Florida’s Hillsborough County is one particular of them.
In that county on Wednesday, Gov. Ron DeSantis approached a group of pupils carrying masks who were being standing behind a podium at the University of South Florida, wherever the Republican governor was scheduled to hold a news conference. He instructed the college students, “You do not have to use these masks. I suggest, remember to choose them off.”
But in accordance to the CDC’s newest steerage, folks are suggested to nonetheless wear masks indoors in counties that have “superior” amounts of Covid-19, such as Hillsborough County.
The CDC stated Thursday that “far more than 90{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}” of US residents are now in a area with small or medium Covid-19 community ranges. A CNN analysis of the facts finds that 7{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the US populace is in counties with “superior” Covid-19 group ranges, down from 28{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} previous week.
DeSantis called the students’ mask-donning “preposterous,” but they ended up following CDC suggestions. Dr. Georges Benjamin, government director of the American Public Wellbeing Association, said DeSantis was “bullying” the students for putting on masks.
“Gov. DeSantis has confirmed himself to be somebody who does not comply with excellent science advice, naturally for political factors,” Benjamin told CNN on Thursday. “I was horrified at what he did.”
On Twitter, DeSantis spokeswoman Christina Pushaw doubled down on the governor’s feedback: “I signify, an individual experienced to say it, just after 2 a long time of propaganda that terrified and manipulated youthful men and women. Breathe totally free, truly feel safe and sound and be satisfied.”
Throughout the United States, most of the counties that continue to have substantial Covid-19 degrees, dependent on the CDC’s current metrics, may be afflicted by many things, Benjamin reported: small Covid-19 vaccination fees, constrained entry to health and fitness assets or the continuing spread of the Omicron coronavirus variant.
“Some of these areas ended up spots wherever Omicron kind of hit later on. So like Maine. If you look at Maine proper now, you would think, ‘Maine is extremely vaccinated why is Maine getting hit so greatly? They continue to have an outbreak going on there,’ ” Benjamin explained. “Perfectly, it can be due to the fact they received hit by Omicron afterwards.”
In which Covid-19 is still ‘high’ but mask mandates are lifting
Some of the counties that nevertheless have “significant” degrees of Covid-19 are in states that either never ever experienced indoor mask mandates or lifted their mandates previously on in the pandemic.
Last 7 days, California dropped its indoor mask mandate for unvaccinated persons. In that state, 11 counties have “large” degrees of Covid-19. Illinois also lifted its statewide indoor mask requirement and has six counties with “significant” concentrations of Covid-19.
Oregon and Washington prepare to lift their principles requiring masks in indoor community sites on March 11. There are four counties with “significant” levels of Covid-19 in Oregon and four counties with “high” amounts in the point out of Washington, in accordance to the CDC’s updated metrics.
Only 1 state and a single US territory — Hawaii and Puerto Rico — nevertheless have indoor mask mandates on the state or territorial level and have not introduced plans to raise individuals prerequisites.
Even in states the place indoor mask demands are lifted, counties can nonetheless require indoor mask-putting on on the nearby degree, Benjamin told CNN.
“The states are stating, ‘OK, we governors are no more time heading to manage it statewide. We’re now likely to lift a mandate from our point of view, and we are going to make it possible for you to customise this,’ ” he claimed.
With the updated county-level CDC metrics, “I feel the brilliance of what CDC did was, they were being able to pull the knowledge alongside one another at the neighborhood neighborhood degree — to allow neighborhood communities to make individuals decisions when to consider masks [off]. But it also presents them the capacity to re-mask, improve screening plan as they will need to, open and shut items,” Benjamin explained. “I would hope this not only puts it again in the fingers of regional elected officers but it also, I would hope, even a lot more powerfully, places it back in the fingers of neighborhood public health and fitness officials. That’s what I hope.”
The CDC’s “Covid-19 group amount” metrics are centered on 3 parts of info in a community: new Covid-19 hospitalizations, medical center capacity and new Covid-19 instances. The CDC’s internet site consists of a record of US counties and their current Covid-19 stages.
Beneath the CDC guidance, up to date last week, men and women in counties with very low or medium Covid-19 neighborhood stages no for a longer time have to have to wear masks indoors except they are immunocompromised or at “superior danger” for significant Covid-19 and if so, the CDC endorses to communicate to their wellbeing treatment company about sporting a mask.
In places with “superior” Covid-19 community levels, the CDC advises anyone to don a mask in public indoor options, like schools.
At all group concentrations, the CDC also endorses persons get vaccinated and boosted, and get tested if they have indicators.
The CDC’s new metrics are calculated at the county level to make it possible for for a “far more focused” being familiar with of the results of the coronavirus regionally and to inform own steps, these kinds of as mask carrying, as well as community policy decisions, Adriane Casalotti, chief of federal government and general public affairs at the National Association of County and Town Wellbeing Officials, wrote in an e mail to CNN on Thursday.
