When will the world be vaccinated against COVID-19?

COVID-19

The global effort to find vaccines for COVID-19 has been incredibly successful, with multiple vaccines demonstrating high efficacy in clinical trials less than a year after the disease was discovered.

But it will take several years to manufacture and distribute enough vaccine doses to cover the almost eight billion people on earth.

Current estimates are that it will probably take well into 2023-24 for everyone who needs a vaccine to receive one.

So how should the global community prioritize the distribution of vaccines to give us the best chance of ending the pandemic and saving lives?

Decisions on how to prioritize vaccine doses have to balance the needs in each country, and the world.

COVID-19 vaccines will have the biggest impact on reducing strain on our health services, and reducing restrictions on other parts of society, if we use them to protect the most vulnerable first.

It’s a bit like if you had a family gathering of nine relatives, but you only have three doses of a vaccine now, you’re expecting three more in six months and three more next year. You’d have to decide who to vaccinate first, second and third.

You would probably give it to your grandparents first, because they would be most at risk of dying from COVID-19.

Once they’ve had it, you could see them with much less risk of hurting them.

But what if you had a sibling with asthma? Or those most likely to be traveling around who might bring it into the house from outside?


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The World Health Organization have a recommended priority order starting with health care workers, the oldest (who are most at risk of serious illness and death) and those who are vulnerable due to other health conditions. Most countries are basing their response on this. As more vaccine doses become available, it will be possible to work down by age and vulnerability range. We may also need to review recommendations taking into account new virus variants and outbreaks that occur due to them

It’s a tricky decision for which there is no way to make everyone happy, but most countries now have a clear plan in place.

The global perspective

It’s vital that we think globally as well as nationally when distributing the vaccine. Without worldwide measures, COVID-19 could remain active, and continue to spread.

A virus often mutates and creates new strains as it spreads. We have seen this play out in recent weeks, with two highly transmissible new strains being found in the UK and South Africa, increasing the number of patient cases. Although mutations will always occur, by limiting the presence of the virus worldwide we can reduce both the spread of all strains, and help reduce the risk of new strains forming that could further threaten the global population.

We need to quickly distribute the vaccines to the most vulnerable people, everywhere, and then to the remaining population. If some countries hoard the vaccines, doses will be less available to others.

COVAX is a global initiative that’s been designed to help create global vaccine access. Its aim is to provide 2 billion doses by the end of 2021, with the aim of providing coverage to at least 20% of the population in 195 countries across the world, from X to Y to Z. COVAX needs support from governments around the world to provide critical funds to make sure its work can continue.

Economic recovery is predicted to take much longer if we don’t distribute the vaccines around the world, because we cannot have a healthy global economy if there is still a risk of COVID-19 spreading. By using the vaccines fairly, it’s estimated we could see economic benefits of up to $466 billion in the next five years.

The good news

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Study finds genetic clues to pneumonia risk and COVID-19 disparities

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Researchers at Vanderbilt University Medical Center and colleagues have identified genetic factors that increase the risk for developing pneumonia and its severe, life-threatening consequences.

Their findings, published recently in the American Journal of Human Genetics, may aid efforts to identify patients with COVID-19 at greatest risk for pneumonia, and enable earlier interventions to prevent severe illness and death.

Despite the increasing availability of COVID-19 vaccines, it will take months to inoculate enough people to bring the pandemic under control, experts predict. In the meantime, thousands of Americans are hospitalized and die from COVID-19 each day.

“This study is so important because we performed analyses separately in participants of Caucasian ancestry as well as African ancestry to identify genetic risk factors contributing to pneumonia susceptibility and severity,” said Jennifer “Piper” Below, Ph.D., associate professor of Medicine and the paper’s corresponding author.

“Combined with systemic racism and socioeconomic factors that have been reported by others, these genetic risk differences may contribute to some of the disparities we observe in COVID-19 outcomes,” Below said.

The researchers conducted genome-wide association studies (GWAS) of more than 85,000 patients whose genetic information is stored in VUMC’s BioVU biobank and which has been linked to “de-identified” electronic health records stripped of personal identifying information. GWAS can identify associations between genetic variations and disease.

With colleagues from the University of North Carolina at Chapel Hill, the University of Texas MD Anderson Cancer Center in Houston, and the Icahn School of Medicine at Mount Sinai in New York, the VUMC researchers identified nearly 9,000 cases of pneumonia in patients of European ancestry, and 1,710 cases in patients of African ancestry.

