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New Variant From India, Cases Raising in Europe, Brazil’s Worst Health Crisis: COVID-19 Global Weekly Highlights | Instant News


This is the global coronavirus story you need to know this week.

On Monday, AstraZeneca announced interim results from its 3rd phase United States of America a study that showed 79% overall effectiveness of the vaccine against the symptoms of COVID-19. But on Tuesday, officials at the US National Institute of Allergy and Infectious Diseases has issued a statement questioned the completeness of company data and data and the security watchdog criticized the company for “taking cherry” favorable findings rather than reporting the most recent figures. On Thursday, company revises the efficacy figures to 76%.

Meanwhile, researchers reported that Americans earn nearly 2 pounds per month during COVID-19 shelter orders in 2020, exacerbates obesity problem.

The European Medicines Agency (EMA) will do this forming an ad hoc expert group provide “additional input” in the assessment of thromboembolic events occurring in European Union (EU) residents who have received the COVID-19 vaccine from AstraZeneca.

Meanwhile, the EU has told AstraZeneca to “catch up” on vaccine shipments in Europe before exporting doses to other countries.

Brazil is going through the worst period of her health crisis. Cases increased and deaths reached new heights of 3158 in 24 hours. The health system experiences long waiting times for intensive care beds, and problems with intubation, medications, respirators and oxygen. In the state of São Paulo, 115 cities are at risk of running out of oxygen cylinders. The country has seen 298,843 deaths and 12,136,615 diagnoses since February 2020. Deaths totaled 13.3 per million population. Vaccination rates remain slow with 6% of the population getting the first dose, and 2% taking the second dose on Tuesdays.

In German, after gradually lifting some of the lockdown restrictions, the number of COVID-19 patients in intensive care units has increased again with more than 3000 beds filled, as high as a peak first wave in spring 2020. As of Wednesday, the number of new infections reported in 7 days per 100,000 population reached 108.1 nationwide.

That ENGLISH be marked one year since the first lockout with a day of reflection. In the past 12 months the number of people who have died in the UK in the 28 days after testing positive has risen from 938 to 126,172, including about 247 frontline health and care workers. Saturday saw nearly 100,000 doses of the COVID-19 vaccine delivered in one hour, or 27 per second, for a UK record 844,285 vaccines in one day. Deaths and hospitalizations continue to decline but new cases remain at around 5,000 per day.

Spanish restarting use AstraZeneca vaccine on Wednesday, and has extended the age limit to 65 years. There were concerns people would not believe it but the Health Minister said the vaccine was “safe and effective” and explained that if someone refuses the AZ vaccine, they will not be vaccinated. Only 4.6% of the population has been fully vaccinated. This week Spain recorded the biggest increase in COVID-19 cases in the past 10 days. Travel restrictions will remain in effect during Easter.

In Portugal, the incidence of the British variant (B.1.1.7) is increasing to cover 70% of positive cases and is expected to reach 90%. There are currently 712 COVID-19 patients hospitalized and 155 in ICU beds, the lowest since October. The current incidence rate is 81.3 cases per 100,000 population. However, between March 14 and 20, more than 30 cities saw an increase of more than or equal to 30 new cases per 100,000 inhabitants, according to the Público newspaper. On Monday, Portuguese health authorities decided to continue rolling out the AstraZeneca vaccine.

France facing the resurgence of COVID-19 and curbing lockdown measures have been extended to new territories. President Macron announced several steps aimed at speeding up vaccination , including extending vaccination to people over 70 years without comorbidities. New vaccination centers will open next week. The National Drug and Product Safety Agency (ANSM) was provided an inventory of reported thromboembolic events in France with three available vaccines.

Epidemic in Italy got worse. According to the latest government reports from the Ministry of Health, the national incidence rate was above the threshold of 250 cases a week per 100,000 population for seven consecutive weeks.

The number of people hospitalized with COVID-19 increased significantly (28,438 as of Wednesday), as well as those in intensive care (3,588), and those under home quarantine (540,740). The average positive swab rate is 5.8% at the national level. Vaccination campaigns are slowing down due to a lack of supply. Nationwide, eight million people have been vaccinated with more than 1.6 million people over 80 receiving at least one dose.

