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Tag: coronavirus

  • Four years after shelter-in-place, covid-19 misinformation persists

    Four years after shelter-in-place, covid-19 misinformation persists

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    From spring break parties to Mardi Gras, many people remember the last major “normal” thing they did before the novel coronavirus pandemic dawned, forcing governments worldwide to issue stay-at-home advisories and shutdowns.

    Even before the first case of covid-19 was detected in the U.S., fears and uncertainties helped spur misinformation’s rapid spread. In March 2020, schools closed, employers sent staff to work from home, and grocery stores called for physical distancing to keep people safe. But little halted the flow of misleading claims that sent fact-checkers and public health officials into overdrive.

    Some people falsely asserted covid’s symptoms were associated with 5G wireless technology. Faux cures and untested treatments populated social media and political discourse. Amid uncertainty about the virus’s origins, some people proclaimed covid didn’t exist at all. PolitiFact named “downplay and denial” about the virus its 2020 “Lie of the Year.” 

    Four years later, people’s lives are largely free of the extreme public health measures that restricted them early in the pandemic. But covid misinformation persists, although it’s now centered mostly on vaccines and vaccine-related conspiracy theories.

    PolitiFact has published more than 2,000 fact checks related to covid vaccines alone.

    “From a misinformation researcher perspective, [there has been] shifting levels of trust,” said Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security. “Early on in the pandemic, there was a lot of: ‘This isn’t real,’ fake cures, and then later on, we see more vaccine-focused mis- and disinformation and a more partisan type of disinformation and misinformation.”

    Here are some of the most persistent covid misinformation narratives we see today:

    A loss of trust in the vaccines

    Covid vaccines were quickly developed, with U.S. patients receiving the first shots in December 2020, 11 months after the first domestic case was detected.

    Experts credit the speedy development with helping to save millions of lives and preventing hospitalizations. Researchers at the University of Southern California and Brown University calculated that vaccines saved 2.4 million lives in 141 countries starting from the vaccines’ rollout through August 2021 alone. Centers for Disease Control and Prevention data shows there were 1,164 U.S. deaths provisionally attributed to covid the week of March 2, down from nearly 26,000 at the pandemic’s height in January 2021, as vaccines were just rolling out.

    But on social media and in some public officials’ remarks, misinformation about covid vaccine efficacy and safety is common. U.S. presidential candidate Robert F. Kennedy Jr. has built his 2024 campaign on a movement that seeks to legitimize conspiracy theories about the vaccines. PolitiFact made that its 2023 “Lie of the Year.”

    PolitiFact has seen claims that spike proteins from vaccines are replacing sperm in vaccinated males. (That’s false.) We’ve researched the assertion that vaccines can change your DNA. (That’s misleading and ignores evidence). Social media posts poked fun at Kansas City Chiefs tight end Travis Kelce for encouraging people to get vaccinated, asserting that the vaccine actually shuts off recipients’ hearts. (No, it doesn’t.) And some people pointed to an American Red Cross blood donation questionnaire as evidence that shots are unsafe. (PolitiFact rated that False.)

    Experts say this misinformation has real-world effects.

    A September 2023 survey by KFF found that 57% of Americans “say they are very or somewhat confident” in covid vaccines. And those who distrust them are more likely to identify as politically conservative: Thirty-six percent of Republicans compared with 84% of Democrats say they are very or somewhat confident in the vaccine.

    Immunization rates for routine vaccines for other conditions have also taken a hit. Measles had been eradicated for more than 20 years in the U.S. but there have been recent outbreaks in states including Florida, Maryland, and Ohio. Florida’s surgeon general has expressed skepticism about vaccines and rejected guidance from the CDC about how to contain potentially deadly disease spread.

    The vaccination rate among kindergartners has declined from 95% in the 2019-20 school year to 93% in 2022-23, according to the CDC. Public health officials have set a 95% vaccination rate target to prevent and reduce the risk of disease outbreaks. The CDC also found exemptions had risen to 3%, the highest rate ever recorded in the U.S.

    Unsubstantiated claims that vaccines cause deaths or other Illness

    PolitiFact has seen repeated and unsubstantiated claims that covid vaccines have caused mass numbers of deaths.

    A recent widely shared post claimed 17 million people had died because of the vaccine, despite contrary evidence from multiple studies and institutions such as the World Health Organization and CDC that the vaccines are safe and help to prevent severe illness and death. 

    Another online post claimed the booster vaccine had eight strains of HIV and would kill 23% of the population. Vaccine manufacturers publish the ingredient lists; they do not include HIV. People living with HIV were among the people given priority accessduring early vaccine rollout to protect them from severe illness.

    Covid vaccines also have been blamed for causing Alzheimer’s and cancer. Experts have found no evidence the vaccines cause either conditions.

    “​​You had this remarkable scientific or medical accomplishment contrasted with this remarkable rejection of that technology by a significant portion of the American public,” said Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. 

    More than three years after vaccines became available, about 70% of Americans have completed a primary series of covid vaccination, according to CDC figures. About 17% have gotten the most recent bivalent booster.

    False claims often pull from and misuse data from the Vaccine Adverse Event Reporting System. The database, run by the CDC and the FDA, allows anybody to report reactions after any vaccine. The reports themselves are unverified, but the database is designed to help researchers find patterns for further investigation.

    An October 2023 survey published in November by the Annenberg Public Policy Center at the University of Pennsylvania found 63% of Americans think “it is safer to get the covid-19 vaccine than the covid-19 disease” — that was down from 75% in April 2021.

    Celebrity deaths falsely attributed to vaccines

    Betty White, Bob Saget, Matthew Perry, and DMX are just a few of the many celebrities whose deaths were falsely linked to the vaccine. The anti-vaccine film “Died Suddenly” tried to give credence to false claims that the vaccine causes people to die shortly after receiving it.

    Céline Gounder, editor-at-large for public health at KFF Health News and an infectious disease specialist, said these claims proliferate because of two things: cognitive bias and more insidious motivated reasoning. 

    “It’s like saying ‘I had an ice cream cone and then I died the next day; the ice cream must have killed me,” she said. And those with preexisting beliefs about the vaccine seek to attach sudden deaths to the vaccine.

    Gounder experienced this personally when her husband, the celebrated sports journalist Grant Wahl, died while covering the 2022 World Cup in Qatar. Wahl died of a ruptured aortic aneurysm but anti-vaccine accounts falsely linked his death to a covid vaccine, forcing Gounder to publicly set the record straight.

    “It is very clear that this is about harming other people,” said Gounder, who was a guest at United Facts of America in 2023. “And in this case, trying to harm me and my family at a point where we were grieving my husband’s loss. What was important in that moment was to really stand up for my husband, his legacy, and to do what I know he would have wanted me to do, which is to speak the truth and to do so very publicly.”

    Out-of-control claims about government control

    False claims that the pandemic was planned by government leaders and those in power abound.

