Physical activity and the risk of SARS-CoV-2 infection, severe Covid-19 illness and Covid-19 related mortality in South Korea: A nationwide cohort study

What are the findings?

‘Our results indicated that those who engaged in both aerobic and muscle strengthening activity according to 2018 exercise guidelines had a lower risk of SARS-CoV-2 infection (adjusted relative risk (aRR), 0.85; 95% CI 0.72 to 0.96), severe COVID-19 illness (aRR 0.42; 95% CI 0.19 to 0.91) and COVID-19 related death (aRR, 0.24; 95% CI 0.05 to 0.99) than those who did not.

‘Our findings reported that the recommended key target range of metabolic equivalent task (MET; 500–1000 MET min/week) was associated with the maximum beneficial effect size for reduced the risk of SARS-CoV-2 infection (aRR 0.78; 95% CI 0.66 to 0.92), severe COVID-19 illness (aRR 0.62; 95% CI 0.43 to 0.90) and COVID-19 related death (aRR 0.17; 95% CI 0.07 to 0.98). The length of stay in hospital was shortened about approximately 2 days in patients with both aerobic and muscle strengthening or with 500–1000 MET min/week.’

How might it impact on clinical practice in the future?

‘The findings of the study suggest that public health policies and strategies to increase physical activity at the population level may reduce the risk of SARS-CoV-2 infection and minimise adverse consequences in patients with COVID-19.

‘Encouraging individuals to have active level of physical activity during the COVID-19 pandemic should be promptly and actively considered at the public health level.’

Read here (BMJ British Journal of Sports Medicine, July 22, 2021)

Physical inactivity is associated with a higher risk for severe Covid-19 outcomes: a study in 48,440 adult patients

What are the findings?

‘Patients with COVID-19 who were consistently inactive during the 2 years preceding the pandemic were more likely to be hospitalised, admitted to the intensive care unit and die than patients who were consistently meeting physical activity guidelines. Other than advanced age and a history of organ transplant, physical inactivity was the strongest risk factor for severe COVID-19 outcomes.

‘Meeting US Physical Activity Guidelines was associated with substantial benefit, but even those doing some physical activity had lower risks for severe COVID-19 outcomes including death than those who were consistently inactive.’

How might it impact on clinical practice in the future?

‘The potential for habitual physical activity to lower COVID-19 illness severity should be promoted by the medical community and public health agencies.’

Read here (BMJ British Journal of Sports Medicine, April 13, 2021)

Covid-19: Pfizer BioNTech vaccine reduced cases by 94% in Israel, shows peer reviewed study

‘The Pfizer BioNTech coronavirus vaccine produces as good results in the “real world” as have been previously documented in randomised trials.

‘A case control study, which has been peer reviewed and published in the New England Journal of Medicine, compared 596 618 people who were newly vaccinated in Israel and matched them to unvaccinated controls.1 Two doses of the mRNA vaccine reduced symptomatic cases by 94%, hospitalisation by 87%, and severe covid-19 by 92%, according to the data from the Clalit Institute for Research which is Israel’s biggest healthcare provider.

‘Researchers recorded the outcomes at three periods: days 14 to 20 after the first dose of vaccine, days 21 through 27 after the first dose, and day 7 after the second dose. In Israel, the second dose of vaccine is given on day 21 in line with the trials and the manufacturer’s recommendation. The UK is leaving a 12 week gap between doses.

‘During a mean follow-up of 15 days, 10 561 infections were documented of which 5996 were symptomatic covid-19 illness, 369 required hospitalisation, 229 were severe cases, and 41 resulted in death.

‘After one dose, during days 14 to 20, the vaccine effectiveness was 57% for symptomatic covid-19, 74% for hospitalisation, and 62% for severe disease. The estimated effectiveness in preventing death from covid-19 was 72% in the two to three weeks after the first dose. There was insufficient data to produce an estimate on the reduction in mortality in those who received two doses.

‘The study took place from 20 December 2020, when Israel’s national vaccination drive was launched, to 1 February 2021. It coincided with Israel’s third and largest wave of coronavirus infection and illness.’

