Statins may slightly lower COVID-19 death risk; using a different vaccine as booster may offer more protection

By Nancy Lapid

(Reuters) – The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that have yet to be certified by peer review.

Statins may protect slightly against COVID-19 death

Widely-used statin drugs for lowering cholesterol may be linked to a slightly lower risk of dying from COVID-19, new data suggest. Researchers at Karolinska Institute in Sweden reviewed the medical records of nearly 1 million residents of Stockholm over the age of 45 between March and November 2020, roughly 18% of whom had been prescribed a statin, such as Pfizer Inc’s Lipitor (atorvastatin) and Merck & Co’s Zocor (simvastatin). The people prescribed statins had more risk factors for poor COVID-19 outcomes: they were older, more often male, had more medical conditions, lower education levels and less disposable income. After taking all that into account, statin users were still 12% less likely to have died of COVID-19 during the study period, according to a report published on Thursday in PLOS Medicine. The researchers did not compare outcomes in people who actually got infected with the virus, however. And they only had data on prescriptions – not on whether patients took the medicine as prescribed. A formal clinical trial would be needed to confirm the findings. Still, they conclude, their data “suggest that statin treatment may have a modest preventive therapeutic effect on COVID-19 mortality.”

Boosting with a different vaccine is safe, may be better

People who got Johnson & Johnson’s COVID-19 vaccine as a first shot had a stronger immune response when boosted with vaccines from either Pfizer Inc/BioNTech SE or Moderna Inc, according to a study run by the National Institutes of Health. The trial, which included more than 450 adults who received initial shots from Pfizer/BioNTech, Moderna, or J&J, also showed that “mixing and matching” booster shots using different vaccine technology is safe in adults, the researchers reported in a paper posted on medRxiv on Wednesday ahead of peer review. Moderna’s and Pfizer’s vaccines are based on messenger RNA (mRNA) while J&J’s uses viral vector technology. The trial looked at a total of nine combinations of initial shots and boosters. Using different types of shots as boosters generally produced a comparable or higher antibody response than using the same type, the researchers reported. Mixing booster doses “may offer immunological advantages to optimize the breadth and longevity of protection achieved with currently available vaccines,” they said.

Old age alone does not predict COVID-19 mortality risk

Older patients are known to be at higher risk for poor outcomes after infection with the coronavirus, but among those hospitalized with COVID-19, other characteristics help predict who is likely to do poorly, new data suggest. In a review of data on 4,783 people age 65 and older who were hospitalized for COVID-19 early in the pandemic, researchers at Northwell Health hospitals in New York found that age itself did not independently predict whether a patient was more likely to die. Instead, they reported on Thursday in BMC Geriatrics, more important predictors of death for elderly patients were factors such as how independent they were before the infection, how sick they were when they arrived at the hospital, and their pre-existing medical conditions, such as high blood pressure, kidney disease, lung disease and dementia. The researchers noted that in facilities forced to ration care or facing resource shortages, some guidelines use advanced age as a reason to deny care. “Our findings support the American Geriatrics Society position statement indicating age alone should never be used to make decisions regarding resource allocation under conditions of resource scarcity,” the researchers said. “Although age is still an important factor in the overall risk of COVID-19 mortality… a comprehensive approach that accounts for the above factors is essential in preventing ageism.”

(Reporting by Nancy Lapid and Carl O’Donnell; Editing by Bill Berkrot)

British PM says new variant may carry higher risk of death

By Michael Holden and Alistair Smout

LONDON (Reuters) – British Prime Minister Boris Johnson said on Friday the new English variant of COVID-19 may be associated with a higher level of mortality although he said evidence showed that both vaccines being used in the country are effective against it.

“We’ve been informed today that in addition to spreading more quickly, it also now appears that there is some evidence that the new variant – the variant that was first discovered in London and the southeast (of England) – may be associated with a higher degree of mortality,” he told a news briefing.

The warning about the higher risk of death from the new variant, which was identified in England late last year, came as a fresh blow after the country had earlier been buoyed by news the number of new COVID-19 infections was estimated to be shrinking by as much as 4% a day.