    At any given moment, Microsoft Corp. co-founder and philanthropist Bill Gates, World Economic Forum head Klaus Schwab, or Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases, are blamed for orchestrating pandemic-related threats.

    In November, Rep. Matt Rosendale (R-Mont.) falsely claimed Fauci “brought” the virus to his state a year before the pandemic. There is no evidence of that. Gates, according to the narratives, is using dangerous vaccines to push a depopulation agenda. That’s false. And Schwab has not said he has an “agenda” to establish a totalitarian global regime using the coronavirus to depopulate the Earth and reorganize society. That’s part of a conspiracy theory that’s come to be called “The Great Reset” that has been debunked many times.

    The United Nations’ World Health Organization is frequently painted as a global force for evil, too, with detractors saying it is using vaccination to control or harm people. But the WHO has not declared that a new pandemic is happening, as some have claimed. Its current pandemic preparedness treaty is in no way positioned to remove human rights protections or restrict freedoms, as one post said. And the organization has not announced plans to deploy troops to corral people and forcibly vaccinate them. The WHO is, however, working on a new treaty to help countries improve coordination in response to future pandemics.




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • WHO’s global network for coronavirus expertise

    WHO’s global network for coronavirus expertise

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    WHO has launched a new network for coronaviruses, CoViNet, to facilitate and coordinate global expertise and capacities for early and accurate detection, monitoring and assessment of SARS-CoV-2, MERS-CoV and novel coronaviruses of public health importance.

    CoViNet expands on the WHO COVID-19 reference laboratory network established during the early days of the pandemic. Initially, the lab network was focused on SARS-CoV-2, the virus that causes COVID-19, but will now address a broader range of coronaviruses, including MERS-CoV and potential new coronaviruses. CoViNet is a network of global laboratories with expertise in human, animal and environmental coronavirus surveillance.

    The network currently includes 36 laboratories from 21 countries in all 6 WHO regions.

    Representatives of the laboratories met in Geneva on 26 – 27 March to finalize an action plan for 2024-2025 so that WHO Member States are better equipped for early detection, risk assessment, and response to coronavirus-related health challenges.

    The CoViNet meeting brings together global experts in human, animal, and environmental health, embracing a comprehensive One Health approach to monitor and assess coronavirus evolution and spread. The collaboration underscores the importance of enhanced surveillance, laboratory capacity, sequencing, and data integration to inform WHO policies and support decision-making.

    Coronaviruses have time and again demonstrated their epidemic and pandemic risk. We thank our partners from around the world who are working to better understand high threat coronaviruses like SARS, MERS and COVID-19 and to detect novel coronaviruses. This new global network for coronaviruses will ensure timely detection, monitoring and assessment of coronaviruses of public health importance.”


    Dr. Maria Van Kerkhove, Acting Director of WHO’s Department of Epidemic and Pandemic Preparedness and Prevention

    Data generated through CoViNet’s efforts will guide the work of WHO’s Technical Advisory Groups on Viral Evolution (TAG-VE) and Vaccine Composition (TAG-CO-VAC) and others, ensuring global health policies and tools are based on the latest scientific information.

    Source:

    The World Health Organization

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  • Trial shows blood pressure drops with less sitting

    Trial shows blood pressure drops with less sitting

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    In a recent study published in JAMA Network Open, researchers investigated whether reducing sitting time could effectively improve blood pressure (BP) among older adults.

    ​​​​​​​Study: Sitting Time Reduction and Blood Pressure in Older Adults. Image Credit: insta_photos/Shutterstock.com​​​​​​​Study: Sitting Time Reduction and Blood Pressure in Older Adults. Image Credit: insta_photos/Shutterstock.com

    Background

    Sedentary behavior is associated with adverse health outcomes such as cardiovascular disease, type 2 diabetes, low physical function, and death. Moderate to moderate activity can benefit older adults’ cognitive, physical, functional, and emotional health; however, their compliance with physical activity is poor, with most of them sitting for much of the day.

    Identifying modifiable variables is critical to improving cardiometabolic fitness in older individuals. Short-term experimental investigations demonstrate that lowering sitting duration reduces blood pressure, particularly in hypertensive individuals.

    About the study

    In the present randomized controlled trial, researchers evaluated the impact of sitting time reduction on BP readings in the geriatric population.

    The team conducted the Healthy Aging Resources to Thrive (HART) trial primarily remotely at the state level during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic between January 2019 and November 2022.

    Participants included adult Kaiser Permanente Washington (KPWA) care recipients, enrolled for at least a year, aged between 60 and 89 years, sitting for ≥6.0 hours daily, and a body mass index (BMI) ranging between 30 and 50 kg/m2.

    The researchers excluded palliative, long-term, or hospice care recipients, those with cancer, deafness or considerable hearing impairment, degenerative disorders such as dementia, or adverse mental health conditions in the previous two years, diagnosed using the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10) codes.

    The team randomized the participants in a 1:1 ratio to the sedentary behavior reduction intervention (I-STAND) or healthy living control conditions for six months.

    The intervention group received ten health enhancement contacts, sedentary time reduction targets, and a fitness tracker. The controls received ten health training contacts to establish broad healthy living objectives that excluded physical activity and sedentary behavior.

    The primary study outcome was sitting duration recorded at study initiation, three months, and six months, using accelerometers for a week at every time point. The researchers monitored systolic BP (SBP) and diastolic BP (DBP) at study initiation and after six months.

    The exploratory outcomes included changes in accelerometer standing and walking time, daily step count, number of sitting bouts of ≥30 minutes, mean sitting bouts’ duration, time to perform five chair stands from the Short Physical Performance Battery, and changes in hypertension medication classes.

    The researchers performed linear regression modeling for analysis, with study covariates such as age, sex, race, ethnicity, residence county, physical function, retirement status, diabetes, and hypertension.

    They also performed a sensitivity analysis, separately analyzing data obtained before and during coronavirus disease 2019 (COVID-19).

    Results

    The researchers randomized 283 individuals to the I-STAND intervention (n=140) and control (n=143) groups. The mean participant age was 69 years, 186 (66%) were female, and the mean BMI was 35 kg/m2.

    At study initiation, 52% (n=147) suffered from hypertension, and 69% (n=97) consumed one or more antihypertensive medications. Accelerometer awake time was nearly 16 hours daily over a week of wear in the study groups.

    The team noted sedentary time reduction in favor of the I-STAND intervention, with an average difference of 31 minutes per day at three months and 32 minutes per day at six months.

    The intervention group had a considerably higher mean drop in SBP (3.5 mm Hg) after six months. However, DBP changes were not significantly different across the study groups (0.3 mm Hg).

    The sensitivity analysis showed similar results. The study found six major adverse events in both the I-STAND intervention group (two cancer diagnoses, one emergency department admission, two hospitalizations, and one fall) and the control group.

