Tag: covid

Categories : COVID HospitalsTags :

Bleeding from Full-dose Anticoagulants in COVID ICU Patients

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COVID patients in intensive care units (ICU) receiving full-dose anticoagulants are significantly more likely to experience heavy bleeding than patients prescribed a smaller yet equally effective dose, according to a recent study.

The research, which compared the safety and effectiveness of blood clot treatment strategies for more than 150 critically ill COVID patients at two hospitals, found that almost all patients who experienced significant bleeding were on mechanically ventilation and receiving full-dose anticoagulants.

The results, published last month in Hospital Pharmacy, may inform treatment guidelines for blood clots in hospitalised COVID patients, who are at an increased risk for both blood clots and severe bleeding. Previous reports have found that 17% of hospitalised COVID patients experience blood clots, said first author Maya Chilbert, PharmD, clinical assistant professor in the UB School of Pharmacy and Pharmaceutical Sciences.

“A wide variety of practice exists when it comes to approaching blood clots in hospitalized patients with COVID, and there is little data to suggest improved outcomes using one strategy versus another,” said Chilbert. “Caution should be used in mechanically ventilated patients with COVID when selecting a regimen to treat blood clots, and the decision to use full-dose blood thinners should be based on a compelling indication rather than lab markers alone.”

The study analysed the outcome of blood clot treatments and the rate of bleeding events for more than 150 patients with COVID-19 who received either of two blood thinner regimens: a full-dose based on patient levels of D-dimer, and the other a smaller but higher-than-standard dosage.

Patients’ average age was 58, and all experienced elevated levels of D-dimer, fibrinogen, and prothrombin time.

Significant bleeding events were experienced by almost 14% of patients receiving full-dose anticoagulants, compared to only 3% of patients who received a higher-than-standard dosage. All patients who experienced bleeding events were on mechanical ventilation. No difference was reported in the regimens’ effectiveness at treating blood clots.
Further investigation is needed to determine the optimal strategy for treating blood clots and bleeding in hospitalised COVID patients, said Asst Prof Chilbert.

Source: University at Buffalo

Categories : HospitalsTags :

Operating Room Availability Planning Helped Cushion Staff Shortages

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Decreasing operating room (OR) availability by 15% helped a hospital address a 30% staff shortage caused by the COVID pandemic, while surgeons were largely satisfied with the arrangements, according to a study by UPMC Presbyterian Hospital.

“The Great Resignation has disproportionately impacted health care to near-crisis levels and we were able to address ongoing staff shortages by methodically decreasing available surgical times,” said Dr Kimberly Cantees, clinical director of anaesthesiology and perioperative services at UPMC Presbyterian Hospital. “By using a phased approach, including daily meetings to address scheduling issues, we were able to prioritise essential surgeries and care for patients with the greatest need.”

UPMC is a comprehensive quaternary care regional and national referral centre for many surgical specialties. The hospital implemented a five-phased approach for the study, which started in May 2021, to ensure that it could maintain provision of essential surgical care when its surgical technologist and OR nurse vacancy rate reached 30%. The phases went as follows:

  • Phase I (May 2021): Restricted OR availability for surgeries that were less time- sensitive and moved some to other hospitals and surgery centers in the UPMC system; decreased OR availability for surgeons with highly elective cases (eg, sports orthopedic procedures, select hand surgery cases, some plastic surgery) and moved a small amount of surgical work to the bedside in the intensive care unit.
  • Phase II (July 2021): Formed a multidisciplinary surgical services capacity committee that met daily to ensure the staffing matched the surgical schedule for the subsequent two weeks. Values for surgical care were identified and cases such as transplant and cancer surgeries were prioritised.
  • Phase III (Oct. 2021): Reduced OR time availability by 15% when surgeries could be scheduled and extended the deadline for standard scheduling guidelines from three days to five days before surgery.
  • Phase IV (Nov. 2021): Instituted additional reduction of OR scheduling to meet continued staff shortages and reduced available OR time for all surgical services by an additional 10%. Surgeons with two ORs had their time reduced for all services, except for the care of trauma patients.
  • Phase V (Jan. 2022): Implemented UPMC system-wide review of surgical case prioritisation and opened more ORs for booking, which allowed greater flexibility for performing surgeries depending on staffing availability.

