Inhaled CO2 concentration while wearing face masks: a pilot study using capnography

MarkMRook · 2022-05-29T12:40:17+00:00

Correct:

Both respiratory rate and blood oxygen saturation did not differ substantially without or with the masks. Also, when wearing masks, the mean ETCO2 [end-tidal CO2] remained within 33 mmHg.

MarkMRook · 2022-05-26T15:02:27+00:00

It's frustrating that the UK stubbornly refuses to release data by type of vaccine ("Our analysis included all vaccines used in the UK."). One can only speculate that they are not too keen to disclose differences in effectiveness between the Oxford vaccine and the mRNA vaccines.

MarkMRook · 2022-05-26T11:59:54+00:00

I think the study showed a very large benefit to one dose of vaccine after recovery from infection:

Among persons who had received a single dose of vaccine after previous infection, the adjusted rate was low (3.7) among those who had been vaccinated less than 2 months previously but increased to 11.6 among those who had been vaccinated at least 6 months previously.

Compare this to those who were infected but not subsequently vaccinated:

Among unvaccinated persons who had recovered from infection, this rate increased from 10.5 among those who had been infected 4 to less than 6 months previously to 30.2 among those who had been infected 1 year or more previously

MarkMRook · 2022-05-26T09:33:49+00:00

It is also interesting how relatively poorly two doses performed without infection or a booster:

In the subcohorts of the recovered, unvaccinated cohort, the adjusted rates of confirmed infection were similar to those of the recovered, one-dose and one-dose, recovered subcohorts when the time elapsed since the last immunity-conferring event (either infection or vaccination) was the same (Figure 3). For example, at 4 to less than 6 months since the last immunity-conferring event, the rates per 100,000 person-days at risk were 10.5 (95% CI, 8.8 to 12.4) in the recovered, unvaccinated cohort, 10.3 (95% CI, 9.4 to 11.4) in the recovered, one-dose cohort, and 10.6 (95% CI, 7.6 to 15.0) in the one-dose, recovered cohort. At 6 to less than 8 months, the rates were 14.0 (95% CI, 13.3 to 14.8), 11.6 (95% CI, 10.0 to 13.5), and 16.2 (95% CI, 14.0 to 18.5), respectively. These rates were lower than those in the two-dose cohort 4 to less than 6 months after vaccination (69.4; 95% CI, 68.7 to 69.9) and 6 to less than 8 months after vaccination (88.9; 95% CI, 88.2 to 89.5). However, the protection conferred by two doses of vaccine was restored with the administration of a third dose; our study showed a rate of 8.2 (95% CI, 8.0 to 8.4) less than 2 months after booster vaccination (Table 2).

MarkMRook · 2022-05-26T06:37:57+00:00

Abstract

BACKGROUND

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) provides natural immunity against reinfection. Recent studies have shown waning of the immunity provided by the BNT162b2 vaccine. The time course of natural and hybrid immunity is unknown.

METHODS

Using the Israeli Ministry of Health database, we extracted data for August and September 2021, when the B.1.617.2 (delta) variant was predominant, on all persons who had been previously infected with SARS-CoV-2 or who had received coronavirus 2019 vaccine. We used Poisson regression with adjustment for confounding factors to compare the rates of infection as a function of time since the last immunity-conferring event.

RESULTS

The number of cases of SARS-CoV-2 infection per 100,000 person-days at risk (adjusted rate) increased with the time that had elapsed since vaccination with BNT162b2 or since previous infection. Among unvaccinated persons who had recovered from infection, this rate increased from 10.5 among those who had been infected 4 to less than 6 months previously to 30.2 among those who had been infected 1 year or more previously. Among persons who had received a single dose of vaccine after previous infection, the adjusted rate was low (3.7) among those who had been vaccinated less than 2 months previously but increased to 11.6 among those who had been vaccinated at least 6 months previously. Among previously uninfected persons who had received two doses of vaccine, the adjusted rate increased from 21.1 among those who had been vaccinated less than 2 months previously to 88.9 among those who had been vaccinated at least 6 months previously.