Read here (BMJ, Feb 25, 2021)

• BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting

Read original study here (New England Journal of Medicine, Feb 24, 2021)

No jab, no job? Ethical issues in mandatory Covid-19 vaccination of healthcare personnel

‘Mandating COVID-19 vaccination of healthcare personnel (HCP) could maximise vaccine uptake, but risks exacerbating breakdowns in trust between HCP and their institutions.

‘Ethical arguments for mandating COVID-19 vaccination of HCP appeal to their duties to ‘do no harm’ and to care for patients, but the fulfilment of these duties requires a safe working environment.

‘We argue for policies aimed at strengthening HCP’s trust in healthcare systems by addressing HCP concerns, including the institutional factors that have put them at risk of infection throughout the COVID-19 pandemic, before considering a COVID-19 vaccine mandate.’

Read here (BJM, February 17, 2021)

Covid-19: Social murder, they wrote — elected, unaccountable, and unrepentant

‘After two million deaths, we must have redress for mishandling the pandemic... Murder is an emotive word. In law, it requires premeditation. Death must be deemed to be unlawful. How could “murder” apply to failures of a pandemic response? Perhaps it can’t, and never will, but it is worth considering. When politicians and experts say that they are willing to allow tens of thousands of premature deaths for the sake of population immunity or in the hope of propping up the economy, is that not premeditated and reckless indifference to human life? If policy failures lead to recurrent and mistimed lockdowns, who is responsible for the resulting non-covid excess deaths? When politicians wilfully neglect scientific advice, international and historical experience, and their own alarming statistics and modelling because to act goes against their political strategy or ideology, is that lawful? Is inaction, action?1 How big an omission is not acting immediately after the World Health Organization declared a public health emergency of international concern on 30 January 2020?

‘At the very least, covid-19 might be classified as “social murder,” as recently explained by two professors of criminology. The philosopher Friedrich Engels coined the phrase when describing the political and social power held by the ruling elite over the working classes in 19th century England. His argument was that the conditions created by privileged classes inevitably led to premature and “unnatural” death among the poorest classes. In The Road to Wigan Pier, George Orwell echoed these themes in describing the life and living conditions of working class people in England’s industrial north. Today, “social murder” may describe the lack of political attention to social determinants and inequities that exacerbate the pandemic. Michael Marmot argues that as we emerge from covid-19 we must build back fairer...

Getting redress

‘Where then should citizens turn for accountability, if they don’t find it in their leaders and feel unsupported by experts and the media? The law remains one form of redress, and indeed some legal avenues, including criminal negligence and misconduct in public office, are being explored, although proving any such claims will be difficult and drawn out. But the notion of murder, at least “social murder,” is hard to shake emotionally, and strengthens with every denial of responsibility and every refusal to be held accountable or to change course.

‘That leaves three options. The first is to push for a public inquiry, as The BMJ and others argued for in the summer of 2020—a rapid, forward looking review rather than an exercise in apportioning blame that will identify lessons and save lives. The second is to vote out elected leaders and governments that avoid accountability and remain unrepentant. The US showed that a political reckoning is possible, and perhaps a legal one can follow, although research suggests that mishandling a pandemic may not lose votes.21 The third is for mechanisms of global governance, such as the International Criminal Court, to be broadened to cover state failings in pandemics...

‘The “social murder” of populations is more than a relic of a bygone age. It is very real today, exposed and magnified by covid-19. It cannot be ignored or spun away. Politicians must be held to account by legal and electoral means, indeed by any national and international constitutional means necessary. State failures that led us to two million deaths are “actions” and “inactions” that should shame us all.’

Read here (British Medical Journal, Feb 4, 2021)

Pandemic fatigue? How adherence to Covid-19 regulations has been misrepresented and why it matters

‘To the surprise of many, adherence to stringent behavioural regulations has remained extremely high (over 90%), even though many people are suffering considerably, both financially and psychologically. Equally, despite anecdotal observations about growing violations and polling which shows that people report low levels of adherence in other people, both self-reported data and systematic observations of behaviour in public places suggest that adherence stayed high during the second lockdown. Some 90% of people or more adhere to hygiene measures, to spatial distancing, and to mask wearing most of the time. Moreover, people generally support regulations and, if anything, believe that they should be more stringent and introduced earlier. This pattern has been repeated in the past few days, with 85% of the public endorsing the January lockdown and 77% thinking it should have happened sooner...

