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The serum level of C-reactive protein (CRP) is a significant independent risk factor for Coronavirus disease 2019 (COVID-19). A link was found between serum CRP and genetic diversity within the CRP gene in earlier research. This study examined whether CRP rs1205 and rs1800947 polymorphisms were associated with COVID-19 mortality among various severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) variants. We genotyped CRP rs1205 and rs1800947 polymorphisms in 2023 deceased and 2307 recovered patients using the polymerase chain reaction-restriction fragment length polymorphism method. There was a significant difference between the recovered and the deceased patients in terms of the minor allele frequency of CRP rs1205 T and rs1800947 G. In all three variants, COVID-19 mortality rates were associated with CRP rs1800947 GG genotype. Furthermore, CRP rs1205 CC and rs1800947 GG genotypes showed higher CRP levels. It was found that the G-T haplotype was prevalent in all SARS-CoV-2 variants. The C–C and C–T haplotypes were statistically significant in Delta and Omicron BA.5 variants, respectively. In conclusion, polymorphisms within the CRP gene may relate to serum CRP levels and mortality among COVID-19 patients. In order to verify the utility of CRP polymorphism correlation in predicting COVID-19 mortality, a replication of these results is needed. Published in Scientific Reports (Jan. 6, 2024): https://doi.org/10.1038/s41598-024-51422-y
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Decrease in U.S. life expectancy has come at the expense of teenagers, young adults and those in early middle age. The current COVID-19 situation in the U.S. is both good and bad. The good news is that COVID-19 deaths are at the lowest levels of the three-year pandemic. Given current trends, projections indicate roughly 100,000 COVID-19 deaths for 2023 — less than half of any of the three previous years. The bad news is that the number of overall excess U.S. deaths — the difference between expected numbers of deaths from all causes and the actual number of deaths observed — is rising at a shocking rate. COVID-19 is a factor, but the main causes of excess deaths are more social than medical, and the worst aspect is that they are occurring in the younger demographic in which homicides, suicides, vehicular deaths and drugs are taking a disproportionate toll on what should be the healthiest sector of the population. Since the pandemic began, excess deaths are up by more than 1.25 million in the U.S., about 15% higher than in the pre-pandemic years. This pattern is not limited to the U.S.; excess pandemic deaths are elevated by 5% to 20% in Great Britain, most of Europe and Australia. The reason for these excess deaths defies simple explanation; the cause is certainly multifactorial. Some of this is likely an undercount of COVID-19 deaths. Another factor is delayed deaths caused by past COVID-19 infections. After any acute viral infection like COVID-19 has subsided, patients can suffer long-term medical complications including problems with inflammation and dangerous blood clotting disorders. These late effects of COVID-19 have included increases in fatal heart attacks and strokes. n the arena of excess deaths, unanticipated effects of lockdowns that resulted in health care and societal disruptions have been just as important as COVID-19 itself. Patients have found it more difficult to access care. Appointments with physicians have been delayed; routine surgeries, including biopsies, have been canceled; and even when patients suffer symptoms, many have avoided clinics and hospitals, fearing COVID-19 or just long waits. Combine this with deaths of despair (suicides and overdoses), vehicular accidents (possibly faster and more reckless driving) and homicides. Further, add the deaths that were occasioned by the unhealthy lifestyle choices — overeating and excessive drinking — prompted by lockdowns. The most depressing aspect of this excess death phenomenon is that life expectancy in the U.S. has dropped for the second consecutive year. Current life expectancy in the U.S. is 76.4 years, the lowest figure of the past two decades. After World War II, American longevity was the envy of the world. Now we have fallen behind Lebanon, Cuba and Czechia. All this is in the face of improved care for the elderly: The U.S. has comparable survival after age 75 with industrialized countries, better control of cardiovascular risk factors, lower stroke mortality, and higher rates of cancer screening and survival. The alarming truth is that the decrease in U.S. life expectancy has come at the expense of teenagers, young adults and those in early middle age. This is not the result of COVID-19; in 2021 alone, more potential years of American life were lost because of drugs (primarily opiates), road deaths, firearm violence and obesity than years lost from COVID-19 during the entire pandemic. In “The Tempest,” William Shakespeare cautioned that “what’s past is prologue.” Englishman John Burn-Murdoch, a columnist for the Financial Times, has studied mortality patterns in the U.S. and United Kingdom and warns, “One in 25 American 5-year-olds today will not make it to their 40th birthday. No parent should ever have to bury their child, but on average across the US one set of parents from every kindergarten class most likely will.” Surely a clarion call, to which America must respond immediately.
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Juan Lama
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In a recent study published in the JAMA Journal, researchers compared the mortality rates associated with coronavirus disease 2019 (COVID-19) with those of seasonal influenza during the fall-winter season of 2022–2023. Background During the initial stages of the COVID-19 pandemic, the mortality rates associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were thought to be five times that of seasonal influenza infections. However, the rapid development of COVID-19 vaccines and various therapies, including antivirals and monoclonal antibodies, have significantly decreased the number of deaths due to SARS-CoV-2 infections. Furthermore, the clinical care facilities and immunity against SARS-CoV-2 at a population level have also improved, which has reduced the number of deaths due to COVID-19. These changes could also have affected the mortality rates associated with the seasonal influenza virus. About the study The researchers used the United States Department of Veteran Affairs' electronic health databases to enroll participants in the study. The participants had at least one hospital admission record between October 2020 and January 2023, two days before and ten days following a positive test for influenza or SARS-CoV-2 alongside a diagnosis of influenza or COVID-19 upon admission. Individuals with both infections were excluded. The participants were followed-up for 30 days after hospitalization, until the first event of death, or until latest March 2, 2023. Absolute standardized differences were used to analyze the baseline characteristics of all participants. Cox survival models weighted with inverse probability were used to compare the mortality risk between patients hospitalized with influenza and COVID-19. Propensity scores were calculated while accounting for covariates. The absolute risk was also calculated based on the difference in mortality rates at 30 days between COVID-10 and influenza as the percentage of excess deaths. Additionally, the risk analyses were conducted for subgroups based on age, COVID-19 vaccination status, the severity of SARS-CoV-2 infection, and outpatient treatment with antivirals against COVID-19 before hospitalization. Results The results indicated that the mortality rate associated with COVID-19 among the veteran population during the fall-winter season of 2022–2023 continued to be higher than that of seasonal influenza infections. During the study period, there were 8,996 hospital admissions due to COVID-19, among which there were 538 deaths, while there were 76 deaths among the 2,403 patients hospitalized for seasonal influenza. At 30 days, the mortality rates for SARS-CoV-2 infection and seasonal influenza were 5.97% and 3.75%, respectively, with the excess death rate being 2.23%. The subgroup analysis revealed that COVID-19 vaccination was linked to a decrease in the mortality rate, but the other factors in the subgroup analysis, such as age and antiviral treatment in the outpatient setting, did not affect the mortality rates. Although the mortality rates associated with COVID-19 continue to be higher than the seasonal influenza mortality rates, it must be noted that the death rates for severe SARS-CoV-2 infections requiring hospitalization had decreased substantially since 2020 (when the mortality rates were between 17% and 21%). The seasonal influenza mortality rates have remained relatively steady since 2020 (3.8% vs. 3.7% in 2023). The researchers believe that the decrease in the mortality rate for COVID-19 could be due to multiple factors. These include the emergence of new SARS-CoV-2 variants with lower virulence, increased immunity from multiple doses of vaccines and SARS-CoV-2 infections, and significant improvement in clinical care. The difference in mortality rates between unvaccinated individuals and vaccinated or boosted individuals highlights the importance of COVID-19 vaccines in decreasing the severity and mortality associated with COVID-19. One of the study's limitations is that the study population consisted of predominantly older male veterans, making it difficult to generalize the findings to the larger population. Conclusions Overall, the findings indicated that COVID-19 mortality rates had decreased significantly since the onset of the pandemic. However, the deaths remain higher than those due to seasonal influenza. However, primary and booster vaccines have considerably reduced COVID-19 mortality rates, highlighting the protective effects of the vaccines. Research published in JAMA (April 6, 2023): https://jamanetwork.com/journals/jama/fullarticle/2803749
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China’s murky statistics are fueling widespread public distrust. Its narrow definition of Covid deaths “will very much underestimate the true death toll,” the W.H.O. says. The hearses bearing black and yellow funeral paper flowers crept in a steady stream toward the Dongjiao crematory in eastern Beijing. Several dozen people crowded around the closed gate waiting to be let in. A man unable to get a spot in line could only watch, wondering what to do with the body of a relative who had just died of Covid. The hospital could not keep the body — there were already too many in its morgue. When he called the crematory, an employee told him he had to wait a week. When he called again, nobody answered. A country trying to mourn its dead from an explosive Covid outbreak is grappling with a system unprepared for the surge in fatalities. Two weeks after China abruptly abandoned its “zero Covid” policy, cases have soared in cities like Beijing, along with reports of people dying. Funeral home directors and sellers of funeral supplies describe a flood of phone calls from families needing help handling the bodies of relatives. On Chinese social media, people are sharing videos and photos of morgues crowded with bodies, as well as their own personal accounts of losing loved ones to the outbreak. But China’s government is painting a less dire picture. In its official statistics and propaganda reports, China has acknowledged only seven deaths from Covid in the past two weeks, and only in Beijing. The National Health Commission even reduced the country’s cumulative Covid death toll on Wednesday by one, to 5,241. Officials have explained that China counts Covid deaths only if the virus was the direct cause of a respiratory failure — a definition the World Health Organization said would lead to a vast underestimate. The ruling Communist Party may have a political incentive to downplay the toll of an epidemic it has suddenly stopped trying to control. Xi Jinping, China’s top leader, has portrayed his country’s earlier success in limiting Covid deaths as evidence of China’s superiority over the West, a claim that would be hard to maintain with numerous deaths. “If they were to publicize the death figure, it would amount to a big blow to the prestige of the party,” said Willy Lam, an expert in Chinese politics at the Jamestown Foundation, a research group. But doctors and international health experts say an underestimate of the toll risks fueling public complacency about the risks of the virus. Chinese commentators and the public have widely criticized the death toll, saying it obfuscates the real picture and hurts the government’s credibility. “These are an example of ‘believing in one’s own lies,’” Mei Xinyu, an economist at a research institute affiliated with the Commerce Ministry, wrote on his social media page, commenting on a daily report of Covid figures released by the government. He later posted an announcement that