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  • COVID-19 recovery disparities uncovered among racial and ethnic groups

    COVID-19 recovery disparities uncovered among racial and ethnic groups

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    In a recent study published in Frontiers in Public Health, researchers from the United States of America (US) investigated the racial and ethnic variation in symptoms, activity level, health status, and missed work.

    Depiction of the SARS-CoV-2 virus
    Study: Ethnic and racial differences in self-reported symptoms, health status, activity level, and missed work at 3 and 6 months following SARS-CoV-2 infection. Image Credit: Kateryna Kon/Shutterstock.com

    They assessed this via follow-ups post-initial infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the symptoms were equally prevalent among the groups, they found that three and six months post-infection, Hispanic participants reported poorer health and reduced activity compared to non-Hispanic participants.

    Further, racial minority participants reported more negative impacts on health status, activity, and absence from work as compared to the White population.

    Background

    The coronavirus disease 2019 (COVID-19) pandemic highlighted disparities, wherein ethnic and racial minoritized populations were observed to face greater infection risks due to the essential nature of their work, limited remote work options, and challenges in practicing social distancing.

    The infected individuals faced barriers to care, including underinsurance and lack of primary care, with economic consequences. Disparities persisted in health outcomes, for example, higher hospitalization and mortality rates among Black and Hispanic populations.

    Despite these challenges, recovery-related differences after SARS-CoV-2 infection remained understudied, with existing studies having limitations like varied follow-up durations, inconsistent findings, and insufficient consideration of social health determinants.

    Researchers in the present study aimed to address this gap. The study assessed symptoms and health-related effects following SARS-CoV-2 infection across ethnicities and races, aiming to guide equitable health interventions effectively.

    About the study

    In the present study, a secondary analysis was performed using data from a US-based, prospective, multicenter, longitudinal cohort study named Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE). The primary cohort involved adults positive for SARS-CoV-2 infection enrolled from December 2020 to July 2022, along with a SARS-CoV-2-negative group for considering non-SARS-CoV-2-related effects.

    A total of 3,161 participants completed enrollment and reported symptoms and other outcomes every three months via surveys. Out of these participants, 2,402 were SARS-CoV-2-positive and 759 SARS-CoV-2-negative.

    Among the SARS-CoV-2-positive participants, 14.0% were Hispanic, 11.0% were Asian, 7.9% were Black, 9.9% were categorized as Other/Multiple races, and 71.1% were White. Among the SARS-CoV-2-negative participants, 16.5% were Hispanic, 14.8% were Asian, 13.1% were Black, 8.1% were categorized as Other/Multiple races, and 64% were White.

    The researchers evaluated 21 COVID-19-like symptoms and “other symptoms” at enrollment and three and six months post-infection using the Centers for Disease Control and Prevention’s symptom list.

    During the follow-ups, health status (rated on a 5-point scale from excellent to poor), activity level compared to pre-SARS-CoV-2 symptoms (same, somewhat less, much less), and missed work in the past three months (categorized into workdays) were assessed.

    Data were collected on ethnicity and race. Interactions between ethnicity or race and SARS-CoV-2 infection status were considered.

    Generalized estimating equations (GEE) logistic regression was used to estimate marginal odds ratios (ORs) for various outcomes, adjusting for SARS-CoV-2 infection status, demographic factors, substance use, social determinants of health, pre-existing health conditions, COVID-19 vaccination status, and survey time point.

    Results and discussion

    Post SARS-CoV-2 infection, symptoms were found to be mostly similar across ethnic and racial groups over time. At three months, Hispanic individuals had higher odds of reporting fair/poor health (OR = 1.94) and reduced activity compared to their non-Hispanic counterparts. No significant differences by ethnicity were observed at six months.

    At three months, participants of Other/Multiple races had higher odds of reporting fair/poor health (OR = 1.9) and reduced activity compared to White participants. At six months, Asian participants had a greater probability of reporting fair/poor health (OR = 1.88), Black individuals reported more missed work (OR = 2.83), and Other/Multiple race participants reported more health issues (OR = 1.83), reduced activity, and missed work (OR = 2.25).

    The findings help to improve our understanding of the ethnic and racial disparities in outcomes after SARS-CoV-2 infection and could be used to inform clinical and public health initiatives and policy.

