With UK regs changing to mandatory #masks, here's a short to answer the question: can you wear a disposable #facemask more than once? The answer is YES. Many manufacturers state that masks should be disposed of after 8 hours but this is not true. Read on to find out why ... 1/

It seems the people who write the vaccines w/ a booster aren't working against Omicron are completely out of touch with the data I'd consider ~90% effectiveness vs hospitalization pretty, pretty damn good https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1046853/technical-briefing-34-14-january-2022.pdf… Especially compared with 44% without a booster

2) it doesn’t help that US has the lowest vaccination rate among major counties except Russia.

Pandemic leadership matters. #COVID19 mortality per capita by state. Public health is policy, policy is politics. Human behavior is often driven by misinformation. Misinformation is often driven by politics. Politics can be changed by voting — unless voters can’t.

Study found boosters only 37% effective against Omicron, but data revised

Canadian COVID-19 vaccine study seized on by anti-vaxxers — highlighting dangers of early research in pandemicA Canadian study that vastly underestimated the protection COVID-19 vaccines provide against the Omicron variant has been revised — but not before it spread widely on social media by anti-vaxxers, academics and even the creators of the Russian Sputnik V vaccine.Social Sharing

PARIS, Jan 17 (Reuters) - Novak Djokovic risks being frozen out of tennis as he chases a record 21st Grand Slam title, with rules on travellers who are unvaccinated against COVID-19 tightening in the third year of the pandemic and some tournaments reconsidering exemptions.

No vaccine, no French Open for Djokovic as rules tighten

Here is a bit of a longer explanatory thread on our recent paper on “Infectious viral load in unvaccinated and vaccinated patients infected with SARS-CoV-2 WT, Delta and Omicron”. You can read the full paper here:

10.1016/j.puhe.2021.12.016

ObjectivesTo test whether public knowledge and confidence in one's understanding of the local restrictions, motivation to adhere to local restrictions, and self-reported behaviour (going out for exercise, to work, socially) differed according to tier level.Study designCross-sectional, nationally representative, online survey of 1728 participants living in England (data collection: 26 to 28 October 2020).MethodsWe conducted logistic regression analyses to investigate whether knowledge of restrictions, confidence in knowledge of restrictions, motivation to adhere to restrictions, and self-reported behaviour were associated with personal characteristics and tier.ResultsBetween 81% (tier 2) and 89% (tier 3) of participants correctly identified which tier they lived in. Knowledge of specific restrictions was variable. 73% were confident that they understood which tier was in place in their local area, whereas 71% were confident they understood the guidance in their local area. Confidence was associated with being older and living in a less deprived area. 73% were motivated to adhere to restrictions in their local area. Motivation was associated with being female and older. People living in tiers with greater restrictions were less likely to report going out to meet people from another household socially; reported rates of going out for exercise and for work did not differ.ConclusionsAlthough recognition of local tier level was high, knowledge of specific guidance for tiers was variable. There was some indication that nuanced guidance (e.g. behaviour allowed in some settings but not others) was more poorly understood than guidance which was absolute (i.e. behaviour is either allowed or not allowed).

Tiered restrictions for COVID-19 in England: knowledge, motivation and self-reported behaviour

Code Brown will allow hospitals to make staffing and resource changes to prioritise critical patientsThere are currently 1,152 COVID-19 hospitalisationsTeachers and emergency services, prisons, freight and transport worker will be exempt from close contact isolation rules from tonight

Victoria to issue emergency Code Brown alert for its health services due to Omicron wave

Dr.Claire Steves continued: “Looking in the national core studies, from cohort studies across the UK we’ve looked at 10 different longitudinal studies. Our best estimates are that about 5% of middle aged people are experiencing long term.. 27/ #APPGCoronavirus #LongCovid

Although some use modelling of future scenarios as a synonym for 'modelling', important to remember a lot of the modelling work during COVID has focused on very different questions: https://twitter.com/AdamJKucharski/status/1244549516352720897?s=20… 8/8