Phase 2/3 of trials of the ReiThera vaccine based on gorilla adenovirus have started in Italy, and the Spallanzani Institute will prepare a trial to verify the efficacy of the Russian Sputnik V vaccine, especially against the variant of concern.

Ukraine has reported record number of COVID-related deaths each day, temporarily Bulgaria recorded the highest daily infection rate since the start of the pandemic.

Cuba drug regulatory authorities approved a second COVID-19 vaccine candidate (Soberana) for final stage clinical trials as nations race to secure homegrown jabs to quell their worst outbreak since the start of the pandemic and sell them overseas.

The country is one of the few countries in the region that has not started vaccinating COVID-19, as it is still counting its own vaccine candidates.

India have seen a spike coronavirus case. On Wednesday, the country recorded 53,476 daily cases, the highest since October. A new ‘dual mutant variant’ SARS-CoV-2 with E484Q and L452R mutations has been detected in samples from the western state of Maharashtra.

More than half Israel 9.3 million people now have fully vaccinated against COVID-19, said the country’s health minister.

Japan ending his emergency in and around Tokyo starting in early January. Despite the restrictions being lifted, Tokyo Governor Yuriko Koike has warned people not to let their guard down to help avoid a re-emergence of the infection.

Authority at Hong Kong and Macao temporarily suspended use of the Pfizer / BioNTech vaccine on Wednesday after being notified by distributor Fosun Pharma about a broken cap in one of the batches. Fosun Pharma and BioNTech are currently investigating this matter and clarified that there is no reason to believe that the product is unsafe.

Check out more global coronavirus updates at Medscape’s Coronavirus Resource Center.

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Age 40+ With Diabetes Should Be a Priority for the COVID-19 Vaccine | Instant News


People with type 2 diabetes as young as 40 face a disproportionately increased risk of dying from COVID-19 infection, suggesting a British analysis of three large-scale data sets highlighting the need to prioritize vaccination in younger groups of vulnerable patients.

Research it published February 8 in the journal Diabetology.

Most European countries have prioritized COVID-19 vaccination for people with type 2 diabetes, but usually only age 50 and over. However, data from the current study suggest that this age limit should be lowered.

“It is important to remember that the risk of dying from COVID-19 in middle-aged people with diabetes is very low in absolute terms compared to the elderly,” said lead researcher Andrew P. McGovern, MD, of Royal Devon & Exeter Hospital, Exeter. , United Kingdom, in a press release from its agency.

However, he said that “strategies for determining priority groups for vaccination must take into account the disproportionate relative risk of COVID-19 death in middle-aged people with type 2 diabetes whose risk of COVID-19 has already increased with their age.”

McGovern informed Medscape Medical News that the magnitude of the effect of type 2 diabetes on deaths from COVID-19 is “absolutely shocking” about the new findings, and “not what you expected.”

Therefore, he said it was imperative that diabetics be put “in line” to get the vaccine “in the right place, and clearly in countries where vaccine rollout will be slower, it is more important.”

Bridget Turner, director of policy and improvement campaigns at Diabetes UK, which funded the study, said the results provide “important new insights into how much type 2 diabetes adds to the overall risk of dying from coronavirus at different ages, particularly the additional risk of that condition. increases in middle age. “

“The UK has made good progress in prioritizing those most vulnerable for vaccination, which includes all adults with diabetes,” he added in a press release, “but we need to continue to work with pace to identify and protect those people at a greater level. high risk. “

The Relationship Between COVID-19 Death and Diabetes Is Complex

The authors note that the association between COVID-19-related death and type 2 diabetes is not only a “co-effect of diabetes and age-related risk” but appears to be a “more complex” relationship, with “a disproportionately higher relative risk of excess relative risk.” death in young people with diabetes. “

To investigate this, they examined data from two UK population-based studies that previously reported age-specific hazard ratios for diabetes-related COVID-19 deaths:

  • Open safely, which includes 17.2 million people, 8.8% of whom have diabetes, and has an overall 90-day mortality rate of 0.06%.

  • QCOVID, comprising 6 million people, of whom 7% had diabetes, and had an overall 97-day mortality rate of 0.07%.

The team also looked at data from type 2 diabetes patients with severe COVID-19 from the COVID-19 Hospitalization in England Surveillance System (CHESS), which contained 19,256 patients were admitted to critical care in the UK, 18.3% of whom had diabetes.

