Coronavirus: we separate myths from facts and give advice

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Wuhan market origin of outbreak

SINGAPORE, Nov 19 (Reuters) - The first known COVID-19 case was a market vendor in the Chinese city of Wuhan, not an accountant who appeared to have no link to the market but whose case contributed to speculation the virus could have leaked from a lab, a U.S. researcher wrote in a commentary piece published on Thursday

The origin of the SARS-CoV-2 virus that causes COVID-19 remains a mystery and a major source of tension between China and the United States. The new analysis by the researcher does not provide a definitive answer to that question.

A joint study by China and the World Health Organization (WHO) this year all but ruled out the theory that COVID-19 originated in a laboratory, saying that the most likely hypothesis was that it infected humans naturally, probably via the wildlife trade.

A WHO-led team of experts spent four weeks in and around the central city of Wuhan with Chinese scientists and said in a joint report in March that the SARS-CoV-2 virus had probably been transmitted from bats to humans through another animal but that further research was needed.

The accountant who was widely thought to be the first person with COVID-19, when interviewed, said his first COVID-19 symptoms appeared on Dec. 16, several days later than initially reported, Michael Worobey, head of ecology and evolutionary biology at the University of Arizona, wrote in the commentary piecein the journal Science.

"His symptom onset came after multiple cases in workers at Huanan Market, making a female seafood vendor there the earliest known case, with illness onset 11 December," Worobey said in the article.

He said most early symptomatic cases were linked to the market, specifically to the western section where raccoon dogs were caged, providing strong evidence of a live-animal market origin of the pandemic.

Worobey was among the 18 scientists who had written to Science in May calling for an investigation into whether the source of the virus could have been a laboratory accident.

The WHO proposed last month a new expert panel to investigate the source of the coronavirus.

https://www.reuters.com/world/market-ch ... 021-11-19/

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Gene could double risk of dying

Soon after the pandemic began, we knew that certain groups of people are more at risk of dying from COVID-19 than others. It was immediately clear that those with specific underlying health conditions such as diabetes and cardiovascular disease were at increased risk, but slowly it became evident that certain ethnic groups were also being disproportionately affected

Social factors have played an important role in why these groups have been more affected than others, but genetics may also play a part.

Scientists at Oxford University have now identified a version of a gene that may be associated with doubling the risk of respiratory failure from COVID, and it could go some way to explaining why people from particular backgrounds are more likely to die from the virus. The study’s authors said that their work identifying the gene was extremely difficult because it wasn’t merely the presence of the gene they were looking for, but whether it was switched “on”, making it more high risk.

The researchers found the increased risk comes from a gene that regulates the activity of other genes, including one called LZTFL1 involved in the response of lung cells to viruses. They found the higher-risk version of the gene prevented the cells in the airways and lungs from responding to the virus properly. If the lung cells are unable to protect themselves adequately, then the SARS-Cov-2 virus that causes COVID-19 is more likely to get inside and infect them, causing widespread damage and eventual breathing difficulties more quickly.

This is important as, so far, most medical treatment for people sick with COVID has been aimed at the immune system, but this study may open the door for treatments aimed at improving or enhancing the way the airways protect themselves against invading viruses. The researchers were quick to point out that the gene does not affect the immune system, and there is no evidence to suggest it will change the way the vaccines work in individuals who had the higher-risk version of the gene.

Interestingly, the study also found the gene was more prevalent in people with South Asian ancestry – 60 percent of them carried the high-risk version compared with 15 percent of those with European ancestry. But only 2 percent of those from Afro-Caribbean backgrounds carried the gene. This means that the genetic factor does not completely explain the higher death rates reported for Black and minority ethnic groups.

In reality, the reasons why minority groups are disproportionately affected are complex and multifactorial. Almost every serious analysis of COVID deaths has found that Black and minority people are over-represented compared with what we would expect if the illness affected everyone the same way.

Social factors play a big part in this; when governments were encouraging people to work from home at the peak of the pandemic, key workers still had to go in to keep the country moving. In the United Kingdom, Bangladeshi and Pakistani ethnic groups are more likely than others to work in transport jobs, increasing their risk of exposure. Minority groups are also over-represented in health and social care jobs, again meaning occupational exposure to the virus, and we have seen people from these ethnic backgrounds who work in health and social care die in higher numbers.

The researchers from Oxford pointed out that the gene they identified is only a small part of a bigger picture as to why certain ethnic groups are at higher risk

People from Black and South Asian groups are also at higher risk of having underlying health conditions such as type 2 diabetes that can increase the risk of complications should they get COVID.

But it goes further than this; because of health inequalities that were exposed by the pandemic, people from minority groups suffered greatly. Minority groups tend to have poorer socioeconomic circumstances which can put them at increased risk of catching and dying from COVID. As well as working in jobs that cannot be done from home, they are more likely to live in overcrowded homes with multiple generations residing in them. Combined with their increased propensity to having high-risk underlying health conditions, these social inequalities mean they are at high risk of not only getting COVID but also becoming sick and dying from it.

The researchers from Oxford pointed out that the gene they identified is only a small part of a bigger picture as to why certain ethnic groups are at higher risk.

Any information that helps safeguard the most vulnerable in our society is welcome, and if this leads to better medicine in the future that reduces the risk of death, then that can only be a good thing. But until we take action against the ongoing inequalities that exist in our societies, which were highlighted by the pandemic, the most disadvantaged among us will continue to suffer.

The evidence to support this is overwhelming; multiple studies have shown how minority groups suffered the worst as a result of COVID. The time for talking about it is over; we now need action.

A pill to treat COVID-19, developed by the US pharmaceutical giant Pfizer, cuts the risk of hospitalisation or death by 89 percent in vulnerable adults, the company claims. But the results of the trials are yet to be peer-reviewed.

The drug, known as paxlovid, appears to have surpassed those seen with Merck & Co Inc’s pill, molnupiravir, which reduced the likelihood of dying or needing hospital treatment by half, and was approved for use in the UK.

The regimen Pfizer is proposing involves taking three pills twice a day for five days. One of the pills, a protease inhibitor, works by blocking an enzyme the SARS-Cov-2 virus needs to multiply; it is to be taken alongside an antiviral medication called ritonavir. It is the combination of both drugs that is thought to yield such promising results. If the medication is approved by healthcare regulatory bodies, Pfizer recommends them for those who are at high risk with underlying health conditions and that they should be taken as soon as symptoms develop to prevent hospitalisation and death.

The data that Pfizer has released shows that the trial included adult patients only. Participants were unvaccinated, had mild-to-moderate COVID-19, and were considered high risk due to health problems – including obesity, diabetes or heart disease. The scheduled interim analysis showed an 89 percent reduction in risk of COVID-related hospitalisation or death from any cause, compared with the placebo in patients treated within three days of symptom onset. Seven patients given the placebo died, while there were no deaths among those in the group given the pill. Pfizer has said the reports of side effects were similar in both groups.

The benefits of the drugs led to the trial being stopped early on recommendation of an independent group of medical specialists. Although both the US and UK have ordered large quantities of the drugs, they have yet to be approved by medicines’ regulatory bodies in either country.

If the results of the trials are confirmed through peer review and the regulatory bodies approve their use, we could see the dawn of a new era in managing COVID. The arrival of oral pills to manage the disease at home will mean those who are vulnerable, such as the elderly or immunocompromised who may not mount as strong an immune response to the vaccines, are offered an extra layer of protection.

If more people with COVID are managed at home and kept out of hospitals, it means healthcare workers can get on with the job of clearing the backlog of non-COVID-related work that has built up during the pandemic.

A new study has suggested that previous common cold infections may help protect against COVID-19. The study, carried out by University College London and published in the journal Nature, tracked more than 750 healthcare staff who were working closely with COVID patients and likely exposed to the virus on a regular basis. A group of 58 of the participants never tested positive for COVID despite repeated exposure to patients who had the virus.