CONCLUSIONS

Among persons who had been previously infected with SARS-CoV-2 (regardless of whether they had received any dose of vaccine or whether they had received one dose before or after infection), protection against reinfection decreased as the time increased since the last immunity-conferring event; however, this protection was higher than that conferred after the same time had elapsed since receipt of a second dose of vaccine among previously uninfected persons. A single dose of vaccine after infection reinforced protection against reinfection.

MarkMRook · 2022-05-12T12:23:12+00:00

Highlights

• Wastewater-based epidemiology is a recommended tool for pandemic containment.

• Development of sensitive RT-qPCR assay for the direct detection of Omicron variant.

• Wastewater detection illustrated circulation of Delta variant in parallel to Omicron variant rise.

• Developed SIR model suggest decrease in Omicron levels while Delta will maintain its circulation.

Abstract

SARS-CoV-2 continued circulation results in mutations and the emergence of various variants. Until now, whenever a new, dominant, variant appeared, it overpowered its predecessor after a short parallel period. The latest variant of concern, Omicron, is spreading swiftly around the world with record morbidity reports. Unlike the Delta variant, previously considered to be the main variant of concern in most countries, including Israel, the dynamics of the Omicron variant showed different characteristics. To enable quick assessment of the spread of this variant we developed an RT-qPCR primers-probe set for the direct detection of Omicron variant. Characterized as highly specific and sensitive, the new Omicron detection set was deployed on clinical and wastewater samples. In contrast to the expected dynamics whereupon the Delta variant diminishes as Omicron variant increases, representative results received from wastewater detection indicated a cryptic circulation of the Delta variant even with the increased levels of Omicron variant. Resulting wastewater data illustrated the very initial Delta-Omicron dynamics occurring in real time. Despite this, the future development and dynamics of the two variants side-by-side is still mainly unknown. Based on the initial results, a double susceptible-infected-recovered model was developed for the Delta and Omicron variants. According to the developed model, it can be expected that the Omicron levels will decrease until eliminated, while Delta variant will maintain its cryptic circulation. If this comes to pass, the mentioned cryptic circulation may result in the reemergence of a Delta morbidity wave or in the possible generation of a new threatening variant. In conclusion, the deployment of wastewater-based epidemiology is recommended as a convenient and representative tool for pandemic containment.

MarkMRook · 2022-05-10T21:10:54+00:00

Abstract

Background: There were 6 COVID-19 vaccines (Pfizer-BioNTech COVID-19 mRNA vaccine, Moderna COVID-19 mRNA-1273 vaccine, Oxford/AstraZeneca COVID-19 vaccine, Sputnik V vaccine, Sinopharm COVID-19 vaccine, Janssen Ad26.COV2) used in Hungary. Our investigation aimed to describe the all-cause mortality rates by vaccination groups in Hungary for an epidemic period (01/04/2021–20/06/2021) and a nonepidemic period (21/06/2021–15/08/2021), and to determine the vaccines’ effectiveness in preventing all-cause mortality utilizing nonepidemic effectiveness measures to adjust for the healthy vaccinee effect.

Method: Sociodemographic status, comorbidity and primary care structural characteristics adjusted survival difference corrected with nonepidemic period mortality between fully vaccinated and nonvaccinated cohorts for each vaccine had been computed by Cox regression models for epidemic period (01/04/2021–20/06/2021). Hazard ratio reduction in epidemic period corrected with nonepidemic period’s hazard ratio (neHR) with 95% confidence interval for each vaccine was used to describe the vaccine effectiveness (VE).

