— Mark King in The Baltimore Sun

 

As the Northern hemisphere enters winter, COVID cases are once again surging in many countries – even those with relatively high vaccination rates. Reuters (UK) reports, “Global COVID-19 cases surpassed 250 million on Monday as some countries in eastern Europe experience record outbreaks…. The daily average number of cases has fallen by 36 percent over the past three months, according to a Reuters analysis, but the virus is still infecting 50 million people worldwide every 90 days due to the highly transmissible Delta variant.” But there is some possible relief in sight. Reuters quotes WHO epidemiologist Maria Van Kerkhove: "We think between now and the end of 2022, this is the point where we get control over this virus...where we can significantly reduce severe disease and death.” Yet vaccine inequity remains a seemingly intractable problem: “More than half the world's population has yet to receive a single dose of a COVID-19 vaccine, according to Our World in Data, a figure that drops to less than 5 percent in low-income countries.”
 

If You Are in a Hurry

• Watch AVAC in conversation with award-winning journalist Stephanie Nolen on her reality check about “global” COVID-19 vaccine production.
• Read Nature on when masks can be most useful.
• Read Science on clues to why Delta is more infectious.
• Read POLITICO on how a Trump administration deal with Moderna is standing in the way of global vaccine equity.
• Read Nature on how the UK’s rise in COVID cases are being watched carefully by other countries to help guide pandemic responses.
• Read STAT on the good news about a Pfizer pill.
• And read Reuters on the promise of Regenron’s antibody cocktail as COVID PrEP for people with compromised immune systems.
• Read a long piece in The New York Times Magazine on how COVID is affecting our dreams.
• Read The Washington Post on the devastating impact of COVID on life expectancy.

 

More Good News on Drugs and Antibodies

 
The toolbox of options to respond to the virus continues to grow.
 
STAT (US) reports drug company Pfizer announced late last week that its “experimental antiviral pill…reduced the risk of death and hospitalization by 89 percent in patients who were newly diagnosed with COVID-19 in a large study…. The development of oral medicines that can be used to treat Covid early on could blunt the impact of the pandemic…. The Pfizer result is the second success for an oral pill that prevents COVID patients from becoming hospitalized or dying. Merck and partner Ridgeback Therapeutics announced Oct. 1 that their pill, molnupiravir, reduced hospitalization and death by 50 percent. That pill also prevented death, and was granted conditional approval Thursday by the United Kingdom’s top medical regulators.”
 
Reuters (UK) reports, “Pfizer Inc is in discussions with 90 countries over supply contracts for its experimental COVID-19 pill….”
 
Reuters (UK) reports, “Britain on Thursday became the first country in the world to approve a potentially game-changing COVID-19 antiviral pill jointly developed by Merck and Ridgeback Biotherapeutics, in a boost to the fight against the pandemic. The Medicines and Healthcare products Regulatory Agency (MHRA) recommended the drug, molnupiravir, be used as soon as possible following a positive COVID-19 test and within five days of the onset of symptoms…. In a separate statement, Merck said it was expecting to produce 10 million courses of the treatment by the end of this year, with at least 20 million set to be manufactured in 2022.”
 
NTV (Uganda) reports, “A United States pharmaceutical company [Merck] has granted a royalty-free license for its promising COVID-19 pill to a United Nations-backed non-profit in a deal that would allow the drug to be manufactured and sold cheaply in the poorest nations, mostly in Africa and Asia.
 
NBC News (US) reports, “Many immunocompromised Americans, including people with cancer, autoimmune disorders and transplanted organs, are impatiently awaiting what could be their ticket back to some semblance of normalcy: the ability to receive periodic injections of long-acting monoclonal antibodies. This, research suggests, could provide them the substantial protection against COVID-19 that in their cases vaccination may not…. The Food and Drug Administration could soon grant emergency authorization to monoclonal antibodies from drugmaker Regeneron for what is known as pre-exposure prophylaxis, or PrEP, against COVID-19. If cleared by the FDA, Regeneron’s therapy could be given as a set of injections every one to three months before potential exposure to the coronavirus.”
 
Reuters (UK) reports, “Regeneron Pharmaceuticals Inc said on Monday a single dose of its antibody cocktail reduced the risk of contracting COVID-19 by 81.6 percent in a late-stage trial, in the two to eight months period following the drug's administration…. Data showed that Regeneron's drug has the potential to provide long-lasting immunity from COVID-19 infection, said Myron Cohen, who leads monoclonal antibody efforts for the US National Institutes of Health-sponsored COVID Prevention Network, making it particularly helpful for immunocompromised people and those unresponsive to vaccines.”
 