Others would later apply similar methods to estimate cases elsewhere (e.g. https://ncbi.nlm.nih.gov/labs/pmc/articles/PMC7081176/…). And we'd use exported cases and evaluation flights to help estimate changing transmission in Wuhan as measures came in: https://thelancet.com/article/S1473-3099(20)30144-4/fulltext… 7/

I think above is a useful example of real-time analysis because 1) it's pretty intuitive why you'd need a model, and 2) shows these approaches can provide crucial early insights that wouldn't have been possible by just looking directly at the (noisy, biased, incomplete) data. 6/

Now, of course, it's well known there were loads of infections not appearing the data early on (https://thelancet.com/journals/lancet/article/PIIS0140-6736(21)00434-7/fulltext… & https://thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30089-X/fulltext…). Everything is obvious in hindsight etc. But at the time this modelling went against raw data, so valuable situational awareness. 5/

This is what Imperial did, estimating that those 3 exported infections were consistent with 1723 cases (95% CI: 427 – 4471) in Wuhan https://imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-1-case-estimates-of-covid-19/… 4/

To answer this, we need to outline a model: if there are X cases in Wuhan, and travellers leave to different destinations at given rates, how likely is it we'd observe those three exported cases? With this model outlined, we can then use it to infer X given the observed data. 3/

At the time, only 41 cases of 2019-nCoV (aka COVID-19) had been reported in Wuhan. But two exported cases had just been detected in Thailand and one in Japan. How plausible was it that there were really just 41 cases in Wuhan? 2/

Below analysis was two years ago (https://bbc.co.uk/news/health-51148303…). As well as providing an early warning about the COVID threat, it’s a good illustration of what is often an under-appreciated point: if we want to make sense of epidemic data and dynamics in real-time, we need models… 1/

Highlights the *huge* benefits of investing in ventilation, and changes in the way we work (greater flexibility to work from home)- which is better for the environment as well. We need to think long-term & consider how we can change things to do better.

Hearing a lot of people using excess deaths being low to suggest COVID-19 deaths aren't a serious issue, or didn't surge post-omicron. This isn't true unfortunately. We're still seeing ~1,800 deaths/wk with COVID-19 reported, but other deaths have come down.

Mitigations had a considerable impact on on all respiratory diseases, and COVID-19 deaths have actually increased, but deaths from other causes decreased potentially due to behaviour change - reducing contact, and increased mask use/ventilation.

Exactly this We never talk about the huge benefits mitigations have had in reducing other respiratory illnesses... which means deaths from other causes have reduced. Excess deaths are not a good indicator of COVID-19 deaths - which we should be doing a lot more to prevent!

I used to be a history major, with a focus on social history. And I remember reading about WW2 in a very fascinating book about the evolution of courtship and dating dynamics in America. (I'm going somewhere with this, bear with me.)

If you, like me, are "skipping ahead" during the ACIP meeting re: Moderna vaccine - this slide really drives home the benefit / risk paradigm among the group at highest risk of myocarditis (men 18-35). 2 million shots = 1903 avoided hospitalizations, and 68 myocarditis cases.

This note sets out a range of scenarios to illustrate possible courses of the SARS-CoV-2 pandemic for the UK. All assume that SARS-CoV-2 will continue to circulate for the foreseeable future and that variants will emerge. These are scenarios that illustrate a range of possible futures but are not the only plausible courses that the pandemic could take. Shifts from one scenario to another over time are also possible. An outcome that lies outside the range covered by the four scenarios –better than the reasonable best-case scenario or worse than the reasonable worst-case scenario – cannot be ruled out. In each scenario, it is assumed that a relatively stable, repeating pattern is reached over time (2-10 years) but it is likely that the transition to this will be highly dynamic and unpredictable. It may not be possible to know with confidence from what happens in the next 12-18 months which long-term pattern will emerge

Covid-19 Medium-Term Scenarios – February 2022

Recent reports suggest that some SARS-CoV-2 genetic variants, such as B.1.1.7, might be more transmissible and are quickly spreading around the world. As the emergence of more transmissible variants could exacerbate the pandemic, we provide public health guidance for increased surveillance and measures to reduce community transmission.

