Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19 #covid19rftlks

New England Journal of Medicine

Ad26.COV2.S is a replication-incompetent human adenovirus 26 containing the gene sequence that produces SARS-CoV-2 spike protein in a prefusion-stabilized conformation.

In this randomized trial involving nearly 40,000 persons, vaccine efficacy was 66% against infection and 85% against severe–critical Covid-19. Efficacy against the variant first identified in South Africa was 64% against moderate disease and 82% against severe–critical disease.

Full article: Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19

Altered immune signature linked to Long-Covid #covid19rftlks

Shuwa. H. A. et al | 2021| Alterations in T and B cell function persist in convalescent COVID-19 patients | Med | https://doi.org/10.1016/j.medj.2021.03.013

Researchers from the University of Manchester studied lymphocytes in COVID-19 patients during hospitalization and in convalescent patients over 6 months following hospital discharge. Specifically, they examined lymphocyte characteristics in peripheral blood mononuclear cells (PBMCs) from blood samples taken from COVID-19 patients within 7 days of hospitalization, at hospital discharge, and at up to 6 months post-hospital discharge.

The experts identify key alterations in B cell populations in acute COVID-19 patients with severe disease, which indicate that imbalances within the B cell compartment could contribute to COVID-19 disease severity. They demonstrate that in severe COVID-19 patients, there was a loss of transitional B cells and an expansion of double-negative memory B cells

Image source: Shuwa et al, 2021 Graphical abstract
Highlights

Lymphocytes were examined during COVID-19 and at up to 6 months of convalescence

B cell changes seen during acute COVID-19 were largely restored in convalescence

T cells from convalescent COVID-19 patients displayed persistent changes

Lymphocyte signatures defined 3 convalescent patient groups, one with poorer outcomes

Summary
Background

Emerging studies indicate that some coronavirus disease 2019 (COVID-19) patients suffer from persistent symptoms, including breathlessness and chronic fatigue; however, the long-term immune response in these patients presently remains ill-defined.

Methods

Here, we describe the phenotypic and functional characteristics of B and T cells in hospitalized COVID-19 patients during acute disease and at 3–6 months of convalescence.

Findings

We report that the alterations in B cell subsets observed in acute COVID-19 patients were largely recovered in convalescent patients. In contrast, T cells from convalescent patients displayed continued alterations with persistence of a cytotoxic program evident in CD8+ T cells as well as elevated production of type 1 cytokines and interleukin-17 (IL-17). Interestingly, B cells from patients with acute COVID-19 displayed an IL-6/IL-10 cytokine imbalance in response to Toll-like receptor activation, skewed toward a pro-inflammatory phenotype. Whereas the frequency of IL-6+ B cells was restored in convalescent patients irrespective of clinical outcome, the recovery of IL-10+ B cells was associated with the resolution of lung pathology.

Conclusions

Our data detail lymphocyte alterations in previously hospitalized COVID-19 patients up to 6 months following hospital discharge and identify 3 subgroups of convalescent patients based on distinct lymphocyte phenotypes, with 1 subgroup associated with poorer clinical outcome. We propose that alterations in B and T cell function following hospitalization with COVID-19 could affect longer-term immunity and contribute to some persistent symptoms observed in convalescent COVID-19 patients.

See also University of Manchester Altered immune signature linked to Long-Covid

Preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons #covid19rftlks

New England Journal of Medicine

Many pregnant persons in the United States are receiving messenger RNA (mRNA) coronavirus disease 2019 (Covid-19) vaccines, but data are limited on their safety in pregnancy.

This article reports that preliminary data from the CDC “v-safe after vaccination health checker” surveillance system, the v-safe pregnancy registry, and the Vaccine Adverse Event Reporting System did not show any obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines.

The authors state that more data are needed to better inform maternal, pregnancy, and infant outcomes.

Full article: Preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons

What do we know about airborne transmission of SARS-CoV-2? #covid19rftlks

BMJ | 2021; 373: n1030

How covid-19 spreads is one of the most debated questions of the pandemic. This BMJ briefing explains what the evidence tells us about airborne transmission of the virus, and asks:

  • What does airborne transmission mean?
  • Is covid-19 airborne?
  • What does WHO say about airborne transmission of covid-19?
  • What do national governments say about airborne transmission of covid-19?
  • How can we prevent airborne transmission?
  • Do masks prevent airborne transmission?
  • How does airborne transmission compare outdoors versus indoors?

Full detail: What do we know about airborne transmission of SARS-CoV-2?

Spending on health in Europe: entering a new era #covid19rftlks

COVID-19 has shown the importance of robust health systems and the long-term benefits of investing in the health of the population. Countries were quick to mobilize additional funds for the health system in response to the pandemic, but treating and preventing COVID-19 and addressing the impact of disruption to services will require continued investment in the years ahead | World Health Organisation

This report highlights the need for governments to maintain a higher level of public spending on health for the wider benefit of society despite expected budgetary pressures following the pandemic. The report states that sustained increases in public spending on health coupled with well designed public policy can mitigate the negative effects of COVID-19 while also building health system resilience.

The report also highlights that spending on primary health care accounts for less than half of all health spending, despite being a cost-effective way to deliver health care to communities. WHO has called for an additional 1% of gross domestic product (GDP) in public funding to be spent on primary health care.