“Having said that, there are two difficulties for protecting masking specifications at a nearby plan stage. A single would be condition rules that prohibit this kind of action,” Casalotti wrote. “Yet another is less formal: the tension of taking further action. In particular as several in the community want to transfer further than the pandemic, it can be a challenge to proceed insurance policies like indoor masking necessities, even if it tends to make sense scientifically because of to community problems.”
Total, it can be tricky to keep track of regardless of whether there has been an overall shift in mask mandates currently being lifted in locations that continue to have “higher” Covid-19 degrees, Casalotti mentioned.
“This is more durable to observe as a lot of locations dropped — or ended up in the course of action of moving away from — formal masking specifications even right before the new, extra qualified metrics ended up launched,” she wrote.
“In some of all those locations, regional policy often shifted from indoor masking requirements to powerful recommendations for indoor masking or supporting enterprises to make individuals conclusions location by locale,” she additional. “In these areas, the burden is truly put on the unique to know the position of the virus in their local community, how to attain high-top quality masks, and when and wherever to use them to guard by themselves and their families.”
Most people in the United States live in areas where those who are healthy do not need to wear masks indoors, according to new US Centers for Disease Control and Prevention guidance – a sweeping change from what earlier Covid-19 metrics recommended.
New CDC metrics indicate that about 28{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of people in the United States live in a county where they need to wear masks indoors. Previously, CDC pointed to levels of coronavirus transmission within communities as a key metric for restrictions and recommended that people in areas with high or substantial levels of transmission – about 99{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the population – should wear masks indoors.
Now, the CDC’s “Covid-19 community level” metrics are based on three pieces of data in a community: new Covid-19 hospitalizations, hospital capacity and new Covid-19 cases. The CDC’s website includes a list of US counties and their current Covid-19 levels.
Under the updated guidance, more than 70{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the US population is in a location with low or medium Covid-19 community levels. For those areas, there is no recommendation for indoor masking unless you are at potential “increased risk” for Covid-19 and if so, the CDC recommends to talk to your health care provider about wearing a mask.
“We’re in a better place today than we were six months ago, six weeks ago, six days ago,” US Health and Human Services Secretary Xavier Becerra said in a statement to CNN. “Now it’s time to focus on severity, not just cases, of COVID. Because of all the hard work that’s been done and the many tools we’ve developed to tackle COVID, we can ease the guidance on mask use — not everyone in every place needs to wear a mask.”
At all levels, the CDC recommends people get vaccinated and boosted, and get tested if they have symptoms.
In areas with “high” levels, the CDC also advises wearing a mask in public indoor settings, including schools. In areas with “medium” levels, the CDC advises talking with your doctor about wearing a mask if you’re at increased risk for Covid-19. In areas with “low” Covid-19 community levels, there is no recommendation for mask wearing.
The CDC notes that anyone who wants to wear a mask should continue to do so.
The updated CDC recommendations reflect “a new approach” for monitoring Covid-19 in communities, Dr. Gerald Harmon, president of the American Medical Association, said in a statement Friday.
“But even as some jurisdictions lift masking requirements, we must grapple with the fact that millions of people in the U.S. are immunocompromised, more susceptible to severe COVID outcomes, or still too young to be eligible for the vaccine. In light of those facts, I personally will continue to wear a mask in most indoor public settings, and I urge all Americans to consider doing the same, especially in places like pharmacies, grocery stores, on public transportation – locations all of us, regardless of vaccination status or risk factors, must visit regularly,” Harmon said.
“Although masks may no longer be required indoors in many parts of the U.S., we know that wearing a well-fitted mask is an effective way to protect ourselves and our communities, including the most vulnerable, from COVID-19—particularly in indoor settings when physical distancing is not possible.”
Counties with fewer than 200 new Covid-19 cases per 100,000 people in the past week are considered to have “low” Covid-19 community levels if they have fewer than 10 new Covid-19 hospital admissions per 100,000 or less than 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of staffed hospital beds occupied by Covid-19 patients on average in the past week.
Levels are “medium” if counties have 10 to nearly 20 new Covid-19 hospital admissions per 100,000 or between 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} and 14.9{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of staffed hospital beds occupied by Covid-19 patients on average in the past week.
Levels are considered “high” if counties have 20 or more new Covid-19 hospital admissions per 100,000 or at least 15{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of staffed hospital beds occupied by Covid-19 patients on average in the past week.
Counties with 200 or more new Covid-19 cases per 100,000 people in the past week are not considered to have “low” levels of Covid-19. They are considered “medium” if they have fewer than 10 new Covid-19 hospital admissions per 100,000 or less than 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of staffed hospital beds occupied by Covid-19 patients on average in the past week. They are considered “high” if they have if they have 10 or more new Covid-19 hospital admissions per 100,000 or at least 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of staffed hospital beds occupied by Covid-19 patients on average in the past week.
