Weekly Coronavirus Update: Tuesday, December 15, 2020

Happy Tuesday, everyone. Here is your weekly recap of the latest Coronavirus-related research and news.

1) Yet another study has shown the danger of airborne transmission of Coronavirus. A peer-reviewed study published in The Journal of Korean Medical Science showed that one outbreak of the virus in South Korea was due to long-distance droplet transmission, as one person was shown to infect others over 6.5 meters away who were exposed for as little as 5 minutes. The infector and those who were infected did not have any direct contact. The study was able to analyze the airflow within the restaurant where transmissions took place, and ceiling air conditioners were thought to help spread the virus due to their direction of airflow. The authors conclude that, “droplet transmission can occur at a distance greater than 2 m if there is direct air flow from an infected person in an indoor setting.” They also recommended that masks should be removed only during meals in indoor settings, and loud talking and shouting should be avoided. You can read the full study here: https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e415

2) An arthritis drug called baricitinib, used in conjunction with remdesivir, has been shown to reduce recovery time and speed up improvements in the clinical status of patients hospitalized due to Covid-19. The improvements were greater for patients who were receiving high-flow oxygen or noninvasive ventilation. These patients’ recovery time was 10 days compared to 18 days for those who did not receive the drugs. The study involved 1,033 hospitalized Covid-19 patients and was double-blind, randomized, and placebo-controlled. It was peer-reviewed and published in The New England Journal of Medicine. You can read the full study here: https://www.nejm.org/doi/10.1056/NEJMoa2031994

3) Researchers at Edinburgh University in the UK discovered five genes that increase the risk of developing a severe case of Covid-19. To identify these five genes, the researchers compared the DNA of 2,244 patients with severe Covid with the DNA of healthy individuals in a control group. Doing so allowed them to predict which drug treatments were likely to help the severe patients. The study identified baricitinib as one possible treatment (see point number 2!), as well as an antibody-based medicine currently in clinical trials for the treatment of psoriasis. The authors cautioned that these drugs need to be tested in large-scale clinical trials. The study was peer-reviewed and published in the journal Nature. You can read the full text of it here: https://www.nature.com/articles/s41586-020-03065-y

4) Now that the Pfizer vaccine has been approved for use in several countries, many people are probably quite curious about its safety. A peer-reviewed study published in The New England Journal of Medicine revealed the safety and efficacy data from the vaccine’s randomized trials with 43,548 people. Of those, approximately half received the actual vaccine and approximately half received a placebo. In terms of becoming infected with the virus, 8 of those who received two doses of the actual vaccine became infected with Covid-19, compared to 162 of those in the placebo group. Of the 10 total cases of severe Covid-19, only one occurred in an individual who had received the vaccine and the other 9 were from people in the placebo group. After receiving two doses, the vaccine was shown to be 95% effective. In terms of the vaccine’s safety, the authors stated that it “was characterized by short-term, mild-to-moderate pain at the injection site, fatigue, and headache. The incidence of serious adverse events was low and was similar in the vaccine and placebo groups.” While it is not yet known how long the vaccine will protect against Covid-19, the study concluded that it provides protection for at least two months, and more research is needed to determine its safety and efficacy beyond that time period. You can read the full study here: https://www.nejm.org/doi/full/10.1056/NEJMoa2034577?query=featured_coronavirus
or this is a very handy little one-pager that explains the study well (thanks to my friend Branden for posting this!): https://www.nejm.org/doi/full/10.1056/NEJMoa2034577?query=featured_coronavirus

5) In other vaccine news, you may have heard that the Oxford/AstraZeneca vaccine safety and efficacy data were published in a peer-reviewed article in The Lancet last week. This study revealed the results from trials with 23,848 people in Brazil, South Africa, and the UK. The results showed that only three people experienced severe adverse effects, none of which could conclusively be linked to the vaccine. Only 30 of those in the group who received the vaccine became infected with Covid-19, compared to 101 in the placebo group. Ten people were hospitalized with Covid-19, none of whom were from the vaccine group. Overall, the study reported an efficacy of 70% after two doses of the vaccine. Efficacy in those who received two full doses of the vaccine ranged between 60.3–64.2%, whereas in those who received one half dose and one full dose the vaccine was shown to have 90% efficacy. The researchers stated that further research is needed on this to determine why this dosage showed higher efficacy. Similar to the data on the Pfizer vaccine in point number 4, the authors also stated they were not able to assess how long the vaccine provides protection from Covid-19. You can read the full study here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32661-1/fulltext

6) In even more vaccine news, a letter published in The New England Journal of Medicine revealed findings relating to the Moderna vaccine (which is very similar to Pfizer’s, as both are mRNA vaccines). This study was aimed at understanding how long the vaccine provides protection against Covid-19. Researchers analyzed the blood of 34 of the volunteers who received two doses of the vaccine 28 days apart. They found that four months after receiving the first dose of the vaccine, the participants’ blood still contained neutralizing antibodies that were able to fight off the virus. None of the participants experienced any serious side effects from the vaccine during that time period. The authors noted that they plan to follow-up with these 34 participants over the course of 13 months to continue testing their immune responses to Coronavirus. You can read the full results here: https://www.nejm.org/doi/10.1056/NEJMc2032195
*Note, as I am preparing to post this, I just received news alerts on my phone from three different news outlets that the FDA will review Moderna’s vaccine on Thursday and it is likely to be approved for use by the end of the week: https://www.washingtonpost.com/health/2020/12/15/moderna-vaccine-found-safe-effective/

