As time goes on, it’s getting easier to get a COVID-19 vaccine—in many places in L.A. County you can now just walk up to a vaccine site without an appointment. Millions of Californians have already gotten their Fauci Ouchie, but it’s also okay to have questions about the vaccine. Do you ever wonder if vaccines are safe and effective? This very question came up when we last talked to Kenneth Phillips—if you haven’t listened to his episode about contact tracing yet, be sure to check it out. Ken recommended that we talk to Shira Shafir (@IDPhD), a professor and infectious disease epidemiologist at the UCLA Fielding School of Public Health. She’s also working with the L.A. County Department of Public Health to help train contact tracers. She answered all our questions about the vaccines, from how scientists and doctors know they’re safe to when we might be able to start vaccinating younger kids.

...if vaccines are safe and effective?

GPs have called on the government to update the official list of covid-19 symptoms after seeing patients shun tests to check their infection status because they don’t believe they have been infected by SARS-CoV-2. They also said that a public communication campaign was needed to inform the public about the limitations of lateral flow tests and vaccination.

10.1136/bmj.n1654

Covid-19: GPs urge government to clear up confusion over symptoms

Across the world, more than 2bn doses of Covid-19 vaccines have gone into arms, and on 2 June, the BBC headline “75% of UK adults have had [their] first vaccine jab” was based on an Office for National Statistics estimate of the UK population aged 18 or over in June 2019

Have more than 100% of older people been vaccinated?

To make the most of England’s vaccination rollout we may need to keep wearing masks even after restrictions are lifted

Vaccines are not magic bullets – we’ll still have to take precautions

Emerging reports of SARS-CoV-2 breakthrough infections entail methodical genomic surveillance for determining efficacy of vaccines. This study elaborates genomic analysis of isolates from breakthrough infections following vaccination with AZD1222/Covishield and BBV152/Covaxin.Variants of concern B.1.617.2 and B.1.1.7 responsible for cases surge in April-May 2021 in Delhi, were the predominant lineages among breakthrough infections.

10.31219/osf.io/fgd4x

Variants of Concern responsible for SARS-CoV-2 vaccine breakthrough infections from India

he Vaccine Adverse Event Reporting System or VAERS is being misused by anti-vaxxers to terrify the public. It’s a shame because VAERS plays a vital role in detecting important but rare reactions caused by vaccines. The weaponization of VAERS by anti-vaccine activists serves as a reminder that having access to more information does not always lead to better decisions. Information needs to be correctly interpreted to guide us in the right direction.

Don’t Fall for the ‘VAERS Scare’ Tactic

10.1038/s41591-021-01378-7

The northern state of Amazonas is among the regions in Brazil most heavily affected by the COVID-19 epidemic and has experienced two exponentially growing waves, in early and late 2020. Through a genomic epidemiology study based on 250 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes from different Amazonas municipalities sampled between March 2020 and January 2021, we reveal that the first exponential growth phase was driven mostly by the dissemination of lineage B.1.195, which was gradually replaced by lineage B.1.1.28 between May and June 2020. The second wave coincides with the emergence of the variant of concern (VOC) P.1, which evolved from a local B.1.1.28 clade in late November 2020 and replaced the parental lineage in <2 months. Our findings support the conclusion that successive lineage replacements in Amazonas were driven by a complex combination of variable levels of social distancing measures and the emergence of a more transmissible VOC P.1 virus. These data provide insights to understanding the mechanisms underlying the COVID-19 epidemic waves and the risk of dissemination of SARS-CoV-2 VOC P.1 in Brazil and, potentially, worldwide.

COVID-19 in Amazonas, Brazil, was driven by the persistence of endemic lineages and P.1 emergence

According to ZOE COVID Study figures, it is estimated there are currently 11,908 new symptomatic cases of COVID in the UK on average, based on PCR test data from up to five days ago [*]. This compares to 5,677 daily cases a week ago, an increase of 110%.The cases are higher and increasing faster in the unvaccinated population in the UK. When the data is divided, it shows that there are currently 1,917 new daily symptomatic cases of COVID in vaccinated people, an increase of 89% from 1,014 cases, compared to 9,991 new daily symptomatic cases in unvaccinated people, an increase of 114% from 4,662 cases last week. In terms of prevalence, on average 1 in 543 people in the UK currently have symptomatic COVID [1].