The 30-day hospital mortality rate in this study was 26.4%.

They translated the death hazard ratio associated with COVID-19 infection in diabetics to “COVID-19 age,” which equates to additional years of “risk of death” added to the individual’s chronological age if diabetes is present.

Taking the QCOVID dataset as an example, the results showed that the diabetes-related “COVID age” for someone aged 40 was 20.4 years; which would indicate that “the risk of death [for COVID-19] similar to a 60 year old without diabetes. “

The impact of diabetes on the risk of death from COVID-19 decreases with age, so that diabetic patients aged 50 have COVID-19 aged 16.4 years. This drops to 12.1 years in someone who is 60, and 8.1 years in someone who is 70, meaning the latter has the same risk of dying from COVID-19 as someone without diabetes who is 78 years old.

Similar results were obtained when the team looked at data from the OpenSAFELY study.

But when they looked at the effect of diabetes on the risk of dying from COVID-19 in the CHESS data set, it was less visible..

Just Looking At Diabetes Is Too Simple, But It’s An Easy Marker For Vaccination

The investigators acknowledge that “only considering age and diabetes status when assessing COVID-19-related risk … is an oversimplification,” because factors such as body mass index (BMI), diabetes duration, and glycemic control are also known to play an important role. authority.

However, they said consideration of these factors was “impractical for vaccine rollout at the population level.”

“The time-critical nature of the COVID-19 vaccination population requires pragmatic group level priority, which is the approach initiated by the government so far,” the team concluded.

This study was supported by Diabetes UK. Study author John M. Dennis was supported by an Independent Fellowship funded by the Research England’s Expanding Excellence in England (E3) fund and by the NIHR Exeter Clinical Research Facility. McGovern is supported by the NIHR Exeter Clinical Research Facility.

Diabetology. Published online February 8, 2021. Full text

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Brazil Must Now Compete With Two Variants of SARS-CoV-2 | Instant News


Editor’s note: Find the latest COVID-19 news and guides on Medscape’s Coronavirus Resource Center.

More than 20 days after the Japan National Institute of Infectious Diseases announced the detection of a new SARS-CoV-2 variant – isolated from samples from four travelers from Amazonas, Brazil – variant P.1 has been detected in several countries other than Brazil and Japan, from the United States to Germany to the Faroe Islands, according to a World Health Organization (WHO) report.

“Now we can say that P.1 isn’t just in Manaus,” Felipe Naveca, PhD, deputy director of research at Fiocruz Amazônia, said. Medscape Medical News.

“We sorted about 100 samples in 13 cities in the state of Amazonas and in 11 of them we found P.1 circulating,” he said. He added that in December, the prevalence was 51%, and as of January 13, it has increased to 91%.

“We will increase the number of municipalities even more and sort the samples from Rondônia,” added Naveca.

The first case of infection by P.1 has occurred documented in the United States – among Minnesota residents with a history of travel to Brazil – and three cases in São Paulo were announced on January 26 by the São Paulo State Department of Health.

“As expected,” said Naveca. “When detected, the virus has been circulating for some time.”

The emergence of P.1 probably occurred between November and December 2020, and the spread of new strains appears to be fast. There’s still no data yet, but the Fiocruz Network is studying random samples from different times across the country.

Additionally, the researchers monitored the appearance of a second variant, called P.2, identified in Rio de Janeiro.

In the case of Manaus, researchers led by Naveca confirmed a trend recently announced by the Brazilian-British Center for Discovery, Diagnosis, Genomics and Epidemiology (CADDE), which includes researchers from the University of São Paulo.

Ester Sabino, MD, PhD, and her team released Preliminary results of a sample analysis of 48 tests in Manaus between 1 and 9 January. Of the 48 samples, most (85.4%) were variant P.1. The authors highlight that, despite the preliminaries, this figure is already significantly higher than the 52% of samples with variant P.1 (of 67 patients in Manaus) detected in the last 2 weeks of 2020.

Viruses like SARS-CoV-2 are changing. Of the hundreds of variants that have been detected in the first year of the pandemic, what worries scientists the most – the so-called variant of concern (VOC) – are the variants that originated in Britain, South Africa and P.1 in Brazil. .