Over the course of the phased approach, the available ORs were decreased from 36 to 31 (15%). This has been adequate to address the 30% reduction in surgical services staff, Dr Cantees explained. The approach also helped the hospital to cope with staffing shortages during the Omicron surge.

Dr Cantees said there was minimal pushback from surgeons to the phased approach, mostly thanks to clear communication of both the staffing hurdles, as well as established surgical priorities. Communication occurs between members of the multidisciplinary surgical services capacity committee and individual surgeons.

The study was presented at the American Society of Anesthesiologists’ ADVANCE 2022, the Anesthesiology Business Event.

Source: EurekAlert!

Categories : Medical Research & TechnologyTags :

Why Public ‘Big Data’ Initiatives Failed to Deliver on COVID

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Experts from a data-driven initiative to aid the COVID response have outlined major obstacles to making successful use of new data released by technology companies in times of crisis. Harvard University’s Caroline Buckee and colleagues presented these views in the open-access journal PLOS Digital Health.

Technology companies collect vast amounts of data on their users, including their geographic locations. During the COVID pandemic, many companies made some of their user data available in order to aid public health efforts, such as monitoring the impact of social distancing policies or travel restrictions. However, Buckee and colleagues note, many efforts to harness these “data for good” failed to make a significant impact.

The authors are part of Crisis Ready, in which epidemiologists help policy makers understand and use insights from human mobility data released by technology companies. In this capacity, they have now identified challenges that hinder other efforts to use novel forms of data as part of disaster response.

Firstly, data-sharing agreements between researchers and technology companies were hastily arranged during the pandemic. They recommend pre-established agreements that will be ready for implementation in future crises.

Buckee and colleagues also observed that a lack of standardisation, interoperability, and clarity on uncertainties or biases in novel datasets resulted in the need for highly specialised professionals to process this data. To address this challenge, data access and characteristics can be negotiated prior to a disaster.

The authors also call for global investment in training more professionals that can analyse complex data to provide information in a disaster. In addition, they strongly emphasise the need for local response agencies to collaborate closely with regional scientists.

Without such efforts, no amount of data donated by technology companies will be useful in a crisis.

“It is still very difficult to translate the vast amounts of digital data that are owned by companies into useful public health tools, despite their incredible potential for transforming decision-making during health emergencies,” said Buckee. “We need to build a global cohort of data scientists and epidemiologists who can support local governments, and put in place the data pipelines and analysis tools before disasters hit, so that local responders have context-specific information when they need it most.”

Source: News-Medical.Net

Categories : COVIDTags :

Over 50s Have Greater Risk of Reduced Mobility after COVID

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Adults over 50 with mild or moderate COVID have increased risk of worsening mobility and physical function, even if hospitalisation is not required to treat the virus, new research has found.

The study, published in JAMA Network Open, highlights the burden of COVID among middle-aged and older adults who are not hospitalised, and suggests that even those who experienced even mild COVID have lasting, troublesome symptoms.

Researchers surveyed more than 24 000 people over the age of 50 from across Canada during the initial phase of the lockdown in 2020 to determine the effect of a COVID diagnosis on their mobility. 

The team looked at mobility issues including difficulty getting up from sitting in a chair, ability to walk up and down stairs without assistance and walking two to three neighbourhood blocks, as well as changes in participants’ ability to move around the home, engage in housework and physical activity.

“We found that even those with mild and moderate illness due to COVID experienced adverse changes in mobility and physical function compared to individuals without COVID,” said co-author Professor Susan Kirkland.

“These findings are worth noting because they indicate that the negative effects of COVID are much broader and impact a wider range of older adults than those who are hospitalised for COVID.”

Participants with COVID had nearly double the odds of worsening mobility and physical function, although most had mild or moderate symptoms. Of the 2748 individuals with confirmed, probable or suspected COVID, 94% were not hospitalised.

Individuals with confirmed or probable COVID had double the odds of worsening ability to engage in household activities and participate in physical activity than those without COVID. Similar results were found for those with suspected COVID.

“Our results showed there was a higher risk for mobility problems in people who were older, had lower income, those with three or more chronic conditions, low physical activity and poorer nutrition,” said co-author, assistant professor Marla Beauchamp.

“However, those factors alone did not account for the mobility problems we observed among people with COVID. Rehabilitation strategies need to be developed for adults who avoid hospitalisation due to COVID but still need support to restore their mobility and physical function.”