    However, there were no adverse events associated with the trial. They found no significant intergroup variations in BMI, waist circumference, or body weight.

    The study found that standing time rose while sitting bouts’ duration and extended sitting bouts were reduced after six months, favoring the intervention group. Changes in antihypertensive drug classes in both groups were not significant.

    Women had significantly lower diastolic blood pressure than men, but the impact was minor. Participants in suburban and rural locations demonstrated minor improvements in diastolic blood pressure, supporting the research intervention.

    Conclusion

    The study findings revealed that lowering sitting time may be successfully provided remotely, resulting in considerable blood pressure decreases. The intervention, which involved 283 older individuals, decreased sitting duration by >30 minutes per day and SBP by about 3.5 mm Hg.

    The findings indicate that sitting time reduction by standing more and taking more frequent breaks may be a unique lifestyle option for decreasing blood pressure that is simpler for older individuals with chronic diseases to implement into their everyday lives.

    Possible physiological causes for SBP decreases include frequent interruptions to the bent arterial posture, which may enhance blood flow and vascular shear stress.

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  • Humans to animals transmission more common than previously thought

    Humans to animals transmission more common than previously thought

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    In a recent study published in Nature Ecology & Evolution, researchers harnessed publicly available viral genomic data, using a comprehensive suite of network and phylogenetic analyses to investigate the evolutionary mechanisms underpinning recent viral host jumps.

    Study: The evolutionary drivers and correlates of viral host jumps. Image Credit: Kateryna Kon/Shutterstock.comStudy: The evolutionary drivers and correlates of viral host jumps. Image Credit: Kateryna Kon/Shutterstock.com

    Background

    Viruses found in non-human vertebrates frequently cause infectious diseases, outbreaks, epidemics, and pandemics when they spread to individuals. Zoonotic host jumps, or the transmission of viruses from wild and domestic animal populations to people, have considerably impacted human health.

    Current knowledge is insufficient to forecast, prevent, and control future infectious disease concerns since only a tiny proportion of the viral variety has been defined, with surveillance studies lacking geographical and temporal coverage. Understanding the evolutionary processes underlying host leaps may help reduce these impacts.

    About the study

    In the present study, researchers analyzed 12 million sequenced viruses and host information provided by the National Center for Biotechnology Information (NCBI) to evaluate worldwide viral genomic monitoring.

    They identified overarching patterns in viral host jump directionality among humans and non-human vertebrate organisms and assessed observable adaptability associated with potential host jumps.

    The researchers investigated adaptive evolution signs in viral proteins that facilitate or maintain host leaps. They obtained information on all viral sequences available on NCBI Virus (n = 11,645,803) to determine the extent of acquired viral genomic information.

    The researchers then collected 58,657 quality-controlled viral genomes from NCBI Virus, covering 32 viral families and 62 vertebrate host orders, accounting for 24% of all vertebrate viral species.

    They used a species-agnostic network theory technique to identify viral cliques that are discrete taxonomic groupings with similar levels of genetic variation.

    The researchers found potential host jumps within these viral cliques using curated whole-genome alignments and maximum-likelihood phylogenetic reconstruction.

    They accounted for the most frequent directional selection measure at the genome level, i.e., the proportion of non-synonymous-type amino acid substitutions in each non-synonymous region (dN) to that of synonymous substitutions for every synonymous site (dS).

    The researchers investigated whether the intensity of selection associated with a host hop reduces for viruses with broad host ranges. They used a linear model to predict log10 (dN/dS) differences between host and non-host leaps and clique membership effects to estimate potential adaptation signals associated with lineages that have experienced host jumps for the various gene categories.

    The researchers expected that within each gene, adaptative alterations would be limited to functionally critical areas or subjected to significantly higher selective pressures from host immunity.

    Results

    The study found that individuals are both a source and a sink for viral spillover events, with more viral host transfers from humans to other species than from animals to humans.

    For viruses with greater host ranges, the level of adaptation associated with a host jump is smaller, with structural or auxiliary genes serving as primary selection targets. The work exposes considerable gaps in worldwide viral genomic animal surveillance, underscoring the need for meticulous sample metadata reporting.

    The bulk of viral sequences in NCBI (68%) were linked to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), demonstrating extensive sequencing during the coronavirus disease 2019 (COVID-19).

    This collection contained 93% of vertebrate-related viral sequences, and most (93%) were associated with humans. The four viruses with the most sequenced genomes (Gallus, Sus, Anas, and Bos) were linked to domestic animals, and 15% of viral sequences were from vertebrates.

    User-uploaded host metadata for viral sequences remains inadequate, with 37% and 45% of viral genomic sequences from non-human hosts lacking related host information at the sample collection period and genus levels, respectively. The fraction of missing information varies significantly between virus families and nations.

    The researchers discovered 5,128 viral cliques spanning 32 viral families highly similar to ICTV-defined species. Despite the human-centric nature of genomic monitoring, viral cliques involving just animals account for 62% of all cliques, demonstrating the wide range of animal viruses in the worldwide viral-sharing network.

    The study showed that the minimal mutational distance for a putative host leap inside every viral clique was much higher than that of non-host jumps, showing that adaptation measurements were not biased.

    The observed host range for each viral clique was favorably correlated with higher sequencing intensity, indicating a significant positive relationship between the inter-host diversity of viral organisms and surveillance efforts.

    The intensity of adaptation signals differed by family, with structural proteins in coronaviruses showing the highest signals and auxiliary proteins in paramyxoviruses.

    Conclusion

    The study findings show that genomic data in the public domain helps understand viral host jumps, but there are gaps in understanding viral diversity. 81% of potential host jumps identified do not involve humans, highlighting the global viral-sharing network’s scale.

    Investigating the flow of viruses within this network could provide insights into managing infectious disease emergence at the human-animal interface. The study found that humans transmit more viral organisms to animals than humans, and multi-host virus-host jumps require fewer adaptations.

    The taxonomy-agnostic approach identified cliques consistent with traditional viral species nomenclature but also highlighted inconsistencies. Monitoring human-to-animal transmission of viruses is crucial for managing infectious diseases.

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  • Molnupiravir influences SARS-CoV-2 evolution in immunocompromised patients

    Molnupiravir influences SARS-CoV-2 evolution in immunocompromised patients

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    In a recent study published in The Lancet Microbe, researchers investigated the effects of molnupiravir on the evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in immunocompromised patients.

    Persistent SARS-CoV-2 infection in individuals who are immunocompromised offers genomic variation and has been linked to viral evolution. Antiviral therapy is recommended in immunocompromised patients with acute infection to prevent severe disease. Molnupiravir is the only alternative when first-line therapies (remdesivir and ritonavir-boosted nirmatrelvir) are not feasible, available, or appropriate.