the father-in-law of a prominent economist had died from pneumonia induced by Covid. The man’s family, he wrote, waited hours for an ambulance to arrive and take him to the hospital. “In the end, he could only be left on the floor of the hospital mortuary, awaiting cremation,” Mr. Mei wrote. He said that the family was having trouble getting a cremation slot and hiring a hearse. “The family members are heartbroken.” As is the case elsewhere, deaths in China tend to rise in winter, because of an increase in flu and other respiratory infections, even in normal times. But people working in funeral services say they have noticed a larger increase than usual. At the Yong’an funeral services business in Shijiazhuang, a city about 200 miles southwest of Beijing, an employee said that he used to handle 10 deaths per month but is now getting calls for about five each day. Some Chinese media reports have acknowledged a handful of Covid-related deaths. Wang Ruoji, a 37-year-old retired soccer star, died after a Covid infection worsened an underlying condition. Caixin, a respected news outlet, wrote that Zhou Zhichun, a former senior editor at a Communist Party newspaper, died at 77 after getting Covid, with his doctors classifying the cause as sudden cardiac death. But on social media, users have shared official obituaries of several other prominent people who have died in recent days, including an opera singer and an artist who helped design sports mascots. Many speculated that the true cause of these deaths was being concealed with descriptions such as “severe cold infections.” At a government news conference on Tuesday, Wang Guiqiang, an infectious diseases expert, said China counts only those who died from pneumonia or respiratory failure caused by Covid in its official toll. He said that cases of fatal pneumonia are less frequent because the Omicron variant that is prevalent now infects mostly the upper airway. Another official explained why China revised its Covid death toll down by one this week. A review by experts determined that one death reported on Tuesday was a person who had died from other diseases, Yao Xiujun, a publicity official at the Beijing Municipal Commission of Health and Family Planning, said in a phone interview. China’s limited definition excludes the deaths of people who had underlying diseases that were aggravated by Covid. Deaths in China are also only ascribed to Covid by panels of experts convened by hospitals, potentially leaving out people who died at home or elsewhere. In contrast, the United States, Britain and Hong Kong tend to include people who died with Covid, and not just of it, to varying degrees. China might not be alone in its approach. In Russia, the government counts only deaths confirmed to have been directly caused by the virus. On Wednesday, Michael Ryan, head of health emergencies at the World Health Organization, suggested that China’s definition was inadequate. “It’s quite focused on respiratory failure — people who die of Covid die from many different systems failures given the severity of the infection,” he said. China’s methodology, he said, “will very much underestimate the true death toll associated with Covid.” Such an underestimate has its advantages, health experts say. It could limit public panic and reduce the burden imposed on hospitals by people who are not severely ill. Already, China has been struggling to provide supplies of ibuprofen and other fever-reducing medication as people have rushed to hoard such drugs. An underestimate could also help businesses at a time when the government has been trying to rescue an economy battered by nearly three years of disruptive lockdowns and costly testing programs. In some large cities, companies and officials are encouraging people to go to work even when mildly sick with Covid. But an undercount could also backfire by undermining the government’s own efforts to urge the public to take necessary precautions. Many seniors in China might continue avoiding vaccination, and younger people might take the virus less seriously than they should, said Jin Dongyan, a virologist at the University of Hong Kong. Professor Jin said China has for decades recorded deaths from infectious diseases narrowly, including SARS in 2003 and seasonal flu. It made an exception during the Shanghai lockdown in the spring of this year, using a looser definition as the authorities sought to justify what became a bruising, two-month lockdown. Of the 588 Covid deaths the Shanghai city government reported, one was ascribed to a heart attack, and the rest to “underlying conditions” or “tumors.” Despite this inconsistency, the National Health Commission has never expunged those deaths from the national data. No matter what the official numbers depict, China is expecting a wave of deaths. “Although the overall case fatality rate is low, the number of people infected is very large, so this may make the absolute number of deaths caused by this risk relatively large,” Wang Guangfa, a respiratory specialist at Peking University First Hospital, said in an interview. Already, the strain is fueling public frustration. “The funeral homes are crazily packed,” said a Beijing resident who would only give her surname, Chen, for fear of retaliation from the government. Ms. Chen said that her grandfather died on Tuesday of Covid complications, including pneumonia and kidney failure, after being in a coma for a week. It took two days for Ms. Chen’s family to find a funeral home in Beijing that would cremate her grandfather’s body. Ms. Chen also expressed skepticism over the government’s Covid statistics. “If there are only five Covid deaths in one day, I have known nearly half of them,” she said. “It’s heartbreaking that we Beijing people have to bear the first impact of the massive spread of the virus.” Li You, Claire Fu and John Liu contributed reporting and research.
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A COVID-19 autopsy study from NIAID and many other collaborators helped researchers rethink where SARS-CoV-2 spread in the body and how long its remnants persisted. Autopsies of 44 people who died from COVID-19 in the first year of the pandemic showed researchers that disease-causing SARS-CoV-2 virus spread throughout the body – beyond just a respiratory disease – and remained in tissue for months. The study, from the National Institutes of Health and published in Nature, helped scientists broaden their perspectives on where SARS-CoV-2 could cause infection and persist, including the brain. The work also supported the rationale for a clinical trial evaluating the antiviral drug Paxlovid for the treatment of post-acute sequelae of COVID-19, also known as Long COVID. Findings from the autopsies, which took place between April 2020 and March 2021, confirmed that SARS-CoV-2 primarily infected and damaged the airway and lungs. But scientists also found virus fragments (viral RNA) in 79 of 85 body locations, with some virus found up to 230 days after patient’s symptoms began. Scientists found virus in cardiovascular, lymphoid, gastrointestinal, renal, endocrine, reproductive, muscle, brain and other tissue – although none of these areas sustained significant inflammation compared to what they found in the respiratory tract. Scientists from NIH’s National Institute of Allergy and Infectious Diseases and Clinical Center led the work, closely collaborating with National Cancer Institute (NCI) pathologists, four other NIH institutes, the University of Maryland, and Maryland health care facilities in Salisbury and Towson. “We show SARS-CoV-2 disseminates across the human body and brain early in infection at high levels and provide evidence of virus replication at multiple extrapulmonary sites during the first two weeks following symptom onset,” their study states. Virus can spread throughout the body and viral RNA may remain detectable for months even in cases with mild or no symptoms, they say. Senior study author Dr. Daniel Chertow said prior to the work, “the thinking in the field was that SARS-CoV-2 was predominantly a respiratory virus.” Finding the viral fragments in tissue throughout the body – and sharing those findings with colleagues a year ago – helped scientists explore a relationship between the viral fragments and Long COVID. Long COVID gets its name from the persistent symptoms some people experience after having COVID-19; symptoms can be debilitating, and the cause is not known. Though the study in Nature did not specifically explore Long COVID, finding the viral RNA throughout the body raised speculation that those fragments might contribute to the persistent symptoms, according to Dr. Chertow. Treating people with an effective COVID-19 antiviral such as Paxlovid could, therefore, eliminate the persistent symptoms. The Paxlovid trial, now underway at Duke University, is part of the NIH-funded RECOVER project – Researching COVID to Enhance Recovery – and includes an extension of the autopsy work, according Dr. Stephen Hewitt of NCI, who collaborated on the paper in Nature, and serves on a steering committee for the RECOVER project. He said one branch of RECOVER includes tissue pathology studies, and obtaining material from autopsies is in progress; these autopsies include people who both were vaccinated and infected with variants of concern – data not available in the earlier study that Dr. Chertow’s group led. “We’re hoping to replicate the data on viral persistence and study the relationship with Long COVID,” Dr. Hewitt said, adding that the project is scheduled to last four years. “Less than a year in we have about 85 cases, and we are working to expand these efforts.” Published (Dec. 14, 2022) in Nature: https://doi.org/10.1038/s41586-022-05542-y
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To date, multiple people have died of the virus in several other countries that have not previously experienced monkeypox outbreaks, including Spain, Brazil and India. KEY FACTS The Harris County Public Health Department said an adult resident with “various severe illnesses” died Sunday in the hospital after contracting monkeypox. Health officials said they were still investigating what “role” monkeypox played in the death. The case comes after six monkeypox-related deaths have been reported in countries that have not historically reported outbreaks, including Spain, Brazil, Cuba, Ecuador and India, according to the Centers for Disease Control and Prevention. Health officials shared the information to “err on the side of transparency and to avoid potential misinformation,” Harris County judge Lina Hidalgo said in a statement, adding the best way to “fight the virus is through vaccines.” As of August 29, the U.S. had confirmed 18,101 cases of monkeypox and orthopoxvirus—the class of viruses that monkeypox belongs to—across every state, according to the CDC. CRUCIAL QUOTE “It’s important to emphasize that deaths due to monkeypox, while possible, remain very rare. In most cases, people are experiencing infection that resolves over time, and there have been very few deaths even reported globally out of over 40,000 cases around the world,” Jennifer McQuiston, the CDC's top monkeypox official, said in a briefing Tuesday. WHAT TO WATCH FOR Local health officials plan to share results from an autopsy confirming the final cause of death in the next few weeks. BIG NUMBER 48,401. That’s how many monkeypox cases have been reported in 92 countries that have not historically reported outbreaks as of August 29, according to the CDC. Global cases started to fall last week, the World Health Organization said, including in some hard-hit jurisdictions in the U.S. NEWS PEG The WHO declared monkeypox a public health emergency of international concern on July 23, warning of an outbreak spreading rapidly around the world, followed by the U.S. on August 4. KEY BACKGROUND The ongoing global outbreak of monkeypox began at the end of April, with cases cropping up in several European countries that have not historically experienced outbreaks. At least nine deaths have been reported in Africa this year as well, where the virus is endemic in certain regions, though the outbreaks have received little international attention in the past. Some recent research suggests people infected with monkeypox are experiencing symptoms not typically associated with the viral infection in the past, including rectal pain and swollen tonsils. Monkeypox symptoms typically last two to four weeks, and case fatality rates for the disease in recent years are between 3% to 6%, according to the World Health Organization. The U.S. has declared the virus an emergency to help streamline resources and has approved a new vaccination strategy to stretch supplies of the Jynneos vaccine, the only shot specifically approved by the Food and Drug Administration to protect against monkeypox. The federal government has been aiming to get shots first to those at highest risk for the virus: The vast majority of cases of monkeypox—which is spread through close contact—have been identified among men who have sex with men, particularly those who have multiple or anonymous sexual partners.
