Germany approves AstraZeneca vaccine for over-65s

‘Germany's vaccine commission has approved the use of the Oxford-AstraZeneca jab in people aged over 65. The country previously approved it for under-65s only, citing insufficient data on its effects on older people. That led to public scepticism about its effectiveness, with some Germans spurning it and leaving many doses unused.

‘But German Chancellor Angela Merkel said recent studies had now provided enough data to approve it for all ages. Announcing the commission's decision on Thursday, Health Minister Jens Spahn said the move was "good news for older people who are waiting for an injection".’

Read here (BBC, Mar 5, 2021) 

Khairy: If you’re a healthy Malaysian under 60 and not a frontliner, expect to be vaccinated only by Q3 2021 or even later

‘Malaysians who are not active frontliners, below the age of 60 and in relatively good health can expect to receive their dose of Covid-19 vaccinations only by the third-quarter of this year or later, the science, technology and innovation minister revealed today. Khairy Jamaluddin, also the Special Committee on Ensuring Access to Covid-19 Vaccine Supply (JKJAV) co-chair, said this is because the first batch of vaccines to arrive will be prioritised to inoculate those within vulnerable groups. 

“Frontline workers from the healthcare and security sectors will go first. Then senior citizens and people with chronic illnesses. Only then we will move on to the general population in order to get to a meaningful herd immunity threshold.’

Read here (The Malay Mail, Jan 14, 2021)

Early high-titer plasma therapy to prevent severe Covid-19 in older adults (New England Journal of Medicine, Jan 6, 2021)

‘We report the use of convalescent plasma in older adult patients early in the course of Covid-19. The administration of convalescent plasma with high titers of antibodies against SARS-CoV-2 to infected patients within 72 hours after the onset of symptoms reduced the risk of progression to severe respiratory disease by 48%. Although our trial lacked the statistical power to discern long-term outcomes, the convalescent plasma group appeared to have better outcomes than the placebo group with respect to all secondary end points. Our findings underscore the need to return to the classic approach of treating acute viral infections early, and they define IgG targets that facilitate donor selection...

‘In our randomized, controlled trial, the administration of high-titer convalescent plasma against SARS-CoV-2 to infected older adults within 72 hours after the onset of mild symptoms reduced the progression of Covid-19 to severe illness. This simple and inexpensive intervention can reduce demands on the health care system and may save lives. Early infusions of convalescent plasma can provide a bridge to recovery for at-risk patients until vaccines become widely available.’

Read here (New England Journal of Medicine, Jan 6, 2021)

When will you be eligible for the Covid vaccine? Britain

Broadly, vaccines are being given to the most vulnerable first, as set out in a list of nine high-priority groups, covering about a quarter of the UK population. They are thought to represent 90-99% of those at risk of dying from Covid-19.

1. Residents in care homes for older adults and their carers
2. 80-year-olds and over and frontline health and social care workers
3. 75-year-olds and over
4. 70-year-olds and over and clinically extremely vulnerable individuals
5. 65-year-olds and over
6. 16 to 64-year-olds with serious underlying health conditions
7. 60-year-olds and over
8. 55-year-olds and over
9. 50-year-olds and over

People aged over 80 in hospital, frontline health staff and care home workers have been the first to get the jab at 70 designated hospitals hubs across the UK.

Read here (BBC, Dec 8, 2020)

As first Pfizer vaccine doses arrive in UK, officials tell doctors and nurses they won’t get priority

‘Priority will go to people over 80 years old and to nursing home caregivers, and even for those groups, demand could quickly outstrip supply in the early months, public health officials cautioned. The 800,000 doses Britain expects to get this month “could be the only batch we receive for some time,” warned Chris Hopson, chief executive of NHS Providers.’

Read here (Washington Post, Dec 4, 2020)

AstraZeneca Covid-19 vaccine candidate shows promise among elderly in trials

‘A potential Covid-19 vaccine developed by AstraZeneca and Oxford University produced a strong immune response in older adults, giving hope it may protect some of those most vulnerable to the disease, data from mid-stage trials showed. The data, reported in part last month but published in full in The Lancet medical journal on Thursday (Nov 19), suggest that those aged over 70 - who are at higher risk of serious illness and death from Covid-19 - could build robust immunity to the disease, researchers said.

"The robust antibody and T-cell responses seen in older people in our study are encouraging," said Dr Maheshi Ramasamy, a consultant and a co-lead investigator at the Oxford Vaccine Group.’

