Coronavirus COVID-19 Update for April 11, 2021

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Clinical Reports

Children and COVID19: State Level Data Report
A joint report from the American Academy of Pediatrics and the Children’s Hospital Association. Summary of publicly reported data from 49 states, NYC, DC, PR, and GU Version: 4/16/22. The numbers in this report represent cumulative counts since states began reporting. The data are based on how public agencies collect, categorize and post information. All data reported by state/local health departments are preliminary and subject to change and reporting may change over time. Notably, in the summer of 2021 and winter of 2022, some states have revised cases counts previously reported, begun reporting less frequently, or dropped metrics previously reported. For example, due to several changes on their dashboards and the data currently available, AL, TX, HI, DC and MS data in this report are not current (cumulative data through 7/29/21, 8/26/21, 1/13/22, 3/3/22, and 3/10/22 respectively). Readers should consider these factors. States may have additional information on their web sites.
Comparison of outcomes from COVID infection in pediatric and adult patients before and after the emergence of Omicron – Retrospective Cohort Study
This was a retrospective cohort study that looked at the outcomes from COVID infection in pediatric and adult patients before and after the emergence of the omicron variant. 577,938 first time infected patients were examined from a nationwide database in the United States. After including demographics, socio-economic determinants of health, comorbidities, medications, and vaccination status, the risks in the Omicron cohort outcomes were consistently less than half of those in the Delta cohort. Hospitalization Risk Ratio was 0.44 so a 56% reduction. 60% of people in the study were vaccinated. The study came to the conclusion that first time SARS-CoV-2 infections occurring when the omicron variant was rapidly spreading were associated with significantly less severe outcomes than first time infections when the Delta Variant predominated.
Infectious viral load in unvaccinated and vaccinated patients infected with SARS-CoV-2 WT, Delta and Omicron
In this preprint, the authors of the study report on the assessment of nasopharyngeal swabs of COVID-19 patients for quantitative infectious viral titres (IVT) by focus forming assay and compared that to the overall virus isolation success and RNA genome copies. They assessed infectious viral titres during the first 5 symptomatic days in a total of 384 patients: unvaccinated individuals infected with pre-VOC SARS-CoV-2 (n=118) or Delta (n=127) and vaccine breakthrough infections with Delta (n=121) or Omicron (n=18). The study authors reported that the correlation between RNA copy number and IVT was low for all groups. This indicates that RNA copy number is not actually a measure of viral load. Second, no correlation between IVTs and age and sex was seen. Third, the authors observed higher RNA genome copies in pre-VOC SARS-CoV-2 compared to Delta, but significantly higher IVT’s in Delta infected individuals. Ultimately, what this study showed was that in vaccinated vs unvaccinated Delta infected individuals, RNA genome copies were comparable but vaccinated individuals have significantly lower IVT’s and cleared the virus faster.

Antiviral Therapeutics and Vaccines

Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA Vaccination Against Multisystem Inflammatory Syndrome in Children Among Persons Aged 12–18 Years — United States, July–December 2021
Authors in this study looked at the effectiveness of 2 doses of the Pfizer-BioNTech vaccine against Multisystem inflammatory syndrome in children. They looked at 24 pediatric hospitals in 20 states from July 1-December 9, 2021. This was a period that most MIS-C patients could be temporally linked to the Delta variant. The study reported that the estimated effectiveness of 2 doses of Pfizer-BioNTech vaccine against MIS-C was 91% (95% CI = 78%-97%). It is too be noted that All of the MIS-C patients requiring life support were unvaccinated. In conclusion, the Pfizer-BioNTech vaccine is associated with a high level of protection against MIS-C in persons aged 12-18 years, highlighting the importance of vaccination among all eligible children.
Cross-reactive memory T cells associate with protection against SARS-CoV-2 infection in COVID-19 contacts
The study observes higher frequencies of cross-reactive (p = 0.0139), and nucleocapsid-specific (p = 0.0355) IL-2-secreting memory T cells in contacts who remained PCR-negative despite exposure (n = 26), when compared with those who convert to PCR-positive (n = 26. No significant difference in the frequency of responses to spike is observed, hinting at a limited protective function of spike-cross-reactive T cells. The results are thus consistent with pre-existing non-spike cross-reactive memory T cells protecting SARS-CoV-2-naïve contacts from infection, thereby supporting the inclusion of non-spike antigens in second-generation vaccines.
Infectious viral load in unvaccinated and vaccinated patients infected with SARS-CoV-2 WT, Delta and Omicron
Authors looked at 731 persons seeking COVID-19 testing at a walk-up San Francisco community site in January 2022, simultaneous nasal rapid antigen testing (BinaxNOWTM) and RT-PCR testing was performed. There were 296 (40.5%) positive tests by RT-PCR; 97% of a random sample were the omicron variant. Sensitivity of a single antigen test was 95.2% (95% CI 92-98%) for Ct threshold of < 30. 82.1% (95% CI 77-87%) for Ct threshold of < 35. 65.2% (95% CI 60-70%) for no threshold. A single BinaxNowTM rapid antigen test detected 95% of high viral load omicron cases from nasal specimen in just 15 minutes. The data from this study confirms that the BinaxNOW rapid test detects omicron with a sensitivity similar to that observed for previous variants. The increasing availability of this test in the United States can inform public health strategies that hinge on rapid diagnosis and treatment.

Diagnostics

Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA Vaccination Against Multisystem Inflammatory Syndrome in Children Among Persons Aged 12–18 Years — United States, July–December 2021
This trial was conducted in Brazil, with 320 patients hospitalized with COVID-19 that were at increased risk of venous thromboembolism. Subjects were randomly assigned (1:1) to receive at hospital discharge, rivaroxaban 10 mg/day or no anticoagulation for 35 days. The primary efficacy outcome, which was composite of symptomatic or fetal venous thromboembolism, occurred in five (3%) of 159 patients assigned to rivaroxaban and 15 (9%) of 159 patients assigned to no anticoagulation. No major bledding occurred in either study group. Allergic reactions occurred in two (1%) patients in rivaroxaban group. Researchers concluded that in patients at high risk discharged after hospitalization due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days improved clinical outcomes compared with no extended thromboprophylaxis.