Blood samples were taken from all participants, but the 58 who tested negative throughout were found to have higher levels of immune cells, called T-cells, in their blood than healthcare workers who got COVID. These T-cells are the part of the immune system that act as memory cells, able to recognise specific invaders when they appear in the body. The researchers think these specific T-cells halt SARS-CoV-2 by disabling a cluster of viral proteins called the replication transcription complex, which helps the virus to reproduce. They found that these T-cells were present in blood samples collected before the pandemic.

The SARS-CoV-2 virus belongs to the family of viruses known as coronaviruses, of which there are many. The hypothesis is that these T-cells were most likely generated by previous coronavirus infections that were not the SARS-CoV-2 virus – the most likely being the coronaviruses that cause the common cold.

Most common colds are caused by a group of viruses known as rhinoviruses, but about one in 10 is caused by a coronavirus that may have a shape or part that is not dissimilar to the SARS-CoV-2 coronavirus. The T-cells recognise this part as being similar to a previous invading virus and mount an attack, killing it before it has a chance to infect a person.

Nineteen of the participants also had increased levels of an immune-system protein called IFI27, which the study’s authors say might be an early marker of SARS-CoV-2 infection. This would suggest the SAR-CoV-2 virus attempted to get inside of the cells of these people and infect them but was thwarted by their immune system before it could.

The study has many limitations, one being that all the participating healthcare workers were healthy and there is no definitive evidence that those who tested negative had a SARS-CoV-2 infection to begin with; it may be that they were just lucky enough to avoid it altogether.

Either way, the best way to protect oneself from COVID is not through getting a cold, but by being fully vaccinated.

As of November 11, 2021, all staff who work in care homes in the UK must be fully vaccinated or have a solid medical reason for not being so – or face losing their job. The UK government made a similar announcement for National Health Service (NHS) staff that will come into force in April 2022.

The UK is not alone in mandating vaccines. Italy was the first country in Europe to make the COVID vaccine mandatory for healthcare workers and, in France, 3,000 health workers were suspended without pay for refusing the vaccine. Globally, Indonesia, Canada and New Zealand are also mandating COVID vaccines for parts of their populations.

So, is it right to mandate vaccines for health and social care workers?

Well, the first thing I will say is that I am now “triple-jabbed” – having recently had my booster shot (I also got my flu vaccine at the same time). I am an advocate of the vaccine and have spent time at many a clinic talking to patients about why the vaccine is their best protection against COVID.

I have been having an internal debate about whether it is ethical to make people who do not want the vaccine choose between their job or the jab. It is difficult. As a doctor you are always taught it is your job to give patients all their options and arm them with information, but the ultimate decision as to whether they take any treatment is up to them. There are, of course, exceptions to this if mental health or safeguarding issues are involved, but these are few and far between.

But this time, it is more complex than a simple choice about what treatment is best for the patient in front of you. This is about population health and whatever decision a person makes about taking up the vaccine will have ramifications for those around them – none more so than those who work in health and social care.

Freedom of Information data collected from NHS trusts across England revealed more than 11,000 patients who died in hospital probably caught the virus while on a ward. They may have caught it from healthcare staff who exhibited no symptoms or from other nearby patients – we can’t be sure; either way, they caught it because of being in hospital. That figure is truly shocking.

We know that vaccines reduce the risk of becoming seriously sick from the virus, but they do not completely stop someone from getting it. There are cohorts of the population, such as the immunocompromised, who do not have as strong an immune response to the vaccines and remain at risk of serious illness despite being vaccinated; they are at higher risk of needing medical attention for other things, and they need protecting.

There is increasing evidence the vaccines do help reduce transmission of the virus, particularly in the first few months after having them. So by getting the vaccines, health and social care workers are protecting the people they care for.

I am also mindful that many who are refusing the vaccine have fallen victim to misinformation online and the ideal solution to that is to put those refusing the vaccine in touch with an expert who can allay their fears; but this is impractical and onerous. The information is out there for them to find should they want to; in a way, they are choosing to ignore the science.

On the other hand, the vaccines are not risk-free. Although it is extremely rare, serious adverse effects have been reported and by making healthcare workers choose between their job or the jab, who will be responsible if one of them is unlucky enough to suffer an adverse event?

These are all the things I have been debating with myself. After much back and forth, I am of the opinion that the elderly and vulnerable have suffered enough and that we all want this pandemic to end one way or another. Vaccines are the best way of protecting ourselves and those around us, and as a healthcare worker you have a duty of care to those you look after. With this in mind, I would say, on balance, it is right to mandate vaccines for those who work in health and social care.

Although not an official symptom of COVID, hair loss can occur after any serious illness, particularly one associated with fever. Although it is not technically hair “loss”; it is referred to as hair “shedding”.

Fever from any illness, including COVID, can force more hairs than usual into the shedding phase of the hair growth cycle. Most people see noticeable hair shedding two to three months after having a fever or illness, and it can last anywhere between six and nine months.

There is no specific treatment for hair shedding, it will stop on its own. Time is all that is needed, although I understand that losing hair can be stressful.

https://www.aljazeera.com/features/2021 ... obal-en-GB

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New variant causes concern

The World Health Organization (WHO) has declared a new coronavirus variant to be "of concern" and named it Omicron

It had a large number of mutations, and early evidence suggested an increased reinfection risk, the WHO said.

It was first reported to the WHO from South Africa on 24 November, and has also been identified in Botswana, Belgium, Hong Kong and Israel.

A number of countries have now decided to ban or restrict travel to and from southern Africa.

It is not uncommon for a virus to change, or mutate, over time. A variant becomes a variant of concern when that mutation might affect things like transmissibility, virulence or the effectiveness of vaccines.

'Bad news - but not doomsday'

On Friday, the WHO said the number of cases of this variant, initially named B.1.1.529, appeared to be increasing in almost all of South Africa's provinces.

"This variant has a large number of mutations, some of which are concerning," the UN public health body said in a statement.

It said "the first known confirmed B.1.1.529 infection was from a specimen collected on 9 November".

The WHO said it would take a few weeks to understand the impact of the new variant, as scientists worked to determine how transmissible it was.

A top UK health official warned that vaccines would "almost certainly" be less effective against the new variant.

But Professor James Naismith, a structural biologist from the University of Oxford, added: "It is bad news but it's not doomsday."

He said mutations in the variant suggested it may spread more quickly - but transmissibility "is not just as simple as 'this amino acid does this'" and was determined by how mutations worked together.

If the variant were to spread more quickly, it would inevitably reach the UK, Prof Naismith said.

Meanwhile, US infectious disease chief Dr Anthony Fauci said that while the reports on the new variant threw up a "red flag", it was possible that vaccines might still work to prevent serious illness.

"Until it's properly tested... we don't know whether or not it evades the antibodies that protect you against the virus", Dr Fauci told CNN.

The WHO has warned against countries hastily imposing travel restrictions, saying they should look to a "risk-based and scientific approach".

However, the UK, US, EU countries and Switzerland have temporarily halted flights to and from some southern African countries.

"It is now important that all of us in Europe act very swiftly, decisively and united," European Commission chief Ursula von der Leyen said.

South Africa's Health Minister Joe Phaahla told reporters that the flight bans were "unjustified".

"The reaction of some of the countries, in terms of imposing travel bans, and such measures, are completely against the norms and standards as guided by the World Health Organization," he said.

Echoing his words, Angelique Coetzee, chairperson of the South African Medical Association, told the BBC that the travel restrictions on her country were premature.

"For now, it is a storm in a tea cup," she said.

Stock markets across the world also fell sharply on Friday, reflecting the fears of investors over the potential economic impact.

A "variant of concern" is the World Health Organization's top category of worrying Covid variants.

The decision adds weight to the mounting scientific worry about the potential of this new variant, but it doesn't change any of the facts.

The variant has an astounding collection of mutations which are thought to increase its ability to spread and bypass some, but not all, of the protection from vaccines.

However, we still don't have the clear real-world data.

We don't know for sure that it spreads faster, makes vaccines or drugs less effective or whether it leads to more severe disease.

The WHO have also given it a name and ended days of speculation that we would end up in the slightly ridiculous position of calling the new variant the "Nu variant".

There have even been arguments about the correct pronunciation of the Greek letter Nu (it's technically a "Nee").