The researchers concluded that there is a need to further understand the long-term impacts of COVID and consider “the development and implementation of effective intervention and management approaches to address any persistent deficits in mobility and functioning among those living in the community.”

Source: Dalhousie University

Categories : COVIDTags :

Fourth Wave Ending as COVID Becomes Endemic

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Speaking to  the media on Friday, Dr Joe Phaahla said that vaccinations had “uncontestably” lowered the rate of hospitalisations as seen by reduced hospital admissions in the fourth wave. saying that there has been a decoupling between new infections and hospital admissions and deaths. An article awaiting peer review on the medRxiv preprint server shows evidence of this in Cape Town.

Vaccinations were still lower than expected, despite a renewed vaccination drive from 17 December, a situation he attributed to people focussing on their festivities. As of Thursday, 45.5% of all SA adults had received at least one dose, with just under 40% being fully vaccinated. However, only 31.6% of 18–34 year olds have been vaccinated. About one million doses have been administered to the newly opened 12–17 year age group.

In an interview with eNCA, Dr Phaahla said that he concurs with experts that COVID is heading towards becoming an endemic disease, emphasising that South Africa is prepared for this. A new dashboard is to be unveiled which will show the number of vaccinated and unvaccinated in hospitals.

Dr Phaahla has also said that the issue of mandatory vaccinations is currently being deliberated by the government and that an announcement will be made in due course. In the US, the Supreme Court blocked President Biden’s vaccine mandate for large companies, which is seen as a significant blow to his administration’s COVID response plan.

The NICD’s Dr Michelle Groome said that almost 99% of all COVID cases sequenced are caused by Omicron. Gauteng, has exited the fourth wave with a low rate of new cases (1.4 cases per 100 000) and slight (2.2%) increase, likely attributable to increased testing. All other provinces had observed a decrease in weekly incidence of new cases, save Northern Cape (21.9 per 100 000, 18.3% increase). A 14.3% positivity rate was seen as of 13 January, down from highs above 35% in mid-December.

Test positivity rate had fallen from 25–30% in the last week of 2022 to 14% on Thursday.

Categories : Cancer COVIDTags :

Many Young People with Cancer Experiencing Distress in the Pandemic

On By ModernMedia
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A new study has reported that many adolescents and young adults with cancer are suffering high psychological distress during the COVID pandemic. During the pandemic, adolescents and young adults with cancer had an 85% higher odds of experiencing psychological distress compared with a similar group surveyed in 2018.

For the study, which was published in Psycho-Oncology, 805 individuals in Canada who were diagnosed with cancer between 15 and 39 years of age completed an online survey.  

More than two‐thirds of the group (68.0%) experienced high psychological distress. Additionally, those whose employment had been disrupted during the pandemic and those with blood cancer were more likely to experience high psychological distress, while those who were older and those with a personal income in 2020 that was less than $40 000 tended to have lower distress.  

The survey revealed overarching themes of pandemic experiences that included inferior quality of life, impairment of cancer care, COVID–related concerns, and extreme social isolation.  

“The pandemic has adversely impacted the mental health of adolescents and young adults with cancer,” said senior author Sapna Oberoi, MBBS, MD, DM, of the University of Manitoba. “The findings of this study underscore the importance of providing enhanced and tailored interventions to combat psychological distress among these patients. Cancer organisations and policymakers must prioritise mental health supports for adolescents and young adults with cancer to optimise their health outcomes and quality of life.”

Source: Wiley

Categories : COVIDTags :

Convalescent Plasma was Effective in Early Pandemic

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Convalescent plasma from COVID patients was likely of benefit to patients early on in the pandemic, before the introduction of remdesivir and corticosteroids as treatments, according to results of a landmark study published in JAMA Internal Medicine.

The randomised clinical trial, CONTAIN COVID-19, was established to evaluate the safety and efficacy of convalescent plasma in hospitalised coronavirus patients. Overall, the trial showed that convalescent plasma was safe and well tolerated. It worked best in the early days of the pandemic, when plasma had higher antibody levels, when it was given early in the disease, and particularly for immunosuppressed people.