Cases rising rapidly among those with incomplete vaccinations

A US public health expert has warned that though cases of Covid-19 are at their lowest rates for months and much of the country is returning to normal life, young Americans are still “a vulnerable host” for the coronavirus.

Following the documentation of a case of Bell's palsy associated with vaccination,1Colella G Orlandi M Cirillo N Bell's palsy following COVID-19 vaccination.J Neurol. 2021; (https://dx.doi.org/10.1007%2Fs00415-021-10462-4 published online Feb 21.)Crossref PubMed Scopus (1) Google Scholar we were contacted by patients and colleagues from Canada, Australia, Europe, the UK, and United Arab Emirates. Questions raised were whether mRNA vaccine recipients are at increased risk of developing Bell's palsy, and what to recommend to individuals with a history of Bell's palsy.In their Comment, Al Ozonoff and colleagues2Ozonoff A Nanishi E Levy O Bell's palsy and SARS-CoV-2 vaccines.Lancet Infect Dis. 2021; 21: 450-452Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar considered key statistical and epidemiological aspects of SARS-CoV-2 vaccine trial safety data regarding the onset of facial paralysis. Here, we offer a different interpretation of their findings and statistical consideration of risks associated with mRNA and non-mRNA SARS-CoV-2 vaccines.

10.1016/S1473-3099(21)00273-5

Bell's palsy and SARS-CoV-2 vaccines—an unfolding story

10.1038/s41586-021-03693-y

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to evolve around the world, generating new variants that are of concern based on their potential for altered transmissibility, pathogenicity, and coverage by vaccines and therapeutics1–5. Here we report that 20 human sera, drawn 2 or 4 weeks after two doses of BNT162b2, neutralize engineered SARS-CoV-2 with a USA-WA1/2020 genetic background (a virus strain isolated in January 2020) and spike glycoproteins from the newly emerged B.1.617.1, B.1.617.2, B.1.618 (all first identified in India) or B.1.525 (first identified in Nigeria) lineages. Geometric mean plaque reduction neutralization titers against the variant viruses, particularly the B.1.617.1 variant, appear lower than the titer against USA-WA1/2020 virus, but all sera tested neutralize the variant viruses at titers of at least 40. The susceptibility of these newly emerged variants to BNT162b2 vaccine-elicited neutralization supports mass immunization as a central strategy to end the coronavirus disease 2019 (COVID-19) pandemic across geographies. Download PDF

BNT162b2-elicited neutralization of B.1.617 and other SARS-CoV-2 variants

10.1101/2021.06.04.21258333

In early 2021, the SARS-CoV-2 lineage B.1.1.7 became dominant across large parts of the world. In Denmark, comprehensive and real-time test, contact-tracing, and sequencing efforts were applied to sustain epidemic control. Here, we use these data to investigate the transmissibility, introduction, and onward transmission of B.1.1.7 in Denmark. In a period with stable restrictions, we estimated an increased B.1.1.7 transmissibility of 58% (95% CI: [56%,60%]) relative to other lineages. Epidemiological and phylogenetic analyses revealed that 37% of B.1.1.7 cases were related to the initial introduction in November 2020. Continuous introductions contributed substantially to case numbers, highlighting the benefit of balanced travel restrictions and self-isolation procedures coupled with comprehensive surveillance efforts, to sustain epidemic control in the face of emerging variants.

Introduction and transmission of SARS-CoV-2 B.1.1.7 in Denmark

10.1001/jamacardio.2021.2065

Question  What is the prevalence of myocarditis in competitive athletes after COVID-19 infection, and how would different approaches to screening affect detection?Findings  In this cohort study of 1597 US competitive collegiate athletes undergoing comprehensive cardiovascular testing, the prevalence of clinical myocarditis based on a symptom-based screening strategy was only 0.31%. Screening with cardiovascular magnetic resonance imaging increased the prevalence of clinical and subclinical myocarditis by a factor of 7.4 to 2.3%.Meaning  These cardiac magnetic resonance imaging findings provide important data on the prevalence of clinical and subclinical myocarditis in college athletes recovering from symptomatic and asymptomatic COVID-19 infections.