Looking to the End of the Pandemic

 
A Reuters (UK) analysis looks at how COVID may become endemic and what that might look like in different countries. “[Experts] expect that the first countries to emerge from the pandemic will have had some combination of high rates of vaccination and natural immunity among people who were infected with the coronavirus, such as the United States, the UK, Portugal and India. But they warn that SARS-CoV-2 remains an unpredictable virus that is mutating as it spreads through unvaccinated populations…. COVID-19 is still expected to remain a major contributor to illness and death for years to come, much like other endemic illnesses such as malaria. ‘Endemic does not mean benign,’ [WHO’s] Van Kerkhove said. Some experts say the virus will eventually behave more like measles, which still causes outbreaks in populations where vaccination coverage is low. Others see COVID-19 becoming more a seasonal respiratory disease such as influenza. Or, the virus could become less of a killer, affecting mostly children, but that could take decades, some said.”
 

Clues to Why Delta Is So Infectious

 
Science (US) reports, “a new lab strategy that makes it possible to quickly and safely study the effects of mutations in SARS-CoV-2 variants has delivered one answer [as to why delta is more infectious]: a little-noticed mutation in Delta that allows the virus to stuff more of its genetic code into host cells, thus boosting the chances that each infected cell will spread the virus to another cell…That discovery, published… in Science, is ‘a big deal,’ says Michael Summers, a structural biologist at the University of Maryland, Baltimore County—not just because it helps explain Delta’s ravages. The new system, developed by Nobel Prize winner Jennifer Doudna of the University of California (UC), Berkeley, and her colleagues, is a powerful tool for understanding current SARS-CoV-2 variants and exploring how future variants might affect the pandemic, he says.”
 

Vaccine Efficacy

 
The Los Angeles Times (US) reports, “As the Delta variant became the dominant strain of the coronavirus across the United States, all three COVID-19 vaccines available to Americans lost some of their protective power, with vaccine efficacy among a large group of veterans dropping between 35 percent and 85 percent, according to a new study. … Dr. Barbara Cohn, the study’s lead author, said in addition to its comparison of COVID-19 vaccines, the group’s analysis provides 'a lens for making informed decisions around primary vaccination, booster shots, and other multiple layers of protection.' That includes mask mandates, coronavirus testing and other public health measures aimed at countering viral spread. Strong evidence of the vaccines’ declining power should prompt even states and locales with highly vaccinated populations to consider retaining mask mandates, the authors said. And the findings strongly support the CDC’s recent recommendation that all recipients of the J&J vaccine get a booster.” Read the study in Science (US).
 
Times of Israel (Israel) reports, “Leaked research conducted by Israeli hospital indicates that a third shot [of the Pfizer vaccine] yields more antibodies, and that these antibodies are also better at preventing disease…. Israel was the first country to widely adopt the booster and the end of Israel’s fourth wave has been credited at least in part to its booster vaccine campaign, which began among those over 65 in August and was quickly rolled out to the rest of the population."

Vaccine Inequity and Access

 
If you missed AVAC in conversation with award-winning journalist Stephanie Nolen on her reality check about “global” COVID-19 vaccine production, watch it here.
 
The Guardian (UK) reports, “It will be 'impossible' for Nigeria to meet its target of vaccinating 40 percent of its population by the end of the year because COVID is not being taken seriously, health experts have warned. Fewer than 1.5 percent of the country’s 206 million population has been fully vaccinated. But with more people killed in conflict last year and substantially more recorded deaths from malaria than COVID in Nigeria, experts believe it is further down the list of concerns for many in the country…. From December, government employees without proof of vaccination or a negative test will be barred from public buildings. Their numbers may be negligible in the country’s population, but the ruling was a sign that the government is desperate to move closer to its target.”
 
A blog post on The Centre for Nigeria Progress warns, “A crippling shortage of coronavirus vaccines in sub-Saharan Africa isn’t just a health risk, it’s having a major impact on economic growth…. That may weigh on investor confidence, restrict growth and widen the rift in incomes between advanced and developing economies. It could also reverse decades of progress in the continent’s fight against destitution. The pandemic plunged 30 million people into extreme poverty in 2020, meaning they live on less than $1.90 a day.”
 