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First infection with SARS-CoV-2 is associated with increased risk of acute and post-acute death and sequelae in the pulmonary and extrapulmonary organ systems. However, whether reinfection adds to the risk incurred after the first infection is not clear. Here we use the national health care databases of the US Department of Veterans Affairs to build a cohort of people with first infection (n = 257,427), reinfection (2 or more infections, n = 38,926), and a non-infected control group (n = 5,396,855) to estimate risks and 6-month burdens of all-cause mortality, hospitalization, and a set of pre-specified incident outcomes. We show that compared to people with first infection, reinfection contributes additional risks of all-cause mortality, hospitalization, and adverse health outcomes in the pulmonary and several extrapulmonary organ systems (cardiovascular disorders, coagulation and hematologic disorders, diabetes, fatigue, gastrointestinal disorders, kidney disorders, mental health disorders, musculoskeletal disorders, and neurologic disorders) The risks were evident in those who were unvaccinated, had 1 shot, or 2 or more shots prior to the second infection; the risks were most pronounced in the acute phase, but persisted in the post-acute phase of reinfection, and most were still evident at 6 months after reinfection. Compared to non-infected controls, assessment of the cumulative risks of repeated infection showed that the risk and burden increased in a graded fashion according to the number of infections. The constellation of findings show that reinfection adds non-trivial risks of all-cause mortality, hospitalization, and adverse health outcomes in the acute and post-acute phase of the reinfection. Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention. Preprint available (June 17, 2022) in Research Square
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Understanding the death toll — who makes up the one million and how the country failed them — is essential as the pandemic continues.
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Background: The objective of this study was to describe 12-month mortality following COVID-19 compared with a reference population with no history of COVID-19.
Methods: Retrospective nationwide cohort study using electronic health care data on cases (n= 66,287 COVID-19 patients) and controls (n=254,969) with linkage to SARS-CoV-2 testing and death records.
Results: People infected with COVID-19 had more than three times the risk of dying over the following year compared with those who remained uninfected. Short-term mortality (up to 5 weeks post-infection) was significantly higher among COVID-19 patients (1623/10 000) than controls (118/10 000). For COVID-19 cases over 60 years old, increased mortality persisted until the end of the first year after infection, and was related to increased risk for cardiovascular (aHR 2·1, 95%CI 1·8-2·3), cancer (aHR 1·5, 95%CI 1·2-1·9), respiratory system diseases (aHR 1·9, 95%CI 1·2-3·0), and other causes of death (aHR 1·8, 95%CI 1·4-2·2).
Conclusions: Increased risk of death from COVID-19 is not limited to the acute illness· COVID-19 infection carries a substantially increased risk of death in the following 12 months. This excess death mainly occurs in older people and is driven by broad array of causes of death. Preprint available (The Lancet, Feb. 7, 2022): https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4028547
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GENEVA, Nov 23 (Reuters) - The World Health Organization (WHO) said on Tuesday there could be a further 700,000 deaths from COVID-19 in Europe by March, taking the total to above 2.2 million, as the world body urged people to get vaccinated. Total cumulative deaths from the respiratory disease in the 53 countries of the WHO's European region have already surpassed 1.5 million, it said, with the daily rate doubling from late September to 4,200 a day. The WHO's European region also includes Russia and other former Soviet republics as well as Turkey. "Cumulative reported deaths are projected to reach over 2.2 million by spring next year, based on current trends," it said, adding that COVID-19 is now the top regional cause of death. High or extreme stress on intensive care units is expected in 49 out of 53 countries by March 1, the WHO added. The Netherlands started transporting COVID-19 patients across the border to Germany on Tuesday as pressure rises on hospitals and infections jump to record levels. Austria began its fourth lockdown on Monday. Beyond prevention measures such as masks and hand-washing, the WHO's Regional Director for Europe, Hans Kluge, urged people to get primary vaccines doses and a booster "if offered". WHO officials have previously advised against COVID-19 vaccine boosters until more people around the world have received primary doses. "All of us have the opportunity and responsibility to help avert unnecessary tragedy and loss of life, and limit further disruption to society and businesses over this winter season," said Kluge. Reporting by Emma Farge Editing by Gareth Jones
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Coronavirus vaccines may have prevented 39,000 deaths among seniors by May, a new government study finds. Before vaccines, the San Francisco Department of Public Health needed three whiteboards to capture all the names of senior facilities that had Covid-19 outbreaks. "We had been dealing with outbreaks the whole time. Everywhere, at a ton of facilities, big, small, rich, poor, it didn't matter," said Dr. Louise Aronson,a professor with the UCSF Division of Geriatrics. But by February, when seniors were starting to get vaccinated in greater numbers, the department started to erase names from these outbreak lists. "I think it was April when all the whiteboards were empty. I took a picture of it with my phone. It was so quick. The vaccines were transformational," Aronson told CNN. "It was sort of a very visible miracle." These "visible miracles" were playing out across the country this spring, according to a new report published Tuesday by the US Department of Health and Human Services. Vaccinations prevented at least a quarter of a million Covid-19 infections among seniors and tens of thousands of deaths just between January and May of this year. The report from researchers at HHS's Office of the Assistant Secretary for Planning and Evaluation found that vaccinations of Medicare beneficiaries were linked to a reduction in about 265,000 new Covid-19 infections, 107,000 hospitalizations, and 39,000 deaths in that time period. Seniors have been hit hard by the pandemic. Nearly 80% of Covid-19 deaths have been among people 65 and older. These numbers show why public health leaders have been pushing so hard to get people vaccinated. "The fact that you were able to stop that many deaths and that many cases and hospitalizations even that early on, just a few months into when people could get vaccinated, that really goes to show you that the vaccine works," Dr. Claudia Hoyen, who did not work on this study, told CNN. She is an infectious disease specialist and director of pediatric infection control at UH Rainbow Babies and Children's Hospital in Cleveland. The US Centers for Disease Control and Prevention said people 65 and older who are fully vaccinated saw a 94% reduced risk of hospitalization. Seniors are now the most vaccinated demographic in the US. More than 94% of seniors now have gotten at least one dose of the Covid-19 vaccine, according to the CDC. Even in Alabama where vaccine uptake is slow, seniors are the most vaccinated of any age group, according to the Alabama Public Health Department. When all adults had high vaccination rates in an area, not just seniors, protection was even better. The positive impact the vaccines had were seen across all racial and ethnic groups and across all 48 states where research was available. HHS estimates there was a reduction of 29,000 infections and nearly 4,600 deaths among Black Medicare beneficiaries and a similar number among Hispanic beneficiaries. For people who identify as Asian, it was a reduction of 7,600 infections and 1,400 deaths. Vaccinations made the biggest difference averting deaths and hospitalizations among Alaska Native and American Indian communities, the report found, with an estimated 21% reduction in infections, compared to 18% among White populations, and a 25% reduction in the number of deaths compared to 22% among White people. "This report reaffirms what we hear routinely from states: COVID-19 vaccines save lives, prevent hospitalizations, and reduce infection," HHS Secretary Xavier Becerra said in a statement. "The Biden-Harris Administration has prioritized getting vaccines quickly to pharmacies, nursing homes, doctors' offices and even provided increased reimbursement rates for at-home COVID-19 vaccinations, so that seniors and others can easily get vaccinated." Due to waning immunity, the CDC now recommends that people 65 and older get a booster at least six months after their primary series if they got the Pfizer-BioNTech shots. About 8% of people 65 and older already have. Vaccine advisers to the US Food and Drug Administration are scheduled to discuss booster doses for the Moderna and Johnson & Johnson vaccines later this month. "I hope this makes a lot of seniors really excited about the news that they are now eligible for boosters if they're six months out," Hoyen said. "And as we're going into winter we want to be sure that everyone's immunity is up, so now would also be a good time for those seniors to go ahead and think about boosters and flu shots."