    Study: Effect of molnupiravir on SARS-CoV-2 evolution in immunocompromised patients: a retrospective observational study. Image Credit: creativeneko / ShutterstockStudy: Effect of molnupiravir on SARS-CoV-2 evolution in immunocompromised patients: a retrospective observational study. Image Credit: creativeneko / Shutterstock

    Molnupiravir has been used worldwide in hospital and community settings as well as for immunocompromised patients. Nevertheless, it has been ineffective at reducing coronavirus disease 2019 (COVID-19) hospitalization and mortality rates in high-risk groups, and consequently, it has been designated a third-line therapeutic option. The drug triggers mutagenesis by introducing β-D-N4-hydroxycytidine, the prodrug, into the viral ribonucleic acid (RNA).

    The viral RNA polymerase uses this modified RNA as the template, and an error catastrophe occurs, inhibiting the viral replication. During RNA synthesis, molnupiravir behaves like a cytosine (C) and pairs with guanine (G); however, once incorporated, it transforms into a tautomer analogous to uracil (U), leading to G-to-A mutations in the subsequent round of replication. Likewise, it can induce C-to-U (or -thymine [T]) mutations during the synthesis of the positive-sense genome.

    Reverse T-to-C and A-to-G mutations are also possible but are less frequent. G-to-A mutations indicate molnupiravir treatment; distinctive mutational profiles with extensive G-to-A mutations have been found in global sequences and phylogenetic trees. This is linked to the use of molnupiravir as countries showing long G-to-A branches had increased use of the drug. Contrastingly, countries with infrequent G-to-A branches have not authorized molnupiravir.

    About the study

    In the present study, researchers analyzed the sequencing data from immunocompromised patients with SARS-CoV-2 infection to assess the effects of molnupiravir on viral evolution. The team sequenced around 100 genomes weekly from December 2021 to September 2022, specifically focusing on samples from reinfections, hospitalized patients, overseas travelers, and suspected residential care- and healthcare-related infections.

    Immunocompromised patients with protracted infection were also covered. The team selected nine patients with the same variant with multiple samples (from distinct time points). Four patients (controls) were tested before molnupiravir was available, and five were sampled pre- and post-molnupiravir treatment. All molnupiravir recipients and two controls were immunocompromised. Seven patients received ≥ two vaccine doses, and two were non-vaccinated.

    Patients’ prior infection status was unknown. Patients infected with similar variants and high-quality genomes were selected for group comparisons across time points. Accumulated mutations were compared between groups. The ultrafast sample placement on existing trees (UShER) pipeline and the University of California Santa Cruz genome viewer were leveraged to compare variants from patients with global reference sequences and visualize the locations of mutations.

    Findings

    The team noted that SARS-CoV-2 genomes acquired an average of 30 new low/mid frequency variants by 10 days post-molnupiravir treatment. These changes in viral diversity were not observed in patients who did not receive molnupiravir. On average, 3.3 mutations were acquired per day in the molnupiravir group.

    The probability of observing no mutations among controls during the study period was extremely low. Non-synonymous mutations were common in the spike protein, and subsequent samples indicated that some mutations were fixed. In one patient, 10 non-synonymous mutations were fixed by 35 days post-treatment.

    Accrued mutations were scattered throughout the genome, including those not detected in global Omicron genomes. Mutations acquired in the spike protein clustered at two locations, and their functional relevance was unclear. No known drug-resistance mutations were observed; however, non-synonymous mutations in the open reading frame 1b (ORF1b) were noted.

    The UShER analysis revealed potentially rare/novel mutations in the sequences following treatment. Some samples could not be placed on the global SARS-CoV-2 phylogeny as many mutations were phylogenetically distinct. Mutational profiles post-treatment revealed dominant G-to-A and C-to-T mutations, representing 70% of mutations, which persisted up to 44 days post-treatment.

    Conclusions

    In sum, the findings showed that molnupiravir use in immunocompromised patients modified the patterns of viral evolution, with effects lasting beyond the five-day treatment period. This highlights the risks of treating this subgroup of patients with an error-generating antiviral. The evolution rate in molnupiravir recipients exceeded that observed in non-recipients in this study and globally. Overall, the researchers provided more evidence of the causal link between molnupiravir and the altered mutational landscape of SARS-CoV-2.

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  • Inflammatory responses fuel cardiovascular complications

    Inflammatory responses fuel cardiovascular complications

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    In a recent study published in the journal Circulation, researchers investigate the inflammatory response to acute respiratory distress syndrome (ARDS) within the heart.

    Study: Virus-Induced Acute Respiratory Distress Syndrome Causes Cardiomyopathy Through Eliciting Inflammatory Responses in the Heart. Image Credit: Kateryna Kon / ShutterstockStudy: Virus-Induced Acute Respiratory Distress Syndrome Causes Cardiomyopathy Through Eliciting Inflammatory Responses in the Heart. Image Credit: Kateryna Kon / Shutterstock

    The link between respiratory viral infections and CVD

    Seasonal viral infections can range in severity from mild flu-like symptoms to potentially lethal ARDS. For example, despite being primarily a respiratory tract infection, coronavirus disease of 2019 (COVID-19) can lead to ARDS and other severe cardiovascular disease outcomes with high mortality rates.

    Circulating immune cells may respond to COVID-19 by upregulating cytokine release, which can lead to myocardial injury. Cardiac macrophages, immune cells responsible for the myocardial inflammatory response, are increasingly being investigated for their role in ARDS. Recent evidence indicates that macrophage expansion, which can be accompanied by changes in the population size and relative abundances of various cardiac macrophages, is a characteristic feature of ARDS.

    The main two types of cardiac macrophages include C-C chemokine receptor type 2 negative (CCR2–) and CCR2+ macrophages. Further research is needed to determine the viral-induced contributions of these macrophages to adverse cardiac outcomes.

    These data would allow clinicians to make informed intervention decisions and elucidate whether these outcomes are COVID-19-induced or if observed inflammation is a systemic immune response to viral infection. Furthermore, this information could support the development of future therapies to prevent cardiovascular disease (CVD) following recovery from COVID-19.

    About the study

    In the present study, researchers investigate the role of viral- and non-viral-induced ARDS-associated immune signals in altering cardiac macrophage populations, thereby impacting CVD parameters, including systemic inflammation.

    This study was conducted at Massachusetts General Hospital and involved 33 control samples obtained from patients who died between September and December 2019, prior to the onset of COVID-19, as well as 21 samples obtained between May and July 2020 from patients who died from COVID-19-associated complications. Samples consisted of autopsy tissue excised from the left ventricular or septal region.

    Simultaneously, in vivo studies involved a daily intratracheal administration of an ARDS cocktail of immunostimulatory agents to mice, which included resiquimod, imiquimod, lipopolysaccharide (LPS), and angiotensin-converting enzyme 2 (ACE2) inhibitor MLN-4760. This model allowed the researchers to reproduce clinical ARDS features in mice without the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

    Patient data included results obtained from electrocardiogram (ECG), echocardiography, lung computed tomography (CT) scan, blood gas analyses, body temperature evaluation, bronchoalveolar lavage fluid (BALF) characterization, blood pressure measurements, and flow cytometry. Both human and murine autopsy samples were processed using ribonucleic acid (RNA) isolation, real-time polymerase chain reaction (PCR) assay, and enzyme-linked immunosorbent assays (ELISAs) for protein and gene expression determinations.