“This landmark study shows once and for all that convalescent plasma is an important countermeasure early in a pandemic when no other therapies are available. It was an important finding that lays the foundation for the rapid response to future pandemics,” said Luis Ostrosky, MD, professor and director of the Division of Infectious Diseases at McGovern Medical School at UTHealth Houston. “This trial, the largest of its kind, also showed that with proper funding and structure, researchers across the country were able to come together quickly in the middle of a global crisis to explore this therapeutic intervention.”

Trial results also showed a drop in efficacy after the introduction of remdesivir and corticosteroids, and by the end of the 11-month trial, there was no difference in outcome between plasma and placebo in patients at 14 and 28 days. However, patients on corticosteroids, but not remdesivir, appeared to benefit from convalescent plasma at day 14.

Since the patient characteristics, available treatments, and the virus, all changed over time, subgroup analyses were done, which showed a possible benefit for patients in the first quarter of the trial, a period from April to June 2020.

Participants in that first quarter were older, less severely ill, had a longer duration of symptoms, and received high-titer plasma. Shorter symptom duration can indicate a more severe case of the viral infection.

“Convalescent plasma could be an important early treatment tool in places that don’t have access to monoclonal antibodies, corticosteroids, remdesivir, or other therapies,” said the study’s co-investigator, Professor Bela Patel, MD. “It should also be considered for patients who are immunosuppressed and those whose B cell function is compromised.”

The researchers also suggested that, in addition to the introduction of corticosteroids and remdesivir, the decrease in efficacy over time may have been due to using convalescent plasma that originated from New York City before the emergence of other SARS-Co-V-2 variants .

Source: University of Texas Health Science Center at Houston

Categories : COVIDTags :

Gauteng Peak Passes but WHO Warns not to Underestimate Omicron

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Wastewater monitoring has shown that COVID  infections are falling in Gauteng, indicating that the Omicron wave may have peaked, while the World Health Organization warns that the variant should not be taken lightly despite its mildness.

The findings align with comments by Health Minister Joe Phaahla on Friday that the Omicron-driven wave may be peaking in the province.

Despite Gauteng’s peaking, cases are on the rise in seven of the nine provinces and last week the country saw a new high in cases. Of the infections confirmed on Thursday, Gauteng accounted for 27%, down from 72% of new infections on December 3.

However, the surge of Omicron will likely not be confined to Gauteng. “Early indications are that we might have reached the peak in Gauteng,” Dr Phaahla said in an online media briefing. “But there is a corresponding, rapid increase of cases in the other big provinces.”

He also noted a 70% increase in hospitalisations, though he stressed that this was off of a low base rate. Meanwhile, the WHO has warned that countries should not take the Omicron variant likely in spite of its apparent low severity.

“Countries can – and must – prevent the spread of Omicron with the proven health and social measures.  Our focus must continue to be to protect the least protected and those at high risk,” said Dr Poonam Khetrapal Singh, Regional Director of the WHO South-East Asia Region.

Omicron should not be dismissed as mild, she cautioned, adding that even if it does cause less severe disease, the sheer number of cases could once again overwhelm health systems. Hence, health care capacity including ICU beds, oxygen availability, adequate health care staff and surge capacity need to be reviewed and strengthened at all levels. 

The overall threat posed by Omicron largely depends on three key questions – its transmissibility; how well the vaccines and prior SARS-CoV-2 infection protect against  it, and how virulent the variant is as compared to other variants.

From what we know so far, Omicron appears to spread faster than the Delta variant which has been attributed to the surge in cases across the world in the last several months, Dr Singh said.

She added that emerging data from South Africa suggests increased risk of re-infection with Omicron, and said that there is still limited data on Omicron’s limited severity. Further information is needed to fully understand the clinical picture of those infected with Omicron, and more information is expected in the coming weeks.

Her statements echo those of WHO chief Tedros Adhanom Ghebreyesus, who earlier last week warned that health systems could still be overwhelmed by cases.

Categories : COVIDTags :

Real-world Data Shows Booster Shot Protective against Omicron

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While two doses of a COVID vaccine offered less protection against Omicron, a booster shot restored immunity back to high levels, according to real-world data from the UK.

Two doses of Pfizer vaccine provided just under 40% protection against symptomatic infection with the Omicron variant about 25 weeks after the second dose compared with around 60% protection against Delta, according to a technical briefing released by the UK Health Security Agency. [PDF]

“These early estimates suggest that vaccine effectiveness against symptomatic disease with the Omicron variant is significantly lower than compared to the Delta variant,” the agency noted in the report. However, “moderate to high” vaccine effectiveness was observed in the early period after a booster shot, they added.