Prevalence of Clinical and Subclinical Myocarditis in Competitive Athletes With Recent SARS-CoV-2 Infection: Results From the Big Ten COVID-19 Cardiac Registry

As part of the revised Covid 19 vaccine policy, the Government late on Tuesday issued an order capping the prices for administration of three approved Covid vaccines in private hospitals across India.  The maximum price that can be charged per dose by private vaccine centres is Rs 780 for Covishield, Rs 1,410 for Covaxin and Rs 1,145 for Sputnik V.

Govt caps cost of Covid vaccines in private hospitals

The COVID-19 pandemic has exposed the world's population to sudden challenges that elicited strong emotional reactions. Although investigations of responses to tragic one-off events exist, studies on the evolution of collective emotions during a pandemic are missing. We analyzed the digital traces of emotional expressions in tweets during five weeks after the start of outbreaks in 18 countries and six different languages. We observed an early strong upsurge of anxiety-related terms in all countries, which was stronger in countries with stronger increases in cases. Sadness terms rose and anger terms decreased around two weeks later, as social distancing measures were implemented. Positive emotions remained relatively stable. All emotions changed together with an increase in the stringency of measures during certain weeks of the outbreak. Our results show some of the most enduring changes in emotional expression observed in long periods of social media data. Words that frequently occurred in tweets suggest a shift in topics of conversation across all emotions, from political ones in 2019, to pandemic related issues during the outbreak, including everyday life changes, other people, and health. This kind of time-sensitive analyses of large-scale samples of emotional expression have the potential to inform mental health support and risk communication.

10.31234/osf.io/qejxv

Collective Emotions during the COVID-19 Outbreak

IT SEEMS that every time we think we are turning the tide in the coronavirus pandemic, another new variant emerges. The latest threat is the B.1.617.2 variant that is playing a large role in the terrible outbreak in India and is spreading in many other nations. The big question is, will existing vaccines work well enough to prevent major new outbreaks?

How effective are the different vaccines against covid-19 variants?

Before the COVID-19 pandemic, the USA was already struggling with racial and economic disparities pertaining to affordable and safe housing for its population. There were large areas within cities with reduced access to health care, neighbourhoods with older housing that were many decades old, low-income minority families living in close quarters, and a growing homeless population. The pandemic brought with it sweeping job loss with resulting loss of income and health insurance for many people, particularly low-income, immigrant, and minority families, with concerns of eviction in groups of people already facing structural racism and poverty. Largely comprised of essential workers, a combination of occupational hazards, residential overcrowding, and increased domestic caregiving responsibilities have played major roles in increased incidence rates (and mortality) of COVID-19. Housing insecurity has been a crucial social determinant of health during this pandemic and offers pertinent lessons for place-based discrimination for millions of Americans.When evaluating the origins of housing discrimination and residential segregation, historical redlining comes to mind. A striking example of de jure segregation, the federally funded Home Owners' Loan Corporation produced maps in the 1930s that put forth a colour-coded schema to subdivide American neighbourhoods into a risk-based ranking for mortgage approvals. Such racially explicit policies diverted investment away from minority neighbourhoods and resulted in residents that were Black, low-income, or immigrant being constrained to hazardous neighbourhoods.

10.1016/S1473-3099(21)00257-7

A prescription for fair housing during the COVID-19 pandemic

Since the pandemic began, healthcare workers have been venerated for treating patients with Covid-19, but they have also been attacked for doing their job.Five doctors and nurses treating coronavirus patients, some of whom asked to be kept anonymous, recount their experiences.

‘They stormed the ICU and beat the doctor’: health workers under attack

Once a poster child for blocking coronavirus, Taiwan failed to fully prepare a pandemic response or vaccination rollout

A victim of its own success: how Taiwan failed to plan for a major Covid outbreak

Jerome Kim, director of the International Vaccine Institute in South Korea, told DW that successfully producing and distributing complex vaccines in developing countries will take more than access to biotech secrets.

