COVID-19 Scan for Feb 18, 2021

News brief

Analysis suggests high efficacy for single dose of Pfizer-BioNTech vaccine

An analysis by Canadian researchers suggests that a single dose of the Pfizer-BioNTech COVID-19 vaccine is highly efficacious, according to a letter published yesterday in the New England Journal of Medicine (NEJM).

Results from the phase 3 trial of the Pfizer-BioNTech vaccine, published in NEJM on Dec 31, 2020, suggested the efficacy after the first dose of the two-dose vaccine was 52.4%, based on data collected during the first 2 weeks after the first shot to before the second shot. The overall efficacy after two doses was 94.8%.

But in their analysis of trial data submitted to the US Food and Drug Administration by Pfizer and BioNTech, researchers with the British Columbia Centre for Disease Control and the Institut National de Santé Publique du Québec found that data collected starting 2 weeks after the first shot to before the second shot indicate the efficacy of the first dose was 92.6%. The researchers suggest the initial efficacy analysis was lower because immunity was still mounting in vaccine recipients during the first 2 weeks after the first shot.

"With such a highly protective first dose, the benefits derived from a scarce supply of vaccine could be maximized by deferring second doses until all priority group members are offered at least one dose," the authors wrote.

In a response, trial investigators said that alternative dosing regimens of the Pfizer-BioNTech vaccine have not been evaluated, and that the decision to implement alternative regimens lies with health authorities.
Feb 17 N Engl J Med letter


Study highlights heart damage 1 month after severe COVID-19

More than half of patients with severe COVID-19 and elevated levels of a key marker of heart muscle damage after hospital release showed signs of damage to the heart a month later, a study today in the European Heart Journal finds.

Led by researchers from University College London, the study involved cardiac magnetic resonance imaging (MRI) of 148 COVID-19 patients who had elevated troponin levels, indicating heart damage, and who had required ventilatory support before being released from one of six London hospitals at least a month before. One in three had required mechanical ventilation.

Imaging showed inflammation of the heart muscle (26% of patients), scarring or dead heart tissue (54%), restricted blood supply to the heart (22%), or both inflammation and ischemia (6%). Eight percent showed signs of ongoing heart inflammation.

Co-author Marianna Fontana, MD, PhD, of University College London said in a European Society of Cardiology press release that elevated troponin levels are linked to worse COVID-19 outcomes and that patients with severe infections often have other heart-related medical conditions such as diabetes, high blood pressure, and obesity.

"During severe COVID-19 infection, however, the heart may also be directly affected," Fontana said. "Unpicking how the heart can become damaged is difficult, but MRI scans of the heart can identify different patterns of injury, which may enable us to make more accurate diagnoses and to target treatments more effectively."

The researchers noted that the heart damage seen on imaging may have preceded COVID-19 or have occurred as a result of infection. "While we detected only a small amount of ongoing injury, we saw injury to the heart that was present even when the heart's pumping function was not impaired and might not have been picked up by other techniques," Fontana said. "In the most severe cases, there are concerns that this injury may increase the risks of heart failure in the future, but more work is needed to investigate this further."

The authors said that the findings can also help researchers find ways of preventing heart injury in severely ill COVID-19 patients and detecting and treating blood clots associated with the virus.
Feb 18 Eur Heart J study
Feb 17 European Society of Cardiology
press release


High mortality found in hospitalized COVID-19 patients with diabetes

Updated results from a study of hospitalized COVID-19 patients with diabetes shows 1 in 5 died within 28 days of hospitalization, French researchers reported yesterday in Diabetologia.

The updated results from the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which evaluated outcomes in diabetic French patients hospitalized for COVID-19 from Mar 10 through Apr 10, 2020, show that among 2,796 patients, 577 (20.6%; 95% confidence interval [CI], 19.2% to 22.2%) died within 28 days of hospitalization and 1,404 (50.2%; 95% CI, 48.3% to 52.1%) were discharged from the hospital. Results presented in May 2020 showed that 10% of patients who had diabetes and COVID-19 died within 7 days of hospitalization.

The patients were mostly male (63.7%), with a mean age of 69.7 years, and the vast majority had type 2 diabetes (88.2%). Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of patients, respectively.

In multivariable models, younger age, routine metformin therapy, and longer symptom duration were positively associated with hospital discharge, while history of microvascular complications, anticoagulant routine therapy, shortness of breath on admission, abnormal levels of liver enzymes, and higher white blood cell counts and C-reactive protein levels were associated with a lower chance of discharge and a higher risk of death. Patients receiving routine treatment with insulin and statins also had a higher risk of death.

The study authors said establishing prognostic factors for hospital discharge and death in diabetic COVID-19 patients could help clinicians better manage this population and use hospital resources accordingly.
Feb 7 Diabetologia study

News Scan for Feb 18, 2021

News brief

Antibiotic development effort notes $140 million in donations, new CEO

The AMR Action Fund announced today the appointment of a new chief executive officer and more than $140 million in investments from the Boehringer Ingleheim Foundation, The European Investment Bank, and the Wellcome Trust.

The investments in the AMR Action Fund, a public-private partnership launched in July 2020 to boost the antibiotic development pipeline, are its first non-pharmaceutical industry investments. The fund is an industry-led initiative developed by the International Federation of Pharmaceutical Manufacturers and Associations, and includes Eli Lilly, Pfizer, Merck, Johnson & Johnson, GlaxoSmithKline, and Novartis among its backers. The fund plans to invest more than $1 billion in smaller biotech companies with the aim of bringing two to four new antibiotics to market by 2030.

"This fund will provide a lifeline for companies navigating the expensive and technically complex later stages of antibiotic development," Wellcome Trust director Jeremy Farrar, MD, PhD, said in an AMR Action Fund press release. "We are particularly pleased that the fund will place an emphasis on equitable access and responsible stewardship which is crucial to solving this global health challenge."

Taking the helm of the AMR Action Fund will be Henry Skinner, PhD, who brings decades of experience in the biomedical research, pharmaceutical, and venture capital industries.

"I am honored to join the AMR Action Fund and its incredibly important mission," Skinner said in a press release. "Having worked on this issue from many angles throughout my career, I know how badly novel antibiotics are needed, and I also know how many obstacles currently prevent them from being developed and reaching patients."
Feb 18 AMR Action Fund investment press release
Feb 18 AMR Action Fund
CEO press release


High-path avian flu outbreaks strike more European farms

European countries reported more highly pathogenic avian flu outbreaks, mostly involving H5N8, but also one involving H5N1 in Scotland, according to the latest notifications from the World Organization for Animal Health (OIE).

In Scotland, the H5N1 virus—different from the Asian genotype—struck a game farm in Fife. The outbreak began on Feb 6, killing 6,030 of 14,030 susceptible birds, mostly pheasants and partridges.

In H5N8 developments, officials reported more outbreaks in European poultry. Sweden reported another event that began on Feb 13 at a turkey farm in Skane County in the far south, killing 40 of 3,500 birds. Also, Ukrainian officials reported an outbreak in backyard birds in Kiev province in the north, killing 20 of 68 birds at the location. Meanwhile, Germany reported two more outbreaks at turkey and duck farms in Brandenburg state, which began on Feb 16 and killed 1,264 of 17,000 birds between the two locations.

Several countries in Europe reported more H5N8 detections in wild birds, including Germany, Sweden, Ireland, and Austria.
Feb 17 OIE report on H5N1 in Scotland
Feb 17 OIE report on H5N8 in Sweden
Feb 17 OIE report on H5N8 in Ukraine
Feb 18 OIE report on H5N8 in Germany
OIE outbreak notification page

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