Small differences in the viral genetic material can offer advantages, such as more infectiousness or avoidance of antibodies (either produced by previous infection or stimulated by vaccinations). In the case of the Amazonian P.1 variant, the molecular structure of the microorganism shows that it has both these advantages. Was P.1 then the cause of the chaos in the northern part of the country in Manaus?

“We don’t know whether the complicated epidemiological situation in Manaus is the cause of the P.1 line, or if the P.1 line is causing this health disorder. But if it starts to be found elsewhere and has the same effect that was observed in Manaus, overlapping with other strains, it is already a strong indicator that it is more transmissible, “Tiago Gräf, PhD, said Medscape Medical News. Gräf is a biomedical researcher at the Instituto Gonçalo Moniz, from Fiocruz, who focuses on the evolution and molecular epidemiology of viruses.

Gräf gave an example, the number of COVID-19 cases has also increased in Rio de Janeiro where, until now, the P.1 line has not been detected.

“It could be an increase in cases due to year-end parties, beaches, holidays, crowds, fatigue, euphoria with vaccines, which makes bloodlines more frequent,” he said. “We need to monitor.”

“We are trying to figure out the path the virus is taking in the state of Amazonas, but it is not yet possible,” said Naveca. He added that the pace of work of scientists in recent days has been a frenzy: “The results of the tests conducted on Sunday (January 24), we analyzed everything between [the days right after], I share with colleagues who help me with phylogenetic analysis. We’ll try to understand it better, but we still don’t have that answer. “

Focus on mutations

Presence N501Y it is this mutation that triggers fears of greater transmissibility. There is no shortcut to ascertaining whether or not a mutated strain can be transmitted. This is based on indirect evidence obtained through genomic surveillance, which identifies whether new strains are replacing old ones over time – which seems to be the case. The researchers also tried to interpret the effects of mutations cataloged by surveillance of the viral genome using computer modeling to assess whether the mutations increased the virus’ ability to interact with cells. But that wasn’t enough either.

“Soon, animal studies will begin to emerge,” explains Gräf. “After infecting mice, it needs to be seen if they produce more virus in the airways or if there are more infections in the lungs.”

P.1 is also of concern because it carries other mutations, in particular E484K, associated with reduced effects of neutralizing antibodies – which in turn can result in re-infection and a low immune response to the vaccine.

“We’ve confirmed [a P.1 reinfection]. In fact, it is one of the first samples we sequenced, “says Naveca.

In vitro studies of whether a strain can evade the immune system are relatively simple. The strains are cultured using serum from patients who have been infected with SARS-CoV-2 and, therefore, have antibodies to fight the virus. Researchers measured how many cells the new strain could infect. If it can’t infect anything, it means the patient’s antibodies are working to neutralize it. However, there are other questions that have not been answered.

Scientists still don’t know the severity of the disease caused by variant P.1, says Naveca. They also don’t know which age group is most affected. She says Medscape Medical News that he spoke with many medical colleagues, and “some report that they see younger people, others think there is no big difference between age groups. We need to increase the number of analyzes to apply statistical tests, because we have conflicting opinions, and we must be sure. “

There is also no certainty about whether this new strain will change the effectiveness of the vaccine. The WHO results on January 12 suggested the vaccine protects against the British and South African variants, but P.1 has not been studied. Samples of the new strains have been sent to Fiocruz in Rio de Janeiro to carry out a study on neutralization. According to Naveca, teams there are working in real-time in partnership with vaccine manufacturers to get results as quickly as possible.

Moderna and Pfizer have presented results showing that their vaccine protects against the British and South African variants. However, in vitro tests to measure antibody response are inconclusive.

“This in vitro testing work should be done by everyone, manufacturers and researchers,” said Sabino Medscape Medical News. “Science needs a lot of groups working to answer this question.”

“But it is logical that in vitro studies do not answer all of them. In practice, it is necessary to carry out clinical trials, following vaccinated patients, to verify that P.1 rates and transmission are the same in those who have not been vaccinated. , and monitor what happens in that region, “he said.” You may need to run tests with different vaccines to see which one responds best to this variant. “

Pharmaceutical companies are already considering possible booster doses or making adaptations to formulations. Even with the prospect of reinfection and vaccines that may not protect against some strains, there is still light at the end of the tunnel.