Instead, you can guarantee we'll be talking a lot about Omicron in the weeks to come.

https://www.bbc.co.uk/news/world-59438723

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Dozens test positive on flights

Sixty-one people who arrived in Amsterdam on two flights from South Africa have tested positive for Covid-19 and have been placed in isolation at a hotel near Schiphol airport

They were among some 600 passengers held for several hours after arrival while they were tested for the virus.

Dutch health authorities said Omicron, labelled on Friday as a variant of concern, was "probably found in a number of people" who tested positive.

Other European countries, including the UK and Germany, have confirmed cases of the Omicron variant.

The variant was first reported to the World Health Organization from South Africa on Wednesday, with early evidence suggesting it has a higher re-infection risk.

Many countries around the world have restricted travel from the southern African region.

Meanwhile, the Netherlands is one of several European countries struggling to contain record numbers of infections.

A partial lockdown will be extended on Sunday, with all hospitality and cultural venues forced to close between 17:00 and 05:00, at least until 19 December.

'Kept waiting for hours'

The flights by Dutch national carrier KLM from Johannesburg arrived at 10:30 and 11:00 local time (09:30 and 10:00 GMT) on Friday.

The Dutch government had by then already restricted travel from the region because of the new variant and arranged for the passengers to be tested and isolated.

Some expressed frustration about being kept on the plane without food or drink.

Passengers travelling from Cape Town to Manchester via Amsterdam told the BBC that they were held on the tarmac at Schiphol airport for four hours, before eventually disembarking.

New York Times correspondent Stephanie Nolen, who was on the flight, tweeted that the passengers were not even brought water while they remained on the plane.

When they were eventually allowed to leave, some passengers shared photos of themselves clustered together in a room with little ventilation.

On Saturday, the Dutch health authority said 61 people on the flights had tested positive.

Anyone who tested positive would have to quarantine at a hotel for seven days if showing symptoms and for five days if not, it added.

Those that tested negative have been asked to isolate at home for five days and take further tests, while those in transit are allowed to continue their journeys.

However, there are reports that some passengers have not received written proof of a negative test and are therefore unable to board onward flights.

https://www.bbc.co.uk/news/world-europe-59442149

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UK, Germany and Italy detect Omicron

Summary

Britain, Germany, Italy say Omicron cases detected
UK PM Johnson unveils new measures to try to stop spread
Many states announce travel curbs, bans on southern Africa
Dutch authorities test air passengers for Omicron variant

Britain, Germany and Italy detected cases of the new Omicron coronavirus variant on Saturday and British Prime Minister Boris Johnson announced new steps to contain the virus, while more nations imposed restrictions on travel from southern Africa

The discovery of the variant has sparked global concern, a wave of travel bans or curbs and a sell-off on financial markets on Friday as investors worried that Omicron could stall a global recovery from the nearly two-year pandemic.

Israel said it would ban the entry of all foreigners into the country and reintroduce counter-terrorism phone-tracking technology to contain the spread of the variant. read more
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The two linked cases of Omicron detected in Britain were connected to travel to southern Africa, British health minister Sajid Javid said.

Johnson laid out measures that included stricter testing rules for people arriving in the country but that stopped short of curbs on social activity other than requiring mask wearing in some settings. read more

"We will require anyone who enters the UK to take a PCR test by the end of the second day after their arrival and to self-isolate until they have a negative result," Johnson told a news conference.

People who had come into contact with people testing positive for a suspected case of Omicron would have to self-isolate for 10 days and the government would tighten the rules on wearing face coverings, Johnson said, adding the steps would be reviewed in three weeks.

The health ministry in the German state of Bavaria also announced two confirmed cases of the variant. The two people entered Germany at Munich airport on Nov. 24, before Germany designated South Africa as a virus-variant area, and were now isolating, said the ministry, indicating without stating explicitly that the people had travelled from South Africa. read more

In Italy, the National Health Institute said a case of the new variant had been detected in Milan in a person coming from Mozambique.

Czech health authorities also said they were examining a suspected case of the variant in a person who spent time in Namibia.

Omicron, dubbed a "variant of concern" by the World Health Organization, is potentially more contagious than previous variants of the disease, although experts do not know yet if it will cause more or less severe COVID-19 compared to other strains.

England's Chief Medical Officer, Chris Witty, said at the same news conference as Johnson that there was still much uncertainty around Omicron, but "there is a reasonable chance that at least there will be some degree of vaccine escape with this variant".

The variant was first discovered in South Africa and had also since been detected in Belgium, Botswana, Israel and Hong Kong.

FLIGHTS TO AMSTERDAM

Dutch authorities said 61 of around 600 people who arrived in Amsterdam on two flights from South Africa on Friday had tested positive for the coronavirus. Health authorities were carrying out further tests to see if those cases involved the new variant. read more

One passenger who arrived from South Africa on Friday, Dutch photographer Paula Zimmerman, said she tested negative but was anxious for the days to come.

Digital display boards show cancelled flights to London - Heathrow at O.R. Tambo International Airport in Johannesburg, South Africa, November 26, 2021. REUTERS/ Sumaya Hisham/File Photo

"I’ve been told that they expect that a lot more people will test positive after five days. It's a little scary the idea that you’ve been in a plane with a lot of people who tested positive," she said.

Financial markets plunged on Friday, especially stocks of airlines and others in the travel sector. Oil prices tumbled by about $10 a barrel.

It could take weeks for scientists to understand fully the variant's mutations and whether existing vaccines and treatments are effective against it.

TRAVEL CURBS

Although epidemiologists say travel curbs may be too late to stop Omicron from circulating globally, many countries around the world - including the United States, Brazil, Canada and European Union nations - announced travel bans or restrictions on southern Africa on Friday.

The U.S. Centers for Disease Control and Prevention (CDC) and State Department added on Saturday to Washington's previously announced travel restrictions, advising against travel to eight southern African countries.

U.S. Vice President Kamala Harris told reporters on Saturday that the administration will take it "one step at a time," when asked about additional travel restrictions. "For now we've done what we think is necessary," Harris said.

Also on Saturday, Australia said it would ban non-citizens who have been in nine southern African countries from entering and will require supervised 14-day quarantines for Australian citizens returning from there. read more

Japan and Britain said they were extending travel curbs to more African countries, while South Korea, Sri Lanka, Thailand, Oman, Kuwait and Hungary announced new travel restrictions.

South Africa is worried that the curbs will hurt tourism and other sectors of its economy, the foreign ministry said on Saturday, adding the government is engaging with countries that have imposed travel bans to persuade them to reconsider. read more

Omicron has emerged as many countries in Europe are already battling a surge in COVID-19 infections, and some have re-introduced restrictions on social activity to try to stop the spread. Austria and Slovakia have entered lockdowns.

VACCINATIONS

The new variant has also thrown a spotlight on disparities in how far the world's population is vaccinated. Even as many developed countries are giving third-dose boosters, less than 7% of people in low-income countries have received their first COVID-19 shot, according to medical and human rights groups.

Seth Berkley, CEO of the GAVI Vaccine Alliance that with the WHO co-leads the COVAX initiative to push for equitable distribution of vaccines, said this was essential to ward off the emergence of more coronavirus variants.

“While we still need to know more about Omicron, we do know that as long as large portions of the world’s population are unvaccinated, variants will continue to appear, and the pandemic will continue to be prolonged," he said in a statement to Reuters.

"We will only prevent variants from emerging if we are able to protect all of the world’s population, not just the wealthy parts."

https://www.reuters.com/world/concerns- ... 021-11-27/

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Over 600,000 in Kurdistan vaccinated

ERBIL (Kurdistan 24) – The autonomous Kurdistan Region announced on Thursday that its health workers had so far fully vaccinated well over a half million of its citizens, according to the latest official figures

Since beginning its vaccination drive in early 2021, the regional Ministry of Health has administered 613,900 second vaccine doses, accounting for 33 percent of eligible candidates

Over 4,300,000 people aged over 12 are also now eligible to receive the inoculation.

More than 908,000 additional people have received just one dose of one of the available vaccine brands, according to government figures which estimated them at around 49 percent.