POLITICO (US) reports, “As the coronavirus tore through the US in August 2020, Trump administration officials, desperate for a vaccine, cut a generous deal with a tiny company that had received extensive aid from the federal government…. The government asked for little in return. Moderna got full ownership of the lucrative technology critical to the vaccine’s success, despite its reliance on years of NIH research. The company would face no obligation to share those details with the US—even as it reaped profits from vaccinating millions of Americans…. The Biden administration has been unable to find a workaround to an even more consequential contractual restriction: its inability to access and share the technology needed to make Moderna’s vaccine.”
 

Healthcare Worker Burnout

 
SciDevNet via All Africa reports, “The pandemic could worsen in Sub-Saharan Africa if healthcare workers leave their jobs because of fear of COVID-19, stress, burnout and poor remuneration, a study suggests…. According to the study published in PLOS Global Public Health about one in three healthcare workers (38 per cent) in Ghana and Kenya are dissatisfied with their jobs. Read the study here.
 

Northern Hemisphere Surges Despite Vaccinations

 
China Daily (Hong Kong) reports, “The World Health Organization warned that a surge of coronavirus cases in Europe and Central Asia has pushed the region back as the epicenter of the pandemic. There are now 78 million cases in the European region, which is more than infections reported in Southeast Asia, the Eastern Mediterranean, the Western Pacific and Africa combined, according to the WHO. Last week, Europe and Central Asia accounted for almost half of the world’s reported deaths from COVID-19.”
 
AP (US) reports a surge of cases in Eastern Europe is rooted in vaccine hesitancy. The slow pace of vaccinations in Eastern Europe is rooted in several factors, including public distrust and past experience with other vaccines, said Catherine Smallwood, the World Health Organization’s Europe COVID-19 incident manager. ‘We’re seeing low vaccine uptake in a whole swath of countries across that part of the region,’ she told The Associated Press. ‘Historical issues around vaccines come into play. In some countries, the whole vaccine issue is politicized.’”
 
Reuters (UK) reports, “Germany's coronavirus infection rate has risen to its highest level since the start of the pandemic, public health figures showed on Monday, and doctors warned they will need to postpone scheduled operations in coming weeks to cope.”
 
Nature (UK) looks at the UK case rates of COVID and what it could mean for other countries. “As one of the first countries to trust high vaccine coverage and public responsibility alone to control the spread of SARS-CoV-2, the United Kingdom has become a control experiment that scientists across the world are studying. ‘We are watching the increase in cases closely, trying to dissect what is going on and how that might influence our situation right now,’ says Rafael Radi, a biochemist and coordinator of Uruguay’s COVID-19 Scientific Advisory Group…. ‘This shows how cautious we need to be with the return to normality. Increasing human interactions, even with a high proportion of the population fully vaccinated, may lead to new surges, hospitalizations and death.’”
 

COVID and HIV

 
Longtime HIV activist Mark King writes in The Baltimore Sun (US) of the similarities and differences between COVID and HIV. “In both cases, our government made choices that caused people to die unnecessarily, either through inaction or ineptitude. Both epidemics disproportionately affect the marginalized and the undervalued among us, whether they be gay, racial minorities, drug addicts, old or infirm. The failures of our health care and public health systems have driven the mortality rates even higher.” He notes what the HIV community has to offer in the fight against COVID: “HIV advocacy groups understand how to build networks of people living with a chronic disease from scratch. We’ve also known the desperation of searching for effective treatments and alerting people to the long-term effects of our condition. And yes, we are science and fact based, resisting the curious allure of folk cures and wackadoodles, and we are always pushing researchers for the next generation of medications.”
 
Aidsmap (UK) reports, “Surveys from diverse settings do not suggest unusual levels of COVID-19 vaccine hesitancy among people living with HIV, the 18th European AIDS Conference (EACS 2021) heard last week. Data were presented from Argentina, Greece, Turkey, the Middle East and the United Kingdom. People living with HIV are at increased risk of worse COVID-19 outcomes than the general population. Achieving a high level of vaccination among people with HIV is therefore crucial. However, low levels of confidence in novel COVID-19 vaccines is a widespread phenomenon.”
 

