COVID-19 Scan for Oct 01, 2021

Remdesivir COVID-19 success
COVID vaccines and disabilities
Concomitant flu, COVID vaccines

Remdesivir linked to lower COVID-19 mortality

Hospitalized COVID-19 patients who were treated with remdesivir within 2 days of admission had lower mortality rates than their matched cohort, according to a study today in Clinical Infectious Diseases. The observational cohort consisted of US adults hospitalized with COVID-19 from August to November 2020; 28,855 received remdesivir and 16,887 did not.

About 10.6% of patients who received remdesivir died within 14 days, and 15.4% died within 28 days, while those who didn't receive remdesivir had 14- and 28-day mortality rates of 15.4% and 19.1%, respectively. The researchers estimate that the antiviral drug reduces risk of death by 24% for 14-day mortality and by 11% at 28 days (95% CIs, 0.70 to 0.83 and 0.82 to 0.96, respectively).

This benefit was also seen across patients with no supplementary oxygen, low-flow oxygen, and invasive mechanical ventilation or extracorporeal membrane oxygenation treatment for both 14- and 28-day mortality (hazard ratios [HRs] ranged from 0.68 to 0.70 and 0.77 to 0.80, respectively). For those who received remdesivir and also needed high-flow oxygen or non-invasive ventilation, risk of death was reduced for 14-day mortality (HR, 0.81) but not 28-day mortality.

"While unmeasured confounding cannot be excluded, these findings provide further support that RDV antiviral therapy is a foundational treatment approach for COVID-19," the researchers conclude.

Remdesivir is the first antiviral fully approved by the US Food and Drug Administration to treat COVID-19 in critically ill patients, and it has received conditional authorization by the European Medicines Agency. It is not currently approved by the World Health Organization.
Sep 30 Clin Infect Dis study


People with disabilities face barriers around COVID vaccines, survey says

People with disabilities reported more willingness to receive a COVID-19 vaccine but had lower vaccination rates than people without disabilities, according to survey results published in today's Morbidity & Mortality Weekly Report (MMWR).

The researchers used data from a randomized telephone survey conducted May 30 to Jun 26, of which about 9% of 56,749 US adult respondents were considered as having disabilities. Those who had disabilities were more likely to report that they would definitely get vaccinated (age-adjusted prevalence ratio [aPR], 1.86) but less likely to have received at least one dose of a COVID-19 vaccine (aPR, 0.88).

In the same vein, unvaccinated adults with disabilities were more likely to say that the vaccine would offer protection (aPR, 1.29) as well as more likely to say that it would be difficult to get vaccinated (aPR, 2.69). This subgroup cited difficulties around getting an appointment online (aPR, 2.14, vs unvaccinated people without disabilities), not knowing where to get vaccinated (aPR, 1.95), getting to vaccination sites (aPR, 3.43), and vaccination sites not being open at convenient times (aPR, 1.69).

The study notes that 15.2% of adults in the United States had at least one reported functional disability in the 2019 American Community Survey.

"Reducing barriers to scheduling and making vaccination sites more accessible might improve vaccination coverage among persons with disabilities," conclude the researchers.
Oct 1 MMWR study


Giving flu, COVID vaccines at same time appears to be safe, effective

Giving the flu vaccine at the same time as the second dose of the AstraZeneca/Oxford or Pfizer/BioNTech COVID-19 vaccine appeared to be safe and induce immunogenicity, according to a non–peer-reviewed study in The Lancet yesterday.

From Apr 1 to Jun 26, the researchers divided 679 UK adults into six cohorts, with each concomitantly receiving their second COVID-19 vaccine dose and either a placebo or one of three influenza vaccines (a trivalent, adjuvanted vaccine [aTIV], or a cellular or recombinant quadrivalent vaccine [QIVc or QIVr]). Three weeks later, those who received the placebo received their flu vaccine and vice versa, and total follow-up concluded 6 weeks after that.

The phase IV, blinded, multicenter randomized controlled trial showed non-inferiority among those who received the AstraZeneca and QIVc vaccine (-1.29%), the Pfizer and QIVc vaccine (6.17%), the Pfizer and aTIV vaccine (-12.9%), and the AstraZeneca and QIVr vaccine (2.53%). In the other two cohorts, the upper limit of the 95% confidence interval [CI] exceeded 25% by no more than 1 percentage point.

Reactions were mostly mild or moderate and didn't significantly differ in frequency between those who received the concomitant vaccines and those who didn't (85.2% and 81.7%, respectively). Similarly, immunogenicity was similar across anti-S immunoglobulin G geometric mean units and seroconversion rates 21 days after the COVID-19 dose. No significant differences were seen in hemagglutination inhibition (HAI) geometric mean titer ratios against any flu strain 21 days after receiving the flu vaccine either concomitantly or alone. (People vaccinated against the flu develop HAI antibodies that bind and neutralize the flu virus.)

"In some parts of the world, COVID-19 and seasonal influenza vaccination programmes will overlap, and so administration of both vaccines at the same appointment, concomitantly, would lessen the burden on healthcare systems, support vaccine uptake and afford timely protection against both infections," the researchers write.

"Our findings demonstrate that concomitant administration of six different combinations of COVID-19 and influenza vaccines raises no safety concerns, produces acceptable reactogenicity profiles and preserves immunogenicity."
Sep 30 Lancet preprint study

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