    However, the study is limited by small sample sizes in ethnic and racial subgroups, lack of adjustment for insurance and frontline worker status, potential participant representativeness issues, variations in response rates, lack of exploration of neurological and mental health sequelae, recruitment at different pandemic stages, and the absence of adjustments for multiple comparisons.

    Conclusion

    In conclusion, the findings suggest that while the symptom prevalence was similar among the groups, the ethnic and racial minority groups suffered adverse effects on health status, activity level, and absence from work as compared to non-Hispanic and White populations, respectively.

    Examining the underlying factors contributing to these differences could aid the efforts to promote health equity and improve our preparedness for future pandemics.

    Journal reference:

    • O’Laughlin KN, Klabbers RE, Mannan IE, et al. (2024). Ethnic and racial differences in self-reported symptoms, health status, activity level, and missed work at 3 and 6 months following SARS-CoV-2 infection. Frontiers in Public Health. doi: 10.3389/fpubh.2023.1324636.  https://www.frontiersin.org/articles/10.3389/fpubh.2023.1324636/full

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  • XBB.1.5 updated COVID vaccine booster offers 54% increased protection against symptomatic infection

    XBB.1.5 updated COVID vaccine booster offers 54% increased protection against symptomatic infection

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    In a recent study published in Morbidity and Mortality Weekly Report, researchers estimated the effectiveness of the 2023-24 updated coronavirus disease 2019 (COVID-19) vaccine.

    The Advisory Committee on the Immunization Practices of the United States (US) Centers for Disease Control and Prevention (CDC) recommended on September 12, 2023, that all individuals aged six months or older receive the 2023-24 updated monovalent COVID-19 vaccine. The updated vaccine contains a component from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron XBB.1.5 lineage and lacks ancestral strain components.

    The JN.1 lineage was identified in the US in September 2023, which harbors 30 additional mutations in the spike (S) protein compared to XBB.1.5. Real-time reverse-transcription polymerase chain reaction (RT-PCR) results can help distinguish some SARS-CoV-2 lineages. S-gene target failure (SGTF) is detected in JN.1 and other BA.2.86 lineages, whereas S-gene target presence (SGTP) is detected in most lineages from 2023, including XBB.

    Study: Early Estimates of Updated 2023–2024 (Monovalent XBB.1.5) COVID-19 Vaccine Effectiveness Against Symptomatic SARS-CoV-2 Infection Attributable to Co-Circulating Omicron Variants Among Immunocompetent Adults — Increasing Community Access to Testing Program, United States, September 2023–January 2024. Image Credit: New Africa / ShutterstockStudy: Early Estimates of Updated 2023–2024 (Monovalent XBB.1.5) COVID-19 Vaccine Effectiveness Against Symptomatic SARS-CoV-2 Infection Attributable to Co-Circulating Omicron Variants Among Immunocompetent Adults — Increasing Community Access to Testing Program, United States, September 2023–January 2024. Image Credit: New Africa / Shutterstock

    About the study

    In the present study, researchers estimated the effectiveness of the 2023-24 updated COVID-19 vaccine against symptomatic infection. They included tests conducted between September 21, 2023, and January 14, 2024, among adults reporting at least one symptom. Cases were individuals with a positive nucleic acid amplification test (NAAT).

    Controls were individuals with a negative NAAT. The team excluded tests from Janssen vaccine recipients, Novavax recipients, immunocompromised individuals, those who received the most recent vaccine dose within a week preceding testing, and those with a positive COVID-19 test within the past 90 days.

    Vaccine effectiveness (VE) against symptomatic COVID-19 was estimated by comparing the odds of receipt of the updated vaccine versus non-receipt among cases and controls. Multivariable logistic regression was used to estimate odds ratios. VE was computed separately by SGTP and SGTF status. Test-positive samples with reduced or null S-gene amplification were deemed to have an SGTF, whereas those without SGTF were considered SGTP.

    Findings

    Of over 9,200 NAAT results for individuals with symptoms of COVID-19-like illness, 3,295 tested SARS-CoV-2-positive. Around 1,125 individuals received the updated COVID-19 vaccine ≥ seven days earlier. More controls received the updated vaccine than cases. The median time from the last dose among updated vaccine recipients was 60 days for cases and 51 days for controls.

