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Coronavirus Files: Omicron threat looms large, but boosters and antivirals should help in fight

Coronavirus Files: Omicron threat looms large, but boosters and antivirals should help in fight

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This is the last newsletter before the holiday. The Coronavirus Files wishes you a safe and happy season, however you choose to celebrate.

COVID complicates recovery for amputees

Among the many horrible effects COVID inflicts on its victims, a lesser-known consequence is the loss of limbs. When the virus causes blood clots that interfere with blood flow, the tissue can die and become infected, write Jason Laughlin and Aubrey Whelan at The Philadelphia Inquirer: “The affected limbs have to be removed for the patient to survive.”

According to data from Stanford University, the amputation rate jumped 49% in the 12 months starting March 2020, reports Eli Cahan at WebMD.

Cahan, who wrote a two-part series with support from the Center for Health Journalism’s California Fellowship, also describes how preventable amputations, often in people with diabetes, rose during the pandemic and lockdowns. Some people delayed treatment over fear of the virus; others sought help, but found clinics closed.

The pandemic also worsened amputees’ access to rehab services, as centers filled with COVID patients and survivors.

The increase in amputations was particularly apparent among Asian and Black populations. In the second part of his investigation, Cahan notes that people of color often have greater difficulties accessing crucial after-surgery care as well.

Patient advocate Sean Harrison, who is also a Black amputee, told Cahan things were bad enough before the pandemic: “When you’re hopping on one leg across the river, there are so many opportunities to fall off the lily pads.” But with COVID, Harrison says, “it was death by one thousand cuts.”

U.S. omicron wave could peak in January

The CDC issued a warning last week that the omicron variant is spreading fast and could lead to a fierce winter surge.

The worst-case scenario, which one official described as a “triple whammy,” would involve the omicron and delta strains of COVID alongside influenza in a season that could “overwhelm health systems and devastate communities,” according to The Washington Post.

The less terrifying prediction is a smaller omicron surge in springtime; experts don’t know which is more likely.

Omicron cases are already rapidly surging in European countries such as England and Denmark, and some experts believe it’s already driving a surge in the northeastern U.S., writes Faye Flam at Bloomberg.

The variant’s ability to cause severe disease and evade immunity will also influence the coming months, and preliminary real-world studies of omicron infection offered mixed results. A private health insurance administrator in South Africa reported that while omicron led to fewer hospitalizations, vaccines were less effective.

“Experts say it’s too early to say whether these findings are good or bad news for the rest of the world,” writes Alexander Smith at NBC News. About one-quarter of people in South Africa are fully vaccinated — still defined, for now, as two shots with an mRNA vaccine or one with Johnson & Johnson’s.

But a new study of limited data on U.K. infections by scientists at Imperial College London, says there’s no evidence” omicron is any less severe than delta. It’s existing immunity, despite the reduced efficacy of antibodies, that’s keeping people out of the hospital, University of Texas epidemiologist Katelyn Jetelina said Friday at a webinar hosted by the Association of Health Care Journalists. The variant also appears to be much more contagious than previous variants.

More than 60% of the U.S. population is fully vaccinated, and of those, more than 28% have had boosters.

Those boosters make a big difference against omicron, the NIH’s Dr. Anthony Fauci said last week. He and other experts currently think the current vaccine formulations should be satisfactory, without an omicron-specific version. Early reports suggest that three doses of the mRNA vaccines are about 80% effective against omicron infection, while two-dose efficacy is only 33%.

But those who just started the vaccination series in fall won’t be eligible for boosters until spring under current guidelines, potentially leaving them vulnerable over winter, notes Caitlin Owens at Axios. Waiting six months is considered important for immunity to mature, but other nations are trying shorter intervals.

While the race gap in initial vaccination has narrowed, data on boosters by race are incomplete, notes the Kaiser Family Foundation. Among people aged 65 and older, for whom CDC reports race and ethnicity, white people initially made up a large share of booster recipients but the numbers among Black and Hispanic people seem to be rising.

Only half of people living in nursing homes have gotten their booster, notes Deidre McPhillips at CNN.

Finally, preliminary lab work suggests why omicron might be highly contagious, reports Hannah Devlin at The Guardian. Compared to other COVID variants, omicron replicates more quickly in the bronchial tubes that connect the lungs to the windpipe. That could mean a large volume of virus high in the respiratory tract, ready to be exhaled.

Lead study author Michael Chan Chi-wai of the University of Hong Kong cautioned that even if omicron-based disease were mild, it's nothing to ignore. “By infecting many more people, a very infectious virus may cause more severe disease and death even though the virus itself may be less pathogenic,” he told Devlin. “The overall threat from the omicron variant is likely to be very significant.”

