Covid-19 vaccines don't raise miscarriage risk, three studies show

Pregnant women who received at least one dose of a COVID-19 vaccine were not at higher risk for miscarriage than their unvaccinated counterparts, according to a trio of new US studies:

Miscarriage no more likely in vaccinated: In the first study, published yesterday in JAMA, researchers from the Vaccine Safety Datalink (VSD) surveillance network used diagnostic and procedure codes and electronic health records to identify and assign gestational ages of miscarriages and ongoing pregnancies from Dec 15, 2020, to Jun 28, 2021... Read here.

More evidence of vaccine safety in pregnancy: Similarly, in a letter yesterday in the New England Journal of Medicine (NEJM), CDC scientists enrolled 2,456 women who were part of the agency's COVID-19 vaccine safety pregnancy registry... Read here.

A revised risk estimate: And in response to a letter yesterday in NEJM, a separate group of CDC researchers updated its analysis of 2,456 pregnant women who received one or two doses of an mRNA COVID-19 vaccine before conception or 20 weeks' gestation... Read here.

Read here (Center for Infectious Disease Research and Policy, Sept 9, 2021)

Effect of ivermectin on time to resolution of symptoms among adults with mild Covid-19: A randomised clinical trial

‘In this randomized clinical trial that included 476 patients, the duration of symptoms was not significantly different for patients who received a 5-day course of ivermectin compared with placebo (median time to resolution of symptoms, 10 vs 12 days; hazard ratio for resolution of symptoms, 1.07).

‘The findings do not support the use of ivermectin for treatment of mild COVID-19, although larger trials may be needed to understand effects on other clinically relevant outcomes.’

Read here (JamaNetwork, Mar 4, 2021)

Convalescent plasma did not improve patient outcomes compared with placebo group: Study

‘In a systematic review and meta-analysis published in JAMA, researchers evaluated treatment with convalescent plasma compared to standard of care or use of a placebo in randomized clinical trials (RCTs)—published through January 29, 2021. The researchers identified 10 total RCTs—4 published peer-reviewed studies and 6 unpublished studies—including a total of 11,782 COVID-19 patients. 

‘Overall, convalescent plasma did not significantly differ from placebo or standard of care for any of the major outcomes of interest: all-cause mortality, length of hospital stay, mechanical ventilation use, clinical improvement, clinical deterioration, and serious adverse events. The researchers noted that there was limited data available regarding clinical improvement, clinical deterioration, and serious adverse events in these studies.’ (Summary from John Hopkins Centre for Health Security newsletter of March 2)

Read here (JAMA Network, Feb 26, 2021)

Prevalence and outcomes of SARS-CoV-2 infection among migrant workers in Singapore

‘There were 43 dormitories housing 198 320 migrant workers with a median occupancy of 3578 (interquartile range, 1458-6120); 99.8% of residents were male, with a median age of 33 years (interquartile range, 28-39 years). As of July 25, 95.1% of all residents had at least 1 SARS-CoV-2 test, including 63.6% with PCR and 68.4% with serology. There were 111 280 residents with a positive PCR or serology result, for an overall infection prevalence of 56.1% (95% CI, 55.9%-56.3%) (range per dormitory, 0%-74.7%; median, 52.9%). 

‘There were 24 197 clinical cases (12.2% of all residents; 21.7% of infected) from 42 dormitories and 87 083 subclinical cases (43.9% of all residents; 78.3% of all infected) (Table). Of all clinical cases, 20 cases required ICU admission (0.08% [95% CI, 0.05%-0.13%]), with 1 COVID-19 attributable death (case-fatality rate, 0.004% [95% CI, 0.0002%-0.027%]).’

Read here (JamaNetwork, Feb 9, 2021) 

Pregnant women can pass antibodies to their foetus: Some implications for vaccinations

‘A study published in JAMA: Pediatrics provides evidence that pregnant women may be able to pass IgG antibodies against SARS-CoV-2 to their fetus. The study involved 1,417 women who recently gave birth. Among 83 mothers with detectable SARS-CoV-2 antibodies, 72 (86.7%) transferred IgG antibodies to their fetus—as detected in the newborns’ cord blood. IgM antibodies were not detected in any cord blood specimens, and antibodies were not detected in any infants born to mothers without detectable antibodies. The concentration of antibodies in the cord blood was significantly correlated with the concentration in the mother, but the antibodies were successfully transferred by mothers who exhibited symptomatic disease and asymptomatic infection. The study did not explicitly evaluate the ability to transfer antibodies developed as a result of vaccination; however, the researchers indicate that the results align with similar studies on transplacental transfer of vaccine-conferred antibodies for other diseases. Further research is necessary to determine the recommended timing for vaccination of pregnant women in order to achieve sufficient transplacental transfer of SARS-CoV-2 antibodies to the fetus.’ [John Hopkins Newsletter]