    Similar immune responses in non-viral- and SARS-CoV-2-associated ARDS

    In the absence of viral infection, mice treated with the ARDS cocktail exhibited significant weight loss over the five-day cocktail treatment period. This was accompanied by hypothermia, a common feature of both ARDS and septic shock, as well as a mortality rate of over 40% by day five.

    Mice with ARDS exhibited bilateral opacities and immune cell infiltrations within their lungs, as well as reduced blood oxygenation. Furthermore, increased D-dimer, neutrophil, and monocyte levels were observed, as well as reduced blood pressure and lower heart rates in ARDS mice. Other inflammatory pathways that were activated in ARDS mice included increased levels of interleukin 6 (IL-6), IL-1ß, tumor-necrosis factor α (TNF-α), and interferon y (IFN-y), all of which are also associated with SARS-CoV-2 infection.

    In both non-infected ARDS and SARS-CoV-2-infected mice, an increased infiltration of interstitial macrophages and reduced levels of alveolar macrophages were observed. Although both mouse models exhibited increased levels of cardiac macrophages, this immune response was more pronounced in infected mice. Nevertheless, both models’ subsets of cardiac macrophages were altered to similar levels.

    Upon comparison of control and COVID-19 patient myocardium samples, SARS-CoV-2 infection recruited a more significant number of CCR2+ CD68+ macrophages, thus indicating that a robust immune response is elicited after severe infection compared to other life-threatening diseases.

    “Our findings indicate that systemic and myocardial inflammatory signals elicited by virally induced ARDS may contribute to the cardiovascular complications and high mortality rates of this condition. In addition, our study confirms previous reports that SARS-CoV-2 infection increases overall macrophage numbers in hearts.”

    The cardiac benefits of TNF-α immune therapy

    TNF-α neutralizing antibodies were also administered to mice to evaluate their effects on immune activation during ARDS. To this end, TNF-α immune therapy reduced weight loss, improved body temperature, increased blood oxygenation, and led to better survival rates. Histological analysis indicated that ARDS mice receiving anti-TNF-α therapy exhibited reduced macrophages, Cxcl2, IL-1ß, and IL-6 expression within the lungs.

    TNF-α therapy also improved systolic dysfunction, cardiomyocyte apoptosis, and monocyte infiltration in ARDS mice. Total cardiac macrophage counts and reduced expression of IL-1ß, IL-6, and TNF-α within the myocardium were also observed, thus demonstrating the anti-inflammatory benefits associated with TNF-α immune therapy in the lungs and hearts of mice with ARDS.

    Conclusions

    The study findings demonstrate that SARS-CoV-2 infection leads to significant alterations in cardiac macrophage subset levels, particularly increased levels of CCR2+ macrophages, in both mice and humans. Even in the absence of SARS-CoV-2 or another virus, the immune response to ARDS-like injury is capable of inducing significant alterations in heart macrophage levels, which may increase the risk of cardiovascular complications and mortality associated with ARDS.

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  • Health workers fear it’s profits before protection as CDC revisits airborne transmission

    Health workers fear it’s profits before protection as CDC revisits airborne transmission

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    Four years after hospitals in New York City overflowed with covid-19 patients, emergency physician Sonya Stokes remains shaken by how unprepared and misguided the American health system was.

    Hospital leadership instructed health workers to forgo protective N95 masks in the early months of 2020, as covid cases mounted. “We were watching patients die,” Stokes said, “and being told we didn’t need a high level of protection from people who were not taking these risks.”

    Droves of front-line workers fell sick as they tried to save lives without proper face masks and other protective measures. More than 3,600 died in the first year. “Nurses were going home to their elderly parents, transmitting covid to their families,” Stokes recalled. “It was awful.”

    Across the country, hospital leadership cited advice from the Centers for Disease Control and Prevention on the limits of airborne transmission. The agency’s early statements backed employers’ insistence that N95 masks, or respirators, were needed only during certain medical procedures conducted at extremely close distances.

    Such policies were at odds with doctors’ observations, and they conflicted with advice from scientists who study airborne viral transmission. Their research suggested that people could get covid after inhaling SARS-CoV-2 viruses suspended in teeny-tiny droplets in the air as infected patients breathed.

    But this research was inconvenient at a time when N95s were in short supply and expensive.

    Now, Stokes and many others worry that the CDC is repeating past mistakes as it develops a crucial set of guidelines that hospitals, nursing homes, prisons, and other facilities that provide health care will apply to control the spread of infectious diseases. The guidelines update those established nearly two decades ago. They will be used to establish protocols and procedures for years to come.

    “This is the foundational document,” said Peg Seminario, an occupational health expert and a former director at the American Federation of Labor and Congress of Industrial Organizations, which represents some 12 million active and retired workers. “It becomes gospel for dealing with infectious pathogens.”

    Late last year, the committee advising the CDC on the guidelines pushed forward its final draft for the agency’s consideration. Unions, aerosol scientists, and workplace safety experts warned it left room for employers to make unsafe decisions on protection against airborne infections.

    “If we applied these draft guidelines at the start of this pandemic, there would have been even less protection than there is now — and it’s pretty bad now,” Seminario said.

    In an unusual move in January, the CDC acknowledged the outcry and returned the controversial draft to its committee so that it could clarify points on airborne transmission. The director of the CDC’s National Institute for Occupational Safety and Health asked the group to “make sure that a draft set of recommendations cannot be misread to suggest equivalency between facemasks and NIOSH Approved respirators, which is not scientifically correct.”

    The CDC also announced it would expand the range of experts informing their process. Critics had complained that most members of last year’s Healthcare Infection Control Practices Advisory Committee represent large hospital systems. And about a third of them had published editorials arguing against masks in various circumstances. For example, committee member Erica Shenoy, the infection control director at Massachusetts General Hospital, wrote in May 2020, “We know that wearing a mask outside health care facilities offers little, if any, protection from infection.”

    Although critics are glad to see last year’s draft reconsidered, they remain concerned. “The CDC needs to make sure that this guidance doesn’t give employers leeway to prioritize profits over protection,” said Jane Thomason, the lead industrial hygienist at the union National Nurses United.

    She’s part of a growing coalition of experts from unions, the American Public Health Association, and other organizations putting together an outside statement on elements that ought to be included in the CDC’s guidelines, such as the importance of air filtration and N95 masks.

    But that input may not be taken into consideration.

    The CDC has not publicly announced the names of experts it added this year. It also hasn’t said whether those experts will be able to vote on the committee’s next draft — or merely provide advice. The group has met this year, but members are barred from discussing the proceedings. The CDC did not respond to questions and interview requests from KFF Health News.