‘The problem, then, is that in psychologising and individualising the matter of adherence, one disregards the structural factors that underlie the spread of infection and the differential rates in different groups. One also avoids acknowledging the failures of government to provide the support necessary to follow the rules (most obviously in the case of self-isolation). Additionally, one overlooks the fact that some of the rules and the messaging around them may be the problem (such as encouragement to go out to the pub—doing one’s “patriotic best” according to the prime minister—and to return to work after the first lockdown). It is particularly misleading and unfair to ask people to do things and then blame them for doing so.’

Read here (BMJ, Jan 18, 2021)

Peter Doshi: Pfizer and Moderna’s “95% effective” vaccines—we need more details and the raw data

Peter Doshi: Pfizer and Moderna’s “95% effective” vaccines—we need more details and the raw data 

‘Five weeks ago, when I raised questions about the results of Pfizer’s and Moderna’s covid-19 vaccine trials, all that was in the public domain were the study protocols and a few press releases. Today, two journal publications and around 400 pages of summary data are available in the form of multiple reports presented by and to the FDA prior to the agency’s emergency authorization of each company’s mRNA vaccine. While some of the additional details are reassuring, some are not. Here I outline new concerns about the trustworthiness and meaningfulness of the reported efficacy results...’

Read here (BMJ, Jan 4, 2021) 

Anti-inflammatory therapy for Covid-19 infection: The case for colchicine [also used for gout]

‘Given the large body of data demonstrating colchicine’s inhibitory effects on neutrophil activity, cytokine generation and the inflammation/thrombosis interface, together with an overall lack of evidence for systemic immunosuppression, there is a rationale to study colchicine as a potential treatment for COVID-19. Given that colchicine is generally well tolerated, simple to take and inexpensive, demonstration of colchicine as a useful agent in COVID-19 would potentially spare patients morbidity and mortality, help to conserve valuable clinical resources (hospital floor and ICU beds, ventilators, etc), and dramatically reduce the cost of COVID-19 care. Colchicine might be of particular use in resource-poor rural and developing world settings, both of which have been increasingly affected by COVID-19. However, unless and until evidence is obtained from adequately designed and randomised placebo-controlled trials, this hypothesis must remain speculative.

‘The optimal dose of colchicine for daily use, even in well-established conditions such as gout, is unknown. Many but not all patients tolerate up to 1.2 mg daily in divided doses; whether lower doses such as 0.5 mg or less daily can be equally effective is unknown. The largest colchicine study for COVID-19 (ColCorona) is testing a dose of 0.5 mg daily based on prior cardiology trials. The duration of colchicine therapy for SARS-COV2 infection would also need to be determined. Most studies to date test a treatment duration of 2–4 weeks, concordant with the acute course of the infection; whether a shorter or longer treatment would be optimal is unknown. Finally, the timing of colchicine initiation is uncertain, with some studies beginning treatment in the outpatient setting, and others in the early inpatient setting. Given the recent track record of failure of treatment of severe COVID-19 treatment with anti-IL-6 biologics such as tocilizumab (a much more potent but also more specific immunosuppressive agent), it is likely that the severe inpatient setting is not the optimal condition under which to assess colchicine efficacy.’

Read here (BMJ, Dec 8, 2020)

Covid-19: Politicisation, “corruption,” and suppression of science

‘When good science is suppressed by the medical-political complex, people die

‘Politicians and governments are suppressing science. They do so in the public interest, they say, to accelerate availability of diagnostics and treatments. They do so to support innovation, to bring products to market at unprecedented speed. Both of these reasons are partly plausible; the greatest deceptions are founded in a grain of truth. But the underlying behaviour is troubling.

‘Science is being suppressed for political and financial gain. Covid-19 has unleashed state corruption on a grand scale, and it is harmful to public health. Politicians and industry are responsible for this opportunistic embezzlement. So too are scientists and health experts. The pandemic has revealed how the medical-political complex can be manipulated in an emergency—a time when it is even more important to safeguard science.’

Read here (BMJ, Nov 13, 2020)