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Covid-19 Mortality: A Matter of Vulnerability Among Nations Facing Limited Margins of Adaptation – Frontiers in Public Health

Results: Higher Covid death rates are observed in the [25/65°] latitude and in the [−35/−125°] longitude ranges. The national criteria most associated with death rate are life expectancy and its slowdown, public health context (metabolic and non-communicable diseases (NCD) burden vs. infectious diseases prevalence), economy (growth national product, financial support), and environment (temperature, ultra-violet index). Stringency of the measures settled to fight pandemia, including lockdown, did not appear to be linked with death rate.

Conclusion: Countries that already experienced a stagnation or regression of life expectancy, with high income and NCD rates, had the highest price to pay. This burden was not alleviated by more stringent public decisions. Inherent factors have predetermined the Covid-19 mortality: understanding them may improve prevention strategies by increasing population resilience through better physical fitness and immunity.

https://www.frontiersin.org/articles/10.3389/fpubh.2020.604339/full

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Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers – Annals of Internal Medicine

The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use. The data were compatible with lesser degrees of self-protection.

https://www.acpjournals.org/doi/10.7326/M20-6817

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What the data say about asymptomatic COVID infections – Nature

Now, evidence suggests that about one in five infected people will experience no symptoms, and they will transmit the virus to significantly fewer people than someone with symptoms. But researchers are divided about whether asymptomatic infections are acting as a ‘silent driver’ of the pandemic.

https://web.archive.org/web/20201118211843/https://www.nature.com/articles/d41586-020-03141-3

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Mass testing for covid-19 in the UK – BMJ

Spending the equivalent of 77% of the NHS annual revenue budget on an unevaluated underdesigned national programme leading to a regressive, insufficiently supported intervention—in many cases for the wrong people—cannot be defended.

https://www.bmj.com/content/371/bmj.m4436

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Covid-19 vaccine candidate is unimpressive: NNTV is around 256 – BMJ

Pfizer’s vaccine “may be more than 90% effective.” (Mahase, BMJ 2020;371:m4347, November 9) Specific data are not given but it is easy enough to approximate the numbers involved, based on the 94 cases in a trial that has enrolled about 40,000 subjects: 8 cases in a vaccine group of 20,000 and 86 cases in a placebo group of 20,000. This yields a Covid-19 attack rate of 0.0004 in the vaccine group and 0.0043 in the placebo group. Relative risk (RR) for vaccination = 0.093, which translates into a “vaccine effectiveness” of 90.7% [100(1-0.093)]. This sounds impressive, but the absolute risk reduction for an individual is only about 0.4% (0.0043-0.0004=0.0039). The Number Needed To Vaccinate (NNTV) = 256 (1/0.0039), which means that to prevent just 1 Covid-19 case 256 individuals must get the vaccine; the other 255 individuals derive no benefit, but are subject to vaccine adverse effects, whatever they may be and whenever we learn about them……We’ve already heard that an early effect of the vaccine is “like a hangover or the flu.” Will vaccinees who are later exposed to coronaviruses have more severe illness as a result of antibody-dependent enhancement of infection (ADEI), a known hazard of coronavirus vaccines? Is there squalene in the Pfizer vaccine? If so, will vaccinees be subject to autoimmune diseases, like Gulf War Syndrome and narcolepsy that have been associated with the adjuvant?

https://www.bmj.com/content/371/bmj.m4347/rr-4

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Opinion Publications

Covid-19: politicisation, “corruption,” and suppression of science – BMJ

Politicians and governments are suppressing science. They do so in the public interest, they say, to accelerate availability of diagnostics and treatments. They do so to support innovation, to bring products to market at unprecedented speed. Both of these reasons are partly plausible; the greatest deceptions are founded in a grain of truth. But the underlying behaviour is troubling.

Politicians and governments are suppressing science. They do so in the public interest, they say, to accelerate availability of diagnostics and treatments. They do so to support innovation, to bring products to market at unprecedented speed. Both of these reasons are partly plausible; the greatest deceptions are founded in a grain of truth. But the underlying behaviour is troubling.

