Since March 2020, TCTMD reporters and editors have been keeping tabs on breaking research and policy news–our COVID-19 Dispatch is now updated three days a week. If you have something to share, tell us. Our in-depth coverage of COVID-19 and the heart can be found on our COVID-19 Hub.

February 16, 2022

COVID-19 case numbers continue to fall across the United States, including in the pediatric population, CIDRAP News reports. Last week, there were about 300,000 pediatric cases reported, far below the peak of 1.15 million in the week ending January 20, although that number remains higher than the peak of the Delta surge. Many states have dropped their mask mandates and have started to plan for the end of COVID-19, with Stateline describing their exit strategies.

The pandemic has resulted in over 1 million excess deaths among Americans, according to US Centers for Disease Control and Prevention (CDC) numbers, mostly from the virus itself but also from exacerbated conditions like heart disease, hypertension, and dementia (Washington Post).

Though the Omicron wave is receding in the US, other parts of the world continue to battle high numbers of infections. In Asia, the Associated Press reports, China’s leader Xi Jinping is urging Hong Kong officials to get control of a surge in cases, and South Korea will hand out free rapid tests at schools and senior care facilities starting next week amid an Omicron-driven wave of infections. And the European office of the World Health Organization (WHO) warned of growing rates of COVID-19 in eastern Europe, where cases have doubled over the last 2 weeks in six countries—Armenia, Azerbaijan, Belarus, Georgia, Russia, and Ukraine.

Estrogen supplementation in postmenopausal women is associated with a lower risk of dying from COVID-19, according to a study in BMJ Open. The absolute risk of death was 2.1% in women receiving hormone replacement therapy and 4.6% in a control group (OR 0.47; 95% CI 0.34 to 0.63). “Consequently, drugs increasing estrogen levels may have a role in therapeutic efforts to alleviate COVID-19 severity in postmenopausal women and could be studied in randomized control trials,” the authors say.

For the vaccines available in the US, protection against symptomatic SARS-CoV-2 infection was lower during the period of Delta predominance than before the emergence of the variant and also waned over time, a study in JAMA confirms. For the mRNA vaccines in particular, the decline in protection was more strongly related to time than the variant.

In Germany, hospital admission rates across all disease groups fell in 2020 compared with previous years, but an increase in the incidence of in-hospital death was observed only in patients with respiratory diseases, driven by those with SARS-CoV-2 infections, researchers report in JAMA Network Open. “Further research including the investigation of a potential shift of deaths to the outpatient setting is required,” they say.

When pregnant women receive an mRNA COVID-19 vaccine, it protects against virus-related hospitalizations in their newborns in the first six months of life, according to research in Morbidity and Mortality Weekly Report. Protection was 61% overall, with a higher rate seen when the primary vaccination series was completed later instead of earlier in pregnancy (80% vs 32%).

Disney World and Disneyland will drop mask requirements for vaccinated visitors starting Thursday, the Washington Post reports. Face coverings will be optional for fully vaccinated people both inside and outside, but “we expect guests who are not fully vaccinated to continue wearing face coverings in all indoor locations, including indoor attractions and theaters,” according to the new policy. Masks will still be required for everyone on Disney transportation.

February 14, 2022

On Friday, the US Food and Drug Administration (FDA) authorized an additional monoclonal antibody therapy for the treatment of COVID-19. Bebtelovimab (Eli Lilly), which is said to maintain activity against the Omicron variant, is indicated for mild-to-moderate disease in patients 12 and older who have a positive COVID-19 test, are at high risk for progression to severe disease, and for whom other options are not accessible or clinically appropriate. STAT has more.

The FDA also postponed an advisory committee meeting to discuss authorization of the vaccine from Pfizer/BioNTech to children ages 6 months to 4 years after the companies informed the agency that new data have emerged. “Based on the agency’s preliminary assessment, and to allow more time to evaluate additional data, we believe additional information regarding the ongoing evaluation of a third dose should be considered as part of our decision-making for potential authorization,” FDA officials said in a statement. According to STAT, “both the FDA and the companies suggested the application for authorization won’t proceed until there are data showing how well the vaccine works after a third dose. Those data should be available in early April, the companies said.”

