News Scan for Oct 08, 2020

News brief

WHO advisors propose new vaccine virus strains for pandemic readiness

During recent meetings to recommend the flu strains to include in the Southern Hemisphere's 2021 flu season, the World Health Organization (WHO) advisory group also reviewed the latest developments with zoonotic strains and recommended two new candidate vaccine viruses for pandemic preparedness.

Based on results from genetic characterization and antigenic testing, the group proposed developing an new candidate vaccine virus against a new clade of H5N6 recently detected in poultry in Vietnam, an influenza A/chicken/Vietnam/RAHO4-CD-20-421/2020–like virus.

It also recommended a new candidate vaccine virus against variant H1 (H1v) that was detected in Germany, an influenza A/Hessen/47/2020–like virus.
October zoonotic candidate vaccine virus recommendations

Study shows lower mortality in MERS patients treated with drug combo

In a study today in the New England Journal of Medicine, a combination of recombinant interferon beta-1b plus lopinavir-ritonavir lowered mortality in Middle Eastern respiratory syndrome coronavirus (MERS-CoV) patients.

The randomized, double-blind experiment involved 43 hospitalized MERS patients receiving the treatment and 52 patients getting a placebo for 14 days (or hospital discharge, if earlier) to determine all-cause mortality after 90 days. Participants were enrolled from nine sites in Saudi Arabia from November 2016 to April 2020.

Researchers found that the mortality rate was 28% in patients in the intervention group and 44% in the placebo group, marking a difference of 19 percentage points when adaptive design was taken into account. The researchers write, "In a prespecified subgroup analysis, treatment within 7 days after symptom onset led to lower 90-day mortality than use of placebo (relative risk, 0.19; 95% CI, 0.05 to 0.75), whereas later treatment did not."

Secondary outcomes included the median number of days patients did not need mechanical ventilation (16 days for the treatment group, 5.5 days for the placebo group) and the median number of days that patients were alive outside the intensive care unit (9 days vs 0 days). On day 90, the median Karnofsky performance-status score was 70 points for those who received the treatment and 50 for those who received the placebo. Serious adverse events were reported in 9% of the intervention group and 19% in the placebo group, with most being related to elevated liver enzyme levels. The researchers, though, believe these events were caused by the disease, not any treatment.

Interferons have been investigated for years because of their potential to inhibit viral reproduction and stimulate certain immune reactions, and while this study is promising, the researchers point out that future studies should particularly look at quantifying the viral RNA amounts.
Oct 8 N Engl J Med study

COVID-19 Scan for Oct 08, 2020

News brief

Study reveals prolonged COVID-19 symptoms in pregnant women

Most pregnant women with COVID-19 experience mild disease, but many have prolonged symptoms lasting weeks after infection, according to a large nationwide study yesterday in Obstetrics & Gynecology.

Pregnant women have a higher risk of severe disease with other respiratory viruses, leading to concerns that COVID-19 infection during pregnancy may represent an increased risk. Recent reports show higher rates of intensive care unit (ICU) admission and ventilation among pregnant COVID-19 patients, but the clinical presentation and morbidity for pregnant patients is not fully understood.

The new study—the largest known to date that included non-hospitalized COVID-19 pregnant women—followed 594 geographically and demographically diverse US women who tested positive for SARS-CoV-2 during pregnancy and reported symptoms at the time of testing. Symptoms and symptom duration for pregnant COVID-19 patients were gathered from Mar 22 to Jul 10. Only 27 of the women (5%) were hospitalized, with 11 (2%) admitted to the ICU.

Primary first symptoms included cough (20%), sore throat (16%), body aches (12%), fever (12%), and loss of taste or smell (6%), although symptom data were complicated by overlap with symptoms of normal pregnancy. The study found that almost half of the participants (48%) were still symptomatic after 3 weeks, with 60% reporting no symptoms after 4 weeks. For 25% of pregnant women, symptoms persisted for 8 weeks or longer. The median time for symptoms to resolve was 37 days (95% confidence interval, 35 to 39).

"Despite the potential risks of COVID-19 for pregnant people and their newborns, there are large gaps in our knowledge on the course of the disease and the overall prognosis," said lead author Yalda Afshar, MD, PhD, of the University of California-San Francisco (UCSF), in a UCSF press release. "Our results can help pregnant people and their clinicians better understand what to expect with COVID-19 infection."
Oct 7 Obstet Gynecol study
Oct 7 UCSF news release

Developing nations bear heavy COVID-19 burden, data show

A study of the economic impacts of the pandemic in Latin America and the Caribbean finds negative effects concentrated among low-income workers, suggesting that COVID-19 may exacerbate existing economic inequality and negative health outcomes in developing countries.

Government pandemic mitigation efforts like physical distancing regulations, closing of non-essential businesses, travel restrictions, and stay-at-home orders, while necessary for public health, can harm economies and may deepen existing inequality. A large-scale PLOS One study yesterday examined the differential impacts of the pandemic across income distribution in 230,540 house-holds in Latin America and the Caribbean from Mar 27 to Apr 30.

The study found that job losses and business closures had a greater economic impact on the lowest-income households. The largest impacts were experienced in households reporting incomes below the national monthly minimum wage, with 71% reporting a household job loss and 61% reporting a business closure. In contrast, just 14% of high-income households reported a job loss, with 54% reporting a business closure.

Respondents reporting a job loss or business closure were 24 percentage points (P < 0.01) more likely to report a reduction in income, and these households were 13 percentage points (P < 0.01) more likely to suffer from hunger and 8 percentage points (P < 0.01) more likely to have a less healthy diet compared with their pre-pandemic status.

Overall, 58% of the Latin American and Caribbean respondents reported a business closure, compared with a 43% rate of small business closure in the United States, "Implying that the economic impacts of the pandemic may be stronger in developing countries," the study authors wrote.

Differences in the ability to telework and high levels of informal workers—often self-employed and working outside the formal labor market—in Latin American and Caribbean nations may play a role in the more precarious financial status of low-income workers, the study authors suggest.

"The covid-19 pandemic has large, unequal effects on job loss and business closure. The loss of livelihood leads to reductions in health and nutrition, further exacerbating economic inequality in the region," the study authors conclude in a PLOS press release.
Oct 7 PLOS One study
Oct 7 PLOS news release