10.1016/j.cell.2021.01.044

Public health actions to control new SARS-CoV-2 variants

Very disappointing non-answer from the Health Secretary to my question why the U.K. has the highest #Covid19 infection, hospitalisation & death rates in Western Europe.

11) Careful data analysis, and a deep appreciation of local knowledge and specificities, coupled with global action (as argued with @GYamey and @BillHanage last week: https://time.com/6128506/omicron-covid-19-how-to-fight/…) may yet get us through this.

11) Until we have a better sense of the issues raised here (esp in #9), premature celebration is uncalled for outside of SA; and in SA, perhaps we should spare a thought for the families of 250 000 of our fellow citizens whose loved ones will not be joining them for Christmas.

10) No, I do not have the answers. Yes, I am deeply grateful by what we are seeing here. But, I am appalled by how the South African Experience (TM) is being used to weaponise against unfolding events in other countries ("don't intervene, it's a nothingburger" says my bete noire)

9) SO. WHAT IF ... South Africa's 'light escape' (in the context of a QUARTER OF A MILLION excess natural deaths) is _in no small measure because_ we 'bought' that present at horrendous cost during past waves.

8) But the UK had begun to vaccinate extensively by then. Our programme only got going in July, by which time Delta was on us.

7) I am struck by this comparison from OWID. Their SA data are ours (but all-cause not natural-only). And we can see towards of the beta wave, excess deaths in the two countries were of a kind.

6) From Worldometer (yes, I *know* - I am pulling approximates here), the UK is around 2 150 -- roughly HALF the unofficial SA number

5) So that means, perhaps 250 000 Covid deaths since Autumn 2020. (cf: the official number of barely 90 000). Expressed per million, that is an 'unofficial Covid deaths' of around 4 200.

4) Excess natural deaths as of 11 Dec were 278 000 as per our weekly @MRCza report. https://samrc.ac.za/reports/report-weekly-deaths-south-africa?bc=254… We have also been of the view that between 85 and 95% of these ED, over the entire course of the epidemic, are related to Covid (https://genus.springeropen.com/articles/10.1186/s41118-021-00134-6…)

3) It really *does seem* as if South Africa, my country, will escape relatively unscathed in this wave. None of that is particularly new. But other things gnaw at me.

2) Despite massive number of cases (and incredibly high PTP: in the week to 11Dec, in Gauteng an ALL-TIME high of 38.7% - and an intra-week daily high of 41% when looking at PCR tests only), we have seen relatively few hospitalisations and deaths.

A series of mini-thoughts for a Sunday afternoon. South Africa vs. Rest of the World - the Omicron Edition. 1) We are pretty confident that Gauteng, the province at the South African Omicron epicentre is past its peak in terms of proportion of tests returning positive.

When I last updated this chart in September, the maximum y-axis value was ~120.

Estimates for England, Wales, Northern Ireland and Scotland. This survey is being delivered in partnership with University of Oxford, University of Manchester, UK Health Security Agency and Wellcome Trust. This study is jointly led by the Office for National Statistics (ONS)  and the Department for Health and Social Care (DHSC) working with the University of Oxford and Lighthouse laboratory to collect and test samples.

Coronavirus (COVID-19) Infection Survey, UK: 11 February 2022

The number of suspected cases is insane: Denmark has completely lost control. Many of the hospitalized elderly will never leave the hospitals again. Many of those babies will live with long-lasting consequences all their lives. 3/3

Rocketing covid+ hospitalizations. ICU starting to trend up again. Not even commenting the situation in the psychiatric wards. 2/3

New epi data from Denmark - Denmark has lost control. Rocketing covid+ hospitalizations for the elderly. New record for hospitalized *babies* 1/3

On 26 November 2021 WHO designated omicron a variant of concern. With its sublineage BA.2 now widespread, Elisabeth Mahase looks at what science has found out about the variant and its three (so far) variations

10.1136/bmj.o358

Covid-19: What do we know about omicron sublineages?

