Considerations in boosting Covid-19 vaccine immune responses

‘In an expert review published September 13 online in the peer-reviewed journal The Lancet, a group of US and international scientists claim current evidence does not support providing booster doses of SARS-CoV-2 vaccines to the general public. The group—including 2 departing US FDA officials and WHO experts—said that any decision to provide additional vaccine doses should be evidence-based, concluding that despite a small drop in protection against symptomatic disease caused by the Delta variant, authorized vaccine regimens continue to provide high levels of protection against severe disease and hospitalization for all major SARS-CoV-2 variants. The authors acknowledged that some additional doses might be needed immediately for certain elderly and immunocompromised populations, but they encouraged prioritizing primary immunizations over booster shots for the general public.

‘The authors also acknowledged that booster doses might be necessary in the future due to waning immunity or the emergence of a vaccine-resistant variant but that current evidence does not warrant additional doses now because “efficacy against severe disease remains high.” The authors noted that currently available vaccine doses could save more lives and provide better protection against the emergence of new SARS-CoV-2 variants if used in previously unvaccinated populations, especially those in low- and middle-income countries.’

Read here (The Lancet, Sept 13, 2021)

Analysis: How for-profit health care worsened the pandemic

‘The U.S. remains the only one of the 25 wealthiest countries to not provide universal health care, and the health care system’s focus on profits and not health has cost Americans their lives. Despite having less than 5% of the world’s population, the U.S. has had 25% of the world’s confirmed cases and 20% of the deaths. Public Citizen’s new report demonstrates how:

• Before the pandemic, approximately 87 million Americans were uninsured or underinsured. About one-third of COVID-19 deaths and 40% of infections were tied to a lack of insurance;
• About half of Americans receive their health care through their employer. With more than 22 million Americans losing their job during the pandemic, millions have lost their health insurance;
• Racial health disparities, including access to care, have led to disproportionate deaths in communities of color;
• We have the highest rate of unmet need of any comparably wealthy country, with one-third of Americans reporting that they or a family member has avoided going to the doctor when sick or injured in the past year due to cost;
• Americans are significantly more likely to die of chronic respiratory disease, cardiovascular disease, diabetes or cancer than people in comparably wealthy countries with universal health care systems; and
• A lack of essential funding led to insufficient hospital capacity. The U.S. had only around half the hospital beds per capita of peer nations and far fewer than countries like Japan or Germany.’

Read here (Public Citizen, Mar 16, 2021)

Most Covid-19 hospitalisations due to four conditions

‘Based on this data, the model calculated the percentage of COVID-19 hospitalizations that could have been prevented without these four underlying conditions. Results were published in the Journal of the American Heart Association on February 25, 2021. The researchers estimated that more than 900,000 COVID-19 hospitalizations occurred through November 2020. Based on their model, 30% of these hospitalizations were attributable to obesity, 26% to hypertension, 21% to diabetes, and 12% to heart failure. These people would still have been infected with COVID-19, but likely would not have been sick enough to need hospitalization.

‘More than one of these conditions are often present in the same person. The model also estimated hospitalizations due to different combinations. The numbers weren’t simply additive. In total, 64% of the hospitalizations might have been prevented if not for the four conditions. The model suggested that COVID-19 hospitalizations due to these conditions varied by age. Older adults with diabetes, heart failure, or hypertension were more likely to be hospitalized than younger people with the same condition. However, obesity affected COVID-19 hospitalization risk similarly across age groups.’

Read here (NIH, Mar 9, 2021)

Obesity, walking pace and risk of severe Covid-19 and mortality: Analysis of UK Biobank

‘Both obesity and self-reported walking pace are independently associated with the population level risk of severe COVID-19 and COVID-19 mortality in UK Biobank. However, self-reported slow walkers had the highest risk regardless of their obesity status, with normal weight slow walkers having over twice the risk of severe disease and almost four times the risk of COVID-19 mortality compared to normal weight brisk walkers.’

Read here (International Journal of Obesity, February 26, 2021)

Revelations in Malaysia’s pioneering Covid-19 study

‘Malaysia has something new to be proud of... Just two weeks ago, a band of Malaysian medical professionals wrote and published Southeast Asia’s first national study on Covid-19 cases, representing an entire country’s experience.

‘It was featured in The Lancet, arguably the most prestigious and influential medical journal in the world. Titled “Clinical characteristics and risk factors for severe Covid-19 infections in Malaysia: A nationwide observational study”, it was written by Benedict Lim Heng Sim, Suresh Kumar Chidambaram, Xin Ci Wong, Mohan Dass Pathmanathan, Kalaiarasu M Peariasamy, Chee Peng Hor, Hiu Jian Chua, and Pik Pin Goh. It provides a detailed picture of the disease’s spread in Malaysia from Feb 1 till May 30, 2020.

Ethnic mix: ‘Malays account for 58.4% of all cases and 70.0% of all severe cases, while the Chinese account for 6.7% of all cases and 12.1% of severe cases and Indians account for 2.3% of all cases and 4.5% of severe cases. The ratio of severe cases to all cases of almost 2 to 1 for Chinese and Indians might be due to their slightly older-skewing population. Other nationalities account for 23.8% of all cases but only 4.9% of all severe cases – a ratio of almost 5 to 1. This, again, could be due to the foreign worker population which generally skews younger and so has a reduced chance of developing a severe instance of the disease.’

