Day: December 9, 2021

Health officials in the United States, Israel and other nations have for months been pushing for COVID-19 booster shots among older populations, and those calls are now growing worldwide.  The issue was discussed at an extraordinary meeting at World Health Organization in Geneva convened by SAGE, the 15-member Strategic Advisory Group of Experts on vaccination.

Current data show that vaccines against COVID-19 provide a robust level of protection against severe forms of disease. However, emerging evidence indicates vaccines begin to lose their effectiveness about six months after they have been administered. This puts older adults and people with underlying conditions at particular risk. 

Chair of SAGE, Alejandro Cravioto, says the group of experts agrees a booster shot would provide a greater level of protection for people at risk.  However, he notes vaccines are in short supply in many parts of the world.  He says the wide administration of booster doses risks exacerbating inequities in vaccine access.

He notes most current infections are among unvaccinated people, the majority of whom live in poor, developing countries.  He says SAGE believes they should receive these life-saving vaccines instead of further doses being provided to people who already are fully inoculated against the coronavirus.

“For the time being, we continue to support — one, the need for equity in the distribution and allocation of vaccines and, two, the use of third doses only on those that we have previously recommended.  Those that have received inactivated vaccines and those that are immuno-compromised, which are the two groups that we feel should be protected further by a third dose of the primary process,” he said.  

Cravioto said meeting participants also discussed the feasibility of mixing and matching different vaccines, such as those developed by Pfizer and Moderna to achieve full immunity against COVID.

“WHO supports a flexible approach to homologous or a single platform versus a heterologous mix and match schedules. We still believe that the best approach is to use the same vaccine for the two primary doses,” Cravioto said.

For national immunization programs, however, he said a different vaccine can be used for an additional third dose.  This, if the vaccine used for the two primary shots is in short supply and unavailable. 
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As cases of COVID-19 caused by the omicron variant soar in South Africa, hospital officials monitoring the outbreak say patient reports offer compelling evidence the variant causes illness that is less severe than previous forms of the disease.

“Most of the people we’re seeing are having mild or moderate form of COVID-19, and not the severe form that requires hospitalization and may lead to death,” said Dr. Richard Friedland, the chief executive of Netcare, one of South Africa’s largest private hospital groups, based in Johannesburg.

“Patients present with mild to moderate flu-like symptoms, a scratchy or sore throat, a headache, or a runny or blocked nose,” he said.  

Similar symptoms are being reported nationwide as hospitals monitor patients.

World health authorities caution that the patient information is preliminary, and they say it is not known how omicron will behave as it spreads more widely.

The World Health Organization says the variant has been found in more than 50 countries. Anecdotal information from countries including the United States so far indicates less severe symptoms than exhibited in previous variants, echoing findings in South Africa hospitals.

“We certainly have information from South Africa that many of the patients that are identified with omicron have a milder course of disease, but it does take time for people to go through the full course of their infection,” said Maria Van Kerkhove, WHO’s technical lead for COVID-19.

South Africa’s National Institute for Communicable Diseases reported 20,000 new COVID-19 cases and 36 COVID-19 related deaths Wednesday, the highest numbers since the omicron variant was first detected. 

NetCare’s Dr. Friedland said the company’s hospitals are seeing far fewer admissions, however, than in the nation’s earlier phases of COVID-19 and most patients are not suffering enough to need oxygen.

“Ninety percent of the patients we have in the hospital now need no oxygen at all,” he said. “They’re on room air. All they have is mild upper respiratory tract infections.

“So, it’s a very, very different clinical picture,” he said. “That contrasts to 100% of patients that we admitted during the first, the second and the third wave, who were very sick, and all required oxygen therapy.”

Most omicron-positive people in NetCare’s hospitals are what Friedland called “incidental” COVID-19 patients, who come to the hospital because of other emergencies, or to have a surgical procedure, and are subsequently diagnosed with coronavirus.

Roughly 75% of people in NetCare hospitals diagnosed with COVID-19 are unvaccinated, Dr. Friedland said. He added that patient admission data appears to be “clear evidence” that current vaccines offer some protection against omicron.

Some 36% of South Africans are fully vaccinated and the government is strongly urging citizens to get the shots.

Some information in this report came from Reuters. 
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Pakistan has detected its first case of the omicron variant of the coronavirus.

Official said Thursday the infection was found in a 57-year-old unvaccinated woman in Karachi, the country’s largest city and capital of the southern Sindh province.