10.1371/journal.pone.0263381

The COVID-19 pandemic has been damaging to the lives of people all around the world. Accompanied by the pandemic is an infodemic, an abundant and uncontrolled spread of potentially harmful misinformation. The infodemic may severely change the pandemic’s course by interfering with public health interventions such as wearing masks, social distancing, and vaccination. In particular, the impact of the infodemic on vaccination is critical because it holds the key to reverting to pre-pandemic normalcy. This paper presents findings from a global survey on the extent of worldwide exposure to the COVID-19 infodemic, assesses different populations’ susceptibility to false claims, and analyzes its association with vaccine acceptance. Based on responses gathered from over 18,400 individuals from 40 countries, we find a strong association between perceived believability of COVID-19 misinformation and vaccination hesitancy. Our study shows that only half of the online users exposed to rumors might have seen corresponding fact-checked information. Moreover, depending on the country, between 6% and 37% of individuals considered these rumors believable. A key finding of this research is that poorer regions were more susceptible to encountering and believing COVID-19 misinformation; countries with lower gross domestic product (GDP) per capita showed a substantially higher prevalence of misinformation. We discuss implications of our findings to public campaigns that proactively spread accurate information to countries that are more susceptible to the infodemic. We also defend that fact-checking platforms should prioritize claims that not only have wide exposure but are also perceived to be believable. Our findings give insights into how to successfully handle risk communication during the initial phase of a future pandemic.

Misinformation, believability, and vaccine acceptance over 40 countries: Takeaways from the initial phase of the COVID-19 infodemic

Updates This is the eighth version (seventh update) of a living guideline. It replaces earlier versions (4 September 2020, 20 November 2020, 17 December 2020, 31 March 2021, 6 July 2021, 23 September 2021, and 6 December 2021). The previous versions can be found as data supplements. New recommendations will be published as updates to this guideline.Clinical question What is the role of drugs in the treatment of patients with covid-19?Context The evidence base for therapeutics for covid-19 is increasing with numerous recently completed randomised controlled trials (RCTs). This update adds new recommendations on Janus kinase (JAK) inhibitors based on three RCTs with 2659 participants for baricitinib, two RCTs with 475 participants for ruxolitinib, and one RCT with 289 participants for tofacitinib. It also adds a recommendation for sotrovimab (monoclonal antibody) based on one RCT with 1057 participants, that was completed before the emergence of the omicron variant.New recommendations The Guideline Development Group (GDG) made:• A strong recommendation for the use of baricitinib as an alternative to interleukin-6 (IL-6) receptor blockers, in combination with corticosteroids, in patients with severe or critical covid-19• A conditional recommendation against the use of ruxolitinib and tofacitinib for patients with severe or critical covid-19• A conditional recommendation for the use of sotrovimab in patients with non-severe covid-19, restricted to those at highest risk of hospitalisation.Following the publication of a previous conditional recommendation for casirivimab- imdevimab, pre-clinical evidence has emerged suggesting that this monoclonal antibody combination lacks neutralisation activity against the omicron variant in vitro. Sotrovimab has been reported to retain activity against omicron in pseudovirus assays but with higher concentrations being required for neutralisation. More data are required to ascertain whether efficacy against the omicron variant will be maintained at the studied doses of monoclonal antibodies, and these living guidelines will be updated when additional data becomes available.Understanding the new recommendations When moving from evidence to recommendations, the GDG considered a combination of evidence assessing relative benefits and harms, values and preferences, and feasibility issues. The strong recommendation for baricitinib in those with severe or critical illness reflects moderate certainty evidence for benefits on mortality, duration of mechanical ventilation, and hospital length of stay, with no observed increase in adverse events leading to drug discontinuation. Baricitinib and IL-6 receptor blockers have similar effects; when both are available, choose one based on issues including cost and clinician experience. The conditional recommendation against the use of ruxolitinib and tofacitinib was driven by low certainty evidence from small trials, failing to demonstrate benefit, and suggesting a possible increase in serious adverse events for tofacitinib. A conditional recommendation for the monoclonal antibody sotrovimab in patients with non-severe illness reflects substantial reduction in risk of hospitalisation in those at higher risk, and trivial benefits in those at lower risk. There were insufficient data to recommend one monoclonal antibody treatment over another, and evidence on their efficacy for emerging variants is likely to influence future recommendations.Prior recommendations • Recommended for patients with severe or critical covid-19—a strong recommendation for systemic corticosteroids; a strong recommendation for IL-6 receptor blockers (tocilizumab or sarilumab); and a conditional recommendation for casirivimab-imdevimab, for those having seronegative status.• Recommended for patients with non-severe covid-19—a conditional recommendation for casirivimab-imdevimab, for those at highest risk of severe illness.• Not recommended for patients with non-severe covid-19—a conditional recommendation against systemic corticosteroids; and a strong recommendation against convalescent plasma.• Not recommended for patients with severe or critical covid-19—a recommendation against convalescent plasma, except in the context of a clinical trial.• Not recommended, regardless of covid-19 illness severity—a conditional recommendation against remdesivir; a strong recommendation against hydroxychloroquine; a strong recommendation against lopinavir/ritonavir; and a recommendation against ivermectin, except in the context of a clinical trial.About this guideline This living guideline from the World Health Organization (WHO) incorporates three new recommendations on two therapies for covid-19, and updates existing recommendations. The GDG typically evaluates a therapy when WHO judges sufficient evidence is available to make a recommendation. While the GDG takes an individual patient perspective in making recommendations, it also considers resource implications, acceptability, feasibility, equity, and human rights. This guideline was developed according to standards and methods for trustworthy guidelines. MAGIC Evidence Ecosystem Foundation provides methodological support, including the coordination of living systematic reviews with network meta-analyses to inform the recommendations.