The agency found that a Pfizer booster increased vaccine effectiveness to 76%. Among people who received the AstraZeneca series for their initial immunisation (which offered almost no protection against Omicron), vaccine effectiveness jumped to 71% after a Pfizer booster.

The reportcompared vaccine effectiveness against Omicron versus Delta, including 581 people who were infected with the new strain and more than 56 000 infected with Delta from the end of November to December 6.

Omicron’s reinfection rate was also much higher than Delta’s. Of 329 individuals infected with Omicron, 7% had a previous infection, compared with 0.4% of the approximately 85 000 people infected with Delta.

After adjustments for age and area, the risk ratio of reinfection for Omicron was 5.2 (95% CI 3.4-7.6).

The report also found a 20- to 40-fold reduction in neutralising antibody activity compared with the viruses used to develop the vaccines. However, a booster dose significantly improved neutralising antibodies, regardless of which vaccine was given in the initial immunisation.

Katelyn Jetelina, PhD, an epidemiologist at the University of Texas Health Science Center at Houston, said that the study data confirm what researchers have already discovered in lab research: vaccines offer significantly less protection against Omicron, and reinfection rates are expected to be high.

Dr Jetelina noted that it was reassuring to see that “we can curb infection still with a booster, which is really quite phenomenal.” However, she said that cases were likely to increase.

“I think all this data is showing us that we’re going to have a lot of infections with Omicron,” Jetelina told MedPage Today. While a high rate of infection does not necessarily translate to severe illness, Dr Jetelina said that she is concerned about population-level outcomes resulting from a flood of new cases.

“That’s where I get a bit more nervous,” she said. She pointed out that “even if the rate of severe disease is low […] those numbers start adding up real quickly.”

The UK Health Security Agency advised interpreting the results with caution, due to the low number of Omicron cases. Additionally, more data are needed before scientists can determine how well vaccines will work against severe illness, hospitalisation, and death from the Omicron strain.

“It will be a few weeks before effectiveness against severe disease with Omicron can be estimated,” the agency stated. “However, based on this experience, this is likely to be substantially higher than the estimates against symptomatic disease.”

Source: MedPage Today

Categories : COVIDTags :

Alcohol Curbs may Return while UK Red List may be Scrapped

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With the COVID test positivity rate climbing above 30%, President Cyril Ramaphosa is widely expected to address the nation in the coming days. Health Minister Dr Joe Phaahla said on Friday that the National Coronavirus Command Council would be meeting on Tuesday or Wednesday to discuss new restrictions in the face of surging infections.

The main concern is centred around the large number of gatherings that will take place over the festive period: under Level 1 lockdown rules, gatherings of up to 750 individuals are permitted indoors. The Bureau for Economic Research issued a report saying that data so far indicates that there are fewer hospitalisations and less severe disease with the Omicron variant, in line with observations made since the start of the variant’s outbreak.

A partial ban on alcohol sales seems likely, according to a source cited by City Press: “He is considering proposing to the NCCC and cabinet a few adjustments, which include banning the sale of alcohol on weekends and public holidays until mid-January. Don’t be surprised when we have a family meeting before Thursday. He is serious about protecting the country.”

He initially had no plans to address the nation, sources said, but was motivated to change his view in light of the increasing rate of transmission.

Meanwhile, the UK appears set to scrap its controversial red list, which had been widely viewed as unfairly targeting South Africa. The red list amounted to a virtual travel ban, with travellers forced to pay £2285 (R48 400) per person for a ten day stay in often substandard quarantine accommodation. However, it will come too late for many people who have cancelled travel plans.

In a windfall for South Africans, the cost of PCR testing has been revised downward to R500 from R850 as of Sunday following a complaint lodged with the Council for Medical Schemes against private pathology laboratories, alleging the pricing for COVID PCR tests was unfairly inflated. Pricing for rapid antigen tests is said to be next on the list for the Competition Commission. 

On Sunday, a technical glitch caused the National Health Laboratory Service to delay release of a large portion of test results. The glitch meant that initially 18 035 cases were released initially, which rose to over 37 000 after the correction.

The cause was put down to IT difficulties with various laboratories.