The strongest pneumonia association in patients of European ancestry was the gene that causes cystic fibrosis (CF). This disease produces abnormally thick mucus leading to chronic infections and progressive respiratory failure.

In patients of African ancestry, the strongest pneumonia association was the mutation that causes sickle cell disease (SCD), a red blood cell disorder that increases the risk for pneumonia, influenza and acute respiratory infections.

Children with CF and SCD are at particular risk for severe disease if they contract COVID-19.

The researchers found that “carriers” who are unaffected by CF yet carry a copy of the CF gene had a heightened susceptibility to pneumonia, and those who are unaffected by SCD yet carry a copy of the SCD mutation were at increased risk for severe pneumonia.

Further studies will be needed to determine whether these carriers also bear “a silent, heightened risk for poor outcomes from COVID-19,” the researchers said.

To identify other genetic variations that increase pneumonia risk, they removed patients with CF and SCD from their analysis, repeated the GWAS, and used another technique called PrediXcan, which correlates gene expression data with traits and diseases in the electronic health record.

This time they found a pneumonia-associated variation in a gene called R3HCC1L in patients of European ancestry, and one near a gene called UQCRFS1 in patients of African ancestry. The molecular function of R3HCC1L is unclear, but deletion of the UQCRFS1 in mice disrupts part of their infection-fighting immune response.

“Although our understanding about the genetic mechanism of pneumonia is still limited, this study identified the novel candidate genes, R3HCC1L and UQCRFS1, and offered an insight for further host genetic studies of COVID-19,” said the paper’s first author, Hung-Hsin Chen, Ph.D., MS, a postdoctoral fellow in Below’s lab.

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China to donate 500,000 Covid-19 vaccines to Pakistan

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China will donate 500,000 doses of its COVID-19 vaccine to Pakistan, the country’s foreign minister Shah Mahmood Qureshi said Thursday.

It comes as the number of coronavirus cases surged to 527,146 in Pakistan, with over 11,000 deaths since the virus was first detected in February last year.

“Pakistan greatly appreciates the 500,000 doses of the vaccine gifted by China,” foreign minister Qureshi tweeted.

The news follows similar announcements from other nations in the region—the Philippines, Cambodia and Myanmar have all announced they were set to receive vaccine donations from Beijing.

Qureshi had earlier told reporters: “China has assured us that the first shipment of half a million doses will be free of cost and will arrive by end of January”.

Beijing also promised to send another one million doses by end of February, he said, adding that emergency use and authorisation of the SinoPharm vaccine had been approved in Pakistan.

For years, China has focused much of its attention in Pakistan on mammoth development projects, bankrolling the construction of roads, power plants and a strategic port.

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COVID-19 registries offer lessons beyond the coronavirus

AHA news: COVID-19 registries offer lessons beyond the coronavirus

As the U.S. marks one year since the arrival of SARS-CoV-2, the coronavirus has made history in epic and terrible ways. But it also sparked innovative and inspiring science, say researchers who raced to establish registries of COVID-19 patients.

Their efforts have elements of a medical drama, with mysteries to unravel, lives on the line and obstacles to gathering even basic details. Researchers were forced to adapt quickly and collaborate creatively.

And beyond answering urgent questions about the disease, leaders of those efforts say what they learned might change the way such work is done in years to come.

Dr. James de Lemos, a professor of medicine at UT Southwestern Medical Center in Dallas who helped create one such registry, said the crisis helped researchers cut through red tape and led them to adapt new technologies in ways that would have developed much more slowly without the pandemic.

Registries are a basic scientific tool. The usual work of setting one up takes years. Even then, the projects done from a registry usually involve a handful of investigators working on one or two projects at a time with a centralized corps of statisticians, he said. But as COVID-19 cases exploded across the country last year, “we had to do something different to shorten the time window from idea to discovery.”

De Lemos calls it “burst science,” a burst of speed or creativity from many players. “We democratized the process, which allowed us to basically put scientific discovery in many more hands.”

The need to work quickly and in entirely new ways was also part of the process for Dr. Monika Safford, chief of the Division of General Internal Medicine at Weill Cornell Medicine in New York City. The first U.S. coronavirus case was confirmed last Jan. 20, and by mid-February, “I recognized that we were going to be in deep trouble because we weren’t taking the public health measures that needed to be taken,” she said.