Politicians and governments are suppressing science. They do so in the public interest, they say, to accelerate availability of diagnostics and treatments. They do so to support innovation, to bring products to market at unprecedented speed. Both of these reasons are partly plausible; the greatest deceptions are founded in a grain of truth. But the underlying behaviour is troubling.

The UK’s pandemic response provides at least four examples of suppression of science or scientists. First, the membership, research, and deliberations of the Scientific Advisory Group for Emergencies (SAGE) were initially secret until a press leak forced transparency.2 The leak revealed inappropriate involvement of government advisers in SAGE, while exposing under-representation from public health, clinical care, women, and ethnic minorities. Indeed, the government was also recently ordered to release a 2016 report on deficiencies in pandemic preparedness, Operation Cygnus, following a verdict from the Information Commissioner’s Office.

https://www.bmj.com/content/371/bmj.m4425

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Opinion Publications

When good science is suppressed by the medical-political complex, people die – BMJ

The UK’s pandemic response relies too heavily on scientists and other government appointees with worrying competing interests, including shareholdings in companies that manufacture covid-19 diagnostic tests, treatments, and vaccines. Government appointees are able to ignore or cherry pick science—another form of misuse—and indulge in anti-competitive practices that favour their own products and those of friends and associates.

https://www.bmj.com/content/371/bmj.m4425

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The impact of cold on the respiratory tract and its consequences to respiratory health – NCBI (2018)

Published online 2018 May 30

In particular, if indoor exposure occurs quickly and without any gradual adaptation to a temperature 2°–3° lower than the external temperature and especially with a 5° difference (avoiding indoor temperature below 24°) and an humidity between 40 and 60%, there is a risk of negative consequences on the respiratory tract and the patient risks to be in a clinical condition characterized by an exacerbation of the respiratory symptoms of his chronic respiratory disease (asthma and COPD) within a few hours or days. Surprisingly, these effects of cold climate remain out of the focus of the media unless spells of unusually cold weather sweep through a local area or unstable weather conditions associated with extremely cold periods of increasing frequency and duration.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031196/

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SARS-CoV-2 Transmission among Marine Recruits during Quarantine – New England Journal of Medicine

Among Marine Corps recruits, approximately 2% who had previously had negative results for SARS-CoV-2 at the beginning of supervised quarantine, and less than 2% of recruits with unknown previous status, tested positive by day 14. Most recruits who tested positive were asymptomatic, and no infections were detected through daily symptom monitoring. Transmission clusters occurred within platoons. 

https://www.nejm.org/doi/full/10.1056/NEJMoa2029717

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Covid-19: GPs to get £12.58 per dose to deliver vaccine from December – BMJ

Practices will be paid £12.58 (€14.15; $16.69) per vaccination. This is 25% more than the current £10.06 practices receive for an influenza vaccination, in recognition of the need for extra training, post-vaccine observation, and other associated costs. Practices will need to provide most of the required staff from their own workforce.

https://www.bmj.com/content/371/bmj.m4354

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Harms of public health interventions against covid-19 must not be ignored – BMJ

The harmful consequences of public health choices should be explicitly considered and transparently reported to limit their damage, say Itai Bavli and colleagues

The SARS-CoV-2 pandemic has posed an unprecedented challenge for governments. Questions regarding the most effective interventions to reduce the spread of the virus—for example, more testing, requirements to wear face masks, and stricter and longer lockdowns—become widely discussed in the popular and scientific press, informed largely by models that aimed to predict the health benefits of proposed interventions. Central to all these studies is recognition that inaction, or delayed action, will put millions of people unnecessarily at risk of serious illness or death.