The Kurdistan Regional Government (KRG)’s stated goal is to fully vaccinate 40 percent of those over 12 years old.

So far, 373,699 patients across the four provinces of the Kurdistan Region have contracted the highly contagious disease, with more than 6,800 of them having died.

Despite spiking numbers in recent months, November has seen an overall downward trend in new infections.

On Nov. 10, the Kurdistan Regional Government (KRG) announced that it had allocated significant additional funds to support efforts to combat the coronavirus across the autonomous region of Iraq.

A government statement explained that Prime Minister Masrour Barzani had "agreed to allocate additional funds to the health sector, based on the public interest, and in order to preserve the lives of the citizens of the Kurdistan Region."

https://www.kurdistan24.net/en/story/26 ... t-COVID-19

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Omicron Cases Seen Mild

The doctor who alerted government scientists to the possibility of a new variant said people infected with omicron are showing milder symptoms than those suffering the delta strain. South African researchers said omicron appears to be more transmissible than its predecessors but that existing vaccines are still likely to offer good protection against severe illness and death

Governments across the globe stepped up restrictions on travel, as the World Health Organization warned that the new variant of the virus could fuel a fresh surge in infections with severe consequences. U.S. President Joe Biden cautioned Americans against panicking and urged them to instead get vaccinated or obtain booster shots.

Cases of omicron have cropped up in locations from Australia to the U.K., Spain and Canada, leading economists to reassess their outlooks for the global recovery. But a relative sense of calm returned to global markets as U.S. stocks climbed and bonds fell.

Key Developments:

Virus Tracker: Cases top 261.6 million; deaths pass 5.2 million
Vaccine Tracker: More than 7.91 billion doses given
Covid gives the world a blunt reminder it won’t go away easily
Toddlers make up 10% of hospital cases in omicron epicenter
What we know about the omicron variant so far
Omicron’s market risk already looks overdone: John Authers

New York Governor Kathy Hochul said there were no reported cases of the omicron variant in the state but she was monitoring infections found nearby in Ontario, Canada. At a briefing Monday, she said she was focused on getting more of the state vaccinated and planned to tap its National Guard to help administer booster shots at nursing homes.

N.Y. Doesn’t Plan Mask Mandate

Hochul said she has no plans for a statewide mask mandate, preferring a targeted approach to restrictions that are guided by local officials. She also called out the stark divide in cases between Upstate regions -- which account for most of New York’s recent Covid hospitalizations -- and the rest of the state. Downstate hospitals are sending workers to help upstate, she said, adding guardsmen could provide help too.

Hospital Workers Rejected at Supreme Court

A U.S. Supreme Court justice turned away a request from eight Mass General Brigham Inc. workers for a religious exemption from the Massachusetts hospital system’s requirement that they be vaccinated against Covid-19.

Justice Stephen Breyer rejected the request without requesting a response from the hospital or referring the matter to the full, nine-member court. Breyer, who is assigned to handle emergency matters from Massachusetts, gave no explanation.

Pfizer Sees 2-3 Weeks to Study Omicron

Pfizer Inc.’s top executive said the company will know within two to three weeks how well its Covid-19 vaccine holds up against the new omicron variant, and even in a worst-case scenario he expects the existing formula will retain some efficacy against the heavily mutated strain.

The company is currently conducting lab tests to see how antibodies generated by the existing vaccine work against the new variant, Chief Executive Albert Bourla said on Bloomberg Television’s “Balance of Power with David Westin.”

Omicron Covid Variant Unlikely to Escape Pfizer Vaccine, CEO Says

Pfizer Inc. Chief Executive Officer Albert Bourla says its vaccine is very likely to work against the new omicron Covid-19 variant. He is on “Balance of Power With David Westin.”

N.J. Hospitalizations at Highest in 7 Weeks

New Jersey hospitalizations for Covid-19 reached 950, the highest in seven weeks, Governor Phil Murphy said. The number has surged 35% since Nov. 1. Even so, the total is about a third of the 2,908 hospitalizations a year ago, when vaccinations weren’t available.

More than 78% of New Jersey’s population has received at least one dose of the Covid-19 vaccine, higher than the U.S. total of 69.7%. The unvaccinated continue to make up most of the hospitalizations, Murphy said. New Jersey health officials are on alert for the omicron variant, as delta continues to fuel the recent surge, Murphy said.

Biden Cautions Against ‘Panic’

President Joe Biden cautioned Americans against panicking over a new variant of the coronavirus recently identified in South Africa, and urged them to instead get vaccinated or obtain booster shots.

“This variant is a cause for concern. Not a cause for panic,” Biden said in remarks at the White House after a private briefing from his health advisers.

He said the administration doesn’t yet believe new formulations of coronavirus vaccines will be necessary but that it is already working with Pfizer Inc. and Moderna Inc. on contingency plans. He said he’ll issue a new strategy to combat a winter surge of coronavirus on Thursday, adding that the U.S. will not have to practice further lockdowns or shutdowns.

Madrid Region Confirms First Omicron Case

The Madrid region has confirmed its first case of a patient with the omicron coronavirus variant. A 51-year-old man who arrived in the capital on Nov. 28 after traveling from South Africa with a stopover in Amsterdam, has tested positive, the health department for the Madrid region said in an emailed statement. The patient has mild symptoms and is isolated in quarantine.

Sweden IDs First Case of Omicron Variant

Sweden has identified its first case of the omicron variant of Covid-19, the nation’s Public Health Authority said on its website. The person had recently visited southern Africa and lives in southern Sweden.

NYC ‘Strongly Recommending’ Indoor Masks

New York City issued a new mask advisory on Monday, “strongly recommending” residents wear masks in all indoor locations regardless of vaccination.

The health advisory stops short of a mandate but signifies officials’ trepidation of a new Covid-19 wave as the omicron variant spreads around the world and New York sees an increase in post-Thanksgiving Covid cases.

U.K. Urges Boosters for All Adults

The U.K. is poised to offer Covid booster shots to all adults and second shots to more children amid worries that the new omicron variant could spread even more easily and fuel another surge in cases.

A committee that advises the U.K. government said all adults should be eligible for a third dose, with availability expanded to those under 40. Children ages 12 to 15 should get second shots, the group said.

An expansion of the booster program comes with tougher pandemic rules set to take effect this week in the U.K. Prime Minister Boris Johnson’s government is seeking to buy scientists time to determine the risks posed by the new strain. The announcement also follows a World Health Organization warning.

Merkel, Scholz to Meet With State Leaders

Chancellor Angela Merkel and her incoming successor, Olaf Scholz, will hold talks with Germany’s 16 state premiers on Tuesday to discuss the next steps in the fight against Covid-19.

The discussions will follow a decision by the Constitutional Court due in the morning, according to an official familiar with their plans. Germany’s top court is expected to lay out parameters for what restrictions are admissible to tackle the nation’s worst outbreak of the coronavirus pandemic.

German authorities are under pressure to introduce new curbs as case numbers climb and the new omicron variant has been discovered in the country.

EU Discussing Emergency Virtual Summit

European Union leaders are discussing whether to hold an emergency virtual summit on Friday on how to tackle the new omicron coronavirus variant, even as the bloc was already battling sharply rising case numbers.

The timing of the possible video call has yet to be decided, according to an EU official who declined to be named discussing a confidential issue

Norway to Increase Isolation Times

Norway is extending isolation times for those testing positive to the coronavirus and where there’s reason to believe the infection is the omicron variant, the Health and Care Services Ministry said in a statement.

Other household members will be required to quarantine for 10 days and close contacts to those infected must undergo testing under the new measures, which will apply regardless of vaccination status.

Italy to Consider Infant Vaccination Units

Italy may start Covid vaccinations on children in the 5-11 age group as soon as December 23, should the Italian Medicines Agency, Aifa, give the proposal the green light this week, Franco Locatelli, head of the National Health Institute, said in an interview on SkyTg24.

Italy’s medical authorities are considering setting up dedicated children units within the vaccination hubs, Locatelli said.