Chaos followed as virus cases spiked and doctors struggled with shortages of protective gear, hospital and intensive care beds, and even personnel; limits on testing; and a lack of information on treatment. Safford called it a “resource-scarce environment combined with knowledge scarcity. I couldn’t do anything about the resource scarcity. But I could do something about the knowledge scarcity.”

That something: build a registry, with the goal of answering doctors’ most burning clinical questions.

Getting even basic details from patients was a challenge, as gear shortages limited who could get close to patients. Technology came to the rescue, making it possible to link attending doctors with medical students, who weren’t allowed on-site but could review and collect data from medical charts. Graduate and undergraduate students at Cornell University’s campus in Ithaca, New York, and elsewhere crunched statistics.

The registry quickly provided crucial details that helped physicians predict who was most likely to need intensive care. Eventually, it gathered data on more than 4,000 patients. The team published last April in the New England Journal of Medicine what Safford said was the first front-line report on COVID-19 patients in the United States. Among other things, it suggested obesity made a patient more likely to need a ventilator.

“We got that published within just about six weeks of the first patient coming to our front door,” she said. “And that’s the kind of speed that we should be shooting for.”

Many COVID-19 registries are up and running. Some gather information on groups such as health care workers or college athletes; others focus on specific diseases. The one de Lemos co-leads, the American Heart Association’s COVID-19 Cardiovascular Disease Registry, focuses on cardiac issues. It launched last April and currently includes more than 32,000 patients from 110 sites.

The effort made use of a technology platform developed by the AHA that centralizes data, standardizes tools and allows multiple teams to collaborate through cloud computing.

Even before the pandemic, scientists had been exploring such tools. But the demand for information motivated everyone to make it work as quickly as possible, he said.

Preliminary research from the registry showed rates of heart attack, heart failure and stroke in COVID-19 patients were lower than expected, de Lemos said. But data published last November in the AHA journal Circulation pointed to a higher risk for obese patients, particularly in younger people. Other research highlighted how COVID-19 has disproportionately harmed Black and Hispanic communities.

De Lemos and Safford both say studies from their registries will lead to further insights on the disease. “There’s a lot more coming soon,” de Lemos said.

For him, building a registry has helped him and his colleagues practice ways of being creative, of “thinking on your feet, and recognizing that you have to be flexible and adaptable,” de Lemos said.

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New trial finds arthritis drug tocilizumab no better than standard care for severe COVID-19

COVID-19, coronavirus

Adding the arthritis drug tocilizumab to standard care for patients in hospital with severe or critical COVID-19 is no better than standard care alone in improving clinical outcomes at 15 days, finds a new trial published by The BMJ today.

There was an increased number of deaths at 15 days in patients receiving tocilizumab, resulting in the trial being stopped early.

Today’s results contradict earlier observational studies suggesting a benefit of tocilizumab. However, observational effects are limited by a high risk that they may be due to other unknown (confounding) factors—and some studies have not yet been peer reviewed or published in a medical journal.

A randomised trial assessing tocilizumab in critically ill patients with COVID-19 (REMAP-CAP) published as a preprint earlier this month, found a beneficial effect of the drug on days free from organ support within 21 days and mortality. Reasons for these apparently contradictory effects, for example differences between patients’ characteristics, need to be assessed in future analysis, say the researchers.

Tocilizumab blocks a specific part of the immune system (interleukin 6) that can go into overdrive in some patients with COVID-19. Doctors think this might help lessen the body’s inflammatory response to the virus and avert some of the more dire consequences of the disease, but its effects are not well defined.

To test this theory, researchers based in Brazil conducted a randomised controlled trial comparing tocilizumab plus standard care with standard care alone in patients admitted to hospital with severe or critical COVID-19.

Their findings are based on 129 relatively young adults (average age 57 years) with confirmed COVID-19 at nine hospitals in Brazil between 8 May and 17 July 2020.

Patients were receiving supplemental oxygen or mechanical ventilation and had abnormal levels of at least two chemicals linked to inflammation in their blood.

Patients were randomly divided into two groups: 65 received tocilizumab plus standard care and 64 received standard care alone.

Other potentially important factors, such as underlying conditions and use of other medication, were taken into account and all patients were monitored for 15 days.

