envelope is a protective barrier that surrounds the virus.

However, there is not enough evidence to support that mouthwash is an effective tool against COVID-19, and further research is needed.

Some mouthwash is antiseptic and may kill microorganisms in the mouth. It may also help prevent tooth decay and bad breath, alongside brushing and flossing. People use mouthwash by swishing it in their mouth and gargling with it after brushing their teeth and then spitting it out.

Mouthwash may kill COVID-19 in the mouth temporarily, but the virus will make more copies of itself rapidly. Therefore, it may only offer a temporary solution at best.

This article discusses COVID-19, research about mouthwash and COVID-19, and COVID-19 prevention.

COVID-19 is a highly infectious disease caused by the SARS-CoV-2 virus. Most people who contract COVID-19 experience mild to moderate symptoms and recover without special treatment. However, some people become severely ill and require medical attention. Any person can contract COVID-19 and become seriously ill or die.

The virus can transmit from the nose or mouth of a person with COVID-19 through small particles when they sneeze, cough, breathe, sing, or speak.

Symptoms of COVID-19 include:

According to the World Health Organization (WHO), there have been more than 550 million confirmed cases of COVID-19 and more than 6 million deaths globally. To help prevent the virus, the Centers for Disease Control and Prevention (CDC) recommend that every person aged 6 months and older receive vaccinations.

According to the CDC, more than 222 million people in the United States are fully vaccinated.

Dentists currently use antimicrobial mouthwashes to reduce the number of microorganisms in liquid particles that may escape a persons mouth during procedures. These rinses contain antiseptic chemicals, which include:

Research suggests that using mouthwash may temporarily prevent the transmission of SARS-CoV-2 during dental procedures. However, a person can still exhale the virus from their lungs and nasal cavity.

Emerging studies suggest that although they are not primary targets for infection, the salivary glands and throat are important sites of virus transmission and replication in the early stages of COVID-19. This may mean that using mouthwash could be a helpful tool for preventing the spread of the virus.

However, at this stage, studies are too small and short term for researchers to make conclusive statements, and further research is necessary.

A 2020 study suggested that mouthwashes containing certain ingredients may break down or destroy the SARS-CoV-2 viral lipid envelope, which acts as protection for the virus.

The authors stated that published research supports the theory that oral rinsing helps break down viral envelopes in other viruses, including coronaviruses, and should be researched further in relation to COVID-19.

Another 2020 study found that after swishing and gargling a mouthwash formulation for 60 seconds, 16 out of 33 study participants became Neisseria gonorrhea culture-negative within 5 minutes, compared to 4 of 25 participants who gargled saline.

However, the study was not large enough to provide conclusive evidence and indicated a need for further research.

The authors of a 2021 study suggested that oral rinses containing 0.5% povidone-iodine may interrupt the attachment of SARS-CoV-2 to tissues in the nose, throat, and mouth, and lower viral particles in the saliva.

Although research is promising, recent studies have limitations and are insufficient to prove that mouthwash can act as a preventive measure against COVID-19.

Available, published studies are small, and there are no large-scale clinical studies that provide evidence of mouthwash as a successful measure against COVID-19.

Researchers that suggested mouthwash as a promising measure generally also suggested that further research is needed, and did not offer recommendations for the use of mouthwash as a COVID-19 prevention tool.

While researchers have found evidence that certain mouthwash formulas could successfully destroy the virus, the results were only true for people who had only had the virus for a short while.

While some studies found that mouthwash could create a hostile environment for the SARS-CoV-2 virus, research does not support that it can treat active infections or control the spread of the virus.

Finally, although mouthwash may have an effect on the virus in the mouth and throat, COVID-19 also collects in nasal passages. Even if mouthwash could effectively kill the virus in the throat, it would remain in the nasal passages, which could pass the virus down to the throat.

According to the CDC, to prevent infection and the transmission of SARS-CoV-2, a person should consider:

Research has shown that using certain formulations of mouthwash may help destroy the protective SARS-CoV-2 viral envelope and kill the virus in the throat and mouth. However, current studies have serious limitations.