7) Researchers from the University of Colorado developed a model to understand the best vaccination strategy for nations wishing to minimize the number of deaths from Coronavirus. The researchers tested multiple scenarios and found that in most situations, prioritizing vaccinations in adults aged 60 and older minimized the number of Covid deaths. To minimize the spread of the virus, however, the research found that prioritizing younger age groups was most effective. Additionally, vaccinating those who have not yet been infected with Covid-19 was shown to be an effective strategy for minimizing infections and deaths in those regions that have been hardest-hit by the virus. The study has not yet undergone peer review (important disclaimer!) and can be read in full here: https://www.medrxiv.org/content/10.1101/2020.09.08.20190629v2.full-text

8) Today a joint editorial was published in two top British medical journals, The BMJ and HSJ, urging the government to put a stop to household-mixing in the UK this year for Christmas. It is only the second time in more than a century that these two journals have published a joint editorial, and they stated that the decision to do so is because “we believe the government is about to blunder into another major error that will cost many lives. If our political leaders fail to take swift and decisive action, they can no longer claim to be ‘protecting the NHS.’” The authors argue that with the number of cases and hospitalizations on the rise in the UK, allowing household mixing at Christmas will result in the National Health Service (NHS) being overwhelmed and most elective and non-urgent medical care will be forced to stop. Average waiting times for elective procedures are predicted to reach 12 months according to their analysis. The authors concluded, “When government devised the current plans to allow household mixing over Christmas it had assumed the covid-19 demand on the NHS would be decreasing. But it is not, it is rising, and the emergence of a new strain of the virus has introduced further potential jeopardy. Members of the public can and should mitigate the impact of the third wave by being as careful as possible over the next few months. But many will see the lifting of restrictions over Christmas as permission to drop their guard. The government was too slow to introduce restrictions in the spring and again in the autumn. It should now reverse its rash decision to allow household mixing and instead extend the tiers over the five-day Christmas period in order to bring numbers down in the advance of a likely third wave.” I strongly recommend everyone reading this from the UK takes a few minutes to read the full letter. As I have said from the beginning of this pandemic, trust the scientists: https://www.bmj.com/content/371/bmj.m4847.full.print

9) Finally, your world update. First, the US has surpassed 300,000 deaths from Coronavirus, hitting 301,006 total deaths today. Furthermore, the number of daily cases has increased 31% in the US over the past two weeks (current seven-day average is 209,600 cases per day), deaths have increased 65%, and hospitalizations have increased 18%. Think back. Why might the number of cases and hospitalizations be increasing? What happened a little over two weeks ago? That’s right, Thanksgiving. Indiana, you are now ranked fourth in terms of number of cases per capita. Over the past seven days, the average daily number of new cases is 6,171. Meanwhile, the US received its first doses of Pfizer’s Coronavirus vaccine yesterday, with healthcare workers receiving the first doses.
— In the UK, the number of new daily cases has increased 29% over the past seven days, with 20,263 new cases yesterday. London and areas in the southeast will enter Tier 3 at midnight, meaning they will be under the UK’s highest level of restrictions. Yesterday the UK Health Secretary Matt Hancock revealed that scientists have discovered a new variant of the virus that could be responsible for the sharp rise in cases in areas preparing to go into Tier 3. Medical experts said the new variant is still detectable in swab tests, but it is unknown whether it causes worse cases or whether the current vaccines will protect against it.
— Elsewhere, it is reported that the European Medicines Agency will approve the Pfizer vaccine by the 23rd of December. The Netherlands began a strict five-week lockdown yesterday, with schools, nonessential shops, museums, and gyms forced to close. South Korea is experiencing a new wave of infections, with 880 new cases reported yesterday. Australia and New Zealand, which have both managed to eliminate nearly all cases of Coronavirus, are reportedly considering opening up travel between the two countries early in the new year in what is called a “travel bubble”. Oh, how I wish I still lived in one of those countries!
Sources:
US numbers: https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html?action=click&module=Spotlight&pgtype=Homepage
Indiana numbers: https://www.nytimes.com/interactive/2020/us/indiana-coronavirus-cases.html
Vaccines in the US: https://www.reuters.com/article/health-coronavirus-usa/vaccinations-under-way-u-s-turns-to-educating-skeptics-economic-aid-idUSKBN28P1L2
UK numbers: https://www.nytimes.com/interactive/2020/world/europe/united-kingdom-coronavirus-cases.html
New variant in UK: https://www.bbc.co.uk/news/health-55308211
Other updates: https://www.theguardian.com/world/live/2020/dec/15/coronavirus-live-news-netherlands-announces-five-week-lockdown-as-uk-detects-new-covid-strain
Australia/New Zealand travel bubble: https://www.abc.net.au/news/2020-12-15/nz-tasman-travel-bubble-covid-jacinda-ardern-when-to-book-flight/12983022

That’s all for this week. Please stay safe, everyone. There is a light at the end of the tunnel and we need to remain vigilant for a few more months to get there.

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