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The study, which was suspended following three deaths last year, had been restarted in February after Astellas lowered the treatment dose used. A young boy enrolled in a clinical trial testing an experimental gene therapy died last week after developing abnormal liver function following treatment, the study's sponsor, Astellas Pharma, said in a brief statement Tuesday. The boy's death is the fourth to occur in the trial, which is studying Astellas' gene therapy as a treatment for a rare and fatal neuromuscular condition known as X-linked myotubular myopathy. The trial had been halted after the first three deaths, which happened in May, June and August last year. Following the trial's suspension, Astellas lowered the treatment dose, which was one of the highest being tested in any gene therapy study, by more than half. The Food and Drug Administration subsequently allowed Astellas to resume the trial in December 2020, only for the company to pause it again Sept. 1 after tests showed abnormal liver function in the boy who died last week. He was the first and only participant treated following the restart, Astellas said. The cause of death is still pending and the company continues to gather more information. "We will investigate and review all findings with our independent data monitoring committee, our expert liver advisory panel and the ASPIRO site investigators," said Nathan Bachtell, head of gene therapy, medical and development at Astellas, in the Tuesday statement. ASPIRO is the name of Astellas' trial. The information disclosed to date, however, appears to share similarities with what Astellas reported about three other study participants who died last year. Each developed signs of liver damage following treatment with the high dose of Astellas' therapy, which later progressed to liver failure. The cause of death in two of the participants was sepsis and in the third, gastrointestinal bleeding. The trial's tragedy is a serious blow to gene therapy research, confronting both Astellas and the broader field with weighty questions on the safety of these gene-based treatments, particularly those involving higher doses. "This is clearly a call to action for the field," said Nicole Paulk, an assistant professor at the University of California, San Francisco who works on gene therapy but doesn't have ties to Astellas. "We all need to start looking at the clinical data we already have, but also to set up preclinical modeling in mice or non-human primates and try to figure it out." Earlier this month, the FDA convened a panel of expert advisers to discuss gene therapy safety in a closely followed two-day meeting that touched on the then three deaths that had occurred in Astellas' study. Experts made several recommendations for how to better screen participants and suggested lower doses might help manage side effects. But they didn't call for upper limits to gene therapy doses, citing inconsistencies in how dose size is measured, among other points. Signs of liver toxicity, but not patient deaths, have been reported in trials of other gene therapies for hemophilia and spinal muscular atrophy. In those cases, however, the liver-related side effects were either more benign, or effectively managed with steroid treatment. Intravenously administered gene therapies, like other drugs, are processed by the liver as blood flows through the organ. While factors like dose size and underlying patient conditions are clearly important, it's still unclear exactly what else may have contributed to make Astellas' gene therapy so toxic for the four trial volunteers who died. "This brings up more questions than answers," said Paulk. She noted, however, that it seems "there is clearly something to do with this background of preexisting and/or active liver disease." Audentes Therapeutics, the original biotech developer of the therapy that Astellas bought in late 2019, has previously been criticized for not sharing more information on the first three patient deaths. In a letter to the patient community dated Sept. 13, Astellas' Bachtell said all other enrolled study participants will be followed closely and asked parents to reach out to trial investigators with any questions. The company is awaiting a formal clinical hold letter from the FDA after receiving notice the agency would officially halt further study via a Sept. 3 email. "Following receipt of the official FDA clinical hold letter, Astellas will review its contents and have further dialogue with regulators on the path forward," the company said in its statement. To date, two dozen boys have been treated with Astellas' therapy, which is known as AT-132. Seventeen were given the high dose that was suspended last year, and seven received the lower dose. X-linked mytobular myopathy, or XLMTM, is a fatal disease of the muscles, caused by mutations in a gene known as MTM1. As the disease is inherited via the X chromosome, it occurs almost exclusively in boys. Progressive muscle weakness limits patients' ability to stand, walk and sit. When severe, breathing and eating can also be affected. AT-132 is designed to treat the disease by delivering a functional copy of the MTM1 gene to muscle cells via a special type of virus commonly used in gene therapy.
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Purpose: To develop a reliable tool that predicts which patients are most likely to be COVID-19 positive and which ones have an increased risk of hospitalization. Methods: From February 2020 to April 2021, trained nurses recorded age, gender, and symptoms in an outpatient COVID-19 testing center. All positive patients were followed up by phone for 14 days or until symptom-free. We calculated the symptoms odds ratio for positive results and hospitalization and proposed a random forest machine-learning model to predict positive testing. Results: A total of 8,998 patients over 16 years old underwent COVID-19 RT-PCR, with 1,914 (21.3%) positives. Fifty patients needed hospitalization (2.6% of positives), and three died (0.15%). Most common symptoms were: cough, headache, sore throat, coryza, fever, myalgia (57%, 51%, 44%, 36%, 35%, 27%, respectively). Cough, fever, and myalgia predicted positive COVID-19 test, while others behaved as protective factors. The best predictors of positivity were fever plus anosmia/ageusia (OR=6.31), and cough plus anosmia/ageusia (OR=5.82), both p<0.0001. Our random forest model had an ROC-AUC of 0.72 (specificity=0.70, sensitivity=0.61, PPV=0.38, NPV=0.86). Having steady fever during the first days of infection and persistent dyspnea increased the risk of hospitalization (OR=6.66, p<0.0001 and OR=3.13, p=0.003, respectively), while anosmia-ageusia (OR=0.36, p=0.009) and coryza (OR=0.31, p=0.014) were protective. Conclusion: Present study and algorithm may help identify patients at higher risk of having SARS-COV-2 (online calculator http://wdchealth.covid-map.com/shiny/calculator/), and also disease severity and hospitalization based on symptoms presence, pattern, and duration, which can help physicians and health care providers. Available as Preprint in medRxiv (August 10, 2021): https://doi.org/10.1101/2021.08.09.21261729
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Coronavirus Disease 2019 (COVID-19) vaccination has resulted in excellent protection against fatal disease, including in older adults. However, risk factors for post-vaccination fatal COVID-19 are largely unknown. We comprehensively studied three large nursing home outbreaks (20–35% fatal cases among residents) by combining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) aerosol monitoring, whole-genome phylogenetic analysis and immunovirological profiling of nasal mucosa by digital nCounter transcriptomics. Phylogenetic investigations indicated that each outbreak stemmed from a single introduction event, although with different variants (Delta, Gamma and Mu). SARS-CoV-2 was detected in aerosol samples up to 52 d after the initial infection. Combining demographic, immune and viral parameters, the best predictive models for mortality comprised IFNB1 or age, viral ORF7a and ACE2 receptor transcripts. Comparison with published pre-vaccine fatal COVID-19 transcriptomic and genomic signatures uncovered a unique IRF3 low/IRF7 high immune signature in post-vaccine fatal COVID-19 outbreaks. A multi-layered strategy, including environmental sampling, immunomonitoring and early antiviral therapy, should be considered to prevent post-vaccination COVID-19 mortality in nursing homes. Although vaccination drops COVID-19 mortality in older adults, post-vaccine fatal COVID-19 in nursing home outbreaks was linked to Delta, Gamma and Mu variants, persistently detected in aerosols. Mortality was predicted by IFNB1 or age, ORF7a and ACE2 mRNAs. Published May 22, 2023: https://doi.org/10.1038/s43587-023-00421-1
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By applying machine learning to medical record data, scientists found that secondary bacterial pneumonia that does not resolve was a key driver of death in patients with COVID-19. It may even exceed death rates from the viral infection itself. The scientists also found evidence that COVID-19 does not cause a “cytokine storm,” so often believed to cause death. "Our study highlights the importance of preventing, looking for and aggressively treating secondary bacterial pneumonia in critically ill patients with severe pneumonia, including those with COVID-19," said senior author Dr. Benjamin Singer, an associate professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine pulmonary and critical care physician. The investigators found nearly half of patients with COVID-19 develop a secondary ventilator-associated bacterial pneumonia. “Those who were cured of their secondary pneumonia were likely to live, while those whose pneumonia did not resolve were more likely to die,” Singer said. “Our data suggested that the mortality related to the virus itself is relatively low, but other things that happen during the ICU stay, like secondary bacterial pneumonia, offset that.” The study findings also negate the cytokine storm theory, said Singer, also the Lawrence Hicks Professor of Pulmonary Medicine at Feinberg. “The term ‘cytokine storm’ means an overwhelming inflammation that drives organ failure in your lungs, your kidneys, your brain and other organs,” Singer said. “If that were true, if cytokine storm were underlying the long length of stay we see in patients with COVID-19, we would expect to see frequent transitions to states that are characterized by multi-organ failure. That’s not what we saw.” The study analyzed 585 patients in the intensive care unit (ICU) at Northwestern Memorial Hospital with severe pneumonia and respiratory failure, 190 of whom had COVID-19. The scientists developed a new machine learning approach called CarpeDiem, which groups similar ICU patient-days into clinical states based on electronic health record data. This novel approach, which is based on the concept of daily rounds by the ICU team, allowed them to ask how complications like bacterial pneumonia impacted the course of illness. These patients or their surrogates consented to enroll in the Successful Clinical Response to Pneumonia Therapy (SCRIPT) study, an observational trial to identify new biomarkers and therapies for patients with severe pneumonia. As part of SCRIPT, an expert panel of ICU physicians used state-of-the-art analysis of lung samples collected as part of clinical care to diagnose and adjudicate the outcomes of secondary pneumonia events. “The application of machine learning and artificial intelligence to clinical data can be used to develop better ways to treat diseases like COVID-19 and to assist ICU physicians managing these patients,” said study co-first author Dr. Catherine Gao, an instructor in pulmonary and critical care medicine at Feinberg and a Northwestern Medicine physician. “The importance of bacterial superinfection of the lung as a contributor to death in patients with COVID-19 has been underappreciated because most centers have not looked for it or only look at outcomes in terms of presence or absence of bacterial superinfection, not whether treatment is successful or not,” said study co-author Dr. Richard Wunderink, who leads the Successful Clinical Response in Pneumonia Therapy Systems Biology Center at Northwestern. The next step in the research will be to use molecular data from the study samples and integrate it with machine learning approaches to understand why some patients go on to be cured of pneumonia and some don’t. Investigators also want to expand the technique to larger datasets and use the model to make predictions that can be brought back to the bedside to improve the care of critically ill patients. Other Northwestern authors on the paper include Nikolay S. Markov, Thomas Stoeger, Anna E. Pawlowski,Mengjia Kang,Prasanth Nannapaneni, Rogan A. Grant,Chiagozie Pickens, James M. Walter, Jacqueline M. Kruser, Luke V. Rasmussen, Daniel Schneider, Justin Starren, Helen K. Donnelly, Alvaro Donayre, Yuan Luo, Scott Budinger and Alexander Misharin. The study was supported by the Simpson Querrey Lung Institute for Translational Sciences and grant U19AI135964 from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health. Study Published in the J. Clin. Investig. (April 27, 2023): https://doi.org/10.1172/JCI170682