By day 15, 18 (28%) patients in the tocilizumab group and 13 (20%) in the standard care group were receiving mechanical ventilation or died.

Death at 15 days occurred in 11 (17%) patients in the tocilizumab group compared with 2 (3%) in the standard care group.

The increased number of deaths in the tocilizumab group raised safety concerns and the trial was stopped early. In both groups, deaths were attributed to COVID-19 related acute respiratory failure or multiple organ dysfunction.

The researchers point to some limitations including the small sample size, which affects the chances of detecting a true effect. However, results were consistent after adjusting for levels of respiratory support needed by patients at the start of the trial, suggesting that the findings withstand scrutiny.

As such, the researchers conclude that in patients with severe or critical COVID-19, “tocilizumab plus standard care was not superior to standard care alone in improving clinical status at 15 days and might increase mortality.”

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Lack of physical exercise during COVID-19 confinement may lead to a rise in mortality

Lack of physical exercise during COVID-19 confinement may lead to a rise in mortality

Social distancing and working from home help prevent transmission of the novel coronavirus but can be conducive to unhealthy behavior such as binging on fast food or spending more time in a chair or on a couch staring at a screen, and generally moving about less during the day. Scientists believe the reduction in physical activity experienced during the first few months of the pandemic could lead to an annual increase of more than 11.1 million in new cases of type 2 diabetes and result in more than 1.7 million deaths.

The estimates are presented by researchers at São Paulo State University (UNESP), Brazil, in a review article published in Frontiers in Endocrinology. The authors stress that there is an “urgent need” to recommend physical activity during the pandemic.

“Recent studies have shown that people with diabetes face a higher risk of developing the severe form of COVID-19, and of dying if the condition is not properly controlled. Others have shown that social distancing and confinement have considerably reduced levels of physical activity, increased sedentary behavior and lowered the quality of people’s nutrition. Our article serves as a warning about the harmful consequences of these trends,” said Emmanuel Gomes Ciolac, a professor at UNESP’s Department of Physical Education in Bauru, and principal investigator for the study.

The first author of the article is Isabela Roque Marçal, who is studying for a master’s degree at UNESP. She was previously a research intern at the University of Leuven, Belgium, with a scholarship from FAPESP.

Among other data sources, the review covers the findings of an international online survey conducted by a group of 35 research institutions on several continents. According to the results, which are preliminary in that they refer to the first 1,000 volunteers to complete the questionnaire, the level of physical activity decreased 35% in the initial months of confinement, and this was accompanied by a 28.6% increase in sedentary behavior, such as sitting or lying for long periods, and unhealthy eating. Previous studies had already shown that a lack of physical activity helped cause some 33 million cases of type 2 diabetes in 2019 and 5.3 million deaths in 2018.

Based on data for the period before the pandemic, the researchers estimated that the current prevalence of physical inactivity (not getting the minimum amount of exercise recommended by health authorities) was 57.3% among over-forties generally and 57.7% among people at risk for diabetes, so that a lack of exercise can be considered responsible for 9.6% of diabetes cases (11.1 million) and 12.5% of all-cause deaths worldwide (1.7 million) if this prevalence persists for a long time.

Exercising at home

“It’s important to be aware of the difference between insufficient levels of physical activity and sedentary behavior,” Ciolac said. “An insufficiently active person is an individual who doesn’t get the minimum amount of exercise recommended by the World Health Organization.” The WHO recommends at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous aerobic exercise per week for adults aged 18-64.

Sedentary behavior, he continued, is associated with the time spent sitting, reclining or lying down. Research shows that watching television or working at a computer for long hours can be bad for the health of even physically active people. Those who are required to use a computer all day for their work should get up every 30 minutes or so to stretch their legs and get whatever light exercise is possible.

Confinement should not prevent people from performing more intense physical activity. The WHO’s recommendations, for example, include taking online exercise classes, many of which are free of charge, playing with children, doing household chores such as cleaning and gardening, going up and down stairs, even walking on the spot.

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Suffering from death anxiety? Here’s what you need to know

Written by Kayleigh Dray

Kayleigh Dray is Stylist’s digital editor-at-large. Her specialist topics include comic books, films, TV and feminism. On a weekend, you can usually find her drinking copious amounts of tea and playing boardgames with her friends.

A psychotherapist explains what we must do to help put a stop to all of our Covid-induced anxiety around death.