Will waiving vaccine patents end 'vaccine nationalism?'

Epidemiological models have been a source of continual controversy from the start of the pandemic, often blamed for fearmongering and inaccuracy. How well have they done?

How good are we at predicting the pandemic?

The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public’s attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and qualitative research, this project tracks the dynamic nature of public opinion as vaccine development and distribution unfold, including vaccine confidence and acceptance, information needs, trusted messengers and messages, as well as the public’s experiences with vaccination.

KFF COVID-19 Vaccine Monitor - April 2021

With vaccination programmes underway across the globe, attention is turning to the longer-term impact of COVID-19 and in particular the condition termed 'long Covid'. Very little is known about the condition at the moment, despite some studies estimating that 1 in 20 are affected. Large-scale research projects and population studies are now looking at the reported symptoms to understand what long Covid is, why some people are affected for months, and how we can treat it. Join Professor Brian Cox as he talks to scientists working at the forefront of research into long Covid, and campaigners with personal experience of the devastating effect it can have on lives. This event is part of a series of Royal Society events discussing the scientific response to the COVID-19 pandemic. Catch up with the first event on the Royal Society’s YouTube channel.

Long Covid: an unfolding story

Adults under 30 should be offered an alternative vaccine instead of the AstraZeneca jab if there is one available in their area and they are healthy and not at high risk of Covid, the UK government’s vaccination advisory body has said.The recommendation from the joint committee on vaccines and immunisation (JCVI) is broadly in line with the thinking in Europe, where some countries have already opted to restrict the Oxford/AstraZeneca vaccine to older groups following concerns about rare events of blood clots allied to low platelets.Overall, the risks from Covid for older people are far higher and they will be encouraged to have the vaccine, which has been proven to be safe and effective in millions of people. In the UK, up to 31 March, there were 79 reports of these rare blood clots with low platelets – some but not all of them in the brain – and 19 deaths, among more than 20m AstraZeneca jabs.

Under-30s in UK should be offered alternative Covid vaccine to AstraZeneca jab, says advisory body

10.1001/jama.2021.4388

Serum neutralizing antibodies rapidly appear after SARS-CoV-2 infection1 and vaccination2 and are maintained for several months.3,4 The emergence of SARS-CoV-2 variants has raised concerns about the breadth of neutralizing-antibody responses. We compared the neutralizing-antibody response to 4 variants in infected and vaccinated individuals to determine how mutations within the spike protein are associated with virus neutralization.

Neutralizing Antibodies Against SARS-CoV-2 Variants After Infection and Vaccination

10.31234/osf.io/hsvc4

In this study we investigated how 14- to 17-year-olds (n = 48) search the web for information about unsettled scientific dilemmas. In particular, we addressed to what extent adolescents' capability to appraise accurate web sources, learn, and mold informed opinions is influenced by the quality of their online search strategies, the control they exert over the online search experience, and the experience they have while searching the web for relevant factual information. Our results show that adolescents' learning resulting from independent online search was not influenced by their search strategies and was generally quite poor, although they did identify and consult the most relevant and informative web sources. Interestingly, we found that having active control over the search process enhanced participants' learning and retention of factual information, but following the search process more passively increased their capability to reflect on, process, and elaborate on the information found on the web. This latter aspect was also positively influenced by having greater experience searching the web to perform school assignments. Taken together, these findings can inform educational practices, supporting the development and implementation of more effective interventions to empower the conscientious use and successful mastery of the pseudo-infinite information available on the web, and highlighting the crucial role of schools in equipping students with the necessary training, strategies, tools and guidance.

Differential impact of web habits and active navigation on adolescents' online learning

The coronavirus variant originally found in Manaus in Brazil and detected in six cases in the UK was able to infect 25% to 61% of the people in the Amazonian city who might have expected to be immune after a first bout of Covid, researchers say.