“This new framework moves beyond just looking at cases and test positivity, to evaluate factors that reflect the severity of disease – including hospitalizations and hospital capacity – and helps to determine whether the level of Covid-19 and severe disease are low, medium or high in a community,” CDC Director Dr. Rochelle Walensky told reporters during a telebriefing call Friday.
“The Covid-19 community level we are releasing today will inform CDC recommendations on prevention measures, like masking, and CDC recommendations for layered prevention measures will depend on the Covid-19 level in the community,” Walensky said. “This updated approach focuses on directing our prevention efforts towards protecting people at high risk for severe illness and preventing hospitals and health care systems from being overwhelmed.”
The update to CDC guidance comes at a time when daily Covid-19 cases in the United States have fallen to a tenth of what they were at their peak last month, according to data from Johns Hopkins University. The 90{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} drop – from an average of more than 802,000 cases per day on January 15 to less than 75,000 currently – happened over the course of about six weeks.
In recent weeks, some states seem to have already made this shift in focus from community transmission to hospitalizations. Many states have made plans to lift indoor or school mask mandates based on their own metrics: declining hospitalization rates and having a larger share of fully vaccinated residents than the national average.
The CDC’s updated Covid-19 community metrics signal an important moment in the pandemic, Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials, told CNN on Friday.
“I think that this is one of the long-awaited moments of the pandemic to hear of such a significant shift in how we view the data to identify the proper mitigation strategies,” Freeman said.
“An important moment during the pandemic in the sense that we’re able to now pivot to more of these community burden metrics that allow us to look at these mitigation strategies differently than we have perhaps before,” Freeman said, adding that, looking ahead, “I think we have to really watch the hospitalization data and identify ways to improve collection of data that allows us to account for individuals who come into the hospital with Covid versus for Covid.”
Share on PinterestMental health risk increases even after mild COVID-19. Jonathan Knowles/Getty Images
A study tracking COVID-19 survivors found them more likely to develop mental health issues than other people over the year following diagnosis.
The researchers saw an increased risk even for those whose COVID-19 was mild enough that they did not require hospitalization.
Conditions the researchers investigated included anxiety, depression, opioid use, and cognitive decline.
Researchers continue to investigate the long-term health effects of COVID-19, or “long COVID.”
Using databases from the United States Department of Veterans Affairs (VA), a new study catalogs a range of mental health issues in the 12 months following a SARS-CoV-2 infection.
The study finds that people who have survived COVID-19 are at increased risk of mental health issues in the first year after the illness.
The study’s senior investigator is Dr. Ziyad Al-Aly, chief of research and development service at the VA Saint Louis Health Care System and a clinical epidemiologist and assistant professor at Washington University in St. Louis. In an opinion piece published alongside the research, he says:
“The body of evidence on long COVID — from our work and others — suggests the need to reframe our thinking about SARS-CoV-2. It is not only a respiratory virus; it is a systemic virus that may provoke damage and clinical consequences in nearly every organ system — including mental health disorders and neurocognitive decline.”
Psychiatrist Dr. Maura Boldrini of Columbia University Irving Medical Center in New York City is the lead author of the article “How COVID-19 Affects the Brain.” She commented on the new study for Medical News Today:
“This is a large study that sheds light on the prevalence of symptoms that reflect brain involvement in post-COVID patients. These symptoms can be classified by the [Diagnostic and Statistical Manual of Mental Disorders] into psychiatric categories, but their pathogenesis is unknown.”
Dr. Noortje Uphoff is a research fellow at the University of York in the United Kingdom and the lead author of a related review published in August 2021.
“The strengths of the study,” Dr. Uphoff told MNT, “are that many patients are included, COVID-19 patients are compared to people without evidence of the infection, and data were collected for a year. Whereas many studies measure mental health outcomes such as self-reported symptoms, in this study, medical records of diagnoses and prescriptions were used.”
The new study appears in the BMJ. Neither Dr. Boldrini nor Dr. Uphoff was involved in the new study.
The researchers analyzed health data from 153,848 veterans who had survived 30 days or more after receiving a positive PCR test result between March 1, 2020, and January 15, 2021. The research team followed their health until November 30, 2021.
The researchers also collected data from two control groups: 5,637,840 veterans who had not contracted SARS-CoV-2 during the same period, and 5,859,251 individuals who used the Veterans Health Administration during a period before the pandemic.
Dr. Uphoff cautioned MNT:
“As the study authors point out, their study sample was not representative of populations across the world. These were retired veterans, mostly white men, who had access to healthcare.”
The authors of the study calculated the post-COVID-19 incidence of developing various mental health issues by comparing outcomes for COVID-19 survivors with those of the control groups.