Assessment of maternal and neonatal cord blood SARS-CoV-2 antibodies and placental transfer ratios

‘Our findings demonstrate the potential for maternally derived antibodies to provide neonatal protection from SARS-CoV-2 infection and will help inform both neonatal management guidance and design of vaccine trials during pregnancy. Further studies are needed to determine if SARS-CoV-2 antibodies are protective against newborn infection; if so, at what concentration; and whether the transplacental kinetics of vaccine-elicited antibodies are similar to naturally acquired antibodies.’

Read here (Jama Pediatrics, Jan 29, 2021)

Readmission and death after initial hospital discharge among patients with Covid-19 in a large multi-hospital system

‘Although more patients are surviving severe coronavirus disease 2019 (COVID-19), there are limited data on outcomes after initial hospitalization. We therefore measured the rate of readmission, reasons for readmission, and rate of death after hospital discharge among patients with COVID-19 in the nationwide Veterans Affairs (VA) health care system...

‘In this national cohort of VA patients, 27% of survivors of COVID-19 hospitalization were readmitted or died by 60 days after discharge, and this rate was lower than matched survivors of pneumonia or heart failure. However, rates of readmission or death were higher than pneumonia or heart failure during the first 10 days after discharge following COVID-19 hospitalization, suggesting a period of heightened risk of clinical deterioration. Study limitations include the inability to measure readmissions to non-VA hospitals and an older, male-predominant study population, who may be at higher risk of severe manifestations of COVID-19. Public health surveillance or clinical trials focused exclusively on inpatient mortality may substantially underestimate burdens of COVID-19.’

Read here (JAMA Network, Dec 14, 2020)

The Covid-19 pandemic and the $16 trillion virus

‘The estimated cumulative financial costs of the COVID-19 pandemic related to the lost output and health reduction are shown in the Table [in the story]. The total cost is estimated at more than $16 trillion, or approximately 90% of the annual gross domestic product of the US. For a family of 4, the estimated loss would be nearly $200 000. Approximately half of this amount is the lost income from the COVID-19–induced recession; the remainder is the economic effects of shorter and less healthy life.’

Read here (JAMA Network, Oct 12, 2020)

Vitamin D may help in Covid-19 fight, studies show

‘Multiple studies suggest that having adequate amounts of vitamin D may play a role in helping people stave off or combat the coronavirus, although the jury is still out on whether the results are conclusive or why this is so.

‘At least one overseas study has associated vitamin D deficiency with a higher risk of Covid-19. Published in medical journal JAMA Network Open on Sept 3, the study observed 489 patients from the University of Chicago Medicine health system, about a third of whom had vitamin D deficiency. Patients with vitamin D deficiency and who were not given treatment for it were 1.77 times more likely to test positive for Covid-19 than those who were not. The study also noted that other research had found that Covid-19 was less prevalent in groups that had lower rates of vitamin D deficiency.’

Read here (Straits Times, Sept 16, 2020)

Steroids can be lifesaving for Covid-19 patients, scientists report: New data in hand, the WHO recommended that doctors give the drugs to critically ill patients worldwide

‘International clinical trials published on Wednesday confirm the hope that cheap, widely available steroid drugs can help seriously ill patients survive Covid-19, the illness caused by the coronavirus. Based on the new evidence, the World Health Organization issued new treatment guidance, strongly recommending steroids to treat severely and critically ill patients, but not to those with mild disease...

‘JAMA published that paper and three related studies, along with an editorial describing the research as an “important step forward in the treatment of patients with Covid-19.” Corticosteroids should now be the first-line treatment for critically ill patients, the authors said. The only other drug shown to be effective in seriously ill patients, and only modestly at that, is remdesivir. Steroids like dexamethasone, hydrocortisone and methylprednisolone are often used by doctors to tamp down the body’s immune system, alleviating inflammation, swelling and pain. Many Covid-19 patients die not of the virus, but of the body’s overreaction to the infection.’