My day began much like any other: I woke up, blearily groped for my phone, and took a quick scroll through my social media feeds. I put my phone down. Then, as something clicked in my brain, I picked it up again and went back through my feeds again.

I hadn’t imagined it – although, Christ, I really wish I had. Because there, in big bold letters, The Surrey Comet informed me that a temporary morgue had been set up about, ooh, 20 minutes from my house “to store Covid dead.”

Just as I’ve made a point of doing with the ever-rising coronavirus death toll, I decided the best course of action was to… well, was just to pretend nothing was wrong. To draw a veil over this unsettling news bulletin, push it to the very darkest recesses of my mind, and go about my day as normal. So I kicked off the duvet, hopped in the shower, swallowed the sudden lump in my throat, and sang along reedily to my favourite bathroom ballads (Celine Dion, eat your heart out). 

This done, I headed downstairs and brewed myself a cup of peppermint tea, ignoring the low hum of anxiety running through me. I logged into my morning meeting over Zoom and pasted a smile over my (slightly paler than normal) face. I cracked jokes, I laughed along as people shared their anecdotes, I made notes, I hit mute whenever I needed to take a few deep, steadying breaths. I shut down the call, I cried a little, I started working on a TV roundup.

Then, when I filed my copy, I cried again. It felt as if I could barely breathe and, when I finally got myself under control and back to work, I found I was still shivering, that my heart was still pounding inside my chest, and that I was still shaking like mad.

Thus went my day. And, when my head hit the pillow later the same night, I found myself plagued by fears of this seemingly never-ending global plague, and of death. Not the skeleton with the scythe, and not my own mortality, but of… well, just of death, full stop.

Because, to paraphrase Wet Wet Wet’s 1994 song, death is seemingly all around us, and so my anxiety grows.

“It sounds like death anxiety,” Stylist’s Lucy Robson tells me, when I mention my experience to her. 

And so, with these words burning in my mind, I reach out to psychotherapist Ruairi Stewart (aka The Happy Whole Coach).

“It’s very normal to feel anxious around death,” Stewart reassures me. “And, as Winston Churchill famously said, ‘Any man who says he is not afraid of death is a liar’.”

He adds: “It has been speculated that death anxiety or thanatophobia as it is medically known, is considered one of the most common human fears. 

“It could be described as a free-floating anxiety that is often ignored and repressed which then leads to it surfacing in other ways.”

But why is my initial reaction to brush all of my feelings around death under the carpet, I wonder? Well, because, as Stewart explains, our day-to-day existences typically don’t tend to remind us of our own mortality.

“In the western world we usually only face the reality of death when in the process of losing a loved one,” he says.

“A lot of people find the thought of death uncomfortable, but having the occasional thought or fear around this is totally normal. When it starts to have a negative impact on your ability to manage your day to day life, however, then it is a problem.

“How grief and loss are handled in the face of a loved one passing away is also a large part of how people tend to frame and experience their own understanding of death. Death can serve as a very painful reminder for people, depending on the nature of the losses they may have endured – how the person died, how this grief was processed and handled, or even the amount of loss a person has experienced and over what amount of time.

“This is something I’m sure a lot of people are struggling with at the moment due to the death tolls around the pandemic constantly updated in the media: it’s a stark reminder of our own mortality.”

Stewart adds reassuringly: “On an intellectual level, we know that life ends for us all at some point. This is still an uncomfortable truth to sit with, however, and the thought of our own mortality is something we tend to push down and deny for the most part.

“It is too overwhelming to be at the forefront of your mind all the time so it ends up dwelling in the subconscious and can subliminally influence behaviours and coping mechanisms when it comes to thinking about death.”

So what can we do to help put a stop to all of our Covid-induced anxiety? Well, Stewart says we need to take the time necessary to get comfortable with the concept of death.

“We all think about our five year plans from time to time, but how often do you sit with the realisation that you are going to die, how often do you reflect on how you’ve been living your life and what would you change if you knew you only had a little time left?” he asks.

“These are intense thoughts but also powerful tools to shift your perspective on things.”

Stewart continues: “There is so much global grief and trauma that we are collectively experiencing right now. People are losing loved ones in the most traumatic ways, the death tolls are constantly in the news and we have a sense of feeling trapped in our homes with the knowledge of it all.

