COVID SCIENCE-Autoimmune-disease drugs may reduce vaccine response; antibody treatments ineffective vs Brazil variant

April 12 (Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Autoimmune disease treatments may reduce vaccine responses

Immunosuppressive drugs for inflammatory diseases like rheumatoid arthritis, multiple sclerosis, and ulcerative colitis can impair the body’s response to the COVID-19 vaccines from Pfizer/BioNTech and Moderna, according to new data. In 133 fully vaccinated people with such conditions, antibody levels and virus neutralization were about three-fold lower than in a comparison group of vaccinated individuals not taking those medicine, researchers reported on Friday on medRxiv ahead of peer review. Most patients in the study “were able to mount antibody responses in response to SARS-CoV-2 vaccination, which is reassuring,” said coauthor Alfred Kim from Washington University School of Medicine in St. Louis. It is not clear yet whether reduced antibody levels will result in decreased protection from infection or hospitalization, Kim said. Particularly concerning, he said, is the 10-fold reduction in vaccine-induced antibody levels seen in patients who routinely use steroids such as prednisone and methylprednisolone and a 36-fold reduction seen with drugs that deplete B cells, including Roche’s Rituxan (rituximab) and Ocrevus (ocrelizumab). Reductions in antibody levels were more modest with widely used rheumatoid arthritis drugs in the class known as TNF inhibitors such as Abbvie’s Humira (adalimumab) and Amgen’s Enbrel (etanercept); antimetabolites like methotrexate and sulfasalazine; JAK inhibitors like Pfizer’s Xeljanz (tofacitinib), gut-specific agents such as Takeda Pharmaceutical Co’s Entyvio (vedolizumab), and IL-12/23 inhibitors including Johnson & Johnson’s Stelara (ustekinumab). (https://bit.ly/2QmzRiY)

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Most antibody drugs ineffective against Brazil variant

The coronavirus variant first identified in Brazil, known as P.1, is resistant to three of the four antibody therapies with emergency use authorization in the United States, according to a laboratory study. In test-tube experiments, researchers exposed the P.1 variant to various monoclonal antibodies, including the four currently being used to treat U.S. COVID-19 patients – imdevimab and casirivimab from Regneron Pharmaceuticals , and bamlanivimab and etesevimab from Eli Lilly and Co . Only imdevimab retained any potency, researchers found. The neutralizing ability of the other three were “markedly or completely abolished,” according to a peer reviewed report available on bioRxiv and provisionally accepted by the journal Cell Host & Microbe. The researchers also exposed P.1 to plasma from COVID-19 survivors and blood from recipients of vaccines from Pfizer/BioNTech or Moderna. Compared to their effects against the original version of the coronavirus, the plasma and the vaccine-induced antibodies were less effective at neutralizing P.1. In earlier studies, however, they were even less effective against the B.1.351 variant first identified in South Africa. This suggests that the Brazil variant might not pose as great a threat of reinfection or decreased vaccine protection as the South Africa variant, said coauthor David Ho from Columbia University. Real-world evidence is needed to confirm the lab results, he said. (https://bit.ly/2Qgv4j1)

South Africa variant can ‘break through’ Pfizer vaccine

The B.1.351 coronavirus variant discovered in South Africa can “break through” Pfizer/BioNTech’s COVID-19 vaccine protection to some extent, Israeli researchers have found. They compared almost 400 people who had tested positive for COVID-19 after one or two doses of the vaccine, against the same number of similar people with COVID-19 who were unvaccinated. The prevalence of the variant in Israel is low, and overall, it accounted for about 1% of all the COVID-19 cases in the study. But among those who received both doses of the vaccine, a larger proportion of COVID-19 infections were caused by B.1.351. The “disproportionately higher rate” of the South African variant in the fully vaccinated group (5.4%) compared to the rate in the unvaccinated group (0.7%) “means that the South African variant is able, to some extent, to break through the vaccine’s protection,” said Tel Aviv University’s Adi Stern. In a report posted on Friday on medRxiv ahead of peer review, Stern’s team said the research was not intended to deduce overall vaccine effectiveness against any variant, since it only looked at people who had already tested positive for COVID-19, not at overall infection rates in the community. (https://bit.ly/3sdVzCR; https://reut.rs/32aqvt0)

Open https://tmsnrt.rs/3c7R3Bl in an external browser for a Reuters graphic on vaccines in development.