Doctor Who Saw Omicron Says Symptoms Milder

People infected by omicron in South Africa are showing very different symptoms to those suffering from the delta strain, said the doctor who alerted government scientists to the possibility of a new variant.

Patients who contracted it complain of fatigue, head and body aches and occasional sore throats and coughs, said Angelique Coetzee, who is also chairwoman of the South African Medical Association. Delta infections, by comparison, caused elevated pulse rates, resulted in low oxygen levels and a loss of smell and taste, she said.

Czech President Urges Mandatory Jabs

Czech President Milos Zeman, who tested positive for Covid-19 last week, urged the country to consider a mandatory vaccination program similar to that imposed in neighboring Austria.

It is the “only way out” from the current crisis, Zeman said in a statement via a spokesman on Twitter. The prime minister designate, Petr Fiala, the head of the incoming cabinet lead by the Civic Democrats, said in the past that the new administration wouldn’t be in favor of such a step.

Countries Closer to Draft Treaty on Pandemics

Countries edged closer to support the idea of a treaty to help avoid future pandemics as more cases of the new omicron strain popped up.

World Health Organization member states, starting a three-day summit in Geneva on Monday, will decide on a proposal that would begin the process of drafting such an agreement, which will take years. A proposal was reached over the weekend that represents a “consensus text,” Gabby Stern, the head of communications for the WHO, said on Twitter Sunday.

Scotland Detects Cases Through Local Transfer

Scotland expects a rise in infections from the latest coronavirus variant, after it emerged that some of the cases so far weren’t all linked to travel and may have been transmitted within the community.

Of the six people to have tested positive for the omicron strain in the country, some likely picked up the infection from others in Scotland, First Minister Nicola Sturgeon said at a press briefing on Monday.

BioNTech Is Working On Omicron Covid Shot

BioNTech SE is working to adapt its Covid-19 vaccine to address the omicron variant and expects to have a new version ready within 100 days if necessary.

The company has started development in order to move as quickly as possible, BioNTech said in a statement. The first steps of developing a new vaccine overlap with the research necessary in order to evaluate whether a new shot will be needed -- a process that began last Thursday as soon as news of the new variant began to spread around the world.

https://www.bloomberg.com/news/articles ... rus-update

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Will Pills Change Pandemic?

In March, 2020, researchers at Emory University published a paper about a molecule called NHC/EIDD-2801

At the time, there were no treatments available for the coronavirus. But NHC/EIDD-2801, the researchers wrote, possessed “potency against multiple coronaviruses,” and could become “an effective antiviral against SARS-CoV-2.”

A few days later, Emory licensed the molecule to Ridgeback Biotherapeutics, a Miami-based biotechnology company which had previously developed a monoclonal antibody for Ebola. Ridgeback partnered with the pharmaceutical giant Merck to accelerate its development.

The Emory researchers named their drug molnupiravir, after Mjölnir—the hammer of Thor. It turns out that this was not hyperbole. Last month, Merck and Ridgeback announced that molnupiravir could reduce by half the chances that a person infected by the coronavirus would need to be hospitalized.

The drug was so overwhelmingly effective that an independent committee asked the researchers to stop their Phase III trial early—it would have been unethical to continue giving participants placebos. None of the nearly four hundred patients who received molnupiravir in the trial went on to die, and the drug had no major side effects.

On November 4th, the U.K. became the first country to approve molnupiravir; many observers expect that an emergency-use authorization will come from the U.S. Food and Drug Administration in December.

https://www.newyorker.com/science/medic ... obal-en-GB

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AstraZeneca Blood Clots

Scientists believe they have found "the trigger" that leads to extremely rare blood clots after the Oxford-AstraZeneca Covid vaccine

The team - in Cardiff and the US - have shown in exquisite detail how a protein in the blood is attracted to a key component of the vaccine.

They think this kicks off a chain reaction, involving the immune system, that can culminate in dangerous clots.

The vaccine is thought to have saved about a million lives from Covid.

However, concerns about rare blood clots shaped how the vaccine has been used around the world including an alternative being offered to the under-40s in the UK.

It also started a scientific detective hunt to figure out what was going on and if it could be prevented. The Cardiff team were given emergency government funding to find the answers.

AstraZeneca's own scientists also joined the research project after earlier results from the team were published.

A spokeswoman for AstraZeneca stressed that clots were more likely to occur because of a Covid infection than the vaccine, and that the complete explanation for why they occur had not yet been established.

"Although the research is not definitive, it offers interesting insights and AstraZeneca is exploring ways to leverage these findings as part of our efforts to remove this extremely rare side effect," she added.

There were two initial clues for the researchers investigating the rare blood clots:

The greater risk of clots was seen only with some of the vaccine technologies

People with clots had unusual antibodies that were attacking a protein in their blood called platelet factor four

The vaccines used in the UK all try to deliver a snippet of the Covid-virus's genetic code into the body to train the immune system.

Some package that code up inside spheres of fat, while the AstraZeneca one used an adenovirus (specifically a common cold virus from chimpanzees) as its microscopic postman.

The researchers thought the adenovirus might be linked to the rare clots occurring in some people. So they used a technique called cryo-electron microscopy to take images of the adenovirus in molecular-level detail.

Their study, published in the journal Science Advances, reveals the outer surface of the adenovirus attracts the platelet factor four protein to it like a magnet.

Prof Alan Parker, one of the researchers at Cardiff University, told BBC News: "The adenovirus has an extremely negative surface, and platelet factor four is extremely positive and the two things fit together quite well."

He added: "We've been able to prove the link between the key smoking guns of adenoviruses and platelet factor four.

"What we have is the trigger, but there's a lot of steps that have to happen next."

The researchers think the next stage is "misplaced immunity", but this needs to be confirmed in further research.

It is thought the body starts to attack platelet factor four after confusing it for part of the foreign adenovirus to which it is stuck. So antibodies are released into the blood, which clump together with platelet factor four and trigger the formation of dangerous blood clots.

However, this requires a series of unlucky events, which could explain why the clots are so rare.

These clots, known as vaccine-induced immune thrombotic thrombocytopenia, have been linked to 73 deaths out of nearly 50 million doses of AstraZeneca given in the UK.

"You could never have predicted it would have happened and the chances are vanishingly small, so we need to remember the bigger picture of the number of lives this vaccine has saved," said Prof Parker.

AstraZeneca said the vaccine is thought to have saved more than a million lives around the world and prevented 50 million cases of Covid.

The University of Oxford declined to comment on the research.

Dr Will Lester, a consultant haematologist at University Hospitals Birmingham NHS Trust, praised the "very detailed" research saying it helps explain the "most likely initial step" in clotting.

He added: "Many questions still remain unanswered, including whether some people may be more susceptible than others and why the thrombosis (clotting) is most commonly in the veins of the brain and liver, but this may come with time and further research."

The Cardiff team hope their findings can be used to improve adenovirus-based vaccines in the future to reduce the risk of these rare events.

Link to Chart - Photos:

https://www.bbc.co.uk/news/health-59418123

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Germany, U.S. agree new COVID curbs

Germany decided on Thursday to bar the unvaccinated from all but the most essential businesses and the United States was due to announce further travel curbs as countries around the globe scramble to keep out the Omicron variant of the coronavirus

U.S. Treasury Secretary Janet Yellen said the variant showed the pandemic could be around for "some time," as countries including the United States, India and France reported their first cases.

In an interview with Reuters, Yellen said she hoped the pandemic would not completely stifle economic activity, adding that the U.S. stimulus at the start of the pandemic had helped fuel a very strong recovery.

The new measures agreed in Germany focus on the unvaccinated, who will only be allowed in essential businesses such as grocery stores and pharmacies, while legislation to make vaccination mandatory will be drafted for early next year

"We have understood that the situation is very serious and that we want to take further measures in addition to those already taken," Chancellor Angela Merkel told a news conference.

A nationwide vaccination mandate could take effect from February 2022 after it is debated in the Bundestag and after guidance from Germany's Ethics Council, she said.

Eager to avoid derailing a fragile recovery of Europe's biggest economy, Germany kept businesses open to the almost 69% of the population that is fully vaccinated as well as those with proof of having recovered from the virus.