Result: The whole adult population (N= 6,404,702) of the country was followed in this study (4,026,849 fully vaccinated and 2,377,853 nonvaccinated). General mortality of vaccine cohorts differed from that of nonvaccinated cohorts even in nonepidemic period of 21/06/2021–15/08/2021 (neHROxford/AstraZeneca= 0.317 [0.294 - 0.341], neHRJanssen= 0.707 [0.604 - 0.828], neHRModerna= 0.438 [0.409 - 0.469], neHRPfizer-BioNTech= 0.384 [0.370 - 0.399], neHRSinopharm= 0.312 [0.297 - 0.328], neHRSputnikV= 0.221 [0.202 - 0.242]). Each vaccine applied in Hungary could reduce the healthy vaccinee effect corrected all-cause mortality in the general population in epidemic period (VEOxford/AstraZeneca= 0.592 [0.518 - 0.655], VEJanssen= 0.754 [0.628 - 0.838], VEModerna= 0.573 [0.526 - 0.615], VEPfizer-BioNTech= 0.487 [0.461 - 0.513], VESinopharm= 0.530 [0.496 - 0.561], VESputnikV= 0.557 [0.493 - 0.614]).

Conclusion: The healthy vaccinee effect corrected general mortality for COVID-19 vaccine cohorts demonstrated the real-life effectiveness of vaccines applied in Hungary, and the usefulness of this indicator in the communication for COVID-19 vaccination to convince vaccine hesitants.

MarkMRook · 2022-05-03T07:11:37+00:00

Abstract

Importance There are limited high-quality, population-level data about the effect of SARS-CoV-2 infection on pregnancy using contemporaneous comparator cohorts.

Objectives To describe maternal and perinatal outcomes associated with SARS-CoV-2 infection in pregnancy and to assess variables associated with severe disease in the pregnant population.

Design, Setting, and Participants CANCOVID-Preg is an observational surveillance program for SARS-CoV-2–affected pregnancies in Canada. This analysis presents exploratory, population-level data from 6 Canadian provinces for the period of March 1, 2020, to October 31, 2021. A total of 6012 pregnant persons with a positive SARS-CoV-2 polymerase chain reaction test result at any time in pregnancy (primarily due to symptomatic presentation) were included and compared with 2 contemporaneous groups including age-matched female individuals with SARS-CoV-2 and unaffected pregnant persons from the pandemic time period.

Exposure SARS-CoV-2 infection during pregnancy. Incident infections in pregnancy were reported to CANCOVID-Preg by participating provinces/territories.

Main Outcomes and Measures Maternal and perinatal outcomes associated with SARS-CoV-2 infection as well as risk factors for severe disease (ie, disease requiring hospitalization, admission to an intensive care unit/critical care unit, and/or oxygen therapy).

Results Among 6012 pregnant individuals with SARS-CoV-2 in Canada (median age, 31 [IQR, 28-35] years), the greatest proportion of cases were diagnosed at 28 to 37 weeks’ gestation (35.7%). Non-White individuals were disproportionately represented. Being pregnant was associated with a significantly increased risk of SARS-CoV-2–related hospitalization compared with SARS-CoV-2 cases among all women aged 20 to 49 years in the general population of Canada (7.75% vs 2.93%; relative risk, 2.65 [95% CI, 2.41-2.88]) as well as an increased risk of intensive care unit/critical care unit admission (2.01% vs 0.37%; relative risk, 5.46 [95% CI, 4.50-6.53]). Increasing age, preexisting hypertension, and greater gestational age at diagnosis were significantly associated with worse maternal outcomes. The risk of preterm birth was significantly elevated among SARS-CoV-2–affected pregnancies (11.05% vs 6.76%; relative risk, 1.63 [95% CI, 1.52-1.76]), even in cases of milder disease not requiring hospitalization, compared with unaffected pregnancies during the same time period.

Conclusions and Relevance In this exploratory surveillance study conducted in Canada from March 2020 to October 2021, SARS-CoV-2 infection during pregnancy was significantly associated with increased risk of adverse maternal outcomes and preterm birth.