(Reporting by Nancy Lapid and Maayan Lubell; Editing by Bill Berkrot)

 

They tested negative for the coronavirus but still have ‘long COVID’ symptoms

Kristin Novotny once led an active life, with regular CrossFit workouts, football in the front yard with her children and a job managing the kitchen at a middle school.

Now, the 33-year-old mother of two from De Pere, Wisconsin, has to rest after the simplest activities, even showering. Just having a conversation leaves her short of breath.

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Novotny has been contending with these symptoms of a malady known as long COVID — including fatigue, shortness of breath, gastrointestinal problems, muscle and joint pain and neurological issues — despite having tested negative seven months ago for COVID-19.

Experts don’t know what causes long COVID or why some people have persistent symptoms while others recover in weeks or even days. They also don’t know just how long the condition — referred to formally by scientists as post-acute sequelae of SARS-CoV-2 infection, or PASC — lasts.

But people like Novotny who never tested positive for coronavirus — whether due to a lack of access to testing or a false-negative result — face difficulty getting treatment and disability benefits. Their cases aren’t always included in studies of long COVID despite their lingering symptoms. And, sometimes just as aggravating, many find that family, friends and even doctors have doubts they ever had COVID at all.

Novotny first became ill in August. She returned to work at the beginning of the school year, but her symptoms worsened. Months later, she couldn’t catch her breath at work. She went home and hasn’t been well enough to return.

“It is sad and frustrating being unable to work or play with my kids,” Novotny said. “My 9-year-old is afraid that, if I’m left alone, I will have a medical emergency, and no one will be here to help.”

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Data about the frequency of false-negative COVID tests is limited. A study done at the Johns Hopkins School of Medicine and Bloomberg School of Public Health, which focused on the time between exposure and testing, found a median false-negative rate of 20% three days after symptoms start. A small study in China, conducted early in the pandemic, found a high rate of negative tests even among people sick enough to be hospitalized. Given the dearth of long-hauler research, people dealing with lingering COVID symptoms have organized to study themselves.

Haphazard protocols for testing people in the United States, the delays and difficulties accessing tests and the poor quality of many of the tests left many people without proof they were infected with the virus that causes COVID-19.

“It’s great if someone can get a positive test, but many people who have COVID simply will never have one for a variety of different reasons,” said Natalie Lambert, an associate research professor at the Indiana University School of Medicine who is the director of research for the online COVID support group Survivor Corps.

Using computational analytics, Lambert has found that long-haulers face such a wide variety of symptoms that no single symptom is a good screening tool for whether they have COVID.

“If PCR tests are not always accurate or available at the right time, and it’s not always easy to diagnose based on someone’s initial symptoms, we really need to have a more flexible, expansive way of diagnosing for COVID based on clinical presentations,” Lambert said.

Dr. Bobbi Pritt, chair of the division of clinical microbiology at the Mayo Clinic in Rochester, Minnesota, said four factors affect the accuracy of a diagnostic test:

  • When a person’s sample is collected.
  • Which part of the body it comes from.
  • The technique of the person collecting the sample.
  • Aand the test type.

“But if one of those four things isn’t correct,” Pritt said, “you could still have a false-negative result.”

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Timing is one of the most nebulous elements in accurately detecting SARS-CoV-2. The body doesn’t become symptomatic immediately after exposure. It takes time for the virus to multiply. This incubation period tends to last four or five days before symptoms start for most people.

“But we’ve known that it can be as many as 14 days,” Pritt said.

Testing during that incubation period means there might not be enough detectable virus yet.

“Early on after infection, you may not see it because the person doesn’t have enough virus around for you to find,” said Dr. Yuka Manabe, an infectious disease expert who is a professor at the Johns Hopkins University School of Medicine.