The overall risk of developing any mental health issue increased to 64.38 additional cases per 1,000 people after 1 year.
The researchers reported the following increased risk of incident mental health cases per 1,000 people in the year following COVID-19:
anxiety disorders: 11.06 additional cases
depressive disorders: 15.12 additional cases
stress and adjustment disorders: 13.29 additional cases
use of antidepressants: 21.59 additional cases
use of benzodiazepines: 10.46 additional cases
opioid prescriptions: 35.90 additional cases
opioid use disorders: 0.96 additional cases
other (non-opioid) substance use disorders: 4.34 additional cases
neurocognitive decline: 10.75 additional cases
sleep disorders: 23.80 additional cases.
While risks were higher for those hospitalized for COVID-19, the study also found that “risks were evident even among those who were not admitted to hospital during the acute phase of COVID-19.”
“The symptoms are most likely due to brain inflammation,” said Dr. Boldrini.
“We know brain inflammation is present in major depressive disorder and dementias,” she continued, “and brain symptoms are found in other inflammatory diseases like [systemic lupus erythematosus]. Even in people with mild COVID-19, there can be a protracted inflammatory response that disrupts brain vasculature and neurotransmitters synthesis, including serotonin.”
Dr. Uphoff suggested stress as an additional potential factor, saying, “It is easy to imagine why infection with [SARS-CoV-2] could cause distress.”
Dr. Uphoff added: “Not only do many patients experience symptoms of illness, ranging from inconvenient to severe, but self-isolation at home causes disruption to people’s lives. On top of this, worries about passing on the infection to loved ones and about the potential severity of the illness are likely to affect well-being at least in the short term.”
“As physicians,” said Dr. Boldrini, “we need to understand better the mechanisms of vascular strokes and protracted inflammation and their damage in the brain so that we can repair it.”
Dr. Boldrini concluded with a plea for help:
“As patients, I would encourage people to volunteer for research studies — clinical and brain imaging ones — and in the event of death, it is crucial that families donate the brain to research so we can study it. Medicine has made the most progress [studying] human organs after death. That’s what we do in my lab. We need brains to be donated so we can understand mechanisms of brain disorders and find new treatments.”
Share on PinterestNew exploration explores a novel COVID-19 treatment method mix involving antibiotics. nevodka/Getty Photographs
A smaller research suggests that treating clients who have moderate or significant COVID-19 with ceftazidime or cefepime, in addition the steroid dexamethasone, is as successful as regular treatment.
The antibiotic-in addition-steroid procedure was linked with fewer facet outcomes as opposed with typical treatment, which can include 7 or much more distinctive medicines.
Lab tests and computer system simulations discovered that equally antibiotics inhibit a critical enzyme employed by SARS-CoV-2, the virus that results in COVID-19.
Even so, there is now no evidence from clinical trials that antibiotics are successful from the virus, and specialists alert that overuse promotes antibiotic resistance.
Healthcare industry experts are normally keen to worry that antibiotics are ineffective against viral infections, with some uncommon exceptions.
Antibiotics have saved the lives of thousands and thousands of people because they came into common use early in the 20th century, but overuse accelerates the evolution of bacterial resistance to the drugs.
In accordance to the Facilities for Disease Control and Prevention (CDC), there are more than 2.8 million situations of antibiotic-resistant an infection and 35,000 resulting deaths per year in the United States by yourself.
For that reason, there are serious concerns that overprescribing antibiotics to sufferers with COVID-19 — in the absence of any proof of a bacterial coinfection — encourages the unfold of antibiotic resistance.
In the United Kingdom, the National Institute for Wellness and Treatment Excellence reports that less than 8{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of people today hospitalized with COVID-19 also have a bacterial an infection.
But 1 research in the U.K. observed that all over 85{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of COVID-19 individuals obtain therapy with an antibiotic through their healthcare facility keep.
All through the pandemic, there experienced been early hopes that the antibiotic azithromycin may possibly be an effective cure for COVID-19. On the other hand, a new Cochrane assessment of scientific trials found no proof for this.
So the findings of a small review that indicates possibly of two antibiotics, in mixture with the steroid dexamethasone, may perhaps be an helpful remedy for the condition are controversial.
The examine associated 370 patients with moderate or significant COVID-19 who were admitted to Beni-Suef University Clinic in Beni Suef, Egypt.
Researchers randomly assigned the clients to 3 groups:
procedure with cefepime additionally dexamethasone: 124 people
procedure with ceftazidime as well as dexamethasone: 136 people
common COVID-19 treatment method, as suggested in Environment Health Group (WHO) suggestions and the Egyptian management protocol, with 7 or much more medication: 110 people
The signify recovery time for people acquiring therapy with cefepime or ceftazidime was 12 times and 13 times, respectively, whilst the signify recovery time with normal remedy was 19 days.