Local media reported the patient, who was isolating at home after being discharged from the hospital a day earlier, did not have a travel history and contact tracing was under way.

“We have not yet concluded the genomic study of the patient’s sample but the way the virus is behaving, it seems like it is omicron,” provincial Health Minister Azra Fazal Pechuno said in a video statement.

Pechuno said people need not panic and urged them to get fully vaccinated against the coronavirus.

“Omicron is highly transmissible, but deaths or serious illnesses have not been seen in reports from South Africa,” where the variant was first detected, she added.

Late last month, Pakistan placed a complete ban on travel from six African countries, including South Africa, Lesotho, Eswatini — formerly known as Swaziland, Mozambique, Botswana and Namibia, and Hong Kong after the discovery of omicron.

Authorities later extended the ban to nine more countries, including Croatia, Hungary, Netherlands, Ukraine, Ireland, Slovenia, Vietnam, Poland and Zimbabwe, and tightened monitoring of passengers arriving from several other nations.

Pakistan, a country of about 220 million people, has reported close to 1.3 million coronavirus cases, including more than 28,800 deaths.

As of Thursday, officials said more than 24% of the total population and 35% of the eligible population had been vaccinated against the pandemic.

 
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New Zealand’s government believes it has come up with a unique plan to end tobacco smoking — a lifetime ban for those 14 or younger.

Under a new law the government announced Thursday and plans to pass next year, the minimum age to buy cigarettes would keep rising year after year.

That means, in theory at least, 65 years after the law takes effect, shoppers could still buy cigarettes — but only if they could prove they were at least 80 years old.

In practice, officials hope smoking will fade away decades before then. Indeed, the plan sets a goal of having fewer than 5% of New Zealanders smoking by 2025.

Other parts of the plan include allowing only the sale of tobacco products with very low nicotine levels and slashing the number of stores that can sell them. The changes would be brought in over time to help retailers adjust.

Because the current minimum age to buy cigarettes in New Zealand is 18, the lifetime smoking ban for youth wouldn’t have an impact for a few years.

In an interview with The Associated Press, New Zealand’s Associate Health Minister Dr. Ayesha Verrall, who is spearheading the plan, said her work at a public hospital in Wellington involved telling several smokers they had developed cancer.

“You meet, every day, someone facing the misery caused by tobacco,” Verrall said. ”The most horrible ways people die. Being short of breath, caused by tobacco.”

Smoking rates have steadily fallen in New Zealand for years, with only about 11% of adults now smoking and 9% smoking every day. The daily rate among Indigenous Maori remains much higher at 22%. Under the government’s plan, a task force would be created to help reduce smoking among Maori.

Big tax increases have already been imposed on cigarettes in recent years and some question why they aren’t hiked even higher.

“We don’t think tax increases will have any further impact,” Verrall said. “It’s really hard to quit and we feel if we did that, we’d be punishing those people who are addicted to cigarettes even more.”

And she said the tax measures tend to place a higher burden on lower-income people, who are more likely to smoke.

The new law wouldn’t impact vaping. Verrall said that tobacco smoking is far more harmful and remains a leading cause of preventable deaths in New Zealand, killing up to 5,000 people each year.

“We think vaping’s a really appropriate quit tool,” she said.

The sale of vaping products is already restricted to those 18 and over in New Zealand and vaping is banned in schools. Verrall said there was some evidence of a rise in youth vaping, a trend she is following “really closely.”

New Zealand’s approach to ban the next generation from tobacco smoking hasn’t been tried elsewhere, she said.

But she said studies have shown youth sales decrease when minimum ages are raised. In the U.S., the federal minimum age to buy tobacco products was raised from 18 to 21 two years ago.

While public health experts have generally welcomed the New Zealand plan, not everybody is happy.

Sunny Kaushal said some stores could be put out of business. Kaushal chairs the Dairy and Business Owners Group, which represents nearly 5,000 corner stores — often called dairies in New Zealand — and gas stations.

“We all want a smoke-free New Zealand,” he said. “But this is going to hugely impact small businesses. It should not be done so it is destroying dairies, lives and families in the process. It’s not the way.”

Kaushal said the tax increases on tobacco had already created a black market that was being exploited by gangs, and the problem would only get worse. He said smoking was already in its twilight in New Zealand and would die away of its own accord.

“This is being driven by academics,” he said, adding that stakeholders hadn’t been consulted.

But Verrall said she didn’t believe the government was overreaching because statistics showed the vast majority of smokers wanted to quit anyway, and the new policies would only help them achieve their goal.