Even with a booster dose of mRNA vaccine, protection against COVID-19-associated emergency department and urgent care encounters and hospitalizations waned over time during the periods of Delta and Omicron predominance, but remained relatively strong by the fourth month, according to a study in Morbidity and Mortality Weekly Report. “The finding that protection conferred by mRNA vaccines waned in the months after receipt of a third vaccine dose reinforces the importance of further consideration of additional doses to sustain or improve protection against” these outcomes, the authors say. Additional data in MMWR showed that adverse reactions were less frequent after a homologous mRNA vaccine booster dose than after the second dose of the primary series; myocarditis was rare after a booster dose.

The US Centers for Disease Control and Prevention (CDC) updated its guidance on vaccination for moderately or severely immunocompromised people on Friday, shortening the recommended interval between completion of the primary mRNA vaccination series and a booster dose from at least 5 to at least 3 months. In addition, those who initially received the single-shot Janssen vaccine from Johnson & Johnson should receive an additional dose using one of the mRNA vaccines and then a booster dose (preferably with an mRNA vaccine) in order to be considered up to date.

For people who complete a primary vaccination series with either the Pfizer/BioNTech or Moderna vaccine, the protection derived from a third booster dose may be greater when the other type of shot—rather than the same one—is used, a study out of Singapore suggests. “Heterologous boosting was associated with lower SARS-CoV-2 incidence rates than homologous boosting,” researchers report in JAMA.

Patient safety has taken a hit during the pandemic, US government researchers highlight in a New England Journal of Medicine perspective. That includes increases in central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated events, and MRSA bacteremia, as well as jumps in rates of pressure ulcers and falls causing major injury in skilled nursing facilities. “The healthcare sector owes it to both patients and its own workforce to respond now to the pandemic-induced falloff in safety by redesigning our current processes and developing new approaches that will permit the delivery of safe and equitable care across the healthcare continuum during both normal and extraordinary times,” the authors write. “We cannot afford to wait until the pandemic ends.”

When clinical trials went virtual during the COVID-19 pandemic, it may have increased the diversity of the patients enrolled, a study in JAMA Network Open suggests. Two trials conducted remotely with online recruitment in the early days of the pandemic saw increases in racial, ethnic, and geographic diversity among participants compared with a third clinic-based trial conducted around the same time. “These findings suggest that remote clinical trials with online advertising may be considered as a strategy to improve diversity among clinical trial participants,” the researchers conclude.

A Turkish man has tested positive for SARS-CoV-2 on 78 straight tests, leaving him isolated from his family for 14 months, Reuters reports. The 56-year-old man, who has leukemia, “has Turkey’s longest recorded continuous COVID-19 infection, doctors say, possibly due to a weakened immune system from the cancer. Despite being in and out of hospital since November 2020, his spirits have been high.”

February 11, 2022

As TCTMD’s Caitlin Cox reports, evidence now suggests that COVID-19 infection should be considered a CV risk factor. Data from the US Department of Veterans Affairs healthcare system show that even those who experience a mild infection and have no known CV risk factors are at increased risk for cerebrovascular disorders, dysrhythmias, inflammation of the heart or pericardium, ischemic heart disease, other CV disorders, and thromboembolic disorders through 1 year.

In a similar vein, a BMJ study of Americans aged 65 and older infected with COVID-19 in 2020 finds that nearly one-third developed at least one new serious health issue in the ensuing months, ranging from respiratory failure and hypertension to memory difficulties and mental health diagnoses. The risk for new health problems was 11% higher that of an age-matched group who never had COVID-19.

A population-based study in JAMA Pediatrics provides reassurance that getting vaccinated against COVID-19 during a pregnancy does not have a detrimental effect on offspring. Women in the study who received the Pfizer/BioNTech vaccine were no more likely than unvaccinated pregnant women to experience preterm birth or to have higher rates of all-cause neonatal hospitalizations, postneonatal hospitalizations, congenital anomalies, or infant death.

Areas with higher concentrations of primary care physicians (PCPs) have better COVID-19 vaccination rates than areas with fewer PCPs. Reporting in JAMA Network Open, researchers say the findings support expanding COVID-19 vaccine distribution to PCPs who they say “play a critical role in ensuring vaccine acceptance, especially in resource-limited and vaccine-hesitant regions, potentially through counseling and building local community trust and partnerships . . .”