“Infection or a second infection in the vaccinated person is not expected to develop into severe COVID-19,” said Gräf. “Antibody immunity, even if reduced, and cellular immunity can still help, perhaps not preventing the person from becoming infected, but by reducing symptoms and the amount of virus in circulation, preventing the person from developing serious illness.”

P.2 and Other Variants

That E484K the mutation is also present in another variant from Brazil that has appeared in several states. This variant, informally called the “Rio de Janeiro” line, also has a new name: P.2.

The P.2 variant was announced in December, after being identified in Rio de Janeiro, Cabo Frio, Niterói, and Duque de Caxias, in Baixada Fluminense. It has also been identified in various states in the northern part of the country and more recently in Rio Grande do Sul. At Amazonas, the P.1 variant still dominates P.2.

“From November until now only one sample has P.2, compared to 60 from P.1,” said Naveca. However, P.2 is still a concern because of its wide geographic distribution and because it carries E484K mutations, which raise concerns about reinfection and, possibly, reducing the vaccine’s efficacy.

“P.2 has mutations that decrease the response to neutralizing antibodies, but the number of mutations is smaller and doesn’t appear to be taking the evolutionary leap that P.1 did,” Sabino said. “P.2 is not yet on the VOC list, but it turns out to have different characteristics from the others, maybe it will be on the list.”

“For now, it is still considered a strain that needs to be studied better,” he added.

That same week, two new strains of SARS-CoV-2 in southern Brazil emerged described and disclosed in two separate preprints. The new variant is not classified as a VOC, “but we need to understand it better because new variants will appear all the time,” said Naveca.

Restriction Measures

The VOC has revived the debate at the start of the pandemic about closing borders – at the national, state or city level. France is moving toward imposing restrictions, Britain is considering mandatory quarantines, Germany is studying flight cancellations, and Australia has even suspended air bubbles it has with New Zealand. Since January 26, the United States has restricted entry of non-US nationals from Brazil.

Experts still debate strategy. Some see closure as necessary. Others believe it is more important to have a good virus sequencing program to detect agile variants, as well as a strong screening program.

“I am concerned about discussing the control measures in Manaus with the situation we are in. There are patients who, if not transferred, could die. The only chance for some people is to be transferred to another location, and there is also a risk with an asymptomatic person,” he said. Naveca.

“It is best to improve genomic surveillance and tracing, limit unnecessary visits and trips, and unnecessary in person encounters,” added Gräf. “The government has to guide this.”

This article was translated and adapted from Medscape Portuguese edition.

Sabino, Naveca and Gräf have reported no relevant financial relationships.

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British Variant Spreads In US As Covid Mutations Increase | Instant News


Editor’s note: Find the latest COVID-19 news and guides on Medscape’s Coronavirus Resource Center.

The British B117 variant is circulating in at least 24 states, according to new data from the surveillance of the COVID-19 Centers for Control and Prevention (CDC) variant. The CDC projects that the British variant will become the dominant strain in the United States by March.

From any point of view, the UK appears to be on the crosshairs of COVID-19: Weeks after a new, highly contagious variant emerged that sparked a spike in cases and a new lockdown, Britain is declared to have the world’s highest death rate from coronavirus.

But Britain also has a less secretive weapon: the genome sequencing program that is widely believed to be the most coordinated and advanced any country has ever created. In the grip of the virus, the British have gathered important insights into the behavior and consequences of SARS-CoV-2.

But B117 is also important for what’s missing: In this case, it results in a negative result on certain PCR tests on the spike protein, or S gene.

One of the S gene mutations specific to the variant deletes two amino acids, causing that portion of the PCR test to be negative. The coincidental finding known as target failure of the S gene has become an integral proxy to help track where and when the variant spread in the UK, where about 5% of samples from COVID-19 infected patients are sequenced, said Sharon Peacock. , PhD, executive director and chair of the COVID-19 Genomics UK Consortium.

The same tactic could prove valuable for doctors overwhelmed by cases and deaths, but lacking high-level sequence information about the virus, Peacock said. Medscape Medical News. A British report released on Friday stated that there was a “realistic possibility” that the variant had a higher death rate than other SARS-CoV-2 cases.