“We need to shift our perspective to take responsibility for how we are currently living our lives,” he adds. “Ask yourself if you’re unhappy, or if anything needs to change, and use these thoughts to help give you clarity.

“They will serve as a reminder that this is your responsibility and something you can control. Choosing to bravely face trauma and work through dark times will help to heal.”

Angharad Burden, Marie Curie’s information and support bereavement service coordinator, agrees wholeheartedly with Stewart, saying that it’s vital we all take the time to confront our fears around death.

More important than even this, though? We must pluck up the courage to talk to loved ones about it, too.

“Our own mortality can be one of the hardest things to accept but taking the time to have important conversations can make a big difference,” Burden says.

“Many people we support wish they’d been able to have these conversations to better understand their loved ones’ wishes before they died. I like to think about it as an act of kindness and love. At a time when the people that are important to you may be experiencing a range of powerful emotions and grief, you will have already acknowledged and shared your final wishes.”

Burden continues: “It can be difficult to know where to start and this doesn’t have to happen in a formal setting. You can talk over dinner, a walk in the park or during a car journey. The more you talk the more natural and comfortable it can become.

“Start by reflecting on a memory, maybe a photograph or piece of music that means a lot to you – it can help start the conversation. Marie Curie has a set of conversation cards you can order that will help you and your loved ones start talking and remove any pressure about knowing where to start. 

“Questions include: ‘What was the last thing that made you laugh out loud?’ and ‘Name the three songs you’d like at your funeral’. This gives you the opportunity to understand the people you care about better, perhaps agree or disagree with questionable music choices, but ultimately save unnecessary stress and confusion later.”

Burden adds: “We are all unique and talking about death can be daunting, so try not to force it. There are books, pieces of music, documentaries and films that all introduce the topic of dying and death in a way that may be more accessible to you. You may also wish to express your own feelings creatively. I often hear of people writing songs, creating drawings or painting their thoughts and feelings, which can be both cathartic for you and informative for your loved ones.”

“It’s easy to not talk about your own mortality but it could be incredibly difficult on those you leave behind if you don’t. Marie Curie can help you think, talk and plan for the end of life. It’s never too soon, until it’s too late.”

Marie Curie can help you and your family or friends open up the conversation, share your thoughts and feelings, discuss your wishes and make plans earlier in life, for what you and your loved ones want for the end of life experience. Visit www.mariecurie.org.uk/talkabout to find ideas and tools to help you get started or call the Marie Curie Support Line free on 0800 090 2309.

Marie Curie Talkabout Conversation Cards are available to order on the Marie Curie online shop.

Images: Getty

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COVID-19: Science scepticism may be reinforced by UK rush to approve vaccines

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Former director of public health Professor John Ashton has said that scientific scepticism may be reinforced by the UK’s rush to approve COVID vaccines for public use and the apparent political desire to be the first out of the blocks in contrast to our European neighbours.

Writing in the Journal of the Royal Society of Medicine, Prof Ashton says that to risk the trust of the public for the sake of a couple of weeks propaganda advantage could prove to be unforgivable should vaccine uptake fall below that required for the ubiquitous ‘herd immunity’ as a result of giving oxygen to the sceptics.

“In this age of scientific rationality, superstition and anti-science still run deep,” he writes. “When an overwhelming majority of the public welcomes the arrival of COVID vaccination, it is salutary to remind ourselves of the main arguments deployed against its value and use.”

As well as the readily understood fear of injections, Prof Ashton writes that other objections have included that vaccination is ‘unchristian’, that it is an infringement of personal liberty and that it is part of a more general suspicion of scientific medicine.

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Metformin use reduces risk of death for patients with COVID-19 and diabetes

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Use of the diabetes drug metformin—before a diagnosis of COVID-19—is associated with a threefold decrease in mortality in COVID-19 patients with Type 2 diabetes, according to a racially diverse study at the University of Alabama at Birmingham. Diabetes is a significant comorbidity for COVID-19.

“This beneficial effect remained, even after correcting for age, sex, race, obesity, and hypertension or chronic kidney disease and heart failure,” said Anath Shalev, M.D., director of UAB’s Comprehensive Diabetes Center and leader of the study.

“Since similar results have now been obtained in different populations from around the world—including China, France and a UnitedHealthcare analysis—this suggests that the observed reduction in mortality risk associated with metformin use in subjects with Type 2 diabetes and COVID-19 might be generalizable,” Shalev said.