Publically available studies do not provide large-scale, clinical evidence to conclude the efficacy of mouthwash against COVID-19. Although mouthwash affects the virus in the mouth and throat, it does not affect the virus in other primary spots such as the nasal passages, which may reinfect the throat.

Research does not show that mouthwash can treat active infections or prevent virus transmission.

Therefore, people should continue adhering to current prevention measures, such as vaccination and regular handwashing. They should also continue to follow measures suggested by the CDC to help stop the transmission of SARS-CoV-2.

More:

What to know about mouthwash and COVID-19 - Medical News Today

The survey instrument used in the study

This is an online survey entitled: "Coverage of COVID-19 Booster (Precautionary) Dose in the Adult Population" being conducted by a group of 4th-year medical students from Kempegowda Institute of Medical Sciences, Bangalore. We intend to study the public acceptance for the COVID-19 precautionary dose vaccines. The survey will take around 5 to 10 minutes of your time.

The questions are related to the demographics of the respondents and their familiarity with the COVID-19 vaccination.

If you have any queries related to the questionnaire- please feel free to contact the undersigned.

We thank you for your time and cooperation!

Anagha Brahmajosyula

Aniket Khamar

Deepika Kondath

Lavanya Bilichod

Namita Acharya

- 4th year MBBS, Kempegowda Institute of Medical Sciences, Bangalore.

INFORMED CONSENT:

PARTICIPATION

Your participation in this survey is purely voluntary. We assure you, your identity would be strictly anonymous and the information provided in the questionnaire would be used only for academic purposes.

* Required 1. Gender * (Mark only one oval.)

o Male

o Female

o Transgender

o Prefer not to say

2. Age * (Mark only one oval.)

o 18-30

o 31-40

o 41-50

o 51-60

o 61-70

o 71-80

o 81 and above

3. Education * (Mark only one oval.)

o Professional degree (PhD scholar) / Postgraduate

o Graduate

o Undergraduate

o 12th pass/ 2nd PUC

o High school (8th to 10th grade)

o Middle school (6th to 8th grade)

o Primary school (1st to 5th grade)

o Other:

4. Location (this form is applicable only for those living in India) * (Mark only one oval.)

o Andhra Pradesh

o Arunachal Pradesh

o Assam

o Bihar

o Chhattisgarh

o Goa

o Gujarat

o Haryana

o Himachal Pradesh

o Jharkhand

o Karnataka

o Kerala

o Madhya Pradesh

o Maharashtra

o Meghalaya

o Mizoram

o Nagaland

o Odisha

o Punjab

o Rajasthan

o Sikkim

o Tamil Nadu

o Telangana

o Tripura

o Uttar Pradesh

o Uttarakhand

o West Bengal

o Others: Please mention

5. Which city do you live in? (Please mention) *

6. Occupation * (Mark only one oval.)

o Medical student

o Paramedics

o Paramedical student

o Student (engineering, commerce, etc.)

o Business sector

o Agriculture, animals, environmental sector

o IT, civil engineering, automation, telecommunication, aeronautics

o Education (Teacher/Professor)

o Industrial workers, production, manufacture

o Housekeeping and cleaning industry

o Driver, Transport industry, Aviation industry

o Housewife

o Public service/ government job

o Media, journalism, graphics, printing, design

o Marketing, PR, advertising

o Legal, Administration

o Hospitality, tourism, leisure, sports

o Commerce industry

o Architecture, interior decorators

o Arts industry

o Salaried professional

o Nursing/Allied Health Sciences/Dentistry

o Retired/not currently working (medical and allied professionals - doctors, paramedics, dentists, nursing professionals.)

o Retired/not currently working (nonmedical professionals)

o Others

7. Have you taken the COVID-19 Vaccine? * (Mark only one oval.)

o No vaccine taken

o 1st dose taken

o 2 doses taken

8. Which vaccine have you taken? (Mark only one oval.)

o CoviShield (Oxford AstraZeneca)

o Covaxin

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Coverage of Coronavirus Disease-2019 (COVID-19) Booster Dose (Precautionary) in the Adult Population: An Online Survey - Cureus

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Are COVID-19 booster shots necessary? Yale study says they're crucial - The Jerusalem Post