However, interventions to limit the spread of the coronavirus also carry negative health effects, which have yet to be considered systematically. Despite increasing evidence on the unintended, adverse effects of public health interventions such as social distancing and lockdown measures, there are few signs that policy decisions are being informed by a serious assessment and weighing of their harms on health. Instead, much of the discussion has become politicised, especially in the US, where President Trump’s provocative statements sparked debates along party lines about the necessity for policies to control covid-19. This politicisation, often fuelled by misinformation, has distracted from a much needed dispassionate discussion on the harms and benefits of potential public health measures against covid-19.

https://www.bmj.com/content/371/bmj.m4074

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Researchers engineer tiny machines that deliver medicine efficiently – Science Daily

Inspired by a parasitic worm that digs its sharp teeth into its host’s intestines, Johns Hopkins researchers have designed tiny, star-shaped microdevices that can latch onto intestinal mucosa and release drugs into the body.

https://www.sciencedaily.com/releases/2020/11/201103132738.htm

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Study to Describe the Safety, Tolerability, Immunogenicity, and Efficacy of RNA Vaccine Candidates Against COVID-19 in Healthy Individuals – NIH

Actual Study Start Date :April 29, 2020
Estimated Primary Completion Date :June 13, 2021
Estimated Study Completion Date :December 11, 2022

https://www.clinicaltrials.gov/ct2/show/NCT04368728?term=Pfizer&cond=SARS-cov-2&draw=2&rank=1

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COVID-19 outpatients: early risk-stratified treatment with zinc plus low-dose hydroxychloroquine and azithromycin: a retrospective case series study – PubMed

The aim of this study was to describe the outcomes of patients with coronavirus disease 2019 (COVID-19) in the outpatient setting after early treatment with zinc, low-dose hydroxychloroquine and azithromycin (triple therapy) dependent on risk stratification. This was a retrospective case series study in the general practice setting. A total of 141 COVID-19 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the year 2020 were included. The main outcome measures were risk-stratified treatment decision and rates of hospitalisation and all-cause death. A median of 4 days [interquartile range (IQR) 3-6 days; available for n = 66/141 patients] after the onset of symptoms, 141 patients (median age 58 years, IQR 40-67 years; 73.0% male) received a prescription for triple therapy for 5 days. Independent public reference data from 377 confirmed COVID-19 patients in the same community were used as untreated controls. Of 141 treated patients, 4 (2.8%) were hospitalised, which was significantly fewer (P < 0.001) compared with 58 (15.4%) of 377 untreated patients [odds ratio (OR) = 0.16, 95% confidence interval (CI) 0.06-0.5]. One patient (0.7%) in the treatment group died versus 13 patients (3.4%) in the untreated group (OR = 0.2, 95% CI 0.03-1.5; P = 0.12). No cardiac side effects were observed. Risk stratification-based treatment of COVID-19 outpatients as early as possible after symptom onset using triple therapy, including the combination of zinc with low-dose hydroxychloroquine, was associated with significantly fewer hospitalisations.

https://pubmed.ncbi.nlm.nih.gov/33122096/

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MHRA urgently seeks software tool to process the expected high volume of Covid-19 vaccine Adverse Drug Reaction – Tenders Electronic Daily

TED (Tenders Electronic Daily) is the online version of the ‘Supplement to the Official Journal’ of the EU, dedicated to European public procurement.

The MHRA urgently seeks an Artificial Intelligence (AI) software tool to process the expected high volume of Covid-19 vaccine Adverse Drug Reaction (ADRs) and ensure that no details from the ADRs’ reaction text are missed.

https://ted.europa.eu/udl?uri=TED:NOTICE:506291-2020:TEXT:EN:HTML&tabId=1

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The engines of SARS-CoV-2 spread – Science Magazine

The engines of the SARS-CoV-2 pandemic—household and residential settings, community, and long-distance transmission—have important implications for control. Moving from international to household scales, the burdens of interventions are shared by more people; there are few international travelers, but nearly everyone lives in households and communities. Measures to reduce household spread may appear particularly challenging, but because they directly affect so many, they need not be perfect. Household mask use and partitioning of home spaces, isolation or quarantine outside the home, and, in the future, household provision of preventive drugs could have large effects even if they offer only modest protection. Conversely, control measures at larger spatial scales (for example, interregional) must be widely implemented and highly effective to contain the virus. Indeed, few nations have managed to curb infection without stay-at-home orders and business closures, particularly after community transmission is prevalent.

https://science.sciencemag.org/content/370/6515/406.full

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Will covid-19 vaccines save lives? Current trials aren’t designed to tell us – BMJ

The world has bet the farm on vaccines as the solution to the pandemic, but the trials are not focused on answering the questions many might assume they are.

