CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 4/7/2022

Why Genomic Sequencing Is Important for the Next Stage of the Pandemic

(J. Harris: Quick review on Genomic  composition of isolated Covid viruses in US)

FROM JAMA:

1. Maternal COVID-19 Vaccine Safe for Infants

”…Astudy in Israel found that individuals who received an mRNA COVID-19 vaccine during pregnancy delivered infants with no increased risk for morbidity or mortality compared with infants whose birthing parents weren’t vaccinated.”

2. Fluvoxamine for Outpatient Management of COVID-19 to Prevent Hospitalization

”…In this systematic review and meta-analysis of data from 3 trials, under a variety of assumptions, we found the probability that fluvoxamine was associated with reduced hospitalization ranged from 94.1% to 98.6% and the probability of moderate association ranged from 81.6% to 91.8%. Ongoing randomized controlled trials of fluvoxamine should continue, particularly those studying lower 50-mg doses (which may be better tolerated), evaluating efficacy in vaccinated individuals, or studying the related SSRI fluoxetine, which is on the World Health Organization’s list of essential medications. In the meantime, fluvoxamine is an immediately available, safe, and inexpensive management option with a high probability of moderate efficacy. It could be recommended as a treatment option for patients without contraindication, particularly in resource-limited settings or for individuals without access to monoclonal antibodies or direct antivirals……..fluvoxamine, which is a selective serotonin reuptake inhibitor (SSRI) that is also a potent activator of the sigma-1 receptor3 which decreases inflammation via reducing endoplasmic reticulum stress.4 In a murine sepsis model, fluvoxamine administration reduced mortality predominantly through sigma-1 activation.5…”

”Based on our analysis, and coupled with worldwide accessibility, decades of safety data, and a current price of approximately $1 per day,30,31 fluvoxamine may be a reasonable option for high-risk outpatients who do not have access to SARS-CoV-2 monoclonal antibodies, direct antivirals, or clinical trials…. Clinicians who prescribe fluvoxamine for COVID-19 should familiarize themselves with relative contraindications and notable drug-drug interactions, including the need to limit caffeine (eTable 2 in the Supplement). The most common reported side effects from fluvoxamine in clinical trials are gastrointestinal (nausea, vomiting, diarrhea, and anorexia) and central nervous system complaints (headache, dizziness, somnolence, and nervousness).”

MORE ABOUT FLUVOXAMINE (LUVOX)

(J. Harris: I have never prescribed or used this medication. It has many side effects and interactions but it seems to limit the effects of Covid on many patients.  It is relatively cheap and available. Do not take it unless your doctor prescribes it.)

FROM NEJM:

1. Pulse Oximetry for Monitoring Patients with Covid-19 at Home — A Pragmatic, Randomized Trial

”…We report the findings from a randomized trial that assessed a text message–based remote-monitoring program (COVID Watch) supplemented with monitoring of oxygen saturation by means of a home pulse oximeter…Among patients with Covid-19, the addition of home pulse oximetry to remote monitoring did not result in a greater number of days alive and out of the hospital than subjective assessments of dyspnea alone.

(J. Harris: Nevertheless, it is reassuring to be able to check blood oxygen levels at home anytime you are concerned, and I still believe it might help in an early diagnosis of Covid, especially in old folks.)

2. Population Immunity and Covid-19 Severity with Omicron Variant in South Africa

RESULTS

Samples were obtained from 7010 participants, of whom 1319 (18.8%) had received a Covid-19 vaccine. The seroprevalence of SARS-CoV-2 IgG ranged from 56.2% , 52.6 to 59.7) among children younger than 12 years of age to 79.7% among adults older than 50 years of age. Vaccinated participants were more likely to be seropositive for SARS-CoV-2 than unvaccinated participants (93.1% vs. 68.4%). Epidemiologic data showed that the incidence of SARS-CoV-2 infection increased and subsequently declined more rapidly during the fourth wave than it had during the three previous waves. The incidence of infection was decoupled from the incidences of hospitalization, recorded death, and excess death during the fourth wave, as compared with the proportions seen during previous waves.

CONCLUSIONS

Widespread underlying SARS-CoV-2 seropositivity was observed in Gauteng before the omicron-dominant wave of Covid-19. Epidemiologic data showed a decoupling of hospitalizations and deaths from infections while omicron was circulating.

(J. Harris: Vaccination and/or prior Covid infection shortend the 4th wave in S. Africa.)

3. Not Ready for the End Game — Why Ending Federal Covid-19 Emergency Declarations Will Harm Access to Care

FROM BECKER:

U of Texas Medical Branch renames med school to honor $1B lifetime donor

(J. Harris: For one billion dollars, I would gladly change my name, and would throw in my recently promoted Norwegian Overseer).

FROM HOPKINS SELECTIONS:

1. SARS-CoV-2 BA.1 Variant is Neutralized by Vaccine Booster-elicited Serum, But Evades Most Convalescent Serum and Therapeutic Antibodies (Science Translational Medicine) The rapid spread of the highly contagious Omicron variant along with its high number of mutations in the spike gene has raised alarms about the effectiveness of current medical countermeasures. We found that titers against the Omicron variant were low or undetectable after two immunizations and in many convalescent serum samples, regardless of the infecting variant. A booster vaccination increased titers more than 30-fold against Omicron to values comparable to those seen against the D614G variant after two immunizations. These findings underscore the potential benefit of mRNA vaccine boosters for protection against Omicron and the need for rapid development of antibody therapeutics that maintain potency against emerging variants. 

LASTLY:

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