Coronavirus COVID-19 Update for April 11, 2021

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Clinical Reports

COVID-19 Cases and Hospitalizations by COVID-19 Vaccination Status and Previous COVID-19 Diagnosis — California and New York, May–November 2021.
Researchers break down people into four cohorts, vaccinated without prior infection, vaccinated with prior infection, unvaccinated without prior infection and vaccinated with prior infection. They then look at different time periods. Major highlights from the study are the following. COVID-19 hospitalization rates in California were always highest among unvaccinated persons without a previous COVID-19 diagnosis. In the pre-Delta period during June 13–June 26, for example, compared with hospitalization rates among unvaccinated persons without a previous COVID-19 diagnosis, hospitalization rates were 27.7-fold lower (95% CI = 22.4–33.0) among vaccinated persons without a previous COVID-19 diagnosis, 7.1-fold lower (95% CI = 4.0–10.3) among vaccinated persons with a previous COVID-19 diagnosis, 6.0-fold lower (95% CI = 3.3–8.7) among unvaccinated persons with a previous COVID-19 diagnosis. When the Delta variant became predominant, during October 3–16, compared with hospitalization rates among unvaccinated persons without a previous COVID-19 diagnosis, hospitalization rates were 19.8-fold lower (95% CI = 18.2–21.4) among vaccinated persons without a previous COVID-19 diagnosis, 55.3-fold lower (95% CI = 27.3–83.3) among unvaccinated persons with a previous COVID-19 diagnosis, and 57.5-fold lower (95% CI = 29.2–85.8) among vaccinated persons with a previous COVID-19 diagnosis.
SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland
Study authors used whole-population data from a national, prospective cohort in Scotland. They reported that 25,917 COVID-19 vaccinations were given to 18,457 pregnant women. Vaccine coverage was substantially lower in pregnant women than in the general female population of 18−44 years; 32.3% of women giving birth in October 2021 had two doses of vaccine compared to 77.4% in all women. Compared to non-pregnant women of reproductive age, pregnant women with SARS-CoV-2 infection are more likely to be admitted to critical care, receive invasive ventilation and die. COVID-19 in pregnancy is associated with increased risk of the pregnancy specific complications such as pre-eclampsia, preterm birth and stillbirth. Study authors also reported that the extended perinatal mortality rate for women who gave birth within 28 days of a COVID-19 diagnosis was 22.6 per 1,000 births (95% CI 12.9−38.5; pandemic background rate 5.6 per 1,000 births; That was a fourfold increased risk of the babies dying if a mother was not vaccinated. Overall, 77.4% of SARS-CoV-2 infections, 90.9% of SARS-CoV-2 associated with hospital admission and 98% of SARS-CoV-2 associated with critical care admission, as well as all baby deaths, occurred in pregnant women who were unvaccinated at the time of COVID-19 diagnosis.
Association between vaccination status and reported incidence of post-acute COVID-19 symptoms in Israel: a cross-sectional study of patients tested between March 2020 and November 2021
In this study, authors compared vaccinated individuals with those unvaccinated and those uninfected in terms of self-reported symptoms post-acute infection. They included 951 infected and 2437 uninfected individuals. Of the infected, 637(67%) were vaccinated. They found that those who received two doses were less likely than unvaccinated individuals to report any of these symptoms by 64%, 54%, 57%, and 68% respectively, (Risk ratios 0.36, 0.46, 0.43, 0.32, p<0.04 in the listed sequence). Those who received two doses were no more likely to report fatigue (22%), headache (20%), weakness (13%), and persistent muscle pain (10%) than individuals reporting no previous SARS-CoV-2 infection. Study authors concluded that vaccination with at least two doses of COVID-19 vaccine was associated with a substantial decrease in reporting the most common post-acute COVID-19 symptom. This suggests that, in addition to reducing the risk of acute illness, COVID-19 vaccination has some protective effect against long COVID.