Full report: Spending on health in Europe: entering a new era

Press release: New report from WHO on health spending calls on governments not to repeat past mistakes when rebuilding from COVID-19

The Health Foundation: Quality improvement made simple

The Health Foundation | April 2021 | The Health Foundation: Quality improvement made simple

The Health Foundations has published the third edition of its quality improvement guide, Quality improvement made simple

Quality improvement is about giving the people closest to issues affecting care quality the time, permission, skills and resources they need to solve them. It involves a systematic and coordinated approach to solving a problem using specific methods and tools with the aim of bringing about a measurable improvement.

The Health Foundation
Key points
  • This guide focuses on quality improvement, and is especially useful for health care staff leading fast and efficient service change as a result of the pandemic. 
  • Quality improvement involves the use of a systematic and coordinated approach to solving a problem using specific methods and tools with the aim of bringing about a measurable improvement within a health care setting.

The guide is available to download and read online

Covid 19: supporting the vulnerable during lockdown #covid19rftlks

House of Commons Public Accounts Committee

This report recognises the pace and urgency with which Government delivered the shielding programme. However, the report concludes that the programme suffered from the problems of poor data and a lack of joined up systems meaning that it took too long to identify some clinically vulnerable people at a time when their need was urgent.

The Committee says “clearly government has learned lessons which have fed into more recent iterations of shielding”, including much greater understanding of the range of covid19 risk factors, where DHSC’s initial, purely clinical approach to vulnerability omitted key characteristics such as ethnicity, postcode and Body Mass Index.

Learning from the community response to Covid-19: how the NHS can support communities to keep people well #covid19rftlks

This report considers what all community-facing NHS organisations can learn from the community response to Covid-19. The report outlines practical guidance and recommendations to help build a future where people are at the heart of keeping communities well | The Health Creation Alliance

COVID-19 has affected communities in different ways and, for some, the effects of the pandemic have been devastating. It has also shone a harsh light on the underlying inequalities in society and reinforced the urgent need for society to do more to address health inequalities.

COVID-19 also demanded that the NHS adopts different ways of working. Examples include primary care focussing on digital methods to continue service delivery and acute trusts and systems having to prioritise and reorganise care processes and pathways. The NHS has learnt from this.

The NHS could also learn from how communities self-organised in response to COVID-19. If the different parts of the NHS respond, respect and connect well to networked and organised communities, this could support a better future in which inequalities are more effectively addressed.

Full report: Learning from the community response to Covid-19: how the NHS can support communities to keep people well

The Health Foundation: Unemployment and mental health Why both require action for our COVID-19 recovery #covid19rftlks

The Health Foundation | April  2021 | Unemployment and mental health Why both require action for our COVID-19 recovery

The Health Foundation has analysed preliminary research findings from Katikireddi et al, 2021.A team of researchers from the universities of Glasgow, Leeds, Essex and Newcastle Research are assessing the potential impact of economic and welfare policy responses to COVID-19 on mental health and mental health inequalities, including who is impacted the most and what the likely consequences will be.

The Health Foundation’s analysis indicates the increase in total unemployment, and the associated rise in long-term unemployment, will result in an additional 200,000 people having poor mental health. This indicates there would be 800,000 unemployed people with poor mental health by the end of 2021.


• The rise in unemployment is not distributed evenly across society. While the unemployment rate was estimated at 5.1% in January 2021, the highest rates were among young people aged 18–24 (14.0 per cent), people with lower qualifications (7.8 per cent ) and people from minority ethnic groups (7.6 per cent ).


• In January 2021, 43 per cent of unemployed people had poor mental health. This was greater than for
people in employment (27 per cent ) and for people who were on furlough (34 per cent ). This suggests that
furloughing has provided some protection for mental health.

The report concludes that a key element of the UK’s recovery from the COVID-19 pandemic will be maintaining high
employment levels. A significant proportion of people who are currently unemployed have mental health problems, such as depression and anxiety. Supporting these individuals into work will be critical to achieving higher employment rates and economic prosperity.

See the report for the full analysis findings Unemployment and mental health Why both require action for our COVID-19 recovery

Further information about the project from Katikireddi et al, 2021 is available from The Health Foundation

See also:

The Health Foundation Over 200,000 more people are at risk of poor mental health this year due to unemployment [press release]

Primary care networks and place-based working: addressing health inequalities in a Covid-19 world #covid19rftlks

The Health Creation Alliance

COVID-19 has accelerated the formation of and action being taken by local networks in the community, giving communities and local partners an urgency, a higher priority and a confidence to act to support members of the community in many ways. The vaccination programme has accelerated the coming together of practices within Primary Care Networks (PCNs) to create a whole new service. COVID-19 has also exposed the extent of health inequalities. What happens now is critical. Primary care, increasingly led by (PCNs), has a huge opportunity to work in more networked ways with communities and local partners to address health inequalities.

This report provides insights from those working to address health inequalities outside the NHS about how primary care, enabled by primary care networks, might access the breadth of potential solutions that are possible when they work in partnership with their communities and local partners. 

Full report: Primary care networks and place-based working: addressing health inequalities in a Covid-19 world