The scientists emphasize that the study was not a medical trial and that there were being insufficient numbers of sufferers in every team to draw organization conclusions.
Nevertheless, they also conducted lab exams and laptop or computer simulations, which recommended that these two antibiotics inhibit the exercise of a protease enzyme termed Mprofessional. Mprofessional is an critical component of a virus’s daily life cycle — a lessened action of the enzyme impairs the replication amount of the virus.
Cefepime and ceftazidime are wide-spectrum, beta-lactam antibiotics in the class identified as cephalosporins. Equally are on the WHO’s Knowledgeable watchlist, indicating there is a high probable for micro organism to develop resistance to them.
Nonetheless, in their paper, the scientists argue that applying existing antibiotics with confirmed antiviral possible from COVID-19 could in fact hold off the emergence of antibiotic resistance.
Ahmed M. Sayed, Ph.D., a pharmacist at Nahda University in Beni Suef and 1 of the authors, told Healthcare News These days that making use of antibiotics that have both antiviral and antibacterial outcomes could stay clear of resistance to other antibiotics.
“Usually, higher respiratory tract viral bacterial infections are related with secondary bacterial bacterial infections that require antibiotics coverage,” stated Dr. Sayed.
“Accordingly, if we use only a specific established of wide-spectrum antibiotics — that have more antiviral possible like the two studied antibiotics in our post — in these types of sorts of bacterial infections, we will preserve, to some extent, other necessary antibiotics from the swift development of bacterial resistance, and speed up the patient’s recovery fee,” he described.
He argued that working with the full arsenal of antibiotics from bacterial coinfections will make these other medicines extra ineffective.
In contrast, medicines, such as cefepime and ceftazidime, which may have a number of therapeutic advantages, could lower the amount of other vital treatments and their associated side effects.
The authors accept that their study only concerned a single healthcare facility and was much too small to attract agency conclusions.
“Of course, the study needs a significantly greater quantity of patients to get extra strong results,” mentioned Dr. Sayed.
He claimed they are organizing a multisite clinical demo of these antibiotics that will contain a more substantial quantity of patients and be far more very likely to supply statistically major findings.
In their paper, the scientists also notice that their laptop or computer simulations and lab results could deliver beneficial prospects for developing a lot more powerful antiviral medicines that concentrate on the Mprofessional enzyme of SARS-CoV-2.
For dwell updates on the hottest developments about the novel coronavirus and COVID-19, click below.
Share on PinterestNew research explores the long-term effects of COVID-19 in older adults. Ungureanu Vadim/EyeEm/Getty Images
Initially, scientists considered COVID-19 a respiratory condition, but they are slowly building up a clearer picture of the wide-ranging impacts of the disease.
Researchers have now shown that COVID-19 can affect many systems in the human body.
A recent study investigated the longer-term effects of COVID-19 in older adults.
It found that around one-third of older adults with COVID-19 went on to develop new conditions, compared with roughly one-fifth of older adults who did not have COVID-19.
In its acute phase, COVID-19 mainly involves the respiratory tract. However, researchers have shown that the disease can affect multiple organs in a person’s body.
In addition, there is a growing recognition of long COVID among researchers and clinicians. Long COVID manifests as persistent symptoms in people who have recovered from the acute phase of a SARS-CoV-2 infection.
In the present study, the researchers wanted to better understand the likelihood of older adults developing health conditions following a SARS-CoV-2 infection, which experts generally refer to as sequelae.
The study, which appears in the BMJ, lays the groundwork for further research to understand the long-term effects of COVID-19 on people’s health.
Medical News Today spoke with Dr. Ken Cohen, executive director of translational research at Optum Labs and the corresponding author of the study.
“With over 400 million cases of COVID-19 worldwide, even a modest risk of long-term sequelae will have a major impact on patients and our healthcare systems. Understanding the magnitude of this impact and the specific organ systems that can be affected by the post-acute sequelae of COVID-19 is critically important information.”
To do this, Dr. Cohen and his colleagues looked at the health insurance records of 133,366 older adults in the United States. The participants were 65 years old or older and received a COVID-19 diagnosis before April 1, 2020.
The researchers matched these participants to three other comparison groups: two groups that did not have COVID-19 in 2020 and 2019, and a third group that did not have COVID-19 but had a lower respiratory tract infection.
The researchers then identified new conditions occurring 3 weeks or more after each participant’s COVID-19 diagnosis.
The study authors found that 32{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the participants who had a SARS-CoV-2 infection in 2020 sought medical attention for a new or persistent condition. This was 11{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} higher than the comparison group from 2020.