Novotny woke up with symptoms on Aug. 14 and got a COVID test that day. Three days later — the same day her test result came back negative — she went to the hospital because of severe shortness of breath and chest pressure.

“The hospital chose not to test me due to test shortages and told me to presume positive,” Novotny said, adding that hospital staffers told her she likely tested too early and had a false negative.

As the virus leaves the body, it becomes undetectable. But patients might still have symptoms because their immune responses kicked in.

At that point, “You’re seeing more of an inflammatory phase of illness,” Manabe said.

An autoimmune response — in which the body’s defense system attacks its own healthy tissue — might be what’s behind persistent COVID symptoms, though small amounts of virus hiding in organs is another possible explanation.

Andréa Ceresa is nearing a year of long COVID and has gastrointestinal and neurological issues. When the 47-year-old from Branchburg, New Jersey, got sick last April, she had trouble getting a COVID test. Once she did, her result was negative.

Ceresa has seen so many doctors since then that she can’t keep them straight. She feels lucky to finally have found “fantastic” doctors, but she’s also seen some who didn’t believe her. One said it was all in her head. And after she waited two months to see a neurologist, she said he didn’t order any tests and told her to take vitamin B, leaving her “crying and devastated.”

“I think the negative test absolutely did that,” Ceresa said.

Among a growing number of doctors specifically treating patients with long COVID, positive test results aren’t vital. In the patient-led research, symptoms patients reported weren’t significantly different between those who tested positive and those who had negative tests.

Dr. Monica Verduzco-Gutierrez, a rehabilitation and physical medicine doctor who leads UT Health San Antonio’s Post-COVID Recovery program in San Antonio, said about 12% of the patients she’s seen never had a positive COVID test.

“The initial test, to me, is not as important as the symptoms,” Gutierrez said.

She tells people “what’s done is done,” and, regardless of test status, “Now, we need to treat the outcome.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues.

Systemic racism must be removed from medicine

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All of us have them — biases and prejudices informed by our lived experiences. Physicians and other health care workers are no different. Yet far too often, those of us in health care fail to recognize our biases and, when baked into organizational policies and practices that have been historically and largely defined by privileged white people (and usually men), the result can be serious and even deadly to the patients we serve.

As two physicians born into white privilege, we acknowledge our complicity in systemic racism in medicine and recognize that we have much work to do to become anti-racist.

Many nonwhite patients describe negative interactions with the health care system — pain assumed to be drug-seeking behavior, referrals for specialty care assumed to be unaffordable, complex prescriptions noted as unlikely to be understood and followed. Just recently, leaders at the American Medical Association (AMA) were appropriately called to task in response to a podcast that suggested doctors were not racist and that downplayed the effects of systemic racism in health care.

The organization’s top physician quickly reached out to stakeholders to assure them the association, which advocates on behalf of physicians across the country, had made a big mistake.

“To be clear, structural racism exists in the U.S. and in medicine, genuinely affecting the health of all people, especially people of color and others historically marginalized in society,” wrote Dr. James L. Madara, AMA CEO and executive vice president. “This is not opinion or conjecture, it is proven in numerous studies, through the science and in the evidence. As physicians, and as leaders in medicine, we have a responsibility to not only acknowledge and understand the impact of structural racism on the lives of our patients, but to speak out against racial injustices wherever they exist in health care and society.”

This is why the Minnesota Medical Association (MMA) and UCare have teamed up and recently launched a two-year initiative to combat clinician biases in order to promote health and racial equity. It is long overdue. Minnesota, often cited as a shining example of superior health care to the rest of the country and world, has some of the worst health disparities in the country among Black, Indigenous, Latinx, Asian and Pacific Islander communities.
Doctor with patient

This initiative will focus on addressing physician and other health professional biases as a contributing factor in health outcomes and support the adoption of an anti-racist culture by Minnesota health care organizations. Its overriding goal is to begin dismantling some of the key elements of structural racism present in Minnesota’s health care system.