…But the truth is that the science remains far from clear cut, even for influenza vaccines that have been used for decades. Although randomised trials have shown an effect in reducing the risk of symptomatic influenza, such trials have never been conducted in elderly people living in the community to see whether they save lives.

Only two placebo controlled trials in this population have ever been conducted, and neither was designed to detect any difference in hospital admissions or deaths. Moreover, dramatic increases in use of influenza vaccines has not been associated with a decline in mortality 

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Covid-19’s known unknowns – BMJ

When deciding whom to listen to in the covid-19 era, we should respect those who respect uncertainty, and listen in particular to those who acknowledge conflicting evidence on even their most strongly held views. Commentators who are utterly consistent, and see whatever new data or situation emerge through the lens of their pre-existing views—be it “Let it rip” or “Zero covid now”—would fail this test.

https://www.bmj.com/content/371/bmj.m3979

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Could certain COVID-19 vaccines leave people more vulnerable to the AIDS virus? – Science

Certain COVID-19 vaccine candidates could increase susceptibility to HIV, warns a group of researchers who in 2007 learned that an experimental HIV vaccine had raised in some people the risk for infection with the AIDS virus. These concerns have percolated in the background of the race for a vaccine to stem the coronavirus pandemic, but now the researchers have gone public with a “cautionary tale,” in part because trials of those candidates may soon begin in locales that have pronounced HIV epidemics, such as South Africa.

Some approved and experimental vaccines have as a backbone a variety of adenoviruses, which can cause the common cold but are often harmless. The ill-fated HIV vaccine trial used an engineered strain known as adenovirus 5 (Ad5) to shuttle into the body the gene for the surface protein of the AIDS virus. In four candidate COVID-19 vaccines now in clinical trials in several countries, including the United States, Ad5 similarly serves as the “vector” to carry in the surface protein gene of SARS-CoV-2, the viral cause of the pandemic; two of these have advanced to large-scale, phase III efficacy studies in Russia and Pakistan.

In today’s issue of The Lancet, four veteran researchers raise a warning flag about those COVID-19 vaccine candidates by recounting their experience running a placebo-controlled AIDS vaccine trial dubbed STEP. An interim analysis of STEP found that uncircumcised men who had been naturally infected with Ad5 before receiving the vaccine became especially vulnerable to the AIDS virus. The vaccine, made by Merck, had been the leading hope for what was then a 20-year search for a shot that could thwart HIV. But after the STEP results appeared, the field went into a tailspin. “It took a decade to recover,” says one of the co-authors of the Lancet correspondence, Lawrence Corey of the Fred Hutchinson Cancer Research Center.

Lancet study: Use of adenovirus type-5 vectored vaccines: a cautionary tale

http://archive.today/2021.10.21-144428/https://www.science.org/content/article/could-certain-covid-19-vaccines-leave-people-more-vulnerable-aids-virus

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Infection fatality rate of COVID-19 inferred from seroprevalence data – Prof. Ioannidis, WHO

Results
I included 61 studies (74 estimates) and eight preliminary national estimates. Seroprevalence estimates ranged from 0.02% to 53.40%. Infection fatality rates ranged from 0.00% to 1.63%, corrected values from 0.00% to 1.54%. Across 51 locations, the median COVID-19 infection fatality rate was 0.27% (corrected 0.23%): the rate was 0.09% in locations with COVID-19 population mortality rates less than the global average (< 118 deaths/million), 0.20% in locations with 118–500 COVID-19 deaths/million people and 0.57% in locations with > 500 COVID-19 deaths/million people. In people < 70 years, infection fatality rates ranged from 0.00% to 0.31% with crude and corrected medians of 0.05%.

Conclusion
The infection fatality rate of COVID-19 can vary substantially across different locations and this may reflect differences in population age structure and case-mix of infected and deceased patients and other factors. The inferred infection fatality rates tended to be much lower than estimates made earlier in the pandemic.

https://www.who.int/bulletin/online_first/BLT.20.265892.pdf