Johnson said however that all the current evidence showed both vaccines remained effective against old and new variants.

Data published earlier on Friday showed that 5.38 million people had been given their first dose of a vaccine, with 409,855 receiving it in the past 24 hours, a record high so far.

England and Scotland announced new restrictions on Jan. 4 to stem a surge in the disease fueled by the highly transmissible new variant of the coronavirus, which has led to record numbers of daily deaths and infections this month.

The latest estimates from the health ministry suggest that the number of new infections was shrinking by between 1% and 4% a day. Last week, it was thought cases were growing by much as 5%, and the turnaround gave hope that the spread of the virus was being curbed, although the ministry urged caution.

The closely watched reproduction “R” number was estimated to be between 0.8 and 1, down from a range of 1.2 to 1.3 last week, meaning that on average, every 10 people infected will infect between eight and 10 other people.

But the Office for National Statistics estimated that the prevalence overall remained high, with about one in 55 people having the virus.

“Cases remain dangerously high and we must remain vigilant to keep this virus under control,” the health ministry said. “It is essential that everyone continues to stay at home, whether they have had the vaccine or not.”

Britain has recorded more than 3.5 million infections and nearly 96,000 deaths – the world’s fifth-highest toll – while the economy has been hammered. Figures on Friday showed public debt at its highest level as a proportion of GDP since 1962, and retailers had their worst year on record.

(Additional reporting by William James, Alistair Smout, Andy Bruce and Sarah Young; Editing by Alison Williams)

South African virus variant may resist antibody drugs; Pfizer/BioNTech vaccine seems to work vs UK variant

By Nancy Lapid

(Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

South African variant may resist current antibody treatments

The variant of the new coronavirus identified in South Africa can resist, or “escape,” antibodies that neutralize earlier versions of the virus, scientists have found. It “exhibits complete escape” from three classes of monoclonal antibodies manufactured for treating COVID-19 patients, and it shows “substantial or complete” resistance to neutralizing antibodies in blood donated by COVID-19 survivors, the scientists reported on Tuesday on bioRxiv ahead of peer review. Similarities between the South Africa variant and another variant identified in Brazil suggest the Brazilian variant will show similar resistance, they added. Liam Smeeth of the London School of Hygiene and Tropical Medicine, who was not involved in the study, noted that these were laboratory tests, and it would be unwise to extrapolate the findings to humans at this point. “The data do raise the possibility that the protection gained from past infection with COVID-19 may be lower for re-infection with the South African variant,” he said. “The data also suggest that the existing vaccines could be less effective against the South African variant.” He called for large studies among populations where the variant is common.

Pfizer/BioNTech shot likely protects against UK variant

The COVID-19 vaccine from Pfizer Inc and BioNTech SE is likely to protect against the more infectious variant of the virus discovered in Britain and now spreading around the world, according to laboratory tests. Researchers took blood samples from 16 people who had received the vaccine and exposed the blood to a synthetic virus, or pseudovirus, that was engineered to have 10 mutations found in the UK variant. The antibodies that had developed in response to the vaccine effectively neutralized the pseudovirus, according to a report posted on Tuesday on bioRxiv ahead of peer review. “This makes it very unlikely that the UK variant will escape from the protection provided by the vaccine,” said Jonathan Stoye, a virus scientist at Britain’s Francis Crick Institute who was not involved in the research. Similar experiments are needed with the more concerning variant first found in South Africa, he suggested. AstraZeneca Plc, Moderna Inc and CureVac NV are also testing whether their respective vaccines will protect against the fast-spreading variants.

Immune system will remember how to make COVID-19 antibodies

People who have recovered from COVID-19 can likely mount a fast and effective response to the virus if they encounter it again because their immune system’s “B cells” will remember how to make the antibodies needed to fight it, a new study shows. Researchers tracked 87 COVID-19 survivors for six months and found that while levels of antibodies to the virus may decline over time, the number of memory B cells remains unchanged. The antibodies produced by these cells are more potent than the patients’ original antibodies and may be more resistant to mutations in the spike protein the virus uses to break into cells, they said. For example, they found, the antibodies could recognize and neutralize at least one of the mutations in the South African variant of the virus that has caused concern among health experts. Even if antibody levels fall, B cells will remember how to make them when necessary, according to study leader Michel Nussenzweig of Rockefeller University, whose findings were reported on Monday in Nature. If this is true at six months, as in this study, it is safe to assume it is probably still true for longer periods, he added. People who have recovered from COVID-19 “may become infected but the immune system will be prepped to fight off the infection,” Nussenzweig said.