    A key point of contention in the draft guidance is that it recommends different approaches for airborne viruses that “spread predominantly over short distances” versus those that “spread efficiently over long distances.” In 2020, this logic allowed employers to withhold protective gear from many workers.

    For example, medical assistants at a large hospital system in California, Sutter Health, weren’t given N95 masks when they accompanied patients who appeared to have covid through clinics. After receiving a citation from California’s occupational safety and health agency, Sutter appealed by pointing to the CDC’s statements suggesting that the virus spreads mainly over short distances.

    A distinction based on distance reflects a lack of scientific understanding, explained Don Milton, a University of Maryland researcher who specializes in the aerobiology of respiratory viruses. In general, people may be infected by viruses contained in someone’s saliva, snot, or sweat — within droplets too heavy to go far. But people can also inhale viruses riding on teeny-tiny, lighter droplets that travel farther through the air. What matters is which route most often infects people, the concentration of virus-laden droplets, and the consequences of getting exposed to them, Milton said. “By focusing on distance, the CDC will obscure what is known and make bad decisions.”

    Front-line workers were acutely aware they were being exposed to high levels of the coronavirus in hospitals and nursing homes. Some have since filed lawsuits, alleging that employers caused illness, distress, and death by failing to provide personal protective equipment.

    One class-action suit brought by staff was against Soldiers’ Home, a state-owned veterans’ center in Holyoke, Massachusetts, where at least 76 veterans died from covid and 83 employees were sickened by the coronavirus in early 2020.

    “Even at the end of March, when the Home was averaging five deaths a day, the Soldiers’ Home Defendants were still discouraging employees from wearing PPE,” according to the complaint.

    It details the experiences of staff members, including a nursing assistant who said six veterans died in her arms. “She remembers that during this time in late March, she always smelled like death. When she went home, she would vomit continuously.”

    Researchers have repeatedly criticized the CDC for its reluctance to address airborne transmission during the pandemic. According to a new analysis, “The CDC has only used the words ‘COVID’ and ‘airborne’ together in one tweet, in October 2020, which mentioned the potential for airborne spread.’”

    It’s unclear why infection control specialists on the CDC’s committee take a less cautious position on airborne transmission than other experts, industrial hygienist Deborah Gold said. “I think these may be honest beliefs,” she suggested, “reinforced by the fact that respirators triple in price whenever they’re needed.”

    Critics fear that if the final guidelines don’t clearly state a need for N95 masks, hospitals won’t adequately stockpile them, paving the way for shortages in a future health emergency. And if the document isn’t revised to emphasize ventilation and air filtration, health facilities won’t invest in upgrades.

    “If the CDC doesn’t prioritize the safety of health providers, health systems will err on the side of doing less, especially in an economic downturn,” Stokes said. “The people in charge of these decisions should be the ones forced to take those risks.”




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • Certain genes slash severity and death risk in older men

    Certain genes slash severity and death risk in older men

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    In a recent study published in The Journal of Infectious Diseases, researchers investigated the inflammation outcomes of three different Interleukin-1 receptor antagonist gene (IL1RN) single-nucleotide variants (SNVs) in acute severe respiratory syndrome coronavirus 2 (SARS-CoV-2) infection patients. Their retrospective study included almost 2,600 confirmed severe coronavirus disease 2019 (COVID-19) patients and showed that the IL1RN CTA haplotype and its rs419598 C/C SNV dramatically attenuated COVID-19-associated hyperinflammation, a characteristic of severe SARS-CoV-2 infections.

    Observed outcomes were substantially improved in men compared to women, with men depicting 15% reduced mortality over women with the same SNV. These findings were most extreme for older men, with patients with the rs419598 C/C SNV above the age of 74 presenting 80% less mortality risk than their non-SNV-expressing age-matched counterparts. This study is one of the first to elucidate the genetic determinants of COVID-19 pathology and may form the basis for personalized future interventions against the disease.

    Study: Interleukin-1 Receptor Antagonist Gene (IL1RN) Variants Modulate the Cytokine Release Syndrome and Mortality of COVID-19. Image Credit: Adao / ShutterstockStudy: Interleukin-1 Receptor Antagonist Gene (IL1RN) Variants Modulate the Cytokine Release Syndrome and Mortality of COVID-19. Image Credit: Adao / Shutterstock

    COVID-19 and the dangers of CRS

    The coronavirus disease 2019 (COVID-19) represents one of the worst pandemics in human history, responsible for almost 7 million deaths worldwide and leaving hundreds of millions of survivors with long-lasting clinical symptoms. In severe cases, the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may result in multiorgan failure, acute respiratory distress syndrome (ARDS), and even death in 10-20% of affected patients.

    Research has shown that severe COVID-19 symptoms are often associated with elevated plasma cytokine levels, especially those of interleukin 1β (IL-1β), IL-2, and IL-6. Unfortunately, a number of immunotherapy drugs, including those used to treat COVID-19, have been implicated in the overexpression of these ILs, a condition similar to cytokine release syndrome (CRS). Previous work by the present research group identified that IL1RN haplotypes containing the rs419598, rs315952, and rs9005 single-nucleotide variants (SNVs) could alter osteoarthritis and rheumatoid arthritis severity by attenuating hyperinflammation.

    Unfortunately, the role of genetics in COVID-19 pathology remains poorly understood. The present study aims to shine a light on this knowledge gap by investigating the role of IL1RN SNP in moderate-to-severe COVID-19 infections.

    About the study

    Previous research by the current group identified the associations of IL1RN genetic variants with osteoarthritis and rheumatoid arthritis outcomes. It revealed that three SNVs (rs419598, rs315952, and rs9005) improved disease outcomes via hyperinflammation reduction mechanisms. The present study aims to investigate if the same genetic variants could improve COVID-19 outcomes due to the central role of hyperinflammation in severe COVID-19 pathology.

    The study is a retrospective, observational study comprising data from adult (19+) patients admitted to Tisch Hospital, New York, United States, between March 2010 and March 2021. The cytokine profiles of these patients were compared against healthy age, sex, and body mass index (BMI)-matched controls without a clinical history of COVID-19 exposure. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assays were used to confirm COVID-19 status and severity. Data sources comprised sociodemographic (sex, age, race, and ethnicity) and medical data obtained from hospital records and discarded COVID-19 blood samples (for plasma extraction). Data generation included whole-genome sequences (low coverage) of participants’ blood. The gencove.org database was used to annotate common SNV genotypes for each sequenced sample.

    Three IL1RN genotypes, namely rs419598, rs315952, and rs9005, formed the focus of this study and were extracted from patients’ plasma samples during routine COVID-19 care. However, since multiple cytokines of interest were not included in routine care, plasma samples from 359 randomly selected study participants and their demography-matched controls were additionally extracted and subjected to a multiplex enzyme-linked immunosorbent assay (ELISA) assay.