How metformin improves prognosis in the context of COVID-19 is not known, Shalev says. The UAB findings suggest that the mechanisms may go beyond any expected improvement in glycemic control or obesity, since neither body mass index, blood glucose nor hemoglobin A1C were lower in the metformin users who survived as compared to those who died.

“The mechanisms may involve metformin’s previously described anti-inflammatory and anti-thrombotic effects,” Shalev said.

The study—first made available in MedRxiv and now published in the peer-reviewed journal Frontiers in Endocrinology—included 25,326 patients tested for COVID-19 at the tertiary care UAB Hospital between Feb. 25 and June 22 of last year. Of the 604 patients found to be COVID-19-positive, 311 were African Americans.

The primary outcome in the study was mortality in COVID-19-positive subjects, and the potential association with subject characteristics or comorbidities was analyzed.

Researchers found that Blacks, who are only 26 percent of Alabama’s population, were 52 percent of those who tested positive for COVID-19, and only 30 percent of those who tested negative. In contrast, only 36 percent of the COVID-19-positive subjects were white, while whites made up 56 percent of those who tested negative, further underlining the racial disparity. Once COVID-19-positive though, no significant racial difference in mortality was observed.

“In our cohort,” Shalev said, “being African American appeared to be primarily a risk factor for contracting COVID-19, rather than for mortality. This suggests that any racial disparity observed is likely due to exposure risk and external socioeconomic factors, including access to proper health care.”

Overall mortality for COVID-19-positive patients was 11 percent. The study found that 93 percent of deaths occurred in subjects over the age of 50, and being male or having high blood pressure was associated with a significantly elevated risk of death. Diabetes was associated with a dramatic increase in mortality, with an odds ratio of 3.62. Overall, 67 percent of deaths in the study occurred in subjects with diabetes.

The researchers looked at the effects of diabetes treatment on adverse COVID-19 outcomes, focusing on insulin and metformin as the two most common medications for Type 2 diabetes. They found that prior insulin use did not affect mortality risk.

However, prior metformin use was a different matter. Metformin use significantly reduced the odds of dying, and the 11 percent mortality for metformin users was not only comparable to that of the general COVID-19-positive population, it was dramatically lower than the 23 percent mortality for diabetes patients not on metformin.

After controlling for other covariates, age, sex and metformin use emerged as independent factors affecting COVID-19-related mortality. Interestingly, even after controlling for all these other covariates, death was significantly less likely—with an odds ratio of 0.33—for Type 2 diabetes subjects taking metformin, compared with those who did not take metformin.

“These results suggest that, while diabetes is an independent risk factor for COVID-19-related mortality,” Shalev said, “this risk is dramatically reduced in subjects taking metformin—raising the possibility that metformin may provide a protective approach in this high-risk population.”

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US COVID-19 deaths hit another one-day high at over 4,300

US COVID-19 deaths hit another one-day high at over 4,300

Coronavirus deaths in the U.S. hit another one-day high at over 4,300 with the country’s attention focused largely on the fallout from the deadly uprising at the Capitol.

The nation’s overall death toll from COVID-19 has eclipsed 380,000, according to Johns Hopkins University, and is closing in fast on the number of Americans killed in World War II, or about 407,000. Confirmed infections have topped 22.8 million.

With the country simultaneously facing a political crisis and on edge over threats of more violence from far-right extremists, the U.S. recorded 4,327 deaths on Tuesday by Johns Hopkins’ count. Arizona and California have been among the hardest-hit states.

The daily figure is subject to revision, but deaths have been rising sharply over the past 2 1/2 months, and the country is now in the most lethal phase of the outbreak yet, even as the vaccine is being rolled out. New cases are running at nearly a quarter-million per day on average.

More than 9.3 million Americans have received their first shot of the vaccine, or less than 3% of the population, according to the Centers for Disease Control and Prevention. That is well short of the hundreds of millions who experts say will need to be inoculated to vanquish the outbreak.






The effort is ramping up around the country. Large-scale, drive-thru vaccination sites have opened at stadiums and other places, enabling people to get their shots through their car windows.

Also, an increasing number of states have begun offering vaccinations to the next group in line—senior citizens—with the minimum age varying from place to place at 65, 70 or 75. Up to now, health care workers and nursing home residents have been given priority in most places.

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