Much remains unknown about Omicron, which was first detected in southern Africa last month and has been spotted in at least two dozen countries, just as parts of Europe were already grappling with a wave of infections of the Delta variant.

But the European Union's public health agency said Omicron could be responsible for more than half of all COVID infections in Europe within a few months, lending weight to preliminary information about its high transmissibility.

In the United States, the Biden administration was expected to announce steps included extending requirements for travellers to wear masks through mid-March.

By early next week the United States will require inbound international travellers to be tested for COVID-19 within a day of departure, regardless of vaccination status.

It will also require private health insurance companies to reimburse customers for at-home COVID-19 tests, a senior administration official said.

Biden is due to spell out the measures at 1840 GMT.

TRAVEL RESTRICTIONS

South Africa said it was seeing an increase in COVID-19 reinfections in patients contracting Omicron - with people who have already had the illness getting infected again - in a way that it did not see with other variants.

The first known U.S. case, announced late on Wednesday, was a fully vaccinated person in California who had travelled to South Africa. The two French cases, in the greater Paris region and in eastern France, were passengers arriving respectively from Nigeria and South Africa.

Global shares fell on Thursday, reversing gains from the previous session as a lack of information about Omicron left markets volatile, while crude oil futures extended losses.

"The World Health Organization classified Omicron as a "variant of concern," due to the number of mutations that might help it spread or evade antibodies from prior infection or vaccination.

Russia has imposed a two-week quarantine for travellers from some African countries including South Africa, the Interfax news agency said, quoting a senior official. Hong Kong extended a travel ban to more countries.

Amid all the new restrictions, Europe's largest budget airline, Ryanair (RYA.I), said it expected a challenging time at Christmas, although it was still optimistic about summer demand.

In the Netherlands, health authorities called for pre-flight COVID-19 tests for all travel from outside the European Union, after it turned out that most of the passengers who tested positive after arriving on two flights from South Africa on Nov. 26 had been vaccinated.

In France, the country's top scientific adviser, Jean-Francois Delfraissy, said the "true enemy" for now was still the more familiar Delta variant of the virus, spreading in a fifth wave.

Laboratory analysis of the antibody-based COVID-19 therapy GlaxoSmithKline (GSK.L) is developing with U.S. partner Vir (VIR.O) has indicated the drug is effective against Omicron, the British drugmaker said.

https://www.reuters.com/world/us-tighte ... 021-12-01/

Our Standards: The Thomson Reuters Trust Principles

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Can You Mix and Match Booster Shot?

Figuring out whether you need a COVID-19 booster shot feels a little like playing a choose-your-own-adventure game, with rules based on which shot you initially got as well as your age, medical history and job

Right now, boosters are recommended for anybody who got the single-dose Johnson & Johnson/Janssen shot at least two months ago. Among people who originally got the mRNA-based shots made by Pfizer-BioNTech and Moderna, boosters are available at least six months after the second dose for elderly adults.

Those with underlying medical conditions and people who live or work in high-exposure settings, such as long-term-care facilities. Pfizer on Nov. 9 asked the U.S. Food and Drug Administration to authorize its booster for all adults, but the agency hasn’t done so yet.

Further complicating matters, the U.S. Centers for Disease Control and Prevention has said eligible people can get boosted with any of the three available vaccines, no matter which type they got the first time around. This approach is known as “mixing and matching.”

But what are the pros and cons of branching out versus staying brand loyal?

It’s a little too soon to say. So far, there’s only been one mix-and-match study on the vaccines available in the U.S. It was not designed to find the “best” vaccine combination, but rather to examine the overall safety and efficacy of mixing and matching.

The result was clear: mixing and matching produces a safe immune response similar to or stronger than that generated by an additional dose of your original shot. But since the study wasn’t meant to compare different combinations, it’s difficult to recommend one type of booster over another.

The data did show that people who originally got the Johnson & Johnson shot produced more antibodies when they were boosted with a dose of Pfizer-BioNTech or Moderna, rather than a second dose of Johnson & Johnson.

But even that result isn’t as straightforward as it may seem, says Dr. Mohammad Sobhanie, an infectious disease physician at The Ohio State University Wexner Medical Center. Antibodies are only one piece of immunity, so “whether or not the more robust antibody response would mean that it’s a better vaccine is left to be said,” Sobhanie says.

Nonetheless, based on what’s known so far, Jason Pogue, an infectious diseases clinical pharmacist at Michigan Medicine, recommends an mRNA booster to anyone who got Johnson & Johnson the first time around. “I think the data is supportive that you get a stronger and a wider breadth of response with the mRNA vaccine,” Pogue says. (Either Pfizer-BioNTech or Moderna is fine, he adds.)

For people who got a two-dose vaccine to begin with, Pogue says the choice of booster is a bit less important. “If it’s more comfortable to get the one you got the first time, then go ahead and go for it,” he says. But if that shot is not in stock when you go to the pharmacy, “it’s totally reasonable to get the one that’s available.”

If you’re not sure which booster to get, Sobhanie recommends talking to a physician who can take into account your specific circumstances. While serious side effects from vaccination are highly uncommon, a very small number of women under 50 have developed serious blood clots after receiving the Johnson & Johnson shot.

While in rare cases the mRNA-based vaccines have been associated with heart issues in young people, especially young men and teenage boys. If you fall into one of those demographics, your doctor may advise you to choose a different shot for your booster, just to be extra safe.

And, of course, if you haven’t gotten vaccinated at all yet, doing so is a very good idea. The original shots are still working well to prevent severe disease and death. Boosters are just another way to protect the vulnerable.

https://time.com/6116324/mixing-booster-shots-covid-19/

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Mandatory vaccinations:

Three reasons for and against

Nearly two years since Chinese doctors first observed mysterious new cases of pneumonia, Covid-19 is still with us. On top of that, what has been described as the most worrying variant yet has emerged. Could mandatory vaccinations be a way out?

Covid vaccinations are already a requirement for public life in many parts of the world.

If you are a French doctor, a New Zealand teacher or a Canadian government employee, getting your shots is essential to go to work. Indonesia can deny benefits to people who refuse jabs. Greece is making them compulsory for the over-60s.

Austria is set to go further still, with a plan to introduce mandatory vaccinations for all by February.

This would not mean Austrians being forcibly injected. There will be medical and religious exemptions. But the bulk of the remaining unvaccinated population face fines for not getting their shots.

With Germany planning a similar move it is not a debate that is going away. I spoke to public health and other experts to get a sense of what's at stake.

FOR: Vaccines save lives

There's a very simple argument in favour of mandating Covid-19 vaccinations. By getting vaccinated you reduce your risk of serious illness. Less serious illnesses mean fewer deaths, and less pressure on hospitals.

Historically, immunisation campaigns have seen huge success, eliminating diseases like smallpox or drastically reducing mortality levels in others.

"We have really good examples that just show a direct causal relationship between requirements, getting very high vaccination rates, and protecting not just individuals but protecting communities," says Jason Schwartz, an associate professor in the History of Medicine at Yale University.

"Vaccines work, they absolutely work, we're got a large body of evidence to show that."

Mandates softer than the one proposed by Austria have achieved their goal of raising vaccination levels. France's pass sanitaire, required to access restaurants and other public spaces, is credited with boosting rates to the extent the government hopes it can avoid compulsory vaccinations.

AGAINST: There will be resistance

Here in London, in July anti-lockdown demonstrators took to the streets to demonstrate against a lockdown that had been lifted just hours earlier.

The point is, whatever a government does, it will face opposition. Covid restrictions in particular have drawn protests around the world and mandatory vaccinations are a step beyond, say, a mask mandate.

"When it comes to vaccines, people do think very differently," says Vageesh Jain, a public health doctor at the Institute for Global Health at University College London.

"Anything that's administered to them in their body, it's not going to be thought of in the same way, even though academics and others may think theoretically it's just a restriction, people do have this kind of emotive response."

Melbourne, Australia is one of many places people took to the streets to oppose Covid restrictions

While there will always be some who will never be persuaded to get vaccinated, it is possible to be sceptical about vaccinations without being an anti-vaxxer.