Brazil variant evaded up to 61% of immunity in previous Covid cases

10.1101/2020.11.04.20225573

Background Knowing the transmissibility of asymptomatic infections and risk of infection from household- and community-exposures is critical to SARS-CoV-2 control. Limited previous evidence is based primarily on virologic testing, which disproportionately misses mild and asymptomatic infections. Serologic measures are more likely to capture all previously infected individuals.Objective Estimate the risk of SARS-CoV-2 infection from household and community exposures, and identify key risk factors for transmission and infection.Design Cross-sectional household serosurvey and transmission model.Setting Geneva, SwitzerlandParticipants 4,524 household members ≥5 years from 2,267 households enrolled April-June 2020.Measurements Past SARS-CoV-2 infection confirmed through IgG ELISA. Chain-binomial models based on the number of infections within households used to estimate the cumulative extra-household infection risk and infection risk from exposure to an infected household member by demographics and infector’s symptoms.Results The chance of being infected by a SARS-CoV-2 infected household member was 17.3% (95%CrI,13.7-21.7%) compared to a cumulative extra-household infection risk of 5.1% (95%CrI,4.5-5.8%). Infection risk from an infected household member increased with age, with 5-9 year olds having 0.4 times (95%CrI, 0.07-1.4) the odds of infection, and ≥65 years olds having 2.7 (95%CrI,0.88-7.4) times the odds of infection of 20-49 year olds. Working-age adults had the highest extra-household infection risk. Seropositive asymptomatic household members had 69.6% lower odds (95%CrI,33.7-88.1%) of infecting another household member compared to those reporting symptoms, accounting for 14.7% (95%CrI,6.3-23.2%) of all household infections.Limitations Self-reported symptoms, small number of seropositive kids and imperfect serologic tests.Conclusion The risk of infection from exposure to a single infected household member was more than three-times that of extra-household exposures over the first pandemic wave. Young children had a lower risk of infection from household members. Asymptomatic infections are far less likely to transmit than symptomatic ones but do cause infections.

Household Transmission of SARS-CoV-2: Insights from a Population-based Serological Survey

The Trials Methodology Research Partnership are delighted to announce a new TMRP webinar series managed and hosted by the UK Trial Managers' Network. Colleagues from TMRP Partner organisations will present each webinar on a different theme.   Future webinars are listed below. If registration is full please do sign up to the waiting list in case places become available.  Links to all webinar recordings and slides will be available below soon after the event. 

MRC-NIHR TMRP Webinar series

It’s year 2 of the pandemic, and masks have gone from a strange new experience to a core part of public life (and a fashion accessory!). With caseloads at record highs and a more infectious new variant on the horizon, we felt it was time to build a concise review for which masks give you the most protection and when you want to use them.

Still using a cloth mask? Upgrade to an N95 or P100!

The disruptions of the COVID-19 pandemic led many social scientists toward online survey experimentation for empirical research. Generalizing from the experiments conducted during a period of persistent crisis may be challenging due to changes in who participates in online survey research and how the participants respond to treatments. We investigate the generalizability of COVID-era survey experiments with 33 replications of 12 pre-pandemic designs fielded across 13 surveys on American survey respondents obtained from Lucid between March and July of 2020. We find strong evidence that these experiments replicate in terms of sign and significance, but at somewhat reduced magnitudes that are possibly explained by increased inattentiveness. These findings mitigate concerns about the generalizability of online research during this period. The pandemic does not appear to have fundamentally changed how subjects respond to treatments, provided they pay attention to treatments and outcome questions. In this light, we offer some suggestions for renewed care in the design, analysis, and interpretation of experiments conducted during the pandemic.

10.31235/osf.io/s45yg

The Generalizability of Online Experiments Conducted During The COVID-19 Pandemic

Besonders in Zeiten einer Pandemie wie der von COVID-19 nimmt das allgemeine Stressniveau der Betroffenen stark zu. Verschiedene Faktoren tragen besonders in einer so außergewöhnlichen Situation vermehrt zu Stress bei. So können mit der Pandemie verbundene Einschränkungen wie eine Kontaktreduzierung, das Tragen von Mund-Nasen-Masken oder auch die Schließung öffentlicher Einrichtungen auch psychisch eine starke Beeinträchtigung bedeuten.