Antiviral Therapeutics and Vaccines

Ancestral SARS-CoV-2-specific T cells cross-recognize Omicron
Authors looked at SARS-CoV-2 spike-specific CD4+ and CD8+ T cells induced by prior infection and by mRNA vaccination and found that particularly for mRNA vaccination, there was comprehensive heterologous immune reactivity against Omicron (B.1.1.529). Pairwise comparisons across groups further revealed that SARS-CoV-2 spike-reactive CD4+ and CD8+ T cells exhibited similar functional attributes, memory distributions, and phenotypic traits in response to the ancestral strain or Omicron (B.1.1.529). They found that established SARS-CoV-2 spike-specific CD4+ and CD8+ T cell responses, especially after mRNA vaccination, remain largely intact against B.1.1.529.
Effectiveness of BNT162b2 COVID-19 booster vaccine against covid-19 related symptoms and hospitalization in England
In individuals aged 50 years and over, the vaccine effectiveness against hospitalization 14-34 days after a BNT162b2 booster dose, relative to unvaccinated individuals, was around 99% (98.6 to 99.5). A similar high protection was seen in the younger age group with a vaccine effectiveness estimate of around 98%. There was little evidence of any waning in vaccine effectiveness against hospitalization up to 69 days after the booster. Vaccine efficacy against hospitalization or death with a primary series followed by a BNT162b2 booster ranged from around 97% to 99% in all age groups irrespective of the primary course with no evidence of waning up to 10 weeks. With regard to timing of that booster, study authors observed that a shorter interval between dose 2 and the booster of 25-29 weeks compared to the baseline interval of 35 weeks or more was associated with an increased adjusted odds ratio of 1.54 (95% confidence interval 1.35- 1.76) for becoming a symptomatic case. This was also seen in the 30-34 week interval, adjusted odds ratio 1.32.
Therapeutic Management of Nonhospitalized Adults With COVID-19
The NIH recommends symptomatic management for all patients who are not at high risk of disease progression. For patients who are at high risk of progressing to severe COVID-19 (treatments are listed in order preference, based on efficacy and convenience of use): Ritonavir-boosted nirmatrelvir (Paxlovid); or Sotrovimab; or Remdesivir; or Molnuprivir. The panel recommends against the use of dexamethasone or other systemic glucocorticoids in the absence of another indication.
Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients
This was the results of a randomized, double-blind, placebo-controlled trial involving nonhospitalized patients with Covid-19 who had symptom onset within the previous 7 days and who had at least one risk factor for disease progression (age ≥60 years, obesity, or certain coexisting medical conditions). Patients were randomly assigned to receive intravenous remdesivir (200 mg on day 1 and 100 mg on days 2 and 3) or placebo. The primary efficacy end point was a composite of Covid-19–related hospitalization or death from any cause by day 28. 562 patients who underwent randomization and received at least one dose of remdesivir or placebo were included in the analyses: 279 patients in the remdesivir group and 283 in the placebo group. Study results showed Covid-19–related hospitalization or death from any cause occurred in 2 patients (0.7%) in the remdesivir group and in 15 (5.3%) in the placebo group (hazard ratio, 0.13; 95% confidence interval [CI], 0.03 to 0.59; P=0.008). So that was an 87% reduction in progression. No patients had died by day 28. No difference in any rates of Adverse events.
Real-Life Effectiveness and Safety of Baricitinib as Adjunctive to Standard-of-Care Treatment in Hospitalized Patients With Severe Coronavirus Disease 2019
Researchers reported in this 2 center, observational retrospective cohort study of 369 patients with severe COVID-19, comparing outcomes and serious events between patients treated with SOC versus those treated with SOC and barictinib combination. In real-life settings, addition of barictinib to SOC in patients hospitalized with severe COVID-19 is associated with decreased mortality without concerning safety signals.
Therapeutic Management of Nonhospitalized Adults With COVID-19
In this study, authors reported on a retrospective chart review of 11,512 patients infected with SARS-CoV-2 who were admitted to a New York health system from March to May 2020. In this very large cohort they reported that hospital mortality was significantly reduced in the tocilizumab group when tocilizumab was administered at the nasal cannula level (10.4% vs 22.0%; P = .002). In subjects who received tocilizumab at the nasal cannula level, the progression to mechanical ventilation was reduced versus subjects who were initially on higher levels of oxygen support (6.3% vs 18.7%; P < .001). In this study there was no improvement in mortality when tocilizumab was given at the time of requiring non-rebreather, high-flow nasal cannula, noninvasive ventilator, or invasive ventilator.

Epidemiology

Trends In SARS-CoV-2 Cases and Admissions Trend in the Omicron-Dominated Fourth Wave from the Government Employees Medical Scheme (Gems)
It is widely held that the Omicron variant has been responsible for most infections in South Africa since the 15th of November 2021. To assess the impact which Omicron has had, experience prior to the 15th of November 2021 (when other variants were dominant) is contrasted with experience thereafter. Younger persons have become responsible for an increasingly large proportion of the persons testing positive for COVID-19 since the emergence of the Delta variant. This is even more evident since the emergence of the Omicron variant. In the original-dominated period, 8.9% of those testing positive were under the age of 18 and 19.0% were under 30. The average age was 43.0. By contrast, in the Delta dominated period, 16.2% of those testing positive were under the age of 18 and 28.9% were under 30. The average age was 40.8. In the Omicron-dominated period, 13.4% of those testing positive were under the age of 18 and 29.5% were under 30 (Figure 1). The average age was 38.5. This may suggest that the Delta and the Omicron variants are of a greater threat to the young than previous variants. Higher case-admission rates are evident amongst persons under the age of 18. For persons between the ages of 0 and 4, the risk-adjusted increase in the case-admission rate is 48,9% and 5 to 17 is 25.4%. This suggests that children, unlike adults, may be more severely affected by Omicron than by preceding variants.