Read here (Straits Times, Nov 20, 2020)

US Covid-19 cases are skyrocketing, but deaths are flat—so far. These 5 charts explain why

 ‘In just the last two weeks, the global daily tally for new COVID-19 cases has jumped more than 30%, according to TIME’s coronavirus tracker, which compiles data from Johns Hopkins University. The steep upward trend is driven by viral waves in Europe and the United States that started in August and mid-September, respectively. On Oct. 23, the daily case count in the U.S. reached a new record high, suggesting that this wave will be worse than the one that swept the country over the summer.

‘But despite this rapid uptick in cases, the daily death count in the U.S. is not yet rising at the same rate, and remains at lower levels than in April. At face value, a lower case-to-fatality rate suggests that fewer people who test positive for the virus are dying from it. But the virus hasn’t necessarily become less lethal; it isn’t mutating quickly enough for that to be the case.

‘What’s happening now is not a result of how the virus treats humans, but rather how humans are treating the virus—that is, how we test for it, how we avoid it and how we combat it. The following five charts explain how human-driven factors are, at least for the moment, keeping deaths from spiking as high as they did early in the pandemic, even as cases rise dramatically...’

Read here (Time, Oct 26, 2020)

How anti-ageing drugs could boost Covid vaccines in older people

‘Unlike fine wine, the human body does not improve with age. Hearing fades, skin sags, joints give out. Even the body’s immune system loses some of its vigour. This phenomenon, known as immunosenescence, might explain why older age groups are so hard-hit by COVID-19. And there is another troubling implication: vaccines, which incite the immune system to fight off invaders, often perform poorly in older people. The best strategy for quelling the pandemic might fail in exactly the group that needs it most...

‘[Eric] Verdin [president and chief executive of the Buck Institute for Research on Aging in Novato, California] agrees that supporting the older immune system should be a priority. “I think the net result of all this will be renewed interest in understanding the defect in the immune response in the elderly.” That has implications not only for the coronavirus, but also for a host of other diseases, including other viral infections and even cancer. “COVID-19 has brought to the front something that a lot of people have ignored.”

Read here (Nature, Oct 14, 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) 

The coronavirus is most deadly if you are older and male — new data reveal the risks

‘For every 1,000 people infected with the coronavirus who are under the age of 50, almost none will die. For people in their fifties and early sixties, about five will die — more men than women. The risk then climbs steeply as the years accrue. For every 1,000 people in their mid-seventies or older who are infected, around 116 will die. These are the stark statistics obtained by some of the first detailed studies into the mortality risk for COVID-19.’

Read here (Nature, August 28, 2020)

WHO urges nations to join global shared vaccine bid

 ‘The WHO wrote to every country on Tuesday (Aug 18) urging them to quickly join its global shared vaccine programme - and spelled out who would get its eventual coronavirus jabs first. The World Health Organisation's director-general Tedros Adhanom Ghebreyesus said that without vaccinating the planet's highest-risk populations simultaneously, it would be impossible to rebuild the global economy.

‘And he said the most exposed 20 per cent of each country's population - including front-line health workers, adults over 65 and those with pre-existing conditions - would be targeted in the first wave of vaccinations, once the WHO-led COVAX shared facility can roll out a proven safe and effective vaccine.’

Read here (Straits Times, August 18, 2020)

Care homes and Covid-19 deaths: An opportunity to cut down mortality rates

‘The impact of COVID-19 on care home residents has been very different internationally, with some countries reporting no deaths (or infections) in care homes, such as Hong Kong, Jordan and Malta, and two countries reporting that over 80% of COVID-19 deaths were of care home residents. Without including the three countries with zero deaths, and with the caveat that the definitions used vary, on average the share of all COVID-19 deaths that were care home residents is 47% (based on 26 countries).’

Read here (International Long-term Care Policy Network, June 26, 2020)

Unsung heroines: Who cares for the carers?

Even before Covid-19, the world was facing a care crisis. The plight of often neglected, under-appreciated, under-protected and poorly equipped ‘frontline’ health personnel working to contain the pandemic has drawn attention to the tip of the care crisis iceberg. Oxfam’s annual early 2020 Davos report, Time to Care, estimates that 2.3 billion people will need care by 2030, 200 million more than in 2015, including 100 million more older people and an additional 100 million children aged 6 to 14 years.

Read here (IPS News, June 11, 2020)

Pandemic exposes systemic staffing problems at US nursing homes - Special report by Reuters

‘In the United States, longstanding problems with staffing shortages and chronic turnover have left nursing homes especially exposed. An estimated 40% of the country’s more than 100,000 COVID-19 deaths are connected to long-term care facilities such as nursing homes or assisted-living centers, according to a Kaiser Family Foundation tally.

‘About a quarter of nursing homes responding to a recent federal survey reported shortages of direct-care staff during at least one of the last two weeks in May, according to a Reuters analysis of survey data from the Centers for Medicare and Medicaid Services.’