10.1136/bmj.m3379

A living WHO guideline on drugs for covid-19

AMA CXO Todd Unger discusses the new omicron variant and what it means for the months ahead with good friend of the show, Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s Hospital Center for Vaccine Development in Houston. 0:00 AMA COVID-19 Update for Dec. 6, 2021 1:33 Explain "predictable variant behaviors" that omicron seems to be following 3:52 Expand on omicron's transmissibility and this variant's immune escape possibilities 6:01 Theorize: omicron vs fully vaccinated person (i.e., triple immunized individual with 2 dose vaccine +booster shot) 8:08 What's the timeline for new data—including laboratory investigations for virus neutralizing antibodies, as well as vaccine effectiveness studies? 10:13 Should anyone wait for an omicron-specific booster or get the available third shot as soon as possible? 11:40 Why is your number one worry about the next big wave of Delta infections—especially among the unvaccinated—and not emerging omicron cases? 12:43 Do you think COVID-19 travel bans are effective? 14:37 In your opinion, what's needed to get the world's population vaccinated? 16:29 What advice do you have for physicians, as well as patients? Stay up to date on the latest information about the pandemic: https://ama-assn.org/covid-19-resources. Visit the COVID-19 Daily Video Updates page for more videos in this series: https://ama-assn.org/covid-19-videos.

Peter Hotez, MD, PhD, on the omicron variant and Delta winter surge | COVID-19 Update for Dec. 6, 20

10.1101/2021.12.28.21268460

The frequency of SARS-CoV-2 breakthrough infections in fully vaccinated individuals increased with the emergence of the Delta variant, particularly with longer time from vaccine completion. However, whether breakthrough infections lead to onward transmission remains unclear. Here, we conducted a study involving 125 patients comprised of 72 vaccinated and 53 unvaccinated individuals, to assess the levels of infectious virus in in vaccinated and unvaccinated individuals. Quantitative plaque assays showed no significant differences in the titers of virus between these cohorts. However, the proportion of nasopharyngeal samples with culturable virus was lower in the vaccinated patients relative to unvaccinated patients (21% vs. 40%). Finally, time-to-event analysis with Kaplan-Myer curves revealed that protection from culturable infectious virus waned significantly starting at 5 months after completing a 2-dose regimen of mRNA vaccines. These results have important implications in timing of booster dose to prevent onward transmission from breakthrough cases.