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COVID-19 is associated with higher risks of cardiovascular disease and death in the short- and long-term, according to a study in nearly 160,000 participants published today in Cardiovascular Research, a journal of the European Society of Cardiology (ESC). Compared to uninfected individuals, the likelihood of COVID-19 patients dying was up to 81 times higher in the first three weeks of infection and remained five times higher up to 18 months later. "COVID-19 patients were more likely to develop numerous cardiovascular conditions compared to uninfected participants, which may have contributed to their higher risks of death," said study author Professor Ian C.K. Wong of the University of Hong Kong, China. "The findings indicate that patients with COVID-19 should be monitored for at least a year after recovering from the acute illness to diagnose cardiovascular complications of the infection, which form part of long COVID." This study compared the occurrence of cardiovascular conditions and death in infected versus uninfected individuals recruited before December 2020, when no vaccines were available in the UK. More than 7,500 patients with COVID-19 infection diagnosed from March 16, 2020 to November 30, 2020 were identified from UK Biobank. Each patient was matched with up to 10 individuals without COVID-19 during the study period (March 16, 2020 to the end of follow-up on August 31, 2021) and a historical cohort before the pandemic (March 16, 2018 to November 30, 2018). Each uninfected group had more than 70,000 participants who were similar to the COVID-19 group for age, sex, smoking, diabetes, high blood pressure, cardiovascular and other health conditions, body mass index, ethnicity, and deprivation. In all three groups, the average age was 66 years and there were nearly equal numbers of women and men. Professor Wong explained, "The historical control cohort was included to rule out the effect of routine healthcare services being reduced or canceled during the pandemic, which led to worsening health and increased mortality even in uninfected people." Data were obtained from medical and death records for outcomes including major cardiovascular disease (a composite of heart failure, stroke and coronary heart disease); numerous cardiovascular conditions such as stroke, atrial fibrillation and myocardial infarction; death from cardiovascular disease; and all-cause death. Associations were evaluated for the acute phase (within 21 days of COVID-19 diagnosis) and the post-acute phase (starting at 22 days after diagnosis and continuing up to 18 months). Participants with a history of a particular outcome were excluded from that analysis. Compared with the two uninfected cohorts, patients with COVID-19 were approximately four times more likely to develop major cardiovascular disease in the acute phase and 40% more likely in the post-acute phase. Compared to uninfected individuals, the risk of death in COVID-19 patients was up to 81-fold higher in the acute phase and five-fold higher in the post-acute phase. Patients with severe COVID-19 were more likely to develop major cardiovascular disease or die than non-severe cases. COVID-19 patients had a greater likelihood of several cardiovascular conditions compared with uninfected participants in both the short- and long-term including myocardial infarction, coronary heart disease, heart failure, and deep vein thrombosis. Risks of some cardiovascular conditions—for example stroke and atrial fibrillation—were elevated in COVID-19 patients in the short-term but then returned to normal levels. Professor Wong said, "This study was conducted during the first wave of the pandemic, and future research should evaluate subsequent outbreaks. Previous research has indicated that COVID-19 vaccination may prevent complications, and further studies are needed to investigate its effectiveness in reducing the risks of cardiovascular disease and death after COVID-19 infection in patients with COVID-19 vaccination compared to those without vaccination." ESC spokesperson Professor Héctor Bueno of the National Centre for Cardiovascular Research (CNIC), Madrid, Spain said, "COVID-19 has had a huge impact on patients with cardiovascular disease, who were less likely to receive optimal care during the pandemic and more likely to die from the infection. This study shows that COVID-19 also increases the risk of having cardiovascular complications and dying in the first weeks after the infection and remains high for months, suggesting that specific cardiovascular monitoring may be appropriate in these patients." Cited study published in Cardiovascular Research (Jan. 19, 2023): https://doi.org/10.1093/cvr/cvac195
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The World Health Organization has a mandate to compile and disseminate statistics on mortality, and we have been tracking the progression of the COVID-19 pandemic since the beginning of 20201. Reported statistics on COVID-19 mortality are problematic for many countries owing to variations in testing access, differential diagnostic capacity and inconsistent certification of COVID-19 as cause of death. Beyond what is directly attributable to it, the pandemic has caused extensive collateral damage that has led to losses of lives and livelihoods. Here we report a comprehensive and consistent measurement of the impact of the COVID-19 pandemic by estimating excess deaths, by month, for 2020 and 2021. We predict the pandemic period all-cause deaths in locations lacking complete reported data using an overdispersed Poisson count framework that applies Bayesian inference techniques to quantify uncertainty. We estimate 14.83 million excess deaths globally, 2.74 times more deaths than the 5.42 million reported as due to COVID-19 for the period. There are wide variations in the excess death estimates across the six World Health Organization regions. We describe the data and methods used to generate these estimates and highlight the need for better reporting where gaps persist. We discuss various summary measures, and the hazards of ranking countries’ epidemic responses. Msemburi et al. describe how the World Health Organization has estimated the excess mortality associated with the COVID-19 pandemic, by month and for 2020 and 2021, and analyse their estimates across the WHO member states, with 14.83 million global excess deaths estimated. Published in Nature (Dec. 14, 2022): https://doi.org/10.1038/s41586-022-05522-2
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SOMERVILLE, Tenn. — Skill Wilson had amassed more than three decades of knowledge as a paramedic, first in Memphis and then in Fayette County. Two places that felt like night and day. With only five ambulances in the county and the nearest hospital as much as 45 minutes away, Skill relished the clinical know-how necessary to work in a rural setting. Doing things like sedating patients to insert tubes into their airways. But when it came to covid-19, despite more than 1 million deaths nationwide, Skill and his family felt their small town on the central-eastern side of Fayette County, with its fields of grazing cattle and rows of cotton and fewer than 200 covid deaths since the start of the pandemic, was a cocoon against the raging health emergency. “It was a lot easier to stay away from others,” his widow, Hollie Wilson, said of the largely White and predominantly conservative county of about 42,000 residents. “Less people. Less chance of exposure.” Covid seemed like other people’s problem — until it wasn’t. The imbalance in death rates among the nation’s racial and ethnic groups has been a defining part of the pandemic since the start. To see the pattern, The Washington Post analyzed every death during more than two years of the pandemic. Early in the crisis, the differing covid threat was evident in places such as Memphis and Fayette County. Deaths were concentrated in dense urban areas, where Black people died at several times the rate of White people. “I don’t want to say that we weren’t worried about it, but we weren’t,” said Hollie, who described her 59-year-old husband as someone who “never took a pill.” After a while, “you kind of slack off on some things,” she said. Over time, the gap in deaths widened and narrowed but never disappeared — until mid-October 2021, when the nation’s pattern of covid mortality changed, with the rate of death among White Americans sometimes eclipsing other groups. A Post analysis of covid death data from the Centers for Disease Control and Prevention from April 2020 through this summer found the racial disparity vanished at the end of last year, becoming roughly equal. And at times during that same period, the overall age-adjusted death rate for White people slightly surpassed that of Black and Latino people. The nature of the virus makes the elderly and people with underlying health conditions — including hypertension, diabetes and obesity, all of which beset Black people at higher rates and earlier in life than White people — particularly vulnerable to severe illness and death. The virus also attacks unvaccinated adults — who polls show are more likely to be Republicans — with a ferocity that puts them at a much higher risk of infection and death. He joined the choir of critics opposing vaccination requirements, his rants in front of the television eventually wearing on Hollie, who, even if she agreed, grew tired of listening and declared their home “covid-talk free.” So, she said, Skill commiserated with like-minded people in Facebook groups and on Parler and Rumble, the largely unmoderated social networking platforms popular with conservatives. “We’re Republicans, and 100 percent believe that it’s each individual’s choice, their freedom,” when it comes to getting a coronavirus shot, Hollie said in January. “We decided to err on the side of not doing it and accept the consequences. And now, here we are in the middle of planning the funeral.” Capt. Julian Greaves Wilson Jr., known to everybody as Skill, died of covid Jan. 23, a month after becoming infected with the coronavirus. He fell ill not long after transporting a covid patient to the hospital. At the time he died, infection rates in Fayette County had soared to 40.5 percent among people taking coronavirus tests. When the coronavirus appeared in the United States, it did what airborne viruses do — latched onto cells in people’s respiratory tract, evaded innate immune responses and multiplied. The pathogen, free of politics or ideology, had a diverse reservoir of hosts and found fertile pathways for growth in the inequalities born from centuries of racial animus and class resentments. Unequal exposure, unequal spread, unequal vulnerability and unequal treatment concentrated harm in communities that needed protection themost yet had the least. Cumulatively, Black, Latino and Native American people are 