Pfizer vaccine stumbles in younger children

In a blow to the hopes of families with young children and the future immunity bulwark against omicron, Pfizer’s two-shot, low-dose regimen for children ages 2 through 4 did not offer a potent immune response, the company announced Friday.

The vaccine is down but not out. The immune response was adequate in children between 6 months and 2 years. And there were no safety concerns.

The company now plans to revise their strategy and test adding a third dose in the under-5 population, and in older children as well.

The company still plans to file for emergency authorization in the second quarter of 2022, reports The Washington Post.

Moderna is also testing its vaccine in children, and recently published results suggesting the vaccine is safe and effective in teenagers.

Pfizer's antiviral pill holds up against omicron

Pfizer’s Paxlovid, which showed promising results in an interim analysis in early November, continues to look good in the final dataset of 2,200 people. In unvaccinated, high-risk individuals, the course of 30 pills over five days was 89% effective at preventing hospitalization and death. In fact, no one who received Paxlovid died.

Pfizer’s chief scientific officer, Mikael Dolsten, told Reuters he expects emergency authorization from the FDA for high-risk patients soon, without need for an advisory committee meeting.

“Patients might begin receiving it by the end of the year,” write Carl Zimmer and Rebecca Robbins at The New York Times, though they add, “supply will be limited at first.”

The U.S. has ordered 10 million courses of the drug, but Pfizer expects to deliver just 300,000 by the end of February. The U.S. is currently averaging about 120,000 COVID-19 cases per day, and vaccines and other preventive measures remain the best way to avoid the virus altogether.

Pfizer also reported that the medicine was effective against the omicron variant in laboratory studies.

The results were “quite amazing and potentially transformative,” Sara Cherry, a virologist at the University of Pennsylvania, told the Times. “If we could keep people out of hospitals, that would have a huge impact.”

CDC reconsiders J&J vaccine

After considering new data on safety risks, the CDC’s vaccine advisory committee voted unanimously to recommend mRNA vaccines over Johnson & Johnson’s. CDC director Dr. Rochelle Walensky quickly signed off on the recommendation.

The concern is a blood clotting problem called thrombosis with thrombocytopenia syndrome (TTS), which most often affects women under 50.

New CDC data include 54 U.S. cases of hospitalization due to TTS, of which nine were fatal. It’s a higher rate than previously estimated, and advisors also noted the J&J vaccine had a lower efficacy rate against COVID compared to the other two vaccines.

Johnson & Johnson’s shot, despite its promise of one-dose convenience, has never become a U.S. favorite; fewer than 18 million doses have been administered compared to more than 470 million for the mRNA vaccines from Moderna and Pfizer.

But the committee declined to withdraw its endorsement of the vaccine altogether, noting that it might be the right choice for certain groups of people. For example, young men at risk of heart inflammation after an mRNA vaccine might opt for J&J.

The advisors also considered the fact that the Johnson & Johnson vaccine is easier to transport to far-flung areas of the United States and around the world, notes Spencer Kimball at CNBC.

From the Center for Health Journalism

Webinar recording: What we know so far about omicron

Watch our Dec. 15 discussion with epidemiologist Dr. Celine Gounder to catch up on the latest research, outstanding questions, and where the pandemic might go from here.

What we're reading

  • “The return of the 10-minute eviction,” by Eli Saslow, The Washington Post
  • “The government asked us not to release records from the CDC’s first failed COVID test. Here they are.” By Dan Vergano, BuzzFeed News
  • “The end of a return-to-office date,” by Emma Goldberg, The New York Times
  • “History made, millions saved: One year later, ‘surreal’ moments of COVID-19 vaccine debut live on,” by Elizabeth Weise and Kristen Jordan Shamus, USA Today
  • “T cells might be our bodies’ best shot against omicron,” by Katherine J. Wu, The Atlantic
  • “For India’s transgender community, getting vaccinated is a battle on multiple fronts,” by Arman Khan, Vice

Events and Resources

  • Naseem S. Miller at The Journalist’s Resource offers tips for debunking misinformation from public officials or physicians. Illustrating the scope of the problem among MDs, advocacy group No License for Disinformation and the de Beaumont Foundation just released a report urging medical licensing officials to investigate physicians who deliberately spread misinformation.
  • Science communication expert Andy Ridgeway summarizes his research on how people consume information and make sense of the pandemic at the Association of British Science Writers.
  • Poynter’s COVID-19 resources include daily briefings, tips, tools and training.

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