October 17, 2024

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COVID: Active Vaccination/Immunity

Relative Effectiveness and Waning of a Third Dose of mRNA COVID-19 Vaccine in Medicare Beneficiaries Aged 65 Years and Older during the BA.1/BA.2 Omicron Period
Here they used Medicare claims data to conduct a retrospective cohort study in U.S. community-dwelling Medicare Fee-for-Service beneficiaries aged ≥65 years during the BA.1/BA.2 Omicron period (December 19, 2021 – March 26, 2022). They estimated relative vaccine effectiveness (RVE) of three versus two doses of mRNA COVID-19 vaccines. They also get some comparisons between the Moderna and the Pfizer/BioNTech vaccines. They looked at 8,135,020 eligible beneficiaries. Of these, 73.3% were three-dose vaccinated by March 26, 2022. At 14-60 days since vaccination, a third dose provided significant added benefit against COVID-19-related hospitalization for Moderna (relative vaccine effectiveness - RVE for hospitalization: 77.2%; 95% confidence interval (CI): 76.0%, 78.4%) and Pfizer-BioNTech (RVE: 72.5%; 95% CI: 70.8%, 74.0%). Added benefit was lower >120 days. For those with prior medically attended COVID-19 diagnoses, Pfizer-BioNTech provided an added benefit for 120 days, while Moderna provided some added benefit >120 days. Added benefit for either vaccine was higher against death compared to less severe outcomes, which still decreased >120 days.

COVID: Testing

SARS-CoV-2 Antigen Rapid Detection Tests: Test Performance During the COVID-19 Pandemic and the Impact of COVID-19 Vaccination
Here they performed a prospective assessment from 12 November 2020 to 30 June 2023 at a single center tertiary care hospital, looking at the sensitivity and specificity (primary endpoints) of RDTs from three manufacturers (NADAL®, Panbio™, MEDsan®) compared to RT-qPCR as the reference standard. They analyzed 78,798 paired RDT/RT-qPCR results. Their regression model showed that a higher RNA copy number and typical COVID-19 symptoms were directly and significantly correlated with the likelihood of a positive RDT result. Age, sex, vaccination status, and the Omicron VOC were not. Right up front we have high RNA copy number and the best sensitivity to our RDTs. This study again confirms that a higher RNA copy number and typical COVID-19 symptoms directly correlated with a positive RDT result. Vaccination status and different variants did not correlate with a positive or negative RDT result.

COVID: Early Inflammatory Week

Remdesivir-associated Survival Outcomes among Immunocompromised Patients Hospitalized for COVID-19: Real-world Evidence from the Omicron Dominant Era
Here they identified adult patients with immunocompromising conditions, hospitalized for COVID-19 between December 2021 and February 2024. Primary outcome was all-cause inpatient mortality examined in propensity score (PS) matched patients in remdesivir versus non-remdesivir groups. Subgroup analyses were performed for patients with cancer, hematologic malignancies, and solid organ/hematopoietic stem cell transplant recipients. Of 28,966 patients included in the study, 16,730 (58%) received remdesivir during first two days of hospitalization. After PS matching, 8,822 patients in remdesivir and 8,822 patients in non-remdesivir group were analyzed. Remdesivir was associated with a significantly lower mortality among patients with no supplemental oxygen (aHR [95% CI]: 14-day, 0.73 [0.62-0.86]; 28-day, 0.79 [0.68-0.91]) and among those with supplemental oxygen (14-day, 0.75 [0.67-0.85]; 28-day, 0.78 [0.70-0.86]). Remdesivir was also associated with lower mortality in subgroups of patients with cancer, hematological malignancies (including leukemia, lymphoma, and multiple myeloma), and solid organ/hematopoietic stem cell transplantation.
Remdesivir Effectiveness in Reducing the Risk of 30-day Readmission in Vulnerable Patients Hospitalized for COVID-19: A Retrospective US Cohort Study Using Propensity Scores
Here they performed a retrospective study looking at 326,033 patients hospitalized for COVID-19. During study period, 210,586 patients met the eligibility criteria. Of these, 109,551 (52%) patients were treated with remdesivir. Lower odds of 30-day COVID-19-related readmission were observed in patients who received remdesivir vs those who did not, in the overall population (3.3% vs 4.2%, respectively; odds ratio [95% confidence interval]: 0.78 [0.75–0.80]), elderly population (3.7% vs 4.7%, respectively; 0.78 [0.75–0.81]), and those with underlying immunocompromising conditions (5.3% vs 6.2%, respectively; 0.86 [0.80–0.92]). These results were consistent irrespective of supplemental oxygen requirements.

COVID: The Late Phase/PASC/Long COVID

Measurement of Circulating Viral Antigens Post-SARS-CoV-2 Infection in a Multicohort Study
In this study plasma and serum samples were collected from adults participating in four independent studies at different time points, ranging from several days up to 14 months post-SARS-CoV-2 infection. The primary outcome measure was to quantify SARS-CoV-2 antigens, including the S1 subunit of spike, full-length spike, and nucleocapsid, in participant samples. The presence of 34 commonly reported PASC symptoms during the postacute period was determined from participant surveys or chart reviews of electronic health records. Of the 1,569 samples analysed from 706 individuals infected with SARS-CoV-2, 21% (95% CI, 18–24%) were positive for either S1, spike, or nucleocapsid. Spike was predominantly detected. Among the participants who reported no ongoing symptoms, antigen was detected in 28 participants (21%). Among participants who reported at least one of the 34 PASC symptoms, 43% were antigen-positive. The presence of antigen was associated with the presence of one or more PASC symptoms, adjusting for sex, age, time postinfection, and cohort (OR, 1.8; 95% CI, 1.4–2.2).
Driving Under the Cognitive Influence of COVID-19: Exploring the Impact of Acute SARS-CoV-2 Infection on Road Safety
Investigators looked at the correlation between acute COVID-19 cases and car crashes across seven states, considering vaccination rates and COVID-19. They found an association between acute COVID-19 rates and increased car crashes with an OR of 1.5 (1.23-1.26 95%CI). The analysis did not find a protective effect of vaccination against increased crash risks. The OR of car crashes associated with COVID-19 was comparable to driving under the influence of alcohol.
Long COVID Facts and Findings: A Large-scale Online Survey in 74,075 Chinese Participants
A retrospective study used an online questionnaire to investigate SARS-CoV-2 infection status and Long COVID symptoms among 74,075 Chinese residents over one year. They analyzed 68,200 responses and found that 10%–30% (including repeated infection) reported symptoms. The most frequent Long COVID symptoms included fatigue (30.53%), memory decline (27.93%), decreased exercise ability (18.29%), and brain fog (16.87%). Women were more likely to experience Long COVID, with symptoms varying by age group, except for sleep disorders and muscle/joint pain, which were more common in older individuals. Risk factors included underlying diseases, alcohol consumption, smoking, and the severity of acute infection (OR > 1, FDR < 0.05). Reinfection was associated with milder symptoms but led to a higher incidence and severity of long COVID (OR > 1, FDR < 0.05). Vaccination, particularly multiple boosters, significantly reduced long-term symptoms by 30%–70% (OR < 1, FDR < 0.05).