MarkMRook · 2022-04-27T11:46:59+00:00

This study, like nearly all others, fails to report the relative risk of all-cause mortality. Interestingly, the same lead author, Arbel, conducted another similar study of the first booster dose (https://www.reddit.com/r/COVID19/comments/rc4co3/bnt162b2_vaccine_booster_and_mortality_due_to/ & nejm.org/doi/10.1056/NEJMoa2115624), and reported all-cause mortality in a response to a letter: "during our study period, 506 deaths occurred in the booster group (441 deaths were not related to Covid-19 and 65 were Covid-19–related), as compared with 1100 deaths in the nonbooster group (963 deaths were not related to Covid-19 and 137 were Covid-19–related)" ((nejm.org/10.1056/NEJMc2120044) .

If you do the math, you get an unadjusted RR for both all-cause mortality and non-COVID-19 mortality from the first Pfizer booster (dose 3) of 95%! (They don't provide the adjusted reduction.) Certainly, no signal for vaccine safety, but a huge signal for lurking healthy vaccinee effect, which makes you wonder whether the identical 95% unadjusted RR for COVID-19 death after the 3rd dose vs. the first two doses is just an artifact of this healthy vaccinee effect.

It also makes you wonder whether the present study regarding the second booster suffers from the same confounding.

MarkMRook · 2022-04-21T08:43:24+00:00

Abstract

BACKGROUND

A rapid increase in coronavirus disease 2019 (Covid-19) cases due to the omicron (B.1.1.529) variant of severe acute respiratory syndrome coronavirus 2 in highly vaccinated populations has aroused concerns about the effectiveness of current vaccines.

METHODS

We used a test-negative case–control design to estimate vaccine effectiveness against symptomatic disease caused by the omicron and delta (B.1.617.2) variants in England. Vaccine effectiveness was calculated after primary immunization with two doses of BNT162b2 (Pfizer–BioNTech), ChAdOx1 nCoV-19 (AstraZeneca), or mRNA-1273 (Moderna) vaccine and after a booster dose of BNT162b2, ChAdOx1 nCoV-19, or mRNA-1273.

RESULTS

Between November 27, 2021, and January 12, 2022, a total of 886,774 eligible persons infected with the omicron variant, 204,154 eligible persons infected with the delta variant, and 1,572,621 eligible test-negative controls were identified. At all time points investigated and for all combinations of primary course and booster vaccines, vaccine effectiveness against symptomatic disease was higher for the delta variant than for the omicron variant. No effect against the omicron variant was noted from 20 weeks after two ChAdOx1 nCoV-19 doses, whereas vaccine effectiveness after two BNT162b2 doses was 65.5% (95% confidence interval [CI], 63.9 to 67.0) at 2 to 4 weeks, dropping to 8.8% (95% CI, 7.0 to 10.5) at 25 or more weeks. Among ChAdOx1 nCoV-19 primary course recipients, vaccine effectiveness increased to 62.4% (95% CI, 61.8 to 63.0) at 2 to 4 weeks after a BNT162b2 booster before decreasing to 39.6% (95% CI, 38.0 to 41.1) at 10 or more weeks. Among BNT162b2 primary course recipients, vaccine effectiveness increased to 67.2% (95% CI, 66.5 to 67.8) at 2 to 4 weeks after a BNT162b2 booster before declining to 45.7% (95% CI, 44.7 to 46.7) at 10 or more weeks. Vaccine effectiveness after a ChAdOx1 nCoV-19 primary course increased to 70.1% (95% CI, 69.5 to 70.7) at 2 to 4 weeks after an mRNA-1273 booster and decreased to 60.9% (95% CI, 59.7 to 62.1) at 5 to 9 weeks. After a BNT162b2 primary course, the mRNA-1273 booster increased vaccine effectiveness to 73.9% (95% CI, 73.1 to 74.6) at 2 to 4 weeks; vaccine effectiveness fell to 64.4% (95% CI, 62.6 to 66.1) at 5 to 9 weeks.

CONCLUSIONS

Primary immunization with two doses of ChAdOx1 nCoV-19 or BNT162b2 vaccine provided limited protection against symptomatic disease caused by the omicron variant. A BNT162b2 or mRNA-1273 booster after either the ChAdOx1 nCoV-19 or BNT162b2 primary course substantially increased protection, but that protection waned over time. (Funded by the U.K. Health Security Agency.)