“In this particular variant, the deletion of the genome causes one part of the diagnostic test to fail,” explains Peacock. “Some targets are positive, but these are negative. In the UK, this has been used as a substitute marker.”

Targeting Unseen Enemies

B117 isn’t the only variant producing these results, Peacock warns, “but in screening for it, you can think about it.”

“Because the UK ranks about 5% of the cases they detect, this gives them very important clues about what’s going on there,” says Anderson Brito, PhD, a virologist and postdoctoral researcher at Yale University School of Public Health in New Haven. , Connecticut, where investigators created a special PCR test to detect the B117 variant.

Brito, who lived in the UK for 4 years while studying for a doctorate at Imperial College London, said a “major advantage” was a more integrated process for collecting and sequencing samples. Important information – including date and place of collection – is included with each sample, which encourages not only sorting, but also an epidemiological perspective.

“They weren’t in the dark at all,” said Brito Medscape Medical News. “I don’t think any other country in the world knows better which lineage of the virus is circulating.”

CDC launches the file SPHERES a consortium in May 2020 to coordinate the sequencing of the SARS-CoV-2 genome across the United States.

But the American genome effort was “not concentrated,” said Brito, whose lab detected the first two cases of the British variant in Connecticut on January 6. “We had difficulty getting samples, because they were decentralized to a level where there was little coordination between hospitals and research centers. They were not as connected as in the UK. If we only get samples and have no collection date and no origin information, for example, it is at basically useless. “

Global genome collaboration incl GISAID, an international database where researchers share new genomes of various coronaviruses. By mid-January, the United States had shipped about 68,000 sequences to GISAID, added about 3,000 new samples each week and expects more from commercial laboratories in the coming days, according to the CDC.

“The UK must have been much more looking for variants when they emerged,” says Gigi Gronvall, PhD, immunologist and senior scholar at the Johns Hopkins Center for Health Security in Baltimore. “The US has now changed it.”

Warning From British Scientists to the World

Despite these genomic achievements, some British scientists say they are sorry too, hoping they would know how fast SARS-CoV-2 actually spread a year ago, when it hit western Europe.

That information is critical not only for prevention efforts, but because the virus is sure to mutate more quickly the more people become infected, says Igor Rudan, MD, PhD, director of the Center for Global Health Research at the University of Edinburgh in the UK.

“Italy showed us how fast it is spreading and how deadly it is for the very old and people with many comorbidities,” said Rudan, who is also the editor in chief of Journal of Global Health. “We hope we know it is spreading so fast, and we hope we know the threshold of cases we can allow to be infected before the virus mutates.”

More mutations meant more new strains of SARS-CoV-2, Rudan said Medscape Medical News. “We have reached that threshold now and will see more of these mutations,” he said.

Despite its current struggles, Britain is trying to go beyond tracking the spread of its new variant and trying to identify new mutations that might change the way the virus behaves.

Three features of each of the variants that emerged were very important, explains Peacock: Is it more contagious? Is it more deadly? And does that bypass the natural or vaccine-induced ability of immunity to protect people from infection?

“We need to sort the people who come to the hospital who are sick,” said Peacock, also a professor of public health and microbiology at the University of Cambridge, UK. “Also, if anyone gets infected after they’ve gotten sick or got vaccinated, we really want to know what it looks like” genomically.

SARS-CoV-2 has recorded more than 4000 mutations, Peacock said. But “knowing that viruses mutate all the time is not reason enough not to look. We really wanted to know whether mutations cause changes in amino acids, and whether they can cause functional changes,” he said.

However, for now, experts say they are relieved that the British strain does not appear to be able to avoid the COVID-19 vaccine or make it less effective.

“Although mutations are common, those that can change the virus code are rare,” explains Brito. If necessary, the vaccine can be changed to replace the spike gene sequence “in a matter of weeks,” he said. “We’ve done this for flu vaccine. Every year, we have to monitor the variants of the virus in circulation to develop a vaccine that covers most of these viruses. If we end up doing it for SARS-CoV-2, I won’t be surprised. “

But the increase in variant-triggered infections will require more people to be vaccinated before herd immunity can be achieved, Rudan warned. “If it spreads faster, we need to vaccinate maybe 85% of people vs 70% to achieve herd immunity,” he said.