60 percent more likely to die of covid. But as the pandemic progressed, the damage done by the virus broadened, and the toxicity of modern-day politics came to the fore. The Post analysis revealed the changing pattern in covid deaths. At the start of the pandemic, Black people were more than three times as likely to die of covid as their White peers. But as 2020 progressed, the death rates narrowed — but not because fewer Black people were dying. White people began dying at increasingly unimaginable numbers, too, the Post analysis found. In summer 2021, the nation saw some of the pandemic’s lowest death rates, as vaccines, shoring up the body’s immune response, became widely available. Then came the delta variant. The virus mutated, able to spread among the vaccinated. As it did, an erosion of trust in government and in medicine — in any institution, really — slowed vaccination rates, stymieing the protection afforded by vaccines against severe illness and death. After delta’s peak in September 2021, the racial differences in covid deaths started eroding. The Post analysis found that Black deaths declined, while White deaths never eased, increasing slowly but steadily, until the mortality gap flipped. From the end of October through the end of December, White people died at a higher rate than Black people did, The Post found. That remained true except for a stretch in winter 2021-2022, when the omicron variant rampaged. The Black death rate jumped above White people’s when the spike in cases and deaths overwhelmed providers in the Northeast, resulting in a bottleneck of testing and treatment. When the surge subsided, the Black death rate once again dropped below the White rate. “Usually, when we say a health disparity is disappearing, what we mean is that … the worse-off group is getting better,” said Tasleem Padamsee, an assistant professor at Ohio State University who researched vaccine use and was a member of the Ohio Department of Health’s work group on health equity. “We don’t usually mean that the group that had a systematic advantage got worse.” That’s exactly what happened as the White death rate surpassed that for Black people, even though Black Americans routinely confront stress so corrosive it causes them to age quicker, become sicker and die younger. The shift in covid death rates “has vastly different implications for public health interventions,” said Nancy Krieger, professor of social epidemiology at Harvard University’s T.H. Chan School of Public Health. Officials must figure out how to connect with “communities who are ideologically opposed to the vaccine” while contending with “the cumulative impact of injustice” on communities of color. “Think about the fact that everyone who is age 57 and older in this country was born when Jim Crow was legal,” she said. “What that did was intersect with covid-19, meaning that embodied history is part of this pandemic, too.” So what contributed to the recent variation in death rates? And why? The easy explanation is that it reflects the choices of Republicans not to be vaccinated, but the reasons go deeper. The Post interviewed historians and researchers who study the effects of White racial politics and social inequality on health, spoke with relatives and friends of those lost to covid, and compiled data from federal databases and academic studies. What emerged is a story about how long-standing issues of race and class interacted with the physical and psychological toll of mass illness and death, unprecedented social upheaval, public policies — and public opinion. Resilience gave way to fatigue. Holes left by rural hospital closures deepened. Medical mistrust and misinformation raged. Skeptics touted debunked alternatives over proven treatments and prevention. Mask use became a victim of social stigma. Many Republicans decided they would rather roll the dice with their health than follow public health guidance — even when provided by President Donald Trump, who was booed after saying he had been vaccinated and boosted. Researchers at Ohio State found Black and White people were about equally reluctant to receive a coronavirus vaccine when they first became available, but Black people overcame that hesitancy faster. They came to the realization sooner that vaccines were necessary to protect themselves and their communities, Padamsee said. As public health efforts to contain the virus were curtailed, the pool of those most at risk of becoming casualties widened. The No. 1 cause of death for 45-to-54-year-olds in 2021 was covid, according to federal researchers......
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BARCELONA, Spain (AP) — Spain reported Saturday a second death in as many days from monkeypox. These are believed to be the first confirmed fatalities from the disease in Europe since its recent spread beyond Africa. The ministry based in Madrid said both fatalities were young men. It reported its first death on Friday, the same day that Brazil also reported its first death from monkeypox. The global monkeypox outbreak has seen more than 22,000 cases in nearly 80 countries since May. There have been 75 suspected deaths in Africa, mostly in Nigeria and Congo, where a more lethal form of monkeypox is spreading than in the West. In the U.S. and Europe, the vast majority of monkeypox infections have happened in men who have sex with men, though health officials have stressed that anyone can catch the virus. The deaths outside Africa come one week after the World Health Organization declared the monkeypox outbreak a global health emergency. “The notification of deaths due to monkeypox does not change our assessment of the outbreak in Europe. We know that although the disease is self-limiting in most cases, monkeypox can cause severe complications,” said Catherine Smallwood, Senior Emergency Officer at WHO Europe. “With the continued spread of monkeypox in Europe, we will expect to see more deaths. Our goal needs to be on interrupting transmission quickly in Europe and stopping this outbreak,” she said. On Friday, Spain’s health ministry reported 4,298 people were infected with the virus, making it the leading European country for monkeypox cases. Of that total, some 3,500 cases were of men who had had sex with other men. Only 64 were women. The ministry said 120 have needed hospital attention. Smallwood said around 8% of the monkeypox cases in Europe have required hospitalization. Monkeypox has been endemic to parts of Africa for decades. Its leap to Europe and North America was linked by experts to two raves in Belgium and Spain. Spanish health authorities are administering 5,300 vaccines that Spain received from the joint EU vaccine purchase scheme. Health workers say that’s far fewer than the number needed to cover the at-risk groups. But the rush to buy limited vaccines by richer Western countries is putting Africa in danger of being left out. Monkeypox spreads mainly through skin-to-skin contact, but it can also be transmitted through bed sheets used by someone with monkeypox. Symptoms include fever, body aches, chills, fatigue and hives. The illness has been relatively mild in many men. But people can be contagious for weeks, and the lesions can be extremely painful. AP Medical Writer Maria Cheng contributed to this report from London.
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Last year, people 65 and older died from Covid at lower rates than in previous waves. But with Omicron and waning immunity, death rates rose again. This winter’s wave of deaths in older people belied the Omicron variant’s relative mildness. Almost as many Americans 65 and older died in four months of the Omicron surge as did in six months of the Delta wave, even though the Delta variant, for any one person, tended to cause more severe illness. While overall per capita Covid death rates have fallen, older people still account for an overwhelming share of them. “This is not simply a pandemic of the unvaccinated,” said Andrew Stokes, an assistant professor in global health at Boston University who studies age patterns of Covid deaths. “There’s still exceptionally high risk among older adults, even those with primary vaccine series.” Covid deaths, though always concentrated in older people, have in 2022 skewed toward older people more than they did at any point since vaccines became widely available. That swing in the pandemic has intensified pressure on the Biden administration to protect older Americans, with health officials in recent weeks encouraging everyone 50 and older to get a second booster and introducing new models of distributing antiviral pills. In much of the country, though, the booster campaign remains listless and disorganized, older people and their doctors said. Patients, many of whom struggle to drive or get online, have to maneuver through an often labyrinthine health care system to receive potentially lifesaving antivirals. Nationwide Covid deaths in recent weeks have been near the lowest levels of the pandemic, below an average of 400 a day. But the mortality gap between older and younger people has grown: Middle-aged Americans, who suffered a large share of pandemic deaths last summer and fall, are now benefiting from new stores of immune protection in the population as Covid deaths once again cluster around older people. And the new wave of Omicron subvariants may create additional threats: While hospitalizations in younger age groups have remained relatively low, admission rates among people 70 and older in the Northeast have climbed to one-third of the winter Omicron wave’s towering peak. “I think we are going to see the death rates rising,” said Dr. Sharon Inouye, a geriatrician and a professor of medicine at Harvard Medical School. “It is going to become more and more risky for older adults as their immunity wanes.” Vaccination Rates for People Age 65+ Harold Thomas Jr., 70, of Knoxville, Tenn., is one of many older Americans whose immunity may be waning because he has not received a booster shot. The Covid States Project, an academic group, recently estimated that among people 65 and older, 13 percent are unvaccinated, 3 percent have a single Moderna or Pfizer shot and another 14 percent are vaccinated but not boosted. When vaccines first arrived, Mr. Thomas said, the state health department made getting them “convenient” by administering shots at his apartment community for older people. But he did not know of any such effort for booster doses. On the contrary, he remembered a state official publicly casting doubt on boosters as they became available. “The government wasn’t sure about the booster shot,” he said. “If they weren’t sure about it, and they’re the ones who put it out, why would I take it?” Mr. Thomas said Covid recently killed a former boss of his and hospitalized an older family friend. Deaths have fallen from the heights of the winter wave in part because of growing levels of immunity from past infections, experts said. For older people, there is also a grimmer reason: So many of the most fragile Americans were killed by Covid over the winter that the virus now has fewer targets in that age group. But scientists warned that many older Americans remained susceptible. To protect them, geriatricians called on nursing homes to organize in-home vaccinations or mandate additional shots. In the longer term, scientists said that policymakers needed to address the economic and medical ills that have affected especially nonwhite older Americans, lest Covid continue cutting so many of their lives short. “I don’t think we should treat the premature death of older adults as a means of ending the pandemic,” Dr. Stokes said. “There are still plenty of susceptible older adults — living with comorbid conditions or living in multigenerational households — who are highly vulnerable.” The pattern of Covid deaths this year has recreated the dynamics from 2020 — before vaccines were introduced, when the virus killed older Americans at markedly higher rates. Early in the pandemic, mortality rates steadily climbed with each extra year of age, Dr. Stokes and his collaborators found in a recent study. That changed last summer and fall, during