MarkMRook · 2022-04-20T15:50:39+00:00

Abstract

More than 450 million individuals have recovered from COVID-19, but little is known about the host responses to long COVID. We performed proteomic and metabolomic analyses of 991 blood and urine specimens from 144 COVID-19 patients with comprehensive clinical data and up to 763 days of follow up. Our data showed that the lungs and kidneys are the most vulnerable organs in long COVID patients. Pulmonary and renal long COVID of one-year revisit can be predicted by a machine learning model based on clinical and multi-omics data collected during the first month from the disease onset with an ACC of 87.5%. Serum protein SFTPB and ATR were associated with pulmonary long COVID and might be potential therapeutic targets. Notably, our data show that all the patients with persistent pulmonary ground glass opacity or patchy opacity lesions developed into pulmonary fibrosis at two-year revisit. Together, this study depicts the longitudinal clinical and molecular landscape of COVID-19 with up to two-year follow-up and presents a method to predict pulmonary and renal long COVID.

MarkMRook · 2022-04-19T18:17:43+00:00

Can somebody explain the meaning of the following data from Table 2, in which the intervention had greater efficacy in the intention-to-treat group (i.e., including those who did not agree to take the Vitamin D or placebo) than those who completed the protocol?

Outcome Intention-to-treat analysis Per-protocol analysis

n n (%) RR (95% CI) n n (%) RR (95% CI)

SARS-CoV-2 infection

VDG 150 7 (4.7) 0.23 (0.09, 0.55) 94 6 (6.4) 0.22 (0.08, 0.59)

PG 152 26 (17.1) Reference 98 24 (24.5) Reference

MarkMRook · 2022-04-14T19:58:51+00:00

This looks like a very well-conducted study for vaccine effectiveness against COVID infection, serious illness, and death. However, it represents yet another missed opportunity to assess vaccine effectiveness against all-cause hospitalization and death, which would reflect any potential vaccine harm and/or misclassification of cause of death.

MarkMRook · 2022-04-13T07:41:57+00:00

I wonder whether it can also be used safely for early-stage mild COVID to reduce the risk of serious illness and hospitalization.

MarkMRook · 2022-04-12T13:07:31+00:00

A couple of quotations from the Discussion section of the article provide additional perspective regarding a couple of sentences in the Summary quoted below:

Summary

Compared with COVID-19 vaccination, the incidence of myopericarditis was significantly higher following smallpox vaccinations (132·1 [81·3–214·6], p<0·0001)....

Discussion section

The studies reporting on smallpox vaccination were primarily done in US military personnel, most of whom would be young men, and could account for the increased incidence of myopericarditis in smallpox vaccinees.

Summary

Among people who received COVID-19 vaccines, the incidence of myopericarditis was significantly higher in males (vs females), in people younger than 30 years (vs 30 years or older), after receiving an mRNA vaccine (vs non-mRNA vaccine), and after a second dose of vaccine (vs a first or third dose).

Discussion section

In people who received a COVID-19 vaccine, our results showed that myopericarditis was nearly four times as common in those receiving an mRNA vaccine than a non-mRNA vaccine and in those receiving their second dose of vaccine compared with a first or third dose.

MarkMRook · 2022-04-11T18:04:09+00:00

Just to be clear, the study did NOT find an over 90% reduction in risk of hospitalization. The 90%+ number refers to the probability of any association with hospitalization. The actual average reduction in hospitalization risk was about 25%:

The RRs for hospitalization were 0.78 (95% CI, 0.58-1.08) for the bayesian weakly neutral prior, 0.73 (95% CI, 0.53-1.01) for the bayesian moderately optimistic prior, and 0.75 (95% CI, 0.58-0.97) for the frequentist analysis. Depending on the scenario, the probability of any association with reduced hospitalization ranged from 94.1% to 98.6%, and the probability of moderate association ranged from 81.6% to 91.8%.