Read here (New York Times, Sept 2, 2020)

WHO ‘living guidance' on corticosteroids for Covid-19:

Download here (WHO)

New evidence suggests young children spread Covid-19 more efficiently than adults

Two new studies, though from different parts of the world, have arrived at the same conclusion: that young children not only transmit SARS-CoV-2 efficiently, but may be major drivers of the pandemic as well. The first, which was published in JAMA yesterday, reports findings from a pediatric hospital in Chicago, Illinois. The second, a preprint manuscript awaiting peer review, was conducted in the mountainous province of Trento, Italy.

Read here (Forbes, July 31, 2020)

Airborne transmission of SARS-CoV-2: Theoretical considerations and available evidence

‘All told, current understanding about SARS-CoV-2 transmission is still limited. There are no perfect experimental data proving or disproving droplet vs aerosol-based transmission of SARS-CoV-2. The balance of evidence, however, seems inconsistent with aerosol-based transmission of SARS-CoV-2 particularly in well-ventilated spaces. What this means in practice is that keeping 6-feet apart from other people and wearing medical masks, high-quality cloth masks, or face shields when it is not possible to be 6-feet apart (for both source control and respiratory protection) should be adequate to minimize the spread of SARS-CoV-2 (in addition to frequent hand hygiene, environmental cleaning, and optimizing indoor ventilation).’

Read here (JAMA Network, July 13, 2020)

‘Only 30% would want to receive a new vaccine’ in the US

‘Recent surveys, that included 493 and 2200 individuals, suggest only 3 in 4 people would get vaccinated if a COVID-19 vaccine were available, and only 30% would want to receive the vaccine soon after it becomes available. Confidence in vaccines lies along a spectrum, and individuals who have hesitation about routine childhood vaccines have expressed various concerns. In their report on vaccine hesitancy, Edwards and Hackell identified 3 broad categories of parents’ concerns regarding childhood vaccines: (1) the necessity of vaccines, (2) vaccine safety, and (3) freedom of choice.’

Read here (JamaNetwork, May 18, 2020)

Children and Covid-19: Systematic review of 18 studies

A systematic review of 18 studies shows most children had mild symptoms, if any, and generally required supportive care only. Typically, they had a good prognosis and recovered within 1 to 2 weeks. ‘In this systematic review of 18 studies with 1065 participants, most pediatric patients with SARS-CoV-2 infection presented with fever, dry cough, and fatigue or were asymptomatic; 1 infant presented with pneumonia, complicated by shock and kidney failure, and was successfully treated with intensive care. Most pediatric patients were hospitalised, and symptomatic children received mainly supportive care; no deaths were reported in the age range of 0 to 9 years.’

Read here (JamaNetwork, April 22, 2020)

Finding effective treatments for COVID-19: Scientific integrity and public confidence in a time of crisis

‘Everyone wants new treatments and vaccines to address the devastation of coronavirus disease 2019 (COVID-19). But, currently, under intense pressure and based on hope and limited data from poorly conducted clinical trials and observational data, many clinicians are embarking on ill-advised and uncontrolled human experimentation with unproven treatments.’

This paper calls for three important considerations:

1. ‘First, the regulatory and research communities owe it to patients, families, and clinicians to quickly learn what treatments are effective... 
2. ‘Second, it is important to optimise treatments that already exist, including supportive critical care. As learned from the Ebola outbreak, mortality can be reduced through identifying best practices...
3. ‘Third, and most important, it is critical to protect the integrity of and resulting public trust in the scientific and regulatory agencies and their advice and decisions. That trust will be needed once vaccines against COVID-19 become available and in future public health emergencies.’

Read here (JamaNetwork, April 16, 2020)

Response to COVID-19 in Taiwan: Big data analytics, new technology, and proactive testing

This paper published in the JAMA (Journal of the American Medical Association) network, covers how Taiwan (1) recognised the crisis (2) managed it (3) communicated to the public about it. It concludes:

‘Taiwan’s government learned from its 2003 SARS experience and established a public health response mechanism for enabling rapid actions for the next crisis. Well-trained and experienced teams of officials were quick to recognize the crisis and activated emergency management structures to address the emerging outbreak.

‘In a crisis, governments often make difficult decisions under uncertainty and time constraints. These decisions must be both culturally appropriate and sensitive to the population. Through early recognition of the crisis, daily briefings to the public, and simple health messaging, the government was able to reassure the public by delivering timely, accurate, and transparent information regarding the evolving epidemic. Taiwan is an example of how a society can respond quickly to a crisis and protect the interests of its citizens.’

Read here (JamaNetwork, March 3, 2020)

Read related article in Stanford.edu here