the Delta surge. Older people were getting vaccinated more quickly than other groups: By November, the vaccination rate in Americans 65 and older was roughly 20 percentage points higher than that of those in their 40s. And critically, those older Americans had received vaccines relatively recently, leaving them with strong levels of residual protection. As a result, older people suffered from Covid at lower rates than they had been before vaccines became available. Among people 85 and older, the death rate last fall was roughly 75 percent lower than it had been in the winter of 2020, Dr. Stokes’s recent study found. At the same time, the virus walloped younger and less vaccinated Americans, many of whom were also returning to in-person work. Death rates for white people in their late 30s more than tripled last fall compared to the previous winter. Death rates for Black people in the same age group more than doubled. The rebalancing of Covid deaths was so pronounced that, among Americans 80 and older, overall deaths returned to prepandemic levels in 2021, according to a study posted online in February. The opposite was true for middle-aged Americans: Life expectancy in that group, which had already dropped more than it had among the same age range in Europe, fell even further in 2021. “In 2021, you see the mortality impact of the pandemic shift younger,” said Ridhi Kashyap, a lead author of that study and a demographer at the University of Oxford. By the time the highly contagious Omicron variant took over, researchers said, more older Americans had gone a long time since their last Covid vaccination, weakening their immune defenses. As of mid-May, more than one-quarter of Americans 65 and older had not had their most recent vaccine dose within a year. And more than half of people in that age group had not been given a shot in the last six months. The Omicron variant was better than previous versions of the virus at evading those already weakening immune defenses, reducing the effectiveness of vaccines against infection and more serious illness. That was especially true for older people, whose immune systems respond less aggressively to vaccines in the first place. For some people, even three vaccine doses appear to become less protective over time against Omicron-related hospital admissions. A study published recently in The Lancet Respiratory Medicine found that trend held for people with weakened immune systems, a category that older Americans were likelier to fall into. Sara Tartof, the study’s lead author and an epidemiologist at Kaiser Permanente in Southern California, said that roughly 9 percent of people 65 and older in the study were immunocompromised, compared with 2.5 percent of adults under 50. During the Omicron wave, Covid death rates were once again dramatically higher for older Americans than younger ones, Dr. Stokes said. Older people also made up an overwhelming share of the excess deaths — the difference between the number of people who actually died and the number who would have been expected to die if the pandemic had never happened. Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in Boston, found in a recent study that excess deaths were more heavily concentrated in people 65 and older during the Omicron wave than the Delta surge. Overall, the study found, there were more excess deaths in Massachusetts during the first eight weeks of Omicron than during the 23-week period when Delta dominated. As older people began dying at higher rates, Covid deaths also came to include higher proportions of vaccinated people. In March, about 40 percent of the people who died from Covid were vaccinated, according to an analysis of figures from the Centers for Disease Control and Prevention. Fewer older Americans have also been infected during the pandemic than younger people, leading to lower levels of natural immunity. As of February, roughly one-third of people 65 and older showed evidence of prior infections, compared with about two-thirds of adults under 50. Estimated Share of People in the U.S. With Antibodies From Covid-19 Infection Long-ago Covid cases do not prevent future infections, but reinfected people are less likely to become seriously ill. A drop-off in Covid precautions this winter, combined with the high transmissibility of Omicron, left older people more exposed, scientists said. It is unclear how their own behavior may have changed. An earlier study, from scientists at Marquette University, suggested that while older people in Wisconsin had once been wearing masks at rates higher than those of younger people, that gap had effectively disappeared by mid-2021. Antiviral pills are now being administered in greater numbers, but it is difficult to know who is benefiting from them. Scientists said that the wintertime spike in Covid death rates among older Americans demanded a more urgent policy response. Dr. Inouye, of Harvard Medical School, said she had waited for a notice from her mother’s assisted living facility about the rollout of second booster shots even as reports started arriving of staff members becoming infected. But still, the facility’s director said that a second booster shot drive was impossible without state guidance. Eventually, her family had to arrange a trip to a pharmacy on their own for a second booster. “It just seems that now the onus is put completely on the individual,” she said. “It’s not like it’s made easy for you.”
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It's the highest total in the world - but the WHO thinks the true death toll may be higher elsewhere. The US has passed more than one million Covid-related deaths, says the White House. President Joe Biden said the country was marking "a tragic milestone" and each death was "an irreplaceable loss". It's the highest official total in the world - although the World Health Organization believes the true death toll may be much higher elsewhere. The US has also recorded more than 80 million Covid cases, out of a 330 million population. The first confirmed case was reported on 20 January 2020, when a man flew home to Seattle from Wuhan in China. The 35-year-old survived, after 10 days of pneumonia, coughs, fever, nausea and vomiting. But deaths began to be reported just a few weeks later. In the two years since, death rates have ebbed and flowed as waves of the virus swept across the country - reaching highs of more than 4,000 a day in early 2021. Public health experts give several reasons for the high US death toll - including high rates of obesity and hypertension, overworked hospital systems, some vaccine hesitancy and a large older population. Each US state may have a slightly different way to define a Covid death, and such deaths are often not solely because of the virus. "One million Covid deaths, one million empty chairs around the family dinner table, each irreplaceable losses," said President Biden in a televised statement on Thursday morning. "Our heart goes out to all those who are struggling, asking themselves, how do we go on without him, how do we go on without her?" The president ordered the White House flags to be lowered to half mast to mark the milestone. When did the deaths take place? The US has seen the number of daily reported deaths spike on several occasions, often coming as new variants spread across the country. The first wave - the initial pandemic - saw highs of more than 2,500 daily reported deaths in April 2020, about eight months before the first vaccines were rolled out in December. "The dangerous surges, where our hospitals were full and new deaths were overwhelming, have all come on the heels of new variants," Dr Mark Cameron, an associate professor in the department of population and quantitative health sciences at Case Western University in Ohio, told the BBC. Most of the one million Americans who died during the pandemic lost their lives after the vaccines were introduced. That's down to the sheer scale of people still catching the virus - it does not mean the vaccines aren't working. Vaccines massively cut severe Covid risk. A study from the Rand Corporation credited the jabs with saving 140,000 lives in the US by May 2021 alone. A separate analysis by the Peterson Center for Healthcare and the Kaiser Family Foundation in April this year estimated that around a quarter of the US deaths - about 234,000 people - could have been prevented with vaccines. "You can't necessarily simplify this to be a pandemic of the unvaccinated. Everyone knows someone who had the whole vaccination regimen and still got very sick," Dr Cameron added. "But the data is clear, the risk of Covid-19 and death is higher in the unvaccinated." Where in the US did the deaths take place? Of the 50 US states, the highest death toll has been reported in California, where about 90,000 people have died. California is followed closely by Texas (about 86,000), Florida (about 74,000) and New York (about 68,000). On a per capita basis, CDC data shows that Mississippi has suffered about 418 deaths per 100,000 residents, followed by Arizona (414), Alabama (399) and West Virginia (384). The per capita death rate in these states far surpasses the average US national rate of about 300 per 100,000. Experts point to several reasons why certain states suffered disproportionately, including unequal access to healthcare. Brittany Kmush, an epidemiologist and global health expert at Syracuse University, said socio-economic status often affected "being able to access hospitals with oxygen and things like that when patients need them". Dr Monica Gandhi, an infectious diseases physician and professor at the University of California San Francisco, said vaccine hesitancy also explains higher death tolls in certain states. In her analysis, shortcomings in vaccinations have contributed more to the US death toll than other public health measures, such as masking or isolation. Demographic trends While deaths have been reported across all age and ethnic groups, experts note that certain sectors of the population have been more likely to die - particularly the elderly and those with co-morbidities. Government data shows the vast majority of Covid deaths in the US - about 740,000 - have been among those older than 65. "Looking at severe illness and death, the demographics haven't changed throughout the pandemic. It has always been older adults, and those with co-morbidities especially," Dr Cameron explained. CDC data analysed by the Kaiser Family Foundation shows that overall - particularly in the early stages of the pandemic in 2020 - black, Hispanic and Native American populations experienced higher rates of both infection and death. Public health experts cite a range of reasons, including vaccine hesitancy among some groups, and an elevated risk of exposure due to working and living conditions. "Part of that is being unable to separate yourself from work," Dr Gandhi said. "And even after the vaccine, there was some scepticism in some of our black and Hispanic populations about taking up the vaccine. But there was a lot more acceptance after Delta. That really scared people." The true toll? While the death toll from Covid-19 now officially exceeds one million, the indirect toll of the virus is likely to be far higher, as a result of disrupted health systems and a hesitancy to seek medical attention for fear of catching the virus. One study, published in the journal PLOS Medicine in May 2021, found that for every 100 deaths directly assigned to Covid, another 20 "excess" deaths occurred that were not - many of them in areas with "lower socio-economic status". A study released on Thursday by the World Health Organization put the figure at 140 excess deaths per 100,000 people during 2020 and 2021 - totalling about 930,000 more lives lost than would have been expected on average. "People were waiting for surgery and not seeing their doctors, and [there were] missed opportunities for serious disease diagnoses," Dr Cameron said, adding that this was particularly true for those aged between 25 and 64. "It will be years before we even come close to understanding the impact Covid-19 had on our overall morbidity and mortality rates."