An Austrian study distinguished between the 14.5% of the country's 9m population who were unprepared to get vaccinated and the 9% who were simply hesitant.

Governments must weigh whether the benefits outweigh the backlash. But as Cathleen Powell, a law professor at the University of Cape Town, argues, there is a legal case to be made.

"The right to bodily integrity as a person who doesn't want to be vaccinated, who wants to make his or her own choices about what medical treatment to get, comes up directly against the rights of other people, not to be infected with potentially fatal diseases," she says.

FOR: We've exhausted other options...

Covid has been with us for some time, but then so have vaccines.

In Europe at least, the momentum behind mandates reflects a frustration that after months of vaccinations and widespread availability there remain significant unvaccinated populations.

There's a stark difference in vaccination rates across the continent from west to east.

Vaccine rates across Europe

European Commission chief Ursula von der Leyen said it was now time to think about mandatory vaccinations, although she stressed individual governments would decide.

"We have the vaccines, the life-saving vaccines, but they are not being used adequately everywhere," she said.

AGAINST: ...or maybe not just yet

While there is a strong health argument in favour of mandatory vaccinations, it is not the only way to boost levels.

"What is quite noticeable in the past is how politicians do like the idea of mandatory vaccination because it seems to give a quick answer to the problem," says Samantha Vandeslott, a social sciences researcher at the Oxford Vaccine Group.

"I wouldn't want government to neglect other things that need to be done to make sure that people really have access to vaccines."

Austria won't be making vaccines mandatory until February and is still using other means. "For those who are afraid, who have no trust, for those whose assessment of risk is low - for them it is important that they are listened to and that their concerns are taken seriously," Barbara Juen, a health psychologist at the University of Innsbruck, told national broadcaster ORF.

In South Africa, 24% of the population is vaccinated, less than half the European average but considerably higher than the 7% average recorded across the African continent. There's no shortage of jabs and low take-up has been blamed in part on misinformation.

The government has floated making vaccines compulsory in some circumstances, but the number of vaccines administered has risen rapidly since the discovery of the Omicron variant. It's not just governments that provide nudges.

FOR: End the cycle of lockdowns

Compulsory vaccinations are not the only form of mandate. Most governments have imposed some form of restrictions, from Covid passes to travel bans, that carry their own costs.

On top of the lives saved, a blanket vaccine mandate could spell the end of lockdowns.
Media caption,

Experts answer your questions about the Omicron variant

"It's not just about having your liberty changed... it's about economic damage and the mental health damage the physical health damage," says Alberto Giubilini, a senior research fellow at the Oxford Uehiro Centre for Practical Ethics. He favours mandates for those most vulnerable to coronavirus.

"There is no reason to impose the huge, huge costs of lockdowns on people when you have another measure available."

AGAINST: It could prove counterproductive

Some have more long-term concerns, such as whether a successful programme could build distrust of future campaigns.

"When people have what we call conspiracy theories or they have misbeliefs or misunderstandings, [such schemes] will only strengthen their opinions."

Vandeslott points to the political climate: "We have witnessed, especially in Europe, parties tapping into the vaccine opposition and knowing that that might be a way to get votes from a certain section of the population," she says.

"We could see more parties, and they tend to be on the right, putting out that kind of message in their political campaign and saying that they want to remove measures for mandatory vaccination. That's a fear and then once that happens, we don't have the option anymore to use that as a policy measure."

https://www.bbc.co.uk/news/world-59506339

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Progress in treatments

Vaccines have transformed the pandemic, but there is still a huge need for drugs which can treat Covid

Immunity from vaccines can wane, and access is still a major problem around the world. Also, new variants emphasise the possible need for a back-up.

What drugs are available?

There are now many drugs that target the virus or our body in different ways:

anti-inflammatory drugs that stop our immune system overreacting with deadly consequences

anti-viral drugs that make it harder for the coronavirus to replicate inside the body

antibody therapies that mimic our own immune system to attack the virus

These are all needed at different stages of the infection. They range from dirt cheap to spectacularly expensive, and some are more resilient to new variants than others.

Anti-inflammatory drugs

When you catch Covid, your body releases a flood of chemicals to warn that you're under attack.

This chemical alarm is called inflammation, and is vital for rallying your immune system to boot out Covid.

But if you don't get rid of the virus quickly, then inflammation can spiral out of control and eventually damage vital organs such as your lungs. It's this excessive inflammation that kills.

An anti-inflammatory steroid that already existed before Covid - dexamethasone - was the first drug proved to save the lives of people with Covid.

It's given to seriously ill patients with breathing troubles - it cuts the risk of death by a fifth for patients on oxygen, and by a third for those on ventilators.

It is also so cheap that it has become the go-to drug around the world - with everywhere from Brazil to China using it.

Other anti-inflammatory drugs have been shown to work, including the steroid hydrocortisone.

There are more advanced and targeted anti-inflammatory drugs such as tocilizumab and sarilumab. Tocilizumab has been widely used in hospitals in China, India and Australia.

These are also effective, but up to 100 times as expensive as dexamethasone. This has restricted their use - although they are still cheaper than an intensive care bed.

Anti-inflammatories work best later on in the disease, but an asthma drug called budesonide has been shown to help vulnerable people with early Covid symptoms recover more quickly at home.

How patients on ventilators would fare on dexamethasone

Anti-viral drugs

An anti-viral directly targets the ability of the coronavirus to make copies of itself inside our bodies.

Such a drug keeps levels of the virus in the body low, so there is less of it for your immune system to deal with.

Paxlovid is a pill taken twice a day for five days - according to its maker, Pfizer, it cuts the risk of hospitalisation or death by 89% in vulnerable adults

Molnupiravir stops the virus from making effective copies of itself - the manufacturer, Merck, estimates it cuts the risk of hospitalisation or death by about half

Both Paxlovid and molnupiravir are best taken soon after symptoms appear.

Pfizer expects to make 80 million courses of Paxlovid by the end of 2022 and has said it will allow generic makers in 95 low-income nations to produce and distribute it at cost price.

Merck is allowing Indian generic drug firms to turn out molnupiravir cheaply for 100 low and middle-income countries.

Drug treatments are thought to have great potential for poorer countries such as Sudan, where vaccination is less available

Antibody therapy

The third approach is to give people an infusion of antibodies that can attack the virus.

These stick to the surface of the coronavirus and mark it for destruction by the body's immune system.

The body makes its own antibodies when it is attacked by coronavirus. The most effective of these have been studied in the lab, grown and given to patients. This is known as monoclonal antibody therapy.

These therapies are often reserved for seriously ill patients who are struggling to make their own antibodies.

Ronapreve, by Regeneron and Roche, reduces the length of hospital stays and the risk of death

Sotrovimab, made by GSK, reduces the risk of hospitalisation and death by 79% in high-risk adults

Again, the earlier the drugs are given the better the chances of success.

Another anti-viral, remdesivir, is used in some countries, but the World Health Organization has warned it has "little or no effect on hospitalised Covid" cases.

Will the drugs work against new variants?

Anti-inflammatories should work against all variants because they target our own bodies, rather than the virus itself.

There is more concern about whether monoclonal antibodies would work with new variants, as they rely on being a close match for the virus. If a new variant is heavily mutated then it theoretically makes the drugs weaker.

However, GSK says it has tested its therapy against the Omicron variant and it remains effective in laboratory studies.

Anti-virals are expected to hold up against the variants seen so far. None of the mutations seen in Omicron should affect the ability of the drugs to work. However, if the drugs are used widely then there is the potential for drug resistance to emerge.

What other drugs are available?

A number of drugs have been heralded as potential therapies for Covid - sometimes with no sign that they actually make any difference.

Ivermectin has been controversially promoted for use in many parts of the world, despite no evidence that it works.

Taking antibodies from survivors' blood - known as convalescent plasma therapy - has been touted, but has not reduced deaths.

There was also speculation that drugs used to treat malaria and HIV might work, but this has come to nothing.

https://www.bbc.co.uk/news/health-52354520

[Anthea]

Wait what?