Read here (Reuters, June 10, 2020)

The role of vitamin D in reducing risk of COVID-19: A brief survey of the literature

‘The evidence that higher vitamin D status is causally linked to lower risk of COVID-19 incidence, severity, and death continues to increase. This brief report outlines what has been learned through early June 2020 and provides links to some of the key references.

‘It should be noted that acceptance of the role of vitamin D supplementation will probably not be achieved before reports are published that demonstrate randomized controlled trials of vitamin D supplementation significantly reduced COVID-19 incidence or death. Several RCTs and observational studies regarding vitamin D supplementation and COVID-19 incidence and outcomes are either in the planning stage or in progress. The obvious groups to study are those at highest risk: dark-skinned people living at high latitudes, people in nursing homes or health care facilities; prisoners; factory workers such as in meat-packing facilities in the U.S.; health care workers. A major problem is that the powers that be see vitamin D as a threat to income and profit, so use the Disinformation Playbook to suppress positive information on vitamin D...

‘In a review published in early April, it was proposed that vitamin D supplementation could reduce the risk of COVID-19. Two mechanisms were identified: 1, reduced survival and replication of viruses through vitamin D-stimulated release of cathelicidin and defensins, and 2, reduced risk of the cytokine storm by reducing production of pro-inflammatory cytokines...’

Read here (Orthomolecular Medicine News Service, June 9, 2020)

Nearly 26,000 COVID deaths in nursing homes spur inspections

‘Nearly 26,000 nursing home residents have died from COVID-19, the government reported Monday, as federal officials demanded states carry out more inspections and vowed higher fines for facilities with poor infection control.

“This is not a nursing home problem; this is a health system problem,” said Terry Fulmer, president of the John A. Hartford Foundation, which works to improve care for older adults. “Every system produces the outcome it is set up for. If you set up a system where the sickest and frailest people are in locations that are forgotten about and ignored, where the staff is paid less, why should that surprise anyone?”

Read here (Associated Press, June 3, 2020)

Seniors with Covid-19 taking ACE inhibitors have lower hospitalisation risk

‘A Yale-led study suggests that older COVID-19 patients taking ACE inhibitors for hypertension have a lower risk of hospitalization for the novel coronavirus... The use of ACE inhibitors was associated with an almost 40% lower risk of COVID-19 hospitalization for the older, Medicare Advantage patients — but there was no significant difference in risk for the younger, commercially insured patients.’

Read here (Yale, May 27, 2020)

Read original Medrxiv pre-print paper here

The Guardian view on care work: A vocation that has been betrayed

‘The litany of government failures on social care during the Covid-19 emergency has become grimly familiar. But the mistakes bear repetition, as the latest figures record that close to 15,000 care home residents have died in England and Wales from the disease.

‘There is clear evidence that care homes were pressured into accommodating discharged hospital patients who had not been tested for coronavirus. Some turned out to be carrying it. Personal protective equipment was lethally slow to arrive. In some cases where homes did have functioning supply lines, these were commandeered to funnel PPE to hospitals. An absence of proper testing capacity meant care workers were operating in the dark as the virus spread. Access to hospital for residents was limited.’

Read here (The Guardian, May 19, 2020)

Guide for Covid-19 prevention in aged residential care facilities — Amar-Singh HSS, Vivienne Yong and Liew Tuan Hock

‘Older individuals in residential care need to be shielded from the risk of getting coronavirus infection. The key will be to try and create a bubble (a shield) in which the residents and staff live and operate, so as to minimise new individuals and infection entering the group. This guide and standard operating policy (SOP) aims to help offer ideas and initiatives that could be taken.

‘The guide covers the areas to consider with suggestions for improving Covid-19 prevention. It looks at policy, staff, residents, healthcare workers/therapists and visitors policies. The guide will be useful for nursing homes, old folks homes, retirement villages, palliative care facilities and also relevant to other residential care facilities for any age. It is relevant to non-governmental, private and governmental facilities.’

The full Aged Residential Care Facilities Guide is available for download and use from this link.

Read here (Malay Mail, May 18, 2020)

Coronavirus and the prospect of mass involuntary euthanasia

‘In the now nearly half a century I have lived in the US I had never witnessed such a bold, vicious, cruel demonstration of the laws of the jungle ruling this country. Amid the coronavirus pandemic, one could now see in broad daylight the cruelty that was at work in the mass murder of Native Americans and the business of transatlantic slavery...

‘The once subconscious, now blunt and vulgar, desire to murder one's elders is the logical conclusion of a culture of perpetual consumerist youth. The elders of the tribe have long passed their usefulness and have become a burden on the economy.’ 

Read here (Al Jazeera, May 16, 2020)