This work comes at a time when Minnesotans from Black, Indigenous, Latinx, Asian and Pacific Islander communities are experiencing disproportionate morbidity and mortality from COVID-19, shorter life spans, and higher rates of infant mortality and diseases such as diabetes, heart disease and cancer than their white peers. Beyond this unacceptable toll on the lives and health of Minnesotans, these inequities have economic consequences on the workforce and the affordability of health insurance.

For example, a University of Minnesota Program in Health Disparities Research study found that preventable deaths caused by racial disparities cost the state from $1.2 billion to $2.9 billion each year.

Ultimately, we want to create anti-racist training for future generations of health care professionals as well as establish and facilitate cross-organizational communication and exchange of health equity initiatives, practices and policies. We want to explore and develop communitywide metrics for accountability, and identify opportunities for the use of restorative justice models to facilitate trust building between Black, Indigenous, Latinx, Asian and Pacific Islander communities and Minnesota health care organizations.

There is much to do and undo to create a more just and fair health care system for all Minnesotans. We need to begin today to dismantle structural racism in health care settings, reduce implicit bias among our colleagues and make demonstrable improvement in the health outcomes of Black, Indigenous, Latinx, Asian and Pacific Islander communities.

Marilyn Peitso is president of the Minnesota Medical Association. James Pacala is board chair at UCare.

Colonie police: Homicide victim was an Ellis Medicine respiratory therapist

COLONIE — Police said Marek Kokoszko shot and killed his wife, Dorota, a respiratory therapist at Ellis Medicine, on Friday in their Boght Road home. He then killed himself.

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Shot of shelves stocked with various medicinal products in a pharmacy

As a registered respiratory therapist, Dorota Kokoszko, 54, was trained to work with people suffering from cardiac and pulmonary issues. Her LinkedIn page says that she received a master’s degree in elementary education from the University of Bialystok in Poland in 1990. In the Capital Region, she attended Hudson Valley Community College between 2008 and 2010 to get her associate of science degree in respiratory therapy. In June 2010 she went to work for Ellis.

A GoFundMe established to help with funeral expenses said Dorota was “a beloved member of the Ellis Hospital Respiratory Care department,” and “also a valued member of the Hudson Valley Respiratory Care Faculty, but most importantly she was a loving mother to her daughter.”
“She was so helpful, always. It was a pleasure to see her working with us. She always had a smile and laugh that I will never forget,” wrote a co-worker who donated to the GoFundMe site.

Police said a family member had trouble getting in touch with one of the residents, and asked police to check the home.
Police said their investigation determined that Marek, 57, killed his wife with what appears to be a legally owned rifle. There were other firearms found in the home, which also appear to have been owned legally by Marek, who worked independently as a mason.

An investigation revealed “recent domestic issues that have been escalating over the past few months,” Colonie police said, though the department added officers had not been called to the residence since 2016. In that instance, no charges were filed.

“We have not yet determined what may have led to this incident, but there were many factors that likely played a role in the event,” Colonie police wrote in a prepared statement, adding “including mental health issues for Marek.”

Enhance Brain Health With High-Tech Holistic Medicine

Trisha Swift, DNP is a Whole-Person Care expert, an Ayurveda Medicine student at MIU, and the VP of Innovation & Transformation at ZeOmega.

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There are plenty of warnings regarding the negative impacts of technology on our mood, sleep, attention, vision, mindfulness and overall health. While I agree with many of the cautionary tales, I also believe there is an effective way to apply technology to enhance health and well-being — specifically the health of your brain.

One of the fastest-growing areas in technology includes digital mindfulness and wearable devices. Apps and wearables are easily accessed through smartphones and can interface across devices, even in your car. Overall, mindfulness tech solutions are designed to offer users a sense of well-being, inner peace, calmness and focus.

