Non-vaccine-related papers

Omicron

A news article in Science stressed the need for patience about understanding the impacts of the Omicron variant. Critical lab tests may take several weeks to determine the extent to which it can evade immune responses in vaccinated and unvaccinated people. Similarly, determining how infectious it is and the symptoms it causes will take a while.

However, analysis of infections in South Africa indicates that, unlike the Beta and Delta variants, the Omicron variant is able to evade immune responses generated by prior infections. The impact of vaccination has yet to be studied. The paper has not yet been peer reviewed.

Another news article in Science discusses the hypotheses of the Omicron variant’s origin. While evolution within immunosuppressed people is currently the most favoured origin, further evidence is required. Others have proposed the variant may have developed over many months in undetected infections in communities, or that it is derived from an animal reservoir.

More data on the effectiveness of Covid pills

Pfizer’s Covid pill appears to be as effective against viral variants as against the wildtype virus, at least in lab tests. The paper notes that the virus may be able to develop resistance to the drug, as has been seen for a protease inhibitor used on HIV, but such drugs have proven to be very effective antiviral therapies. The paper has not yet been peer reviewed.

Merck’s molnupiravir Covid pill is not as effective as interim results reported in October (see 8 October Tracker). Data provided to the FDA indicate a 30% relative decrease in hospitalisations for those at highest risk, compared with 50% in the interim data. The final results indicate only a 3% absolute change in hospitalisation risk if given the drug. The reason for this is not clear. Derek Lowe discusses this in his blog for Science.

Nanoviricide shows promise

A polymer-based capsule, called a nanoviricide, for drugs can both protect the drugs from degradation in plasma as well as having its own antiviral activity. The nanoviricide is designed to be a decoy, presenting binding sites for a range of coronaviruses, so can reduce infections of human cells.

The nanoviricide containing Remdesivir was tested on rats and found to be safe and improved survival of animals infected with SARS-CoV-2. Further testing of the nanoviricide on animals and cell cultures is underway. The paper has not yet been peer reviewed.

Dysregulated immune response linked with severe outcomes

A review notes that for human coronaviruses severe disease is associated with dysregulated host immune responses and active viral interference. It highlights the complex interactions between the host and virus, and the different immune system pathways involved. The paper was published in Nature Reviews Immunology.

Severe Covid associated with higher mortality a year later

Analysis of hospital records in Florida found that those who previously had severe Covid-19 were at greater risk of dying over the next year. For those hospitalised with Covid-19 their Hazard Ratio for dying of any cause in the next 12 months was 2.5 times higher than those who were not infected, and 1.87 times higher than those who had mild symptoms. The paper was published in Frontiers in Medicine.

Some cases of Long Covid may be related to chronic fatigue syndrome

Dysfunctional breathing may be an underlying cause of long Covid for many. Tests of 41 people with Covid symptoms lasting over 3 months found 88% had abnormal breathing patterns. In 19 patients the patterns were the same as for those who have myalgic encephalomyelitis or chronic fatigue syndrome, suggesting a common cause. The paper was published in JACC: Heart Failure, although only the abstract is free to view.

Randomised trial tests safety of a large indoor concert

A French randomised trial found that risks of transmission can be low in large indoor events if good prevention processes are in place. For a live concert those registering interest in attending were randomly allocated entry or not. The individuals then self-tested for infection a week later. Incidence of infections in both groups was the same, and low.

Potential attendees had to meet a range of criteria, and attendees had to wear N95 masks at the well ventilated event. Rapid antigen testing at the concert proved to be logistically challenging, and the authors note that some of the measures they used are likely to be impractical at other large events. The paper was published in The Lancet Infectious Diseases.

Impacts of the pandemic on New Zealand GPs

A survey of NZ general practices found that in the 2020 lockdown some practices had dramatic reductions in the number of people making appointments. Some patients appeared to minimise or tolerate symptoms, due to the belief the clinics would be too busy, or they were concerned about becoming infected during a visit. Cancer patients and those with cardiovascular conditions were among those delaying visits.

The study notes that the lockdown helped practices identify how they could make changes to better meet the needs of patients and not overburden practice staff. The paper was published in the New Zealand Medical Journal.

Sensitivity of rapid antigen tests

A New Zealand study confirms the lower sensitivity of several rapid antigen and nucleic acid amplification tests, compared with PCR tests.

The nucleic acid tests were more sensitive than the rapid antigen tests. Rapid tests tend to perform better when viral loads are high.

With the current low levels of infection in NZ none of the rapid tests are suitable for stand alone diagnostic use. They can be used to complement PCR testing, and are likely to be more useful if infection levels increase. The paper was published in the New Zealand Medical Journal.

A Global Health Threats Council

A summary of the recommendations from the Independent Panel for Pandemic Preparedness and Response was published in The BMJ. The Panel, co-chaired by former NZ PM Helen Clark, published its report in May.

A key recommendation, and one made after the 2013/14 Ebola outbreak, is the establishment of a Global Health Threats Council. Council members would include heads of state, business leaders, and civil society organisations.

The panel also recommended establishing a new international pandemic financing facility, which would raise additional reliable financing for preparedness and for surge funding. It also recommends strengthening the authority and independence of the WHO.

A news article in Nature discusses progress in developing a pandemic pact in how to prevent and respond to future pandemics.

Identifying infections with smart watches & fitness trackers

A smartwatch application that detects unusual heart rate and step patterns detected 80% of pre-symptomatic and asymptomatic cases. Pre-symptomatic signs were detected about three days before symptoms developed.

Other conditions not related to SARS-CoV-2 can also trigger alerts, so the system doesn’t provide an infallible early warning of infection. However, the authors suggest that individuals will probably be able to identify the causes of these, so detection of infection may still be high.

Further developments of the algorithm may allow it to be used to screen millions of people in real-time and detect a significant proportion of infections in their early stages. The study involved over 3,000 participants, 84 of whom became infected. The paper was published in Nature Medicine.

Wastewater monitoring - more data sharing desirable

A review of the uses of wastewater monitoring globally during the pandemic concludes that monitoring results are often underutilised because data is not widely shared or accessible. Monitoring sites are also not evenly distributed within or between countries, so national and global overviews are not possible. The authors advocate for better data sharing and coordination of such monitoring. The paper has not yet been peer reviewed.

‍

Source: https://smcnz.substack.com/p/coronavirus-research-tracking-3-december-14d