Co-morbidities: ‘Those with hypertension are the most at risk at 48.6%, followed by diabetes mellitus at 39.1% and chronic cardiac disease at 14.0%. Surprisingly enough, being an active smoker does not indicate an elevated risk of developing a severe infection. Smokers account for 9% of all cases and 7% of severe cases...’

Read here (FreeMalaysiaToday, Dec 2, 2020)

Clinical characteristics and risk factors for severe COVID-19 infections in Malaysia: A nationwide observational study

Read here (The Lancet, Nov 17, 2020)

Five things you need to know about living with a disability during Covid-19

1. Risk of contracting COVID-19 is higher for persons with disabilities
2. Risk of severe symptoms and death is higher
3. Living in institutions increases the risk of contracting and dying from COVID-19
4. Discrimination in accessibility of healthcare and life-saving procedures
5. The broader COVID-19 crisis affects persons with disabilities more

Read here (UN DESA Voice, December 2020)

What fans of ‘herd immunity’ don’t tell you

‘First, it makes no mention of harm to infected people in low-risk groups, yet many people recover very slowly. More serious, a significant number, including those with no symptoms, suffer damage to their heart and lungs. One recent study of 100 recovered adults found that 78 of them showed signs of heart damage. We have no idea whether this damage will cut years from their lives or affect their quality of life...

‘Second, it says little about how to protect the vulnerable. One can keep a child from visiting a grandparent in another city easily enough, but what happens when the child and grandparent live in the same household? And how do you protect a 25-year-old diabetic, or cancer survivor, or obese person, or anyone else with a comorbidity who needs to go to work every day?...

‘Third, the declaration omits mention of how many people the policy would kill. It’s a lot...If these restrictions are simply eased — as opposed to eliminating them entirely, which would occur if herd immunity were pursued — deaths could rise to as many as 571,527. That’s just by Feb. 1. The model predicts daily deaths will still be increasing then.

‘Will we have achieved herd immunity then? No.’

Read here (New York Times, Oct 19, 2020)

NIH: 80% of Malaysia’s 157 coronavirus fatalities had at least one underlying medical condition; 72 per cent male; those aged 60-69 the largest group at 30.6 per cent

NIH: 80% of Malaysia’s 157 coronavirus fatalities had at least one underlying medical condition; 72 per cent male; those aged 60-69 the largest group at 30.6 per cent

‘More than 80 per cent of Covid-19 deaths in Malaysia reportedly had at least one underlying medical condition, said ICR. ICR also found that significantly more men in Malaysia succumbed to Covid-19 at 72 per cent, compared to women at 28 per cent.

‘More than 65 per cent of Malaysia’s coronavirus deaths were aged 60 years and above. Those aged 60 to 69 years formed the largest age group among Malaysia’s Covid-19 fatalities at 30.6 per cent, followed by people aged 70 to 79 years at 21 per cent, and those aged 50 to 59 years at 19.1 per cent. Adults aged 80 years and above comprised 14 per cent of coronavirus deaths in Malaysia.’

Read here (Code Blue, Oct 13, 2020)

What is the risk to Donald Trump's health?

‘Donald Trump has clear risk factors - including his age, weight and being male - that all raise the chances of a severe coronavirus infection. He is 74 and has a Body Mass Index (BMI) over 30, which is the clinical definition of obesity. So now he has tested positive for the virus, what does it mean?’

Read here (BBC, Oct 2, 2020)

How the ageing immune system makes older people vulnerable to Covid-19

‘Covid-19 patients who are 80 or older are hundreds of times more likely to die than those under 40. That’s partly because they are more likely to have underlying conditions — like diabetes and lung disease — that seem to make the body more vulnerable to Covid-19.

‘But some scientists suggest another likely, if underappreciated, driver of this increased risk: the ageing immune system. The changes that ripple through our network of immune cells as the decades pass are complex, resulting in an overreaction here, a delayed response there and, overall, a strangely altered landscape of immunity.’

Read here (Today Online, Sept 13, 2020) 

To understand who’s dying of Covid-19, look to social factors like race more than preexisting diseases

‘The Sutter and MIT studies cast doubt on whether individual risk factors are as important as social determinants of health in affecting someone’s chances of contracting severe and even fatal Covid-19. “It should cause us to ask a different set of questions about what puts you at risk of hospitalization or death,” Schwalbe said.

‘More and more evidence is pointing to social determinants of risk, which puts the role of underlying health conditions in a new light. “Comorbidities are still used to blame people for how hard they are hit by Covid-19,” said Philip Alberti, senior director for health equity research at the AAMC. To reduce the U.S. death toll now that many states are seeing a new surge in cases, he said, “our response to this disease” must look beyond the strictly medical.’

Read here (STAT News, June 15, 2020)

Singapore study finds overweight Asians three times as likely to need intensive care

The study of 91 Covid-19 patients under the age of 60 also found those with a BMI of 25 or higher were six times more likely to need supplemental oxygen. Asians are known to have higher disease risks at lower body mass index thresholds, the researchers said, possibly because of body fat distribution.

Read here (South China Morning Post, May 15, 2020)

A quarter of Covid-19 patients who died in England had diabetes

‘A quarter of people who died with coronavirus in hospitals in England had diabetes, officials say. People with dementia or lung problems are also among those most at risk of dying after contracting COVID-19, according to new NHS figures.’

Read here (Sky News, May 14, 2020)