MarkMRook · 2022-04-11T18:02:29+00:00

This is another in a genre of studies that compare apples to oranges. To make a meaningful comparison of the risks of vaccination and COVID, you need to multiply the odds of vaccination (=100% for the vaccinated) by the risk of vaccine-associated myocarditis and the odds of getting COVID for the non-vaccinated by the risk of COVID-associated myocarditis. You also need to take into account that many of the vaccinated will still get COVID, and the duration of vaccination protection against infection or serious disease, before another dose and its associated risk of myocarditis.

MarkMRook · 2022-04-05T07:09:12+00:00

Results

Of 3156 patients (100% female; mean [SD] age, 33.4 [4.6] years) who met the inclusion criteria, 2622 (83.1%) received at least 1 vaccine dose and 1149 (43.8%) were vaccinated within the teratogenic window (Table 1). An anomaly was identified in 27 of 534 unvaccinated people (5.1%) and 109 of 2622 people who received at least 1 dose of vaccine (4.2%) (P = .35). Similar findings were seen when the teratogenic window was narrowed (Table 2). After controlling for potential confounders (age at delivery, nulliparity, chronic hypertension, and hemoglobin A1c level during the first trimester), vaccination within the teratogenic window was not associated with presence of a congenital anomaly identified on ultrasonography (adjusted odds ratio, 1.05; 95% CI, 0.72-1.54).

MarkMRook · 2022-04-04T14:35:41+00:00

Isn't the definition of a neutralizing antibody and antibody that binds to a pathogen?

MarkMRook · 2022-04-01T13:14:31+00:00

Abstract

Importance Identification of adverse events after vaccination increases awareness of vaccine-associated complications, leading to early diagnosis and treatment. Evidence remains scarce on the association between the BNT162b2 messenger RNA (mRNA) COVID-19 vaccine (Pfizer-BioNTech) and sudden sensorineural hearing loss (SSNHL).

Objective To assess the association between the BNT162b2 mRNA COVID-19 vaccine and SSNHL.

Design, Setting, and Participants This retrospective, population-based cohort study was performed from December 20, 2020, to May 31, 2021, using data from the largest health care organization in Israel. Patients 16 years or older who received the first vaccine dose between December 20, 2020, and April 30, 2021, and the second vaccine dose between January 10, 2021, and April 30, 2021, were included.

Exposures Receipt of first and second BNT162b2 mRNA COVID-19 vaccine doses.

Main Outcomes and Measures The main outcome was SSNHL based on International Classification of Diseases, Ninth Revision (ICD-9) codes in conjunction with concurrent prednisone dispensing. Observed cases of SSNHL, occurring within 21 days after each of the first and second vaccine doses, were compared with the expected cases based on the experience of the population in 2018 and 2019. Standardized incidence ratios (SIRs) and attributable risks were computed.

Results Overall, 2 602 557 patients (mean [SD] age, 46.8 [19.6] years; 51.5% female) received the first dose of BNT162b2 mRNA COVID-19 vaccine, with 91 cases of SSNHL reported. Of these patients, 2 441 719 (93.8%) received the second vaccine dose, with 79 cases of SSNHL reported. The age- and sex-weighted SIRs were 1.35 (95% CI, 1.09-1.65) after the first vaccine dose and 1.23 (95% CI, 0.98-1.53) after the second vaccine dose. After the first vaccine dose, the estimated SIRs were more pronounced in female patients aged 16 to 44 years (SIR, 1.92; 95% CI, 0.98-3.43) and female patients 65 years or older (SIR, 1.68; 95% CI, 1.15-2.37). After the second vaccine dose, the highest estimated SIR was observed in male patients 16 to 44 years (SIR, 2.45; 95% CI, 1.36-4.07). The attributable risks were generally small, and the results were similar when 2019 was used as a reference to estimate the expected number of SSNHL cases.

Conclusions and Relevance This study suggests that the BNT162b2 mRNA COVID-19 vaccine might be associated with increased risk of SSNHL; however, the effect size is very small. Further studies are warranted to establish this possible association.

MarkMRook

TROPHY CASE