She said the pandemic had helped people gain a new appreciation for the benefits of public health measures and rallying communities, and that perhaps that energy could be harnessed not only to tackle smoking but also diseases like diabetes.

 
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U.S. health authorities on Wednesday authorized the use of synthetic antibodies developed by AstraZeneca to prevent COVID-19 infections in people who react badly to vaccines.

It was the first time the Food and Drug Administration has given emergency authorization for such a purely preventative treatment.

The FDA warned the drug Evusheld is “not a substitute for vaccination in individuals for whom COVID-19 vaccination is recommended” and can only be authorized for people with weakened immune systems or those who cannot be vaccinated for medical reasons, such a strong allergic reaction.

In those cases, the drug can be administered to people 12 and older.

Evusheld combines two types of synthetic antibodies (tixagevimab and cilgavimab), and is given as two intramuscular injections, one right after the other. These antibodies help the immune system fight off the virus by targeting its spike protein, which allows it to enter cells and infect them.

The FDA said that the treatment “may be effective for pre-exposure prevention for six months.”

It cannot be administered to someone who is already infected with the virus, the FDA said, although AstraZeneca is testing it for such treatment.

Side effects may include an allergic reaction, bleeding from the injection site, headache, and fatigue.

The FDA authorization was based on a clinical trial carried out on unvaccinated people older than 59, or with a chronic disease, or at high risk of infection.

The drug was given to 3,500 people while 1,700 received a placebo. The trial showed that the treatment cut the risk of developing COVID-19 by 77%.

Two cocktails of antibodies, made by Regeneron and Eli Lilly, are currently authorized for prevention of infection in the United States, but only in people who have been exposed to the virus shortly before, or who have a strong chance of being exposed, such as employees of retirement homes or prisons.

In addition to being immunocompromised or unvaccinated, these people must also be at high risk of developing a severe case of the disease. 
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The Senate narrowly approved a resolution Wednesday to nullify the Biden administration’s requirement that businesses with 100 or more workers have their employees be vaccinated against the coronavirus or submit to weekly testing.

The vote was 52-48. The measure now goes to the Democratic-led House, which is unlikely to take up the measure, which means the mandate would stand, though courts have put it on hold for now. Still, the vote gave senators a chance to voice opposition to a policy that they say has sparked fears back home from businesses and from unvaccinated constituents who worry about losing their jobs should the rule go into effect.

“Every so often Washington, D.C., does something that lights up the phone lines. This is one of these moments,” said Sen. Steve Daines, a Montana Republican. At home, he said, “this issue is what I hear about. This issue is a top-of-mind issue.”

Lawmakers can invalidate certain federal agency regulations if a joint resolution is approved by both houses of Congress and signed by the president, or if Congress overrides a presidential veto. That’s unlikely to happen in this case.

Under the rule, private-sector companies with 100 or more workers must require their employees to be fully vaccinated against COVID-19 or be tested for the virus weekly and wear masks on the job. The Occupational Safety and Health Administration said it would work with companies on compliance but would fine them up to more than $13,000 for each violation, though implementation and enforcement is suspended as the litigation unfolds.

Senate Majority Leader Chuck Schumer said Americans who have refused to get vaccinated are the biggest impediment to ending the pandemic. He implied that some of the resistance to mandated vaccines is based on politics.

Schumer said social media has played a role in spreading falsehoods about the vaccine, and “so has the far right.” He urged senators to vote against the resolution, sponsored by Sen. Mike Braun, R-Ind.

Republicans said they are supportive of the vaccine, but that the mandate amounts to government overreach.

“His mandates are under fire in the courts. Main Street job creators are complaining against it, and tonight, the U.S. Senate must send a clear message: back off this bad idea,” Braun said.

In the end, two Democratic lawmakers voted with 50 Republicans to void the mandate, Sens. Joe Manchin of West Virginia and Jon Tester of Montana. Manchin had said in a tweet that he does not support any federal vaccine mandate for private businesses. Tester’s office said his opposition is based on conversations with Montana businesses who “expressed deep concerns about the negative effect on their bottom lines and our state’s economy during this fragile recovery period.”

Sen. Patty Murray, D-Wash., sided with the Biden administration, noting that the pandemic is still raging and that deaths are overwhelmingly among the unvaccinated.

“How on earth does it make sense right now to undercut one of the strongest tools that we have to get people vaccinated and stop this virus?” Murray said. “In what world is that a good idea?” 
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