One lesson the COVID-19 pandemic brings with it “is to always be vigilant about what happens next,” said Peacock. Although confident about the genome effort in Britain to date, he and his colleagues feel they are still trying to fully understand the evolutionary changes of the virus.

“We’re ahead of the curve right now, but we want to be ahead of the curve,” said Peacock. “It is very important to be ahead of what might happen because we don’t know how the virus will develop.”

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Down Syndrome Is Associated with a Tenfold Risk of Death from COVID-19 | Instant News


Editor’s note: Find the latest COVID-19 news and guides on Medscape’s Coronavirus Resource Center.

People with Down Syndrome those who contracted COVID-19 faced a fivefold increased risk of being hospitalized and a ten-fold increased risk of death compared with infected people who did not have the syndrome, the researchers. report in Annals of Internal Medicine.

Since the pandemic began, public health and infectious disease experts have identified comorbidities that increase the risk of serious complications or death from COVID-19. In Great Britain and the United States, Down syndrome is not yet on that list. The authors of the new report argue that this is the case.

Down syndrome may be associated with more severe COVID-19, due to “immune dysregulation, such as differences in T cell function,” says lead author Ashley Kieran Clift, MA, MBBS, clinical researcher at the University of Oxford, Oxford, United Kingdom. “People with Down syndrome have a higher risk of developing pneumonia and viral respiratory infections, which may also occur with the novel coronavirus. They have high rates of other conditions that may make them more susceptible, such as heart and lung disease. There could also be a role for their environment, such as living in a nursing home or other institution. “

Researchers analyzed data from a UK government-sponsored cohort study of 8.26 million adults over the age of 19. The data includes information on the results of the COVID-19 test; hospitalization and associated death records; whether a person also has Down syndrome or not; and information on age, gender, ethnicity, alcohol intake, smoking status, body mass index (BMI), comorbidities, and medication.

That group includes 4,053 people with Down syndrome. Of these, during the study period, from January 24 to June 30 2020, 68 died ―39.7% from COVID-19, 25.0% from pneumonia or pneumonitis, and 35.3% from other causes. In contrast, among 8,252,105 people who did not suffer from Down syndrome, 41,685 died; The cause of death was recorded as COVID-19 by 20.3%, pneumonia or pneumonitis by 14.4%, and other causes by 65.3%.

The hazard ratio (HR) for COVID-19-related deaths was 10.39 (CI, 7.08 – 15.23) and for hospitalizations, 4.94 (CI, 3.63 – 6.73) after adjusting for age, type gender, ethnicity, BMI, diagnosis of dementia, stay in nursing homes, congenital heart disease, and other comorbidities and treatments. For individuals with a learning disability but not Down’s syndrome, the adjusted HR for COVID-19-related death was only 1.27 (CI, 1.16 – 1.40).

Correspondent author Julia Hippisley-Cox, MD, professor of clinical epidemiology and general practice, St. Anne’s College, University of Oxford, said that although this study was observational and did not identify reasons for the increased risk, “we feel that physicians, policymakers, and other healthcare workers should be aware of the potential risk. These findings can be used by healthcare workers in the context of factors. others to get a more nuanced risk assessment for their patients. “

It may require weighing the relative risks and benefits of protective measures against infection vs. the values ​​of outreach in child care and physical and occupational therapy programs. It’s a balancing act, says Hippisley-Cox.

Preston McCormack, MD, assistant professor of internal medicine and pediatrics at the University of Arkansas for the School of Medicine, Little Rock, Arkansas, agrees that caution is needed in navigating care during this difficult time.

“It is well known that Down syndrome patients are at increased risk. However, with these data emerging, it may be a good time to reassess how we plan to move forward,” McCormack said. “The risks, even after adjusting for age, sex, and associated comorbidities, remain impressive and demand attention as we approach another viral season this fall and the winter to come.

“The fact that a large part of this population requires more frequent medical follow-up, therapy, and other additional services adds to this risk,” he continued. “The decision to limit patients from service providers will likely have to be made on an individual basis, although it is imperative that we are kept informed about the risks vs benefits of this decision. Without a doubt, we cannot optimize therapy and outreach in this pandemic landscape. this is offset by the minimization of the significant risk measured in this current study. “

Ann Intern Med. Published online October 21, 2020. Abstract

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