Mortality higher when ICUs are packed with COVID-19 patients

The more full an intensive care unit (ICU) is with COVID-19 patients, the higher the mortality rate among those patients, new data suggest. When researchers tracked outcomes of 8,515 COVID-19 patients admitted to 88 U.S. Veterans Affairs hospitals in 2020, they found that survival rates improved between March and August. Throughout the study period, however, the risk of death was nearly double when at least 75% of ICU beds were filled with COVID-19 patients, compared to when they accounted for no more than 25% of ICU beds. COVID-19 mortality “increases during periods of peak demand,” said Dr. Dawn Bravata of the Richard L Roudebush VA Medical Center in Indianapolis who co-led the study published on Tuesday in JAMA Network Open. “The more the public can do to avoid infections, the better,” she added. In addition, Bravata said, “facilities within a healthcare system or within a geographic region should collaborate to triage critically ill patients with COVID-19 to sites with greater ICU capacity to reduce strain on any one facility.”

(Reporting by Nancy Lapid, Linda Carroll, Kate Kelland and Ludwig Burger; Editing by Bill Berkrot)

COVID-19 may damage bone marrow immune cells; another reinfection reported

By Nancy Lapid

(Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

COVID-19 may damage immune cells in the bone marrow

Even bone marrow may not be a safe harbor from the ravages of COVID-19, according to a study that found previously unrecognized changes in newly produced immune cells, called monocytes, released into the blood from bone marrow. To learn more about how the body responds to COVID-19, researchers obtained serial “snapshots” of patients’ immune health by analyzing their immune cells at multiple points during their hospital stays. In COVID-19 patients with more severe disease, the monocytes do not function properly, researchers reported last week in Science Immunology. It was not yet clear whether the monocytes are being released from the bone marrow in an altered state or whether the alterations happen after monocytes enter the blood, coauthor Tracy Hussell of the University of Manchester in the UK told Reuters. Either way, she said, treatments that prevent their release from the bone marrow may help reduce the exaggerated immune response that contributes to poor outcomes in patients with severe COVID-19.

COVID-19 reinfections occur, but remain rare

Another case of reinfection after recovery from COVID-19 has been reported, this time in a healthy young military healthcare provider at a U.S. Department of Defense hospital in Virginia. He was first infected by a patient in March. He recovered within 10 days and “returned … to excellent health,” his doctors reported on Saturday in Clinical Infectious Diseases. Fifty-one days later, he was reinfected by a household member. Genetic studies showed the first and second infections to be from slightly different strains of the virus. The reinfection made him sicker, perhaps because the second strain was more potent, or the household contact infected him with a higher load of virus, doctors said. It was also possible antibodies from the first infection may have triggered his immune system to respond more strongly to the virus the second time his body encountered it. COVID-19 reinfections are still rare, they said. Kristian Anderson, professor of immunology and microbiology at Scripps Research in La Jolla, California, recently told Reuters virus reinfections are always possible. “We don’t know at what frequency reinfections (with the new coronavirus) occur and how that might change over time,” Anderson said. Without further studies, “we can’t conclude what a single case of reinfection means for longevity and robustness of COVID-19 immunity and relevance for a future vaccine,” she added.

Proven immunotherapy approach might be possible in COVID-19

A proven approach to severe virus infections, known as cytotoxic T cell therapy, may be applicable to COVID-19 despite a potential hurdle, researchers said. The approach involves treating critically ill patients with infusions of key immune cells known as T-lymphocytes obtained from people who successfully fought off the same virus. These donor T cells have learned to recognize and target the invading virus. But steroids, which are being increasingly used to treat COVID-19 patients, are toxic to lymphocytes, likely canceling out any beneficial effects of the immunotherapy. In a new report posted on bioRxiv ahead of peer review, researchers describe a possible workaround. They say they have figured out a way to take donor T cells that target the novel coronavirus and make them resistant to the deadly effects of steroids. “We are currently working on … developing clinical trials to determine safety and efficacy,” coauthor Dr. Katy Rezvani of The University of Texas MD Anderson Cancer Center told Reuters.