Comparison of infectious SARS-CoV-2 from the nasopharynx of vaccinated and unvaccinated individuals

Restrictive non-pharmaceutical interventions against COVID-19 (known as ‘lockdowns’) are associated with health harmsHowever, it is challenging to determine whether lockdowns have caused the harms or whether these harms are a direct consequence of the underlying health disaster of the pandemicCareful analysis of excess mortality suggests that lockdowns are not associated with large numbers of deaths in places that avoided large COVID-19 epidemics (eg, Australia, New Zealand)This evidence must be weighed against the very severe harms caused by COVID-19 itself, as seen for example in Brazil and IndiaIt is unlikely that government interventions have been worse than the pandemic itself in most situations using data collected to date

10.1136/bmjgh-2021-006653

Is the cure really worse than the disease? The health impacts of lockdowns during COVID-19

"We, as experts, have a responsibility to policymakers and everyday people to match the strength of our recommendations to the strength of our data. When I read Oster, I see a tone and conviction that far exceeds the many limitations of her data."

Post-acute sequelae of COVID-19 (PASC) represent an emerging global crisis. However, quantifiable risk-factors for PASC and their biological associations are poorly resolved. We executed a deep multi-omic, longitudinal investigation of 309 COVID-19 patients from initial diagnosis to convalescence (2-3 months later), integrated with clinical data, and patient-reported symptoms. We resolved four PASC-anticipating risk factors at the time of initial COVID-19 diagnosis: type 2 diabetes, SARS-CoV-2 RNAemia, Epstein-Barr virus viremia, and specific autoantibodies. In patients with gastrointestinal PASC, SARS-CoV-2-specific and CMV-specific CD8+ T cells exhibited unique dynamics during recovery from COVID-19. Analysis of symptom-associated immunological signatures revealed coordinated immunity polarization into four endotypes exhibiting divergent acute severity and PASC. We find that immunological associations between PASC factors diminish over time leading to distinct convalescent immune states. Detectability of most PASC factors at COVID-19 diagnosis emphasizes the importance of early disease measurements for understanding emergent chronic conditions and suggests PASC treatment strategies.

10.1016/j.cell.2022.01.014

Multiple Early Factors Anticipate Post-Acute COVID-19 Sequelae

The network has devoted 8 hours and 43 minutes to the “freedom fighters”

Fox News goes all-in promoting anti-vaccine-mandate Canadian truckers

10.1126/science.ada1117

Giant study shows striking rise in long-term heart and vessel disease

COVID-19 takes serious toll on heart health—a full year after recovery

One doctor says College of Physicians and Surgeons of B.C. needs to do more to tackle misinformation

2 B.C. doctors went on a COVID-19 speaking tour. Colleagues say their misinformation put public at risk

Doses donated to the COVAX initiative by each country. Donations are broken down by whether they havebeen only announced, donated to COVAX, or shipped to a recipient country.

COVID-19 vaccine doses donated to COVAX

Staff shortages caused by the Omicron wave were causing ‘collateral damage’ and leading to procedures or surgeries being postponed, said Dr Katie Rogerson, a paediatrician working in London

Covid absences: NHS bosses facing daily scramble to cover gaps in workforce hit by wave of Omicron cases

on inconsistency in discourse see e.g., our Vaccine Wiki:

and it's hard to think that isn't part of the goal: once consistency is no longer a requirement absolutely anything goes and public discourse aimed at truth or good outcomes is dead

man who contracted potentially disease and then violated public health orders tries to cross borders by providing incorrect info on key docs = just fine is not something I foresaw from this corner... once consistency is thrown out as a standard, rational debate is impossible...

Update. Note @UKHSA has revised recent RSV downwards.

Yup.