    “Plasma cytokines IL-1β, IL-2, and IL-6 were determined by a test developed by ARUP Laboratories (Salt Lake City, UT) and approved by the New York State Department of Health.”

    Summary statistics were used to collate and analyze demographic variables and mortality statuses categorized by sex, race/ethnicity, and age. Univariate parametric tests were computed to evaluate CRS and mortality outcomes for each category. Comparisons between the mortality risks of different genotypes were conducted using multivariate logistic regressions, adjusting for sex and age.

    Study findings

    The present study included records from 2,589 hospitalized patients and an equal number of age, sex, and BMI-matched controls. Study participants presented a mean age of 61.2 years, an average BMI of 30.43, and comprised 53.3% male individuals.

    “IL1RN rs419598, rs315952, and rs9005 genotype data were available for all patients. Biomarkers noted in the clinical electronic hospital record (EHR) for IL-1β, IL-2, and IL-6 were available for 642, 645, and 1229 subjects, respectively, whereas other plasma inflammatory markers were available for more than 2000 subjects.”

    ELISA and cytokine analyses revealed that, compared to healthy control, COVID-19 patients displayed significantly elevated levels of cytokines (IL-1α, IL-5, IL-8, IL-17, IL-1β, IL-2, IL-1Ra, IL-6, tumor necrosis factor-α [TNF-α], interferon-α, and vascular endothelial growth factor [VEGF]). Alarmingly, levels of IL-6, IL-1Ra, IL-8, and IL-10 were found to be more than 10 times higher than baseline controls’ values. Inflammatory markers, including CRP, procalcitonin, D-dimer, and ferritin, were similarly heightened.

    Of the included patients, 397 (15.3%) died during treatment, with age (direct), sex (male at higher risk), and BMI (direct) showing associations with COVID-19-associated mortality.

    “RS-associated inflammatory biomarkers were elevated in both patients who survived and died; however, deceased patients had significantly higher levels of IL-6, CRP, procalcitonin, ferritin, and D-dimer, as well as reduced levels of complement components C3 and C4.”

    Surprisingly, carriers of the IL1RN CTA-1/2 haplotype (either or two copies of the CTA haplotype) displayed substantially reduced inflammatory marker concentrations (except IL-1Ra, which was increased in these patients) compared to patients without the genotype. Encouragingly, the CTA haplotype was found to confer a 40% reduction in COVID-19-associated mortality risk in men above the age of 74. However, no associations with BMI were revealed. When evaluating each IL1RN CTA SNV individually, rs419598 C/C SNV patients exhibited substantially reduced inflammatory marker concentrations compared to their C/T or T/T counterparts.

    Comparison between men and women reveals that, while most biomarker and mortality outcomes are indistinguishable across the sexes, IL1RN rs419598 C/C SNV was found to be associated with a decreased trend in mortality in men of all included age groups. In men above the age of 74, especially, this genotype was associated with an 80% decline in mortality, highlighting the role of hyperinflammation in severe COVID-19 progression.

    Conclusions

    The present study highlights that the IL1RN CTA haplotype, especially in combination with the rs419598 C/C genotype, substantially reduced CRS in patients (irrespective of sex) in severe COVID-19 infections and substantially reduced mortality in men.  

    “We show that concomitant with decreased proinflammatory cytokine production, the IL1RN CTA haplotype and rs419598 C/C SNV are associated with increased levels of its anti-inflammatory gene product IL-1Ra. Our data provide genetic evidence that activation of the inflammasome and the IL-1 pathway is proximal in the systemic cytokine inflammatory cascade. Its regulation by IL-1Ra, an endogenous anti-inflammatory protein, and potential crosstalk with IFN require further elucidation to advance the understanding and treatment of SARS-CoV-2 infection.”

    Journal reference:

    • Attur, M., Petrilli, C., Adhikari, S., Iturrate, E., Li, X., Tuminello, S., Hu, N., Chakravarti, A., Beck, D., & Abramson, S. B. Interleukin-1 Receptor Antagonist Gene (IL1RN) Variants Modulate the Cytokine Release Syndrome and Mortality of COVID-19. The Journal of Infectious Diseases, DOI – 10.1093/infdis/jiae031, https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiae031/7625543

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  • Lower grades for students who use both tobacco and cannabis, California survey reveals

    Lower grades for students who use both tobacco and cannabis, California survey reveals

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    Several reports have raised the issue of increasing absenteeism and lower grades in American public schools after they reopened following the coronavirus disease 2019 (COVID-19) pandemic. These predict higher rates of mental illness and dropout from high school. Substance use is also linked to poor outcomes, including vaping, tobacco, and cannabis, perhaps because of their effects on the developing brain.

    Study: Co-Use of Tobacco Products and Cannabis Is Associated with Absenteeism and Lower Grades in California High School Students. Image Credit: Solid photos/Shutterstock.com
    Study: Co-Use of Tobacco Products and Cannabis Is Associated with Absenteeism and Lower Grades in California High School Students. Image Credit: Solid photos/Shutterstock.com

    A recent study published in The Journal of Pediatrics examines the odds of these outcomes when tobacco and cannabis are co-used after compensating for other risks. With the rise in legalized cannabis, there has been an increase in the national (but not California) proportion of young people who vape, from 11% to 21% over the period 2017 to 2022. Again, the proportion of cannabis users went up from 5% to 15%.

    The current study sought to dissociate this risk in a sample of high school students in California surveyed in 2020-21, immediately after post-COVID school reopening.

    About the study

    The study utilized the California Healthy Kids Survey (CHKS), performed by the WestEd, the California Department of Education, and the Department of Health Care Services, on students in grades 9 and 11 in California. Only public school students were included, numbering about 353,000, who responded to survey questions about tobacco and cannabis use during the 30 days just before the survey and were attending school in person.

    The sample was equally split between males and females, grades 9 and 11, and those with highly educated parents vs others. Almost half were Hispanic, a quarter non-Hispanic White, and 15% Asian. Over one in three said they had felt depressed sometime in the past year, while 6% reported feeling endangered at school.

    Almost a tenth used alcohol, while 2% used tobacco alone. About 4% used cannabis, and the same proportion used both substances. Almost double these numbers were reported as having used these substances at any time.

    Co-use of both substances was linked to 35% absenteeism vs 29% in cannabis-only users, 26% among tobacco-only users, and 17% among those who used neither. Risk factors for absenteeism and/or poor grades that needed to be adjusted for included bullying, poor health, and change of residence if the student is a caregiver for others or comes from a family with food insecurity. Unsafe school conditions or poor educational climates at school also play a role in this phenomenon.

    After adjustment, co-users had a 40% higher risk of absenteeism, the highest among all categories. Compared to tobacco-only users, co-use and cannabis-only users both were ~20% and 15% more likely to report absenteeism, respectively. Similar findings were obtained among ever-users, too.