Compared with the 2020 comparison group, the new or persistent conditions that showed the greatest risk were respiratory failure, fatigue, high blood pressure, memory issues, kidney injury, mental health-related diagnoses, hypercoagulability — which occurs when the blood clots more easily — and cardiac rhythm disorders. The researchers note similar findings for the 2019 comparison group.
When the authors compared the COVID-19 group with the lower respiratory tract infection group, risk increases only occurred for respiratory failure, dementia, and post-viral fatigue.
“Our lower respiratory infection group included exacerbations of chronic obstructive pulmonary disease and likely included some undiagnosed bacterial pneumonias, and therefore, many of these patients were likely quite ill,” said Dr. Cohen.
“The differences in sequelae between this group and the SARS-CoV-2 group were therefore much less pronounced. We saw a higher risk of respiratory failure, dementia, and post-viral fatigue in the COVID-19 group, compared to the lower respiratory tract infection group, but the other sequelae did not occur with a higher frequency in the COVID-19 group.”
Dr. Irene M. Estores, director of the Integrative Medicine Program at the University of Florida Health, said the findings confirm previous work in this area. Dr. Estores was not involved in the study.
“The data builds nicely on Veterans Affairs data on post-acute sequelae of COVID-19, with the inclusion of a cohort of patients who were admitted to a hospital compared to those who were not, and using a comparison group of patients with other viral lower respiratory tract infection.”
“Notwithstanding the limitations acknowledged by the authors, validation of our observations as clinicians allows us to continue to advocate for measures to protect this population,” said Dr. Estores.
MNT spoke with Dr. Alicia Arbaje, director of Transitional Care Research at Johns Hopkins Medicine and a clinician at the Johns Hopkins Bayview Medical Center in Baltimore. Dr. Arbaje was also not involved in the study.
“I think this work is significant. First, because it focuses on older adults, and this is the population that’s most likely to demonstrate long-term effects from this infection, and so I think it’s important and timely given the phase of the pandemic that we’re in.”
“A year ago, 2 years ago, we were asking, ‘How do we treat this illness? What do we do?’ Those are still questions, but now, we’re asking how we help people recover, how we help them long-term, how we deal with the disability that occurs afterward — and how we restructure our healthcare system to deal with a large number of people coming with all these sequelae that this study is starting to highlight.”
– Dr. Alicia Arbaje
“So I think this study is important, because it can help for planning purposes to help us see longer-term what we may need. This is not a simple pneumonia or an illness that comes and goes. It’s something that we’re starting to learn has longer-term effects beyond the respiratory component.”
Dr. Arbaje said that the study would help doctors pay attention to a patient’s perspective and the “disease journey” they are on.
“This study showed that many of the sequelae were respiratory complications, but there were cardiovascular, hypercoagulable, clotting disorders, and fatigue as well. So I think the study is important, because it helps us begin to think of COVID-19 as having a broader effect than maybe one might have thought of before.”
“[Another] reason this is significant is that it honors the patient’s disease or illness journey. In research, we often limit our studies to one disease and what happens with that one disease. But with older adults, it’s so important to look at the entire picture from the person’s perspective, the person’s journey.”
“A person may be experiencing diabetes and hypertension and stroke and COVID-19 — not just COVID-19 alone. So I think this study begins to shift the frame of how we look at illnesses in older people,” said Dr. Arbaje.
Dr. Arbaje also highlighted some of the limitations of the study.
“There are a couple of caveats in looking at this study. We can’t look at causation, which is fine for this kind of study because they are open about it, and I think this study is meant to lead to other studies.”
“The other caveat that I would say is that this was looking at a Medicare Advantage population, which is not the majority of older adults in this country. Most older adults are under traditional Medicare, which would be more representative if the study had focused in that space. That doesn’t diminish the importance of the study, but I think it needs to be interpreted among this population,” said Dr. Arbaje.
Although the research could not demonstrate causation, Dr. Cohen suggested that the findings may be the result of two different syndromes.
“Broadly, I think about post-acute sequelae of COVID-19 as two syndromes, although there is overlap,” he explained. “The first is seen in seriously ill patients typically in the intensive care unit and often on respiratory support. These patients have a systemic inflammatory response that is quite severe, and many of the post-acute sequelae are a consequence of the organ damage that occurs from this process.”
“The other broad category is those with milder infection not requiring hospitalization, and here, we have fewer answers. We do know, for example, that SARS-CoV-2 can affect the olfactory nerve, causing anosmia [inability to smell], and that the clotting system can be activated, increasing the risk of thrombosis,” Dr. Cohen continued.
“But in other areas, such as sleep and mood alterations, cognitive difficulties, and ongoing fatigue and myalgias, to date, we don’t have the answers.”
Dr. Estores said the findings may be due to the limited knowledge doctors currently have of how to care for patients following the acute phase of COVID-19.