Life Years Lost to COVID

The Washington Post (US) reports, “More than 28 million extra years of human life were lost in 2020, a year marked by the global spread of the coronavirus, according to a study released Wednesday that further underscored the immense human toll that the pandemic has wrought…. The highest fall in life expectancy occurred in Russia, where men lost 2.33 extra years at birth, and women 2.14 years. The United States was second, with men losing 2.27 extra years, and women 1.61. Bulgaria, Lithuania, Chile, and Spain followed.” Read the BMJ (UK) study here.

Long COVID

 
The Washington Post (US) reports on the hopes that studying long COVID may help shine a light on long term impacts of other disease. COVID “long-haulers have also opened doors. As a new pathogen, SARS-CoV-2 offers a fresh opportunity to examine what many doctors agree is not well understood—how people recover from infections, even common ones. The National Institutes of Health earlier this year launched a $1.15 billion initiative to study long COVID, and researchers and patients hope it will provide answers…. The quest to find answers is increasingly important as the pandemic approaches a turning point. Now that vaccines and therapeutics have lessened the chance of severe illness and death and people are eager to return to normal life, is the threat of long COVID an ongoing reason to avoid contracting the virus? Others wonder: Could endemic COVID leave millions disabled with long-haul symptoms every year, creating a growing public health crisis?”
 
Healio (US) reports, “Nearly half of patients who had COVID-19 and received treatment at a New Jersey medical center still experience persistent symptoms 1 year later, according to research presented at the CHEST Annual Meeting.”
 

Costa Rica Mandates Vaccine for Children

 
The Tico Times (Costa Rica) reports, “The COVID-19 vaccine will be mandatory for minors in Costa Rica, the Health Ministry announced Friday…. Costa Rica is currently vaccinating all citizens and residents ages 12 and older, and a fully vaccination scheme will be mandatory to enter many businesses starting January 8, 2022.”
 

Don’t Forget Masks

 
Nature (UK) reports, “An analysis of hundreds of COVID-19 cases suggests that face masks are most protective in specific circumstances, such as exposure to a person with COVID-19 that lasts for more than three hours or that takes place indoors The study shows that several of the measures that are collectively known as non-pharmaceutical interventions—such as physical distancing, keeping interactions outdoors and wearing masks—‘are in fact helpful’ for preventing SARS-CoV-2 transmission, says study co-author Joseph Lewnard, an epidemiologist at the University of California, Berkeley. Previous studies provided evidence that masking helps to protect against infection, but the latest work shows that it is beneficial even when other measures, such as distancing, aren’t in use.”
 

Emerging Pathogens

 
NPR’s Goats and Soda Blog (US) reports on a newly discovered coronavirus that may be harbored in dogs and has infected humans in Haiti and Malaysia. This virus, “one that many scientists believe may be a new human pathogen—likely the eighth coronavirus known to cause disease in people. Turns out, this coronavirus in the Haiti travelers has cropped up previously, on the other side of the globe. Back in May, scientists at Duke University reported they had detected a nearly identical virus coronavirus in children at a Malaysian hospital…. By finding this virus early, scientists now have time to study it, create tools to diagnose it and understand what it might take to stop it. Although it's not a cause for deep concern at this time, there's always the risk the virus could evolve and become a bigger problem….”
 

COVID and Dreams

 
The New York Times Magazine (US) looks at how COVID may have affected our dreams. “As the novel coronavirus spread and much of the world moved toward isolation, dream researchers began rushing to design studies and set up surveys that might allow them to access some of the most isolated places of all, the dreamscapes unfolding inside individual brains. The first thing almost everyone noticed was that for many people, their dream worlds seemed suddenly larger and more intense…. In Wuhan, a study of 100 nurses conscripted to work on the front lines found that 45 percent of them were having nightmares—a rate, Nielsen notes, that is ‘twice the lifetime rate among Chinese psychiatric outpatients and many times higher than that among the 5 percent of the general population who have nightmare disorder.’”
 

Big Bird Got Vaccinated

 
And it was political. Seattle Times (US) reports on a tweet in which Big Bird, the giant bird beloved by children everywhere, announced he had gotten a COVID vaccine. “It was seemingly a joyous enough celebration for the childhood icon, who is perpetually 6 years old. But conservative politicians and pundits weren’t so pleased. ‘Government propaganda…for your 5-year-old!’ Cruz tweeted, apparently unaware that Big Bird is not actually on the White House payroll…. Big Bird specifically has been advocating for vaccinations since at least the 1970s and even pointed out Saturday that he has been ‘getting vaccines since I was a little bird.’ Elmo also announced Saturday that he plans to get his shot ‘soon.’”