    The mean grade was 6.16, that is, mostly Bs. Co-use was associated with a mean grade of 5.08 vs 5.61 for tobacco-only users, 5.54 for cannabis-only users, and 6.24 among non-users. If using tobacco only was the reference group, co-users, and cannabis-only users had a decrease of 0.39 points, but it fell by a mean of 0.87 points when co-users were matched to non-users. Cannabis-only and tobacco-only users had no difference in their mean grades.

    Dangers of absenteeism

    School funding suffers when students are absent. Thus, co-use has roughly cost the school $300 per absent student on average.

    With over 8,000 students reporting substance use, absences may potentially have cost the school almost $2.5 million in annual funding, provided all of these absences were due to substance use, though this is an unlikely event.

    What are the implications?

    The drop in grades by almost one category, from Bs to Bs and Cs, associated with co-users compared to non-users, is an important adverse effect. This was accompanied by 40% higher odds of absenteeism (being absent three or more days within the past month) in the co-user group vs non-users and 20% higher odds than among tobacco-only users.

    This novel study supports the hypothesis that substance abuse, especially the dual use of tobacco and alcohol, worsens educational outcomes. Several mechanisms have been speculated about. For instance, these substances could affect cognitive processing and disrupt learning and memory pathways.

    Cannabis heightens nicotine addiction when used during adolescence, making quitting very difficult. Also, the use of either or both of these substances can cause illness, physical or mental, resulting in skipping school. Co-use has been linked to changes in the sleep pattern.

    Finally, vaping at school may distract students, reducing their ability to learn. Another possibility is that vaping or co-use may result in suspension from school. The occurrence of such events is mirrored in the list of reasons for absenteeism, such as illness, anger, sadness, stress, or inadequate sleep.

    Future studies should assess potential interventions to improve educational outcomes with the help of full-spectrum efforts to reduce or eliminate substance use among students.

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  • Impact of intensive delivery initiative

    Impact of intensive delivery initiative

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    In response to the coronavirus disease 2019 (COVID-19) pandemic, several vaccines were produced and rolled out at an unprecedented rate—however, access and cost issues limited vaccine delivery in many parts of the developing world.

    A new study in the journal Nature reports on the success of Sierra Leone’s immunization program against COVID-19, which is based on a simple, cost-effective, and scalable intervention that enhances access to vaccines.

    Study: Last-mile delivery increases vaccine uptake in Sierra Leone. Image Credit: Media Lens King / Shutterstock.com

    COVID-19 vaccine inequity

    COVID-19 vaccines were first rolled out in December 2020. However, by March 2022, only 15% of the population in low-income countries (LIC) had received at least one dose compared to 80% in high-income countries (HICs).

    The hazards associated with low vaccine coverage include the possibility of new surges and subsequent lockdowns, unemployment, loss of income, food insecurity, and the emergence of dangerous new variants and subvariants.

    By March 2022, only one-third of Africa’s population received a single COVID-19 vaccine dose. In Sierra Leone, previous research showed that, on average, a person had to travel seven hours to access one dose of the vaccine and that the cost of access to the vaccine was equivalent to a week’s wages.

    The intervention

    In partnership with the Sierra Leone Ministry of Health and Sanitation (MoHS) and international non-governmental organization (NGO) Concern Worldwide, the authors of the current study designed and executed an intervention aimed at distributing vaccines to remote villages. The permission of the local community was first sought, followed by efforts to mobilize the community in the vaccination initiative.

    The current intervention was a randomized controlled trial (RCT) in rural Sierra Leone that included 150 villages. All of these were outside the five-kilometer radius of primary health units (PHUs) offering COVID-19 vaccines in the area. Of these, 100 villages were involved in the intervention, with 50 serving as controls.

    The villages were small, with about 200 individuals for each village, with a total of just over 20,000 individuals participating in the trial. The mean age of these individuals was 22 years, with approximately 75% of households headed by men. Farming was the primary occupation of the head of the household in 86% of cases.

    The first day of the intervention involved community mobilization with all village elders and political, youth, and religious leaders, with the help of MoHS volunteers. That night, a community meeting was held to educate the people about the vaccine, its safety, effectiveness, and importance, as well as answer questions.

    The next day was devoted to setting up the temporary vaccination site with vaccine delivery workers, MoHS staff for data collection, and vaccine doses. Vaccines were available for the next two to three days, from sunrise to sunset, and community mobilization continued. Individual, door-to-door, small group or randomly selected houses were some of the tested outreach strategies.

    The results

    Daily vaccination uptake increased from nine to 55 people in two to three days, with the vaccination rate rising by 26 percentage points. The initiative attracted large numbers of people from neighboring areas and transients. Overall, about 5,000 people were vaccinated.

    At baseline, the average vaccination rate was 6% and 9% in control and treatment villages, respectively. After the intervention, treatment villages reported a 30% vaccination rate, which rose to over 70% by December 2022, with nearly eight million doses delivered by March 2023.  

    About 65% of those who attended the meetings took the vaccine, compared to 40% among non-attendees. Conversely, about 53% of attendees who were initially unwilling to take the vaccine did so after attending the meetings, compared to only 14% of non-attendees.

    The cost for each administered vaccine dose was about $33. If repeated with the same vetted and trained volunteers, this cost would reduce to about $23 for each person, thereby facilitating large-scale or nationwide efforts.

    Compared to over 200 similar interventions offered during 144 RCTs, including financial and other incentives, social motivation, and community engagement, the intervention discussed in the current study produced a more significant effect size than 95% of the others at a lower cost.

    These results suggest that low vaccination rates are related to deficiencies in access and that a cost-effective intervention is capable of overcoming that deficiency.”

    What this means for the future

    The approach employed in the current study could have significant impacts on public health around the world by encouraging delivery programs to immunize remote communities if these individuals cannot reach vaccine delivery centers. In Bangladesh, similar efforts have increased the infant vaccination rate from 1% during the early 1980s to over 70% by the 1990s.

    Bundling interventions to improve maternal and child health could also reduce healthcare delivery costs, as transport to remote locations accounted for a significant portion of associated costs. Thus, providing access to remote locations in LICs is fundamental in promoting vaccination of the first 50% of the population.

    Prominent behavioral scientists have recently acknowledged our excessive focus on individual behavioural peculiarities (‘i-frame’) at the expense of systemic solutions (‘s-frame’).”

    The current study demonstrates the striking efficiency and cost-effectiveness of a community-based vaccine intervention that benefited the local community and neighboring and migrant populations. Future applications of the approach employed in this study have the potential to improve vaccine uptake rates and ensure near-universal coverage to ultimately increase vaccine equity.

    Journal reference:

    • Meriggi, N. F., Voors, M., Levine, M. et al. (2024). Last-mile delivery increases vaccine uptake in Sierra Leone. Nature. doi:10.1038/s41586-024-07158-w.

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