High COVID-19 mortality seen in assisted-living facilities

Data compiled from more than 4,600 assisted living facilities in seven U.S. states through the end of May showed a four-fold higher COVID-19 fatality rate than in the nearby communities, researchers reported on Monday in the Journal of the American Geriatric Society. In North Carolina and Connecticut, for example, the proportions of COVID-19 cases that were fatal across the state were 3.3% and 9.3%, respectively. In assisted living facilities in those states, the fatality rate climbed to 13% and 31.6%. Unlike nursing homes, assisted living communities are not subject to federal regulation and are not required to collect and report data on COVID-19, coauthor Helena Temkin-Greener of the University of Rochester School of Medicine & Dentistry said in a news release. In this study, and in a separate study of nursing homes her team published on Monday in the same journal, COVID-19 cases were more common in facilities with more minority residents and more residents with dementia, chronic obstructive pulmonary disease, and obesity. “Assisted living communities and their residents urgently need local, state, and the federal governments to pay at least the same level of attention as that given to nursing homes,” Temkin-Greener and colleagues conclude.

(Reporting by Nancy Lapid and Deena Beasley; Editing by Bill Berkrot)

New U.S. health crisis looms as patients without COVID-19 delay care

By Sharon Bernstein

(Reuters) – A Texas man who waited until his brain tumor was softball-sized; a baby who suffered an ear infection for six days; a heart patient who died: The resurgence of COVID-19 is creating another health crisis as hospitals fill and patients are fearful or unable to get non-emergency care.

With U.S. coronavirus infections reaching new heights, doctors and hospitals say they are also seeing sharp declines in patients seeking routine medical care and screenings – and a rise in those who have delayed care for so long they are far sicker than they otherwise would be.

“I had one lady who had delayed for five days coming in with abdominal pain that was getting worse and worse,” said Dr. Diana Fite, who practices emergency medicine in Houston. “When she finally came in, she had a ruptured appendix.”

After the pandemic was declared a national emergency in March, many states banned non-essential medical procedures, and the number of patients seeking care for other ailments took a nosedive. Hospitals and medical practices were hit hard financially.

Emergency department use dropped by 42% during the first 10 weeks of the pandemic despite a rise in patients presenting with symptoms of the coronavirus, data from the U.S. Centers for Disease Control and Prevention show. In the same period, patients seeking care for heart attacks dropped by 23% and stroke care by 20%.

As the initial outbreak leveled off in the weeks that followed, healthcare experts planned to handle primary care differently should infections rise again, making sure minor procedures like cancer screenings were still allowed and assuring patients that hospitals and clinics were safe.

But the recent surge in cases has swamped hospitals in many states, including Texas, Arizona, Florida and parts of California.

CANCER MORTALITY RATES

Texas has again banned many non-emergency procedures, though cancer surgeries are still allowed, and a hospital in California’s San Joaquin Valley for several days admitted only COVID-19 patients.

Patients without COVID-19 – either out of fear, confusion or because of difficulty in obtaining the care they need – are again staying home.

The result is a healthcare crisis in the making, said Austin oncologist Dr. Debra Patt, who said she expects mortality rates from cancer to skyrocket in the years after the pandemic because patients have delayed their care.

“They’re scared to go in the hospital unless they absolutely have to,” said Patt. “And even when the patients are willing, it’s hard to get things done.”

Patt in recent days treated a man who waited to come in for headaches and dizziness until he had lost 35 pounds and had a softball-sized tumor in his head.

Fite, who is president of the Texas Medical Association, cared for a baby whose parents waited six days before bringing him in with a severe ear infection.