“The authors already mention the effect of increased medical attention that can subsequently increase the reported rates of this condition. However, it is also possible this increased risk of sequelae could be attributed to a lack of information on how to best enhance [COVID-19] recovery in the post-acute phase. For instance, how safely can we start rehabilitation interventions? How much or how little should be done?” asked Dr. Estores.
Dr. Arbaje speculated that the increase in sequelae in the COVID-19 group could be due to the significant effect of a SARS-CoV-2 infection on a person’s immune system, as well as the way COVID-19 can damage many parts of a person’s body.
“In terms of causation, or at least speculating around what might account for it, I think — and again, this is speculation — that there may be two things to keep in mind. What I’m thinking about as a geriatrician is that COVID-19 may be accelerating aging in some way.”
“Maybe someone was going to have a stroke or a heart attack 10 years from now, but COVID-19 — because it’s such a heavy hit to the immune system, it’s a huge stressor to the body — may accelerate what was already coming down the pike,” said Dr. Arbaje.
“Again, this is a theory — because if we think about what protects us from heart attacks, strokes, and cancer and other things, it’s our immune system. It’s protecting against inflammation. And when the immune system receives such a hit, I think it may have less ability, defenses, or physiological reserve to do its other duties, like monitoring for cancer cells, monitoring for the things it normally does.”
“So COVID-19 may accelerate what was already coming if we have tendencies that were coming our way, or it may create new injuries that the body then has to deal with. So we were learning that COVID-19 can lead to problems with coagulation, and it may be that it creates a new, thickened blood that can then lead to cardiovascular disease or other things.”
“So I think it could be one of two things or maybe both: accelerating what was already coming, because the immune system is no longer able to tend to those [issues], because it’s so focused on dealing with COVID-19, or it may create new injuries that then need to be dealt with — again, by an immune system that may already be overburdened.”
– Dr. Alicia Arbaje
Dr. Arbaje said that there are many ways that the healthcare system and broader social and political changes could support people in a post-acute phase of COVID-19.
“The bottom line that we can take from this work is that COVID-19 is leading to new [diseases] or is accelerating other illnesses, which means that we need to be ready as a healthcare system. We weren’t ready as a healthcare system to deal with COVID-19, so now, we need to be ready to deal with the consequences [of COVID-19].”
“[This could include] public health infrastructure, disability, rehabilitation, considering what policies might be put into place to support people who have this illness, or the caregivers who are now needing to take off work or maybe quit to care for people with long-term disability,” suggested Dr. Arbaje.
Dr. Arbaje said one way to develop the research is by ensuring the findings are more generalizable.
“I think replicating this work or broadening the scope of the inclusion criteria could be a nice next step — so let’s look at the general Medicare population, or other older adult populations in other countries to see if that’s something similar.”
Dr. Arbaje mentioned that the study uses claims data, something the authors point out as well. An improvement might be to ask patients about their symptoms rather than basing the study on billing and administrative data.
She also said that future research could look at any possible effect the COVID-19 vaccines have on a person’s likelihood of developing sequelae:
“I think that the vaccines are another potential confounder or effect modifier […] Because I think — and this is not a political statement, it is just an observational statement — that just as COVID-19 is a stressor, the vaccines, because they are so effective at generating an immune response, are also stressors.”
“On some level,” said Dr. Arbaje, “they may act as COVID-19 — not in causing illness per se but in being a stressor. And if we’re going to invoke that theory, then we should also study whether there are any sequelae — do people have exacerbations of their underlying illness shortly after vaccination?”
“So I think keeping an open mind on everything related to COVID-19, including vaccines, I think that needs to be studied. That matches with my own clinical practice — I practice in a hospital setting, and I have noticed both patients coming in with exacerbations of their underlying disease after COVID-19, but also after vaccination. And it’s hard to figure out what that is.”
“This is not to say that people shouldn’t get vaccinated — I just think that we’re still early in this process and that it’s important to look at the long-term effects of anything that we’re doing in medicine,” said Dr. Arbaje.
Dr. Estores said extending the study’s observation time could also be a way to develop the research.
“The group looked at symptoms to 120 days. I see patients who still have sequela past 120 days, who want to know if their symptoms can still improve. The research can be expanded to include a longer time frame, such as 6 months, to help me answer this question.”
Dr. Cohen said he and his colleagues have plans to continue the research.
“We have already published a similar analysis in a cohort of 18–64-year-olds, and we are completing work on a pediatric population. Based upon ours and similar studies that have been published, the picture of [long COVID] is becoming more clear.”
New vaccines for COVID-19 are emerging. One such vaccine is Novavax. Early studies indicate that it may have similar efficacy to the Pfizer and Moderna vaccines but fewer side effects. Further trials and analyses of the initial results are underway to understand its effects better.
Share on PinterestWhat side effects can the Novavax vaccine cause? Image credit: Mariano Vimos/Vizzor Image/Getty Images.