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A South African study suggests reduced risks of hospitalisation and severe disease in people infected with the Omicron coronavirus variant versus the Delta one, though the authors say some of that is likely due to high population immunity. Questions about Omicron's virulence are at the heart of scientific and political debate in many countries, as governments grapple with how to respond to the spread of the variant while researchers race to understand it. The study, which has not been peer-reviewed, found that people diagnosed with Omicron in South Africa between Oct. 1 and Nov. 30 were 80% less likely to be admitted to hospital than those diagnosed with another variant in the same period. Among patients admitted in that period, those with Omicron had a similar chance of developing severe disease as those with other variants. However, the study found that people who were hospitalised with Omicron in October-November were 70% less likely to develop severe disease than those admitted with Delta between April and November. "Compellingly, together our data really suggest a positive story of a reduced severity of Omicron compared to other variants," said Professor Cheryl Cohen of the National Institute for Communicable Diseases (NICD), one of the study's authors. She said this was further reinforced by surveillance data showing significantly lower hospitalisations and deaths in South Africa's current Omicron-driven wave of infections than in previous waves, although case numbers were much higher. Cohen said that the study's findings could likely be generalised to other countries in sub-Saharan Africa that also have very high levels of previous infection. "What is unclear is whether the picture will be similar in countries where there are high levels of vaccination but very low levels of previous infection," she said during a media briefing by a group of NICD scientists. The study was carried out by a group of scientists from the NICD and major institutions including University of the Witwatersrand and University of KwaZulu-Natal. The authors included several caveats and cautioned against jumping to conclusions about Omicron's intrinsic characteristics. "It is difficult to disentangle the relative contribution of high levels of previous population immunity versus intrinsic lower virulence to the observed lower disease severity," they wrote. An estimated 60% to 70% of people in South Africa have had a prior COVID-19 infection, Cohen said. Paul Hunter, a professor of medicine at Britain's University of East Anglia, described the South African study as important and said it was the first properly conducted study to appear in pre-print form on the issue of Omicron versus Delta severity. But Hunter said comparing Omicron data from one period with Delta data from an earlier period meant it was hard to determine whether the lower hospitalisation rates were due to Omicron being less virulent or to population immunity having risen. "To a certain extent this does not matter to the patient who only cares that they won't get very sick. But it is important to know to enable improved understanding of the likely pressures on health services," he said. Results of a major study by Imperial College London released last week showed there was no sign that Omicron was milder than Delta, although data on hospitalisations remains very limited. It has not been peer reviewed and published in a medical journal. read more Research cited available at medRxiv (Dec. 21, 2021): https://doi.org/10.1101/2021.12.21.21268116
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Vaccines have slowed the death rate, but officials warn of worrying rises in some countries. The milestone comes amid warnings from health officials that cases and deaths in some places are rising for the first time in months. Nearly 250 million cases of the virus have been recorded worldwide. The World Health Organization (WHO) estimates the pandemic's real global death toll could be two to three times higher than official records. In the US, more than 745,800 people have died, making it the country with the highest number of recorded deaths. It is followed by Brazil, with 607,824 recorded deaths, and India, with 458,437. But health experts believe these numbers are under reported, partly because of deaths at home and those in rural communities. It has taken the world longer to reach the latest one million deaths than the previous two. It took over 110 days to go from four million deaths to five million. That is compared to just under 90 days to rise from three million to four million. While vaccines have helped reduce the fatality rate, the WHO warned last week that the pandemic was "far from over". Its director general Tedros Adhanom Ghebreyesus pointed to a rise in cases in Europe, where countries with low vaccination rates are seeing soaring infections and deaths. Last week, Russia recorded its highest number of daily cases and deaths since the start of the pandemic. Russia accounts for 10% of the last million deaths recorded globally. Bulgaria and Romania have some of the world's worst Covid mortality rates, and their hospitals are struggling to cope. They have the two lowest vaccine rates in the European Union. More than seven billion vaccine doses have been administered worldwide, but there is a gap between rich and poor nations. Only 3.6% of people in low income countries have been vaccinated, according to Oxford University's Our World in Data. Dr Tedros said that if the vaccine doses had been distributed fairly, "we would have reached our 40% target in every country by now". "The pandemic persists in large part because inequitable access to tools persists," he said. Vaccines have allowed many countries to gradually open up, with most of the world now easing restrictions. On Monday, Australia reopened its borders for the first time in 19 months. But China, where the pandemic first emerged, is still perusing a zero-Covid strategy, where even one infection can result in a strict lockdown and mass testing. A country's death toll is based on daily reports from the nation's health authorities, but the numbers may not fully reflect the true toll in many countries. Not all countries record coronavirus deaths in the same way, meaning it is difficult to compare their death rates. Comparing how different countries have suffered during the Covid pandemic is difficult. Total number of deaths is one way, but this number masks some crucial context. How much testing individual countries carry out will have a bearing on their death figures. Very few deaths have occurred in Africa, for example, compared to other continents and this is likely to be one factor. Deaths from Covid can also be measured in different ways - as a proportion of the population (Bulgaria fares worst) or as a proportion of people showing symptoms (Mexico fares worst). And the healthcare systems in different countries as well as the average age of the population will also have an impact - the older the people the more vulnerable they are to the virus. Vaccinations against Covid have made a huge difference to the number of people dying in the past six months - but not all countries have had equal access to shots which protect against the virus. That means there will be more deaths to come - but Covid is not the only health problem the world has to worry about. It's worth remembering that each year more than nine million people die from cancer and nearly the same number from heart disease.
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ONS figures show 51,281 Covid deaths between January and July, with 458 dying at least 21 days after second dose. People who were fully vaccinated accounted for just 1.2% of all deaths involving Covid-19 in England in the first seven months of this year. The figures, published by the Office for National Statistics (ONS), have been seized on as proof of the success of the vaccine programme. The figures show a total of 51,281 deaths involving Covid-19 in England between 2 January and 2 July, of which 38,964 were of unvaccinated people. Of the total Covid-related deaths, 458 (about 0.9%) were of people who died at least 21 days after their second vaccine dose. Just 256 deaths (0.5%) were of people who were fully vaccinated and had their first positive PCR test at least 14 days after their second dose. No vaccine is 100% effective against Covid-19, and health authorities have made it clear that some deaths of vaccinated individuals are to be expected. Public Health England (PHE) has estimated that two-dose effectiveness against hospital admission with infections from the Delta variant – which is now the UK’s dominant strain – has been around 94%. However, the figures on Monday underlined that the risk of death involving Covid-19 is consistently lower for people who have received two doses compared with one dose or no vaccination at all. A detailed breakdown of data was made available for 252 of the 256 people who died after having received both jabs and who first tested positive at least 14 days after the second dose. They are what the ONS describes as “breakthrough” deaths. It shows that just over three-quarters of these deaths (76.6%) occurred in those who were clinically extremely vulnerable – a slightly higher proportion than for other Covid-19 deaths (74.5%) and deaths not involving Covid-19 (69.7%). Of the breakthrough deaths, 61.1% occurred in males, which is higher than for other Covid-19 deaths (52.2%) and deaths not involving Covid-19 (48.5%), while 13% were among people who were immunocompromised. Experts emphasised the importance of context in terms of the data, which covered a period when the seven-day average daily UK deaths varied between six and more than 1,200 per day. Trends were increasing at the end of the ONS study period, when rates were about 25 per day, while daily death rates are now consistently over 100 per day. Dr Duncan Robertson, a data analyst at Loughborough University who has been focusing on Covid-19 modelling and analysis, said: “By definition, as the proportion of vaccinated people increases, fewer remain in the unvaccinated category. In the extreme, if everyone were vaccinated, 100% of deaths would be of vaccinated people, just as before the vaccine rollout, 0% of deaths would be of vaccinated people.” But he added: “What is clear from the ONS data is the significance of being fully vaccinated – full vaccination offers very high – but not perfect - protection against death, where only having a first dose offers significantly less protection.” The PNS data came days after Public Health England published figures showing the vaccination status of individuals who were infected, who were hospitalised, and who died. “While figures for protection against infection needs careful interpretation, particularly in the estimates of population in each age category, it is clear that vaccine protection against death is very high after the second dose,” added Dr Robertson, who stressed that work still needed to be done to ensure that vaccinations reach those in cohorts where there had already been significant uptake. There are about 1 million over-60s who are not fully vaccinated, he pointed out. Only two-thirds of black over-50s have been vaccinated compared with more than 9 in 10 white over-50s. People are four times more likely to not be fully vaccinated if they live in the most deprived areas, compared with those living in the least deprived areas. ONS findings available at(Sept. 13, 2021): https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/deathsinvolvingcovid19byvaccinationstatusengland/deathsoccurringbetween2januaryand2july2021
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Two people have died in Japan days after receiving doses from a batch of Moderna Covid-19 vaccines whose use was suspended Thursday following concerns over a contamination risk, the country's Ministry of Health, Labor and Welfare said Saturday. A causal link between the vaccine and the deaths has not yet been established, according to the ministry and Takeda Pharmaceutical Company, which distributes the Moderna vaccine in Japan. Japan suspended the use of about 1.63 million doses of the Moderna vaccine on August 26 as a precaution after foreign substances were found in some vials. While inquiries are being conducted by the Japanese government and three pharmaceutical companies involved, no police investigation has been announced and there is no present indication of wrongdoing. "Currently, no link has been confirmed between these deaths and the Moderna vaccine, but we believe it is important to carry out a formal probe to investigate the matter further," Takeda Pharmaceutical Company said in a statement released Saturday. Japan's Ministry of Health will conduct that investigation alongside Takeda, the company stated, adding that Moderna has its own investigation underway. Rovi, a Spanish company that manufactured the batches, described the contaminant as "particulate matter" in a statement Thursday. Rovi said it is also investigating the contaminated lots. The 1.63 million doses came from three identified lot numbers -- 3004667, 3004734 and 3004956. The doses had been distributed to 863 vaccination sites across Japan, and some were used. The health ministry said it began notifying the vaccination sites on Thursday morning about the contamination risk. The two people who died had received vaccines from lot 3004734, one of the lots removed from circulation Thursday. Japan's Ministry of Health, Labor and Welfare said that no foreign contaminants had been reported from this lot yet. Results from laboratory tests from contaminated samples will be available in the coming days, according to Takeda. CNN has reached out to Moderna for comment.
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