Patt said screening mammograms are down by 90% in Austin, where she specializes in breast cancer and serves as executive vice president of Texas Oncology. That means some tumors will be missed, and women who develop aggressive cancers might not know about it until the disease is more advanced and more likely to be deadly.

“It’s an impact we will see on cancer survival for years to come,” she said.

Dr. David Fleeger, a colorectal surgeon in Austin and a past president of the Texas Medical Association, said he has had numerous patients cancel colonoscopies in recent days.

“The delays in colonoscopies that are occurring right now ultimately will lead to more cancers and more deaths,” he said.

‘IN A HOLDING PATTERN’

Patt’s patient Helen Knost had to put off surgery for breast cancer in early spring because it was considered non-emergency in Texas and barred at the time, and she was treated instead with the medication Tamoxifen.

“It’s very strange to know you have cancer and you’re just hanging out with it, just in a holding pattern,” said Knost, who did ultimately undergo successful surgery.

In California, doctors at the 150-bed Adventist Lodi Memorial Hospital in the San Joaquin Valley were determined that a second surge in coronavirus cases would not bring a repeat of the pandemic’s early days, when emergency room visits dropped in half. Emergency medical technicians also reported a 45% rise in the number of heart patients who died before they could be brought to the hospital.

Hospital CEO Daniel Wolcott led a campaign to inform the community that the medical center was open and safe, even speaking to people about it in the grocery store.

But with new COVID-19 cases swamping the hospital, sickening nearly 30 staff members and forcing it to divert non-coronavirus cases to other facilities for several days, Wolcott fears that again patients with heart conditions and other illnesses will stay away.

“We won’t know for years how many people lost their lives or lost good years of their lives for fear of coronavirus,” he said.

(Reporting by Sharon Bernstein in Sacramento, California; editing by Bill Tarrant and Cynthia Osterman)

Researchers revise U.S. COVID-19 death forecast upward again

By Steve Gorman

(Reuters) – A newly revised coronavirus mortality model predicts more than 147,000 Americans will die from COVID-19 by early August, up nearly 10,000 from the last projection, as restrictions for curbing the pandemic are relaxed, researchers said on Tuesday.

The latest forecast¬†from the University of Washington’s Institute for Health Metrics and Evaluation (IHME) reflects “key drivers of viral transmission like changes in testing and mobility, as well as easing of distancing policies,” the report said.

The revision reinforced public health warnings, including U.S. Senate testimony on Tuesday from Dr. Anthony Fauci, the nation’s top infectious disease expert, that prematurely lifting lockdowns could lead to more outbreaks of the respiratory virus.

Fauci and other medical experts have urged caution in relaxing restraints on commerce before diagnostic testing and the ability to trace close contacts of infected individuals can be vastly expanded, along with other safeguards.

IHME researchers acknowledged that precise consequences of moves to reopen shuttered businesses and loosen stay-at-home orders are difficult to gauge.

“The full potential effects of recent actions to ease social distancing policies, especially if robust containment measures have yet to be fully scaled up, may not be fully known for a few weeks due to the time periods between viral exposure, possible infection and full disease progression,” the report said.

COVID-19, the respiratory illness caused by the novel coronavirus, has already claimed nearly 81,000 lives in the United States, out of more than 1.36 million known infections, according to a Reuters tally.

The revised IHME model, frequently cited by the White House and other public health authorities, predicted that the cumulative U.S. death toll will climb to 147,040 by Aug. 4, up 9,856 from the institute’s previous update on Sunday.

A week earlier, the model had sharply increased the figure to nearly 135,000 deaths, almost double its April 29 forecast, citing steps in about 30 states to ease social-distancing requirements.

The clamor to reopen businesses ranging from restaurants to auto plants has only gained momentum since then as unemployment hit levels not seen since the Great Depression of the 1930s.

The projections are presented as a range, with the latest forecast – 147,00-plus deaths – representing the average between a best-case scenario of 102,783 lives lost and a worst-case scenario of 223,489 fatalities.

The forecasts have fluctuated over the past couple of months, with a projected death toll as low as 60,000 on April 18.

(Reporting by Steve Gorman in Los Angeles; Editing by Sandra Maler and Cynthia Osterman)