FDA wants 55 years to process FOIA request over vaccine data

(Reuters) - Freedom of Information Act requests are rarely speedy, but when a group of scientists asked the federal government to share the data it relied upon in licensing Pfizer’s COVID-19 vaccine, the response went beyond typical bureaucratic foot-dragging.

As in 55 years beyond

That’s how long the Food & Drug Administration in court papers this week proposes it should be given to review and release the trove of vaccine-related documents responsive to the request. If a federal judge in Texas agrees, plaintiffs Public Health and Medical Professionals for Transparency can expect to see the full record in 2076.

The 1967 FOIA law requires federal agencies to respond to information requests within 20 business days. However, the time it takes to actually get the documents “will vary depending on the complexity of the request and any backlog of requests already pending at the agency,” according to the government’s central FOIA website.

Justice Department lawyers representing the FDA note in court papers that the plaintiffs are seeking a huge amount of vaccine-related material – about 329,000 pages.

The plaintiffs, a group of more than 30 professors and scientists from universities including Yale, Harvard, UCLA and Brown, filed suit in September in U.S. District Court for the Northern District of Texas, seeking expedited access to the records. They say that releasing the information could help reassure vaccine skeptics that the shot is indeed “safe and effective and, thus, increase confidence in the Pfizer vaccine.”

But the FDA can’t simply turn the documents over wholesale. The records must be reviewed to redact “confidential business and trade secret information of Pfizer or BioNTech and personal privacy information of patients who participated in clinical trials,” wrote DOJ lawyers in a joint status report filed Monday.

The FDA proposes releasing 500 pages per month on a rolling basis, noting that the branch that would handle the review has only 10 employees and is currently processing about 400 other FOIA requests.

“By processing and making interim responses based on 500-page increments, FDA will be able to provide more pages to more requesters, thus avoiding a system where a few large requests monopolize finite processing resources and where fewer requesters’ requests are being fulfilled,” DOJ lawyers wrote, pointing to other court decisions where the 500-page-per-month schedule was upheld.

Civil division trial lawyer Courtney Enlow referred my request for further comment to the DOJ public affairs office, which did not respond.

Plaintiffs' lawyers argue that their request should be top priority, and that the FDA should release all the material no later than March 3, 2022.

“This 108-day period is the same amount of time it took the FDA to review the responsive documents for the far more intricate task of licensing Pfizer’s COVID-19 vaccine,” wrote Aaron Siri of Siri & Glimstad in New York and John Howie of Howie Law in Dallas in court papers.

“The entire purpose of the FOIA is to assure government transparency,” they continued. “It is difficult to imagine a greater need for transparency than immediate disclosure of the documents relied upon by the FDA to license a product that is now being mandated to over 100 million Americans under penalty of losing their careers, their income, their military service status, and far worse.”

They also argue that Title 21, subchapter F of the FDA’s own regulations stipulates that the agency “is to make ‘immediately available’ all documents underlying licensure of a vaccine."

Given the intense public interest in the vaccine, the plaintiffs' lawyers say that the FDA “should have been preparing to release (the data) simultaneously with the licensure. Instead, it has done the opposite.”

Siri declined comment.

To meet the plaintiffs’ proposed FOIA deadline, the FDA would have to process a daunting 80,000 pages a month. But the plaintiffs note that the FDA has 18,000 employees and a budget of $6 billion and “has itself said that there is nothing more important than the licensure of this vaccine and being transparent about this vaccine.”

To be sure, most people -- including many who sanctimoniously proclaim “I do my own research” -- lack the expertise to evaluate the information.

But the plaintiffs, who also include overseas professors from the UK, Germany, Denmark, Australia and Canada, appear to be well-positioned to do so.

As Siri and Howe argue, “Reviewing this information will settle the ongoing public debate regarding the adequacy of the FDA’s review process.”

U.S. District Judge Mark Pittman has set a scheduling conference for December 14 in Fort Worth to consider the timeline for processing the documents.

https://www.reuters.com/legal/governmen ... 021-11-18/

[Anthea]

Understanding mRNA COVID-19 Vaccines

What You Need to Know

Messenger RNA (mRNA) vaccines teach our cells how to make a protein that will trigger an immune response inside our bodies.

Like all vaccines, mRNA vaccines benefit people who get vaccinated by giving them protection against diseases like COVID-19 without risking the potentially serious consequences of getting sick.

mRNA vaccines are newly available to the public. However, researchers have been studying and working with mRNA vaccines for decades.

The same COVID-19 mRNA vaccine product should be used for both doses of a two-dose primary series and for an additional primary dose, if needed. However, any of the COVID-19 vaccines can be used for a booster dose. The booster dose product does not need to match the product used for the primary series.

The Pfizer-BioNTech and Moderna COVID-19 vaccines are messenger RNA vaccines also called mRNA vaccines. mRNA vaccines are some of the first COVID-19 vaccines authorized and approved for use in the United States.

How mRNA Vaccines Work

To trigger an immune response, many vaccines put a weakened or inactivated germ into our bodies. Not mRNA vaccines. Instead, mRNA vaccines use mRNA created in a laboratory to teach our cells how to make a protein—or even just a piece of a protein—that triggers an immune response inside our bodies. That immune response, which produces antibodies, is what protects us from getting infected if the real virus enters our bodies.

COVID vaccine

First, COVID-19 mRNA vaccines are given in the upper arm muscle. The mRNA will enter the muscle cells and instruct the cells’ machinery to produce a harmless piece of what is called the spike protein. The spike protein is found on the surface of the virus that causes COVID-19. After the protein piece is made, our cells break down the mRNA and remove it.

Next, our cells display the spike protein piece on their surface. Our immune system recognizes that the protein doesn’t belong there. This triggers our immune system to produce antibodies and activate other immune cells to fight off what it thinks is an infection. This is what your body might do to fight off the infection if you got sick with COVID-19.

At the end of the process, our bodies have learned how to protect against future infection from the virus that causes COVID-19. The benefit of COVID-19 mRNA vaccines, like all vaccines, is that those vaccinated gain this protection without ever having to risk the potentially serious consequences of getting sick with COVID-19. Any temporary discomfort experienced after getting the vaccine is a natural part of the process and an indication that the vaccine is working.

Facts About COVID-19 mRNA Vaccines

COVID-19 mRNA vaccines cannot give someone the virus that causes COVID-19 or other viruses.

mRNA vaccines do not use the live virus that causes COVID-19 and cannot cause infection with the virus that causes COVID-19 or other viruses.

They do not affect or interact with our DNA in any way.

mRNA never enters the nucleus of the cell where our DNA (genetic material) is located, so it cannot change or influence our genes.

The mRNA and the spike protein don’t last long in the body.

Our cells break down mRNA and get rid of it within a few days after vaccination.
Scientists estimate that the spike protein, like other proteins our bodies create, may stay in the body up to a few weeks.

COVID-19 mRNA Vaccines Have Been Rigorously Evaluated for Safety

mRNA vaccines have been held to the same rigorous safety and effectiveness standardsexternal icon as all other types of vaccines in the United States. The only COVID-19 vaccines the Food and Drug Administration (FDA) makes available for use in the United States (by approval or emergency use authorization) are those that meet these standards.

mRNA Vaccines Are Newly Available to the Public But Have Been Studied for Decades

Researchers have been studying and working with mRNA vaccines for decades. Interest has grown in these vaccines because they can be developed in a laboratory using readily available materials. This means vaccines can be developed and produced in large quantities faster than with other methods for making vaccines.

mRNA vaccines have been studied before for flu, Zika, rabies, and cytomegalovirus (CMV). As soon as the necessary information about the virus that causes COVID-19 was available, scientists began designing the mRNA instructions for cells to build the unique spike protein into an mRNA vaccine.

Future mRNA vaccine technology may allow for one vaccine to provide protection against multiple diseases, thus decreasing the number of shots needed for protection against common vaccine-preventable diseases.

Beyond vaccines, cancer research has used mRNA to trigger the immune system to target specific cancer cells.

https://www.cdc.gov/coronavirus/2019-nc ... /mrna.html