10.31234/osf.io/4gduz

COVID-19-Pandemie-Stress-Skala (CPSS)

There has been a huge amount of misinformation during the pandemic. Much of it was unavoidable, especially at the start as we dealt with a new virus, but some myths are persisting a year into the pandemic. The myths range from the ridiculous to the merely implausible, but together they are misleading the public about the danger of Covid-19 and other variants. These false claims could also have serious consequences, such as fuelling premature calls to end social distancing measures before the vaccination rollout has reached a safe level.  To combat some of this misinformation, a group of scientists, journalists, economists and other researchers have created Anti-Virus, a website that tries to address the biggest myths surrounding the pandemic, and highlight claims or points of view that have been expressed by figures in academia or the media that are no longer credible. 

The eight biggest Covid-sceptic myths – and why they’re wrong

London’s intensive care units are overwhelmed, and those elsewhere in the UK may soon be too. The number of Covid-19 patients arriving in ICUs far exceeds the first wave in April, and those needing life-saving treatment such as mechanical ventilation have exhausted resources. Ambulances are queueing at hospital gates, patients are being transferred hundreds of miles and oxygen supplies are running low. The most severe shortage is not in beds, but in staff. NHS England has lowered ICU nurse staffing ratios from one nurse per patient to one for every two, and hospitals in the Midlands are being told to dilute their ratios further.Clinicians are now being forced to make agonising choices about who does and who does not receive care, with consequences for the survival of patients. Research on the first wave last spring found that when ICUs reach full capacity, the chance of a patient dying is 19 per cent higher. Is this decided by a random roll of the dice, or is it based on an assessment of who is at greater risk of dying? How should clinicians decide who gets the limited resources in an overstretched ICU? These are ethical questions that should be addressed by societies through expert committees, not individual clinicians.

Agonising choices in ICUs should be made by society, not individuals

Hospital staff are receiving insufficient support as they make agonising choices about who does and does not receive care, writes Dr Katharina Hauck. In an opinion piece for the Financial Times, Dr Hauck warns that existing guidelines in an overstretched NHS are “only partly helpful”. They avoid “the tough question of how to prioritise care with severely curtailed resources, leaving heartbreaking life-or-death decision-making to clinicians.” 

Staff 'need clearer guidance' as COVID overwhelms ICUs

The effects of the covid-19 pandemic on mental health, especially amongst children, are receiving increasing attention. What is less clear are the channels through which these effects are operating. This paper helps fill this gap by isolating the impact of school closures on children’s mental health. We exploit the way in which primary school children were invited to return to school in England in the summer term of 2020, with government advice being that all children in reception, Year 1 and Year 6 should be invited to return from 1 June, while only vulnerable children and children of key workers could attend in Years 2, 3, 4 and 5. We adopt a difference-in-differences approach with child fixed effects, comparing changes over time (before the pandemic to July 2020) between children who were and were not invited to return to school using parent reports from the Strengths and Difficulties Questionnaire (SDQ). Using reports from September 2020 – when all children had been invited to return school – we can also explore the extent to which these effects persist.

YouTube has been a significant source of misleading information during previous public health crises, including the Ebola and Zika outbreaks (Li et al., 2020). In March of 2020, a search of YouTube revealed that more than one quarter of the most-viewed videos contained misinformation, whereas videos from reputable sources remained underrepresented (Li et al., 2020). An in-depth scholarly analysis of how misinformation and other attributes of the online environment, and how it challenges citizens in a democracy can be found in Kozyreva et al. (2020). A detailed report on the overarching relationship between technology and democracy that was prepared for the European Commission can be found here. A quantitative analysis of the COVID-19 “infodemic” has shown that unreliable information predominated online before infections started rising in February and March 2020, but was then replaced by reliable information and content shifted towards more reliable sources (Gallotti et al., 2020).Unfortunately, misinformation about COVID-19 and COVID-19 vaccinations is sometimes also spread for political reasons. We explore this aspect in a separate page on the politics of COVID-19 vaccination.

Myths about COVID-19 vaccination