    Nearly 8,100 individuals did not receive the updated vaccine. Of these, 30% were non-vaccinated and 70% were vaccinated. Among the vaccinated, the median time since vaccination was 378 days for cases and 363 days for controls. The estimated VE was 57% in the 18–49 age group and 46% among those aged ≥ 50. VE was estimated at 58% and 49% among people tested 7–59 and 60–119 days after receiving the updated vaccine, respectively.

    There were 679 tests available with S-gene target results. Of these, 258 showed SGTF, and 421 exhibited SGTP. VE was not precise for tests with SGTF during the 7–59 days post-receipt of the updated vaccine, given the emergence of JN.1 in the US. VE during the 60–119 days post-receipt of the updated vaccine was 60% for tests with SGTP and 49% for those with SGTF.

    Conclusions

    The study provided early efficacy estimates of the updated monovalent XBB.1.5 vaccine against symptomatic infection and the first VE estimates against the JN.1 lineage. These VE estimates include data up to 119 days post-vaccination. However, VE will likely wane with time since vaccination, as observed after the original monovalent or bivalent COVID-19 vaccination. Prior infection history, medical conditions, and vaccination status were self-reported, thereby subject to recall bias.

    Besides, the VE estimates were computed for a population that opted to be tested for COVID-19; therefore, the estimates are subject to selection biases. Further, coverage of the updated vaccine is low among adults and varies by age. Taken together, the updated monovalent vaccine provided 54% protection from symptomatic illness. Waning of the VE is expected over time, especially against less severe outcomes.

    Journal reference:

    • Link-Gelles R, Ciesla AA, Mak J, et al. Early Estimates of Updated 2023–2024 (Monovalent XBB.1.5) COVID-19 Vaccine Effectiveness Against Symptomatic SARS-CoV-2 Infection Attributable to Co-Circulating Omicron Variants Among Immunocompetent Adults — Increasing Community Access to Testing Program, United States, September 2023–January 2024. MMWR Morb Mortal Wkly Rep, 2024, DOI: 10.15585/mmwr.mm7304a2, https://www.cdc.gov/mmwr/volumes/73/wr/mm7304a2.htm

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  • Covid-19 ’emergency’ ended in 2023 but the virus still lingers

    Covid-19 ’emergency’ ended in 2023 but the virus still lingers

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    A nurse prepares a shot for Jonathan Halter as the German embassy begins its roll out of BioNTech COVID-19 vaccines for German expatriates at a Beijing United Family hospital in Beijing, China January 5, 2023. REUTERS/Thomas Peter

    A covid-19 vaccine being prepared in Beijing in January

    REUTERS/Thomas Peter

    When it comes to covid-19, 2023 was different to the pandemic’s previous three years. Across the globe, hospitalisations and deaths reached all-time lows. On 5 May, the World Health Organization (WHO) announced the virus was no longer a public health emergency, suggesting the pandemic’s crisis phase had ended.

    “It is a really important inflection point of accomplishment,” says Maria Van Kerkhove at the WHO. “But that’s not the end of the story. While the crisis is over, the virus is still with us.”…

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  • Long covid: What we now know about its causes and possible treatments

    Long covid: What we now know about its causes and possible treatments

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    New Scientist Default Image

    FOR many of us, the covid-19 pandemic is fading into memory. But for millions of people, that isn’t possible as they are still unwell. An illness that is often brief and mild is, for some, the start of a rollercoaster of symptoms that can last years. Today, around 65 million people may have long covid.

    That is the bad news. But around four years since the first cases emerged, evidence of the causes of long covid is rapidly accumulating, paving the way for treatments. Multiple trials of therapies are under way and several have already shown promising results. It is now also clear that people experience wide differences in their long covid symptoms, so treating this condition is an exercise in personalised medicine: no single approach will work for everyone.

    Many questions remain, however. Can the plummeting levels of certain hormones explain the fatigue and brain fog, and is the persistence of the virus really key to understanding what is going on? And what should we do – and not do – to avoid developing long covid in the first place?

    Long covid symptoms

    The SARS-CoV-2 coronavirus started spreading around the world in early 2020. Within months, reports began emerging that some people were experiencing lingering symptoms. The term “long covid” was coined in May 2020 and widely adopted. The most common symptoms include headaches, brain fog and fatigue, or post-exertional malaise, in which even small amounts of activity cause exhaustion. Altogether, more than 200 symptoms have been reported, ranging from depression to gastrointestinal problems.

    Since that time…



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