In an attempt to find out what the government is paying for the four “free” rapid COVID test kits promised to every American household, Kaiser Health News reached out to the companies awarded the contracts, the Army Contracting Command, and the Department of Defense. They found email addresses years out of date, wrong phone numbers, and voicemail problems, but no answers. Government contracts worth $10,000 or more are required to be posted to SAM.gov or FPDS.gov, but the information is not there.

Amid falling COVID-19 cases and several states announcing their intentions to do away with mask mandates, the CDC’s latest update from its COVID data tracker shows the 7-day average of daily new cases at 215,418, which is 42.8% lower than last week.

Regardless of how many exposures they have, some people just never get COVID-19 and scientists want to know why. Reporting for AXIOS, Eileen Drage O’Reilly, spoke with scientists who say the “never COVID” population could point toward new vaccine targets or other protections. Working theories—other than luck—include cross immunity, genetics, and mucosal immunity.

A plan by the World Health Organization (WHO) to help African countries learn to make COVID-19 vaccines appears to be in trouble, according to an investigation by the BMJ. Their reporting uncovered evidence that a firm representing BioNTech claims the WHO’s plan will infringe on company patents and instead proposes shipping full mRNA production lines from Europe to Africa, staffing them with BioNTech workers, and using licensing by the European Medicines Agency (EMA) rather than local regulators.

At the time of his death, comedian Bob Saget was positive for COVID-19 on a PCR test and had an enlarged heart with a 95% blockage on one side, according to information from his autopsy that was released today, CNN and other outlets are reporting. However, the cause of the 65-year-old’s death in January was blunt head trauma, as previously concluded.

L.A. McKeown contributed today’s Dispatch.

February 9, 2022

The number of confirmed COVID-19 cases across the world has topped 400 million, according to the Johns Hopkins Coronavirus Resource Center. As the New York Times notes, that comes just a month after the tally reached 300 million: “The actual number of cases is undoubtedly higher, and probably drastically so. Many at-home rapid test results are never officially reported, and not all infected people get tested because they may lack access, have no symptoms, or choose not to.”

As the number of COVID-19 cases continues to fall across the US, several states are removing mask mandates for schools and indoor spaces (CIDRAP News). Connecticut, Delaware, New Jersey, and Oregon have all announced plans to drop requirements for face coverings in schools, with California saying that it will end an indoor mask mandate for people who are vaccinated. New York’s indoor mask mandate will end today, too (New York Times). Rochelle Walensky, MD, director of the US Centers for Disease Control and Prevention (CDC), said Tuesday, however, that it’s too soon to change mask guidance (CNN).

A note of caution comes from the Washington Post, which points out that even though Omicron is considered a milder variant, it “has infected so many people that it has driven the number of daily deaths beyond where it was last spring, before vaccines were widely available.” People older than 75 and those who are unvaccinated or “medically vulnerable” are taking the biggest hit. “Even if on a per-case basis fewer people develop severe illness and die, when you apply a small percentage to a very large number, you get a substantial number,” one epidemiologist said.

A paper published this week in Nature Medicine delves into the long-term cardiovascular consequences of COVID-19, showing that after 30 days following infection, there continue to be increased risks of cerebrovascular disorders, dysrhythmias, ischemic and nonischemic heart disease, pericarditis, myocarditis, heart failure, and thromboembolic disease. Heightened risks were seen even among patients who were not hospitalized for the acute infection. “Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial,” the authors say. Stay tuned for full coverage on TCTMD.

Male sex, Black/African American race, obesity, and several pediatric complex chronic condition subcategories are associated with greater disease severity in children and teens infected with SARS-CoV-2, researchers report in JAMA Network Open. In addition, vital signs and various lab test values from the day of admission to the hospital were tied to peak disease severity. These factors “could assist with early identification of children at risk for severe disease due to SARS-CoV-2 infection,” the researchers suggest.

Earlier this week, the US Food and Drug Administration (FDA) announced “a policy discouraging sponsors from developing or seeking approval or authorization for the use of sanitation tunnels, which are tunnels, walkways, chambers, and similar systems, that spray humans with a mist of disinfectant or aerosolized antiseptic with the aim of preventing or treating COVID-19.” The agency cites a lack of data supporting their use and potential adverse effects from the sanitation chemicals.