Holistic medicine practitioners often view technology as manufactured or impersonal and, therefore, can disregard its utility for whole-person care (WPC) and brain health. However, I believe technology and holistic medicine should be viewed as symbiotic partners in support of a whole-person care model. In fact, there are several ways high-tech holistic medicine can enable whole-person care, specifically by enhancing brain health. In reviewing how high-tech holistic medicine can boost the brain, the following aspects of the whole person come to mind:

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Meditation And Mindfulness

There are hundreds of meditation techniques, each one embracing diverse traditions, cultures and methods to reduce stress and expand consciousness. Scientific research on meditation confirms it has a wide range of health benefits to the body and the mind — each technique having a unique intent, purpose and desired effect.

Nowadays, it’s easy to adopt a meditation practice through a smartphone app. Meditation apps provide guided sessions, relaxing music, breathing techniques and reminders — some even offer social networking for meditators to connect on their shared interest. Using technology to support mindfulness is far from what most imagine meditation to look like. However, it’s exactly what high-tech holistic medicine is — blending the old with the new to provide a modern approach for whole-person care.

Beyond meditation, the idea of positive affirmations has its place in whole-person care. The technology available in this area is becoming wildly popular, especially during the Covid-19 pandemic, when intentional social isolation and depressing news headlines are common. Technology for positivity has a wide range of use and is customizable. Smart devices can remind us to slow down and breathe when our heart rate spikes unexpectedly. Apps can push uplifting quotes to start the day, and voice-activated devices can speak directly to us with a cheerful note. Chatbots can carry on a conversation and help address negative emotions.

The tech market is full of options when it comes to meditation and mindfulness. It’s only a matter of time before the medical community recognizes its utility for improving quality of life by enhancing brain health.

Sleep

Many suffer from sleep issues such as an inability to fall asleep, stay asleep or get restful sleep. Lack of good quality sleep brings on a host of health problems ranging from mood disturbances to headaches to obesity to heart disease, among others.

Whole-person care models seek to address the root cause of an issue rather than treat symptoms. Therefore, applying technology to monitor and improve sleep, rather than taking a sleeping pill, would be the preferred course of action. There are several apps that assist in falling asleep by providing soothing music, white noise or nature sounds. Wearable devices can monitor sleep quality and duration so one can draw correlations between their behaviors and habits that result in better sleep.

Other devices can monitor sleep and initiate a wake-up alarm when you are in the lightest phase of sleep as to not disturb the more restful phases. Looking ahead, there is emerging pillow technology where sounds and vibrations are transmitted to the sleeper that trigger the brain to relax and slow down for a smoother transition to sleep. Technology and sleep have a love-hate relationship, as a dependence on technology can result in real sleep issues. However, there are many tech solutions that are specifically designed to optimize sleep.

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Digital Detox

The term “digital detox” refers to a set time period where one avoids the use of tech devices such as tablets, TVs, smartphones, computers and social media. Taking a hiatus from technology is referred to as a “detox” because the constant mental stimulation by technology and devices can act as a toxin to health and well-being. In fact, some research indicates that nearly 20% of adults report that technology is a significant source of stress in their life.

Honoring an intention to unplug from technology has been shown to help people refocus their attention on in-person social interactions without virtual distractions and associated stress caused by the constant connectivity. As ironic as it sounds, using technology to avoid technology is not only helpful but, in some sense, necessary. Going off the grid is not only hard to do, but it can also cause friends and family to worry.

There are several apps designed to assist in doing a digital detox by setting limits for screen time and keeping tabs on consumption so there is visibility into when a user has had “too much.” Other apps lock down your device for a set period of time as a way to force a break from social media. Going one step further, there are apps that track and trend online behaviors to allow users to take a data-driven approach for self-management and modifications.

A digital detox shouldn’t be viewed as any different than a juice cleanse, bowel flush, nasal wash or skin exfoliation. Digital detox is for the brain, and its positive results on brain health speak for themselves.

High-tech holistic medicine to deliver whole-person care facilitates personal connections without the need for physical touchpoints. This connection with self and others, in many cases, is the missing ingredient in achieving feelings of wholeness. To feel whole, one must also care for and maintain optimal brain health, which is foundational to a WPC model. Therefore, applying technology in ways that enhance brain health is not just complementary, it’s essential to your overall quality of life.

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