10.1038/s41598-019-42788-5

Recent evidence points at the role that human endogenous retroviruses (HERVs) may play through the activation of genes integrated across the human genome. Although a variety of genetic/epigenetic mechanisms maintain most HERVs silenced, independent environmental stimuli including infections may transactivate endogenous elements favoring pathogenic conditions. Several studies associated exposures to Mycobacterium avium subsp. paratuberculosis (MAP) with increased anti-MAP seroreactivity in T1D patients. Here, we assessed humoral responses against HERV envelope antigens (HERV-KEnv and HERV-WEnv) and four MAP-derived peptides with human homologs in distinct populations: Sardinian children at T1D risk (rT1D) (n = 14), rT1D from mainland Italy (n = 54) and Polish youths with T1D (n = 74) or obesity unrelated to autoimmunity (OB) (n = 26). Unlike Sardinian rT1D, youths displayed increased anti-HERV-WEnv Abs prevalence compared to age-matched OB or healthy controls (24.32 vs. 11.54%, p = 0.02 for Polish T1D/OB and 31.48 vs. 11.90%, p = 0.0025 for Italian rT1D). Anti-HERV-KEnv responses showed variable trends across groups. A strong correlation between Abs levels against HERV-WEnv and homologous peptides was mirrored by time-related Abs patterns. Elevated values registered for HERV-WEnv overlaped with or preceded the detection of T1D diagnostic autoantibodies. These results support the hypothesis of MAP infection leading to HERV-W antigen expression and enhancing the production of autoantibodies in T1D. Download PDF

Anti-HERV-WEnv antibodies are correlated with seroreactivity against Mycobacterium avium subsp. paratuberculosis in children and youths at T1D risk

I don’t think it’s the time to stop masking yet but let’s not pretend the big line isn’t going down

10.1001/jama.2022.0040

Importance  One-year outcomes in patients who have had COVID-19 and who received treatment in the intensive care unit (ICU) are unknown.Objective  To assess the occurrence of physical, mental, and cognitive symptoms among patients with COVID-19 at 1 year after ICU treatment.Design, Setting, and Participants  An exploratory prospective multicenter cohort study conducted in ICUs of 11 Dutch hospitals. Patients (N = 452) with COVID-19, aged 16 years and older, and alive after hospital discharge following admission to 1 of the 11 ICUs during the first COVID-19 surge (March 1, 2020, until July 1, 2020) were eligible for inclusion. Patients were followed up for 1 year, and the date of final follow-up was June 16, 2021.Exposures  Patients with COVID-19 who received ICU treatment and survived 1 year after ICU admission.Main Outcomes and Measures  The main outcomes were self-reported occurrence of physical symptoms (frailty [Clinical Frailty Scale score ≥5], fatigue [Checklist Individual Strength—fatigue subscale score ≥27], physical problems), mental symptoms (anxiety [Hospital Anxiety and Depression {HADS} subscale score ≥8], depression [HADS subscale score ≥8], posttraumatic stress disorder [mean Impact of Event Scale score ≥1.75]), and cognitive symptoms (Cognitive Failure Questionnaire—14 score ≥43) 1 year after ICU treatment and measured with validated questionnaires.Results  Of the 452 eligible patients, 301 (66.8%) patients could be included, and 246 (81.5%) patients (mean [SD] age, 61.2 [9.3] years; 176 men [71.5%]; median ICU stay, 18 days [IQR, 11 to 32]) completed the 1-year follow-up questionnaires. At 1 year after ICU treatment for COVID-19, physical symptoms were reported by 182 of 245 patients (74.3% [95% CI, 68.3% to 79.6%]), mental symptoms were reported by 64 of 244 patients (26.2% [95% CI, 20.8% to 32.2%]), and cognitive symptoms were reported by 39 of 241 patients (16.2% [95% CI, 11.8% to 21.5%]). The most frequently reported new physical problems were weakened condition (95/244 patients [38.9%]), joint stiffness (64/243 patients [26.3%]) joint pain (62/243 patients [25.5%]), muscle weakness (60/242 patients [24.8%]) and myalgia (52/244 patients [21.3%]).Conclusions and Relevance  In this exploratory study of patients in 11 Dutch hospitals who survived 1 year following ICU treatment for COVID-19, physical, mental, or cognitive symptoms were frequently reported.

Clinical Outcomes Among Patients With 1-Year Survival Following Intensive Care Unit Treatment for COVID-19