SARS-CoV-2 infection is associated with an increased risk of maternal mortality/serious morbidity from obstetric complications among pregnant and postpartum patients (adjusted relative risk 1.41; 95% CI 1.23-1.61), according to a study in JAMA. The relationship was driven by COVID-19 of at least moderate severity. CIDRAP News has more.

The first research definition for long COVID in children and young people, created through the consensus of 120 experts, has been released in the Archives of Disease in Childhood. The definition, which aligns with the clinical case definition for adults from the World Health Organization (WHO), is as follows: “Post-COVID-19 condition occurs in young people with a history of confirmed SARS CoV-2 infection, with at least one persisting physical symptom for a minimum duration of 12 weeks after initial testing that cannot be explained by an alternative diagnosis. The symptoms have an impact on everyday functioning, may continue or develop after COVID-19 infection, and may fluctuate or relapse over time.”

February 7, 2022

COVID-19 case numbers have spiked in many parts of Asia after Lunar New Year celebrations last week, the Associated Press reports. Hong Kong, Singapore, Thailand, Indonesia, Malaysia have all seen a recent rise in infections, whereas other countries—including South Korea and Vietnam—are warning of potential surges. Numbers are fluctuating in China, where officials “have imposed strict local lockdowns and mass testing, as the country kicked off the Beijing Winter Olympics last week.”

The official COVID-19 death tally has topped 900,000 in the United States, with more than 2,600 Americans dying each day, the New York Times reports. “Yet another, simultaneous reality of the pandemic offers reason for hope,” the story notes. “The number of new coronavirus infections is plummeting, falling by more than half since mid-January. Hospitalizations are also declining, a relief to stressed healthcare workers who have been treating desperately ill coronavirus patients for nearly 2 years.”

Removing all restrictions on people’s movements in “COVID-zero” regions like China could cause about 2 million deaths in a year, according to a paper published Friday in the weekly bulletin of the China Center for Disease Control and Prevention (CCDC). “Even with a global vaccination rate of 95%, if population mobility was restored to 2019 levels, the researchers estimated that all COVID-zero regions would see more than 234 million infections within a year, including 64 million symptomatic cases and 2 million deaths,” Reuters reports.

Unvaccinated people can have anti-spike antibodies detected up to 20 months after a positive COVID-19 test result, adding to prior data showing antibodies for up to 6 months, according to a research letter in JAMA. The authors caution, however, that “although evidence of natural immunity in unvaccinated healthy US adults up to 20 months after confirmed COVID-19 infection is encouraging, it is unclear how these antibody levels correlate with protection against future SARS-CoV-2 infections, particularly with emerging variants.”

Australia announced that it will reopen its borders to vaccinated travelers later this month (Reuters). “The country had taken steps in recent months to relax border controls, like allowing in skilled migrants and quarantine-free travel arrangements—“travel bubbles”—with select countries like New Zealand. But the reopening, which takes effect on February 21, represents the first time since March 2020 that people can travel to Australia from anywhere in the world as long as they are vaccinated.”

On Friday, the Advisory Committee on Immunization Practices (ACIP) recommended use of the Moderna COVID-19 vaccine (Spikevax) in all people 18 and older after the US Food and Drug Administration (FDA) granted it full approval earlier in the week (CIDRAP News). Americans now have access to two fully approved vaccines (the shot from Pfizer/BioNTech is the other).

In patients on hemodialysis, the Moderna vaccine produces a stronger antibody response than does the Pfizer/BioNTech shot, a study in CMAJ shows. Several weeks after two-dose vaccination, the proportion of patients who achieved convalescent levels of anti-spike antibody was 95% with the former vaccine and 73% with the latter.

An Omicron-specific booster may not provide more protection against the virus than additional doses of the existing Moderna vaccine, suggests a primate study performed by US government researchers. “Study of blood from the animals showed that many of the measurable immune responses—rises in neutralizing antibody levels, for instance—were not substantially different, regardless of which booster shot they were given, STAT reports.

The exhaustion of making decisions during the pandemic around things like travel, masking, and testing has a name, according to KHN: decision fatigue. “Faced with a stream of difficult choices about health and safety during a global pandemic, [psychologist Barry] Schwartz suggests, we may experience a unique kind of burnout that could deeply affect our brains and our mental health.”