Medical News Today has contacted over 20 experts for comment on the potential side effects of the Novavax COVID-19 vaccine, Nuvaxovid. As of the time of publication, they have declined to comment until additional peer-reviewed data become available.
On January 31, 2022, Novavax submitted a request to the Food and Drug Administration (FDA) for emergency use authorization for its COVID-19 vaccine candidate.
Over 30 countries, including the United Kingdom, Australia, and Germany, have already approved this vaccine for emergency use.
Unlike mRNA vaccines, such as Pfizer and Moderna, the Novavax vaccine uses a longer-standing protein-based technology. The flu vaccine and the hepatitis B vaccine, which doctors have administered throughout the U.S. since 1986, use this technology.
The proteins inside the Novavax vaccine mimic COVID-19’s spike protein. They were created in moth cells and then assembled into nanoparticles – small particles made of a few hundred atoms. While they share COVID-19’s molecular structure, they do not replicate or cause COVID-19.
The vaccination involves injecting the nanoparticles into arm muscles alongside a compound extracted from the soapbark tree, which acts as an adjuvant to attract immune cells to the injection site.
A full course of the vaccine requires two doses taken 3 weeks apart.
The results from two large phase 3 trials on Novavax have been published.
One trial in the United States and Mexico included 29,949 participants ages 18 and over who had not previously contracted SARS-CoV-2. On a ratio of 2:1, they received two doses of either the Novavax vaccine or a placebo.
Overall, the researchers found that the Novavax vaccine was 92.6{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} effective against the Alpha and Beta variants of the virus. They also tracked side effects for 7 days after each dose.
While side effects occurred after the first dose, they were more common after the second dose. Common side effects included:
tenderness at the injection site for 73{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of participants
pain upon and after vaccination for 60{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of participants
fatigue for 50{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the participants
muscle pain for 48{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of participants
headache for 44{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of participants
malaise for 39{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of participants
Less common side effects after the second dose included:
fever for 6{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of participants, including severe cases for 0.37{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}
nausea and vomiting for 11{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of participants, including severe cases for 0.23{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}
joint pain for 22{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of participants, including severe cases for 2.44{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}
A smaller trial including 15,187 participants in the UK found similar results.
Data so far suggest, that on the whole, the Novavax vaccine may have fewer side effects than both the Pfizer and Moderna vaccines.
16{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} fever, including 1.4{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} severe cases
those living with conditions that increase the risk of severe COVID-19, such as cardiovascular disease, respiratory disease, and diabetes
people who have contracted COVID-19 in the past
people who are breastfeeding and those who are not
The WHO the following not to get the vaccine:
people with a history of anaphylaxis to any component inside the vaccine
people with symptomatic PCR-confirmed COVID-19 until they have recovered and finished self-isolation
people with a body temperature of over 38.5°C until they no longer have a fever
people under 18 years old, as research studying its safety and efficacy is still underway.
The WHO also highlights that data on having the vaccine during pregnancy is not yet available. However, as other protein-based vaccines have comparable efficacy in pregnant and non-pregnant people, they say that the Novavax vaccine may be the same.
Therefore, they recommend that pregnant people receive information about the risks of COVID-19 during pregnancy, the potential benefits of vaccination, and safety data limitations so that they can make their own decision. However, they recommend pregnant people get vaccinated in situations where the benefits outweigh the risks.
Any side effects from the vaccine were largely mild to moderate and transient. The phase 3 trial in the U.S. and Mexico, and the U.K did not raise any safety concerns.
According to Prof. Paul Heath, professor of paediatric infectious diseases and director of the Vaccine Institute, St George’s, University of London and St George’s Hospital, London, and chief investigator of the Novavax United Kingdom trial:
“The results are very reassuring and importantly show that this vaccine appears to be safe and effective in populations from a range of communities and demographic groups, and those with a range of underlying comorbidities, now (across both trials) with a total number of participants of more than 45,000.”
“Both the U.K. and the US. and Mexico trials used the same case definitions, and these consistent results, therefore, provide much confidence in the use of this vaccine for the global population. We now await the peer-reviewed publication. We also look forward to the results of the trial’s adolescent arm (12–17 years), which recently completed enrolment,” Prof Heath adds.
According to Dr. Peter English, a retired consultant in communicable disease control, former editor of Vaccines in Practice, and immediate past chair of the BMA Public Health Medicine Committee:
“[t]he vaccine is a much more traditional sort of vaccine than the mRNA and vector vaccines currently in use. The actual spike protein is injected, in the form of nanoparticles, instead of inserting the genetic material enabling our cells to create the spike protein.”
He adds that:
“It remains to be seen whether this will have consequences in terms of real-world effectiveness or safety; but the more different types of vaccine we have, the greater our ability will be to optimize effectiveness and safety in different groups.”
For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.
