Reinfection by SARS-CoV-2 in healthy young adults is common: Mt Sinai study

 Paper title: SARS-CoV-2 seropositivity and subsequent infection risk in healthy young adults: a prospective cohort study

Corresponding Author:  Stuart C. Sealfon, MD, Professor of Neurology, Neuroscience and Pharmacological Sciences, Icahn School of Medicine at Mount Sinai

Bottom Line: Although antibodies induced by infection to SARS-CoV-2 are largely protective, they do not guarantee effective immunity against subsequent infection, as evidenced through a longitudinal, prospective study of young Marine recruits. Previously infected study participants identified by seropositivity are susceptible to repeat infection, with nearly one-fifth the incidence rate of those without evidence of previous infection. Among the seropositive group, those who became infected again had lower antibody titers than those that were uninfected, and most lacked detectable baseline neutralizing antibodies. Findings suggest that COVID-19 vaccination may be necessary for control of the pandemic in previously infected young adults.

Results:  Among 189 seropositive participants, 19 (10.1%) had at least one positive PCR test for SARS-CoV-2 during the six-week follow-up. In contrast, 1,079 (48.0%) of the 2,246 seronegative participants tested positive. The incidence rate ratio was 0.18 (95% CI 0.11-0.28, p<0.00001). Among seropositive recruits, infection was associated with lower baseline full-length protein IgG titers (p=<0.0001). Compared with seronegative recruits, seropositive recruits had about 10-fold lower viral loads and trended towards shorter duration of PCR positivity (p=0.18) and more asymptomatic infections (p=0.13). Among seropositive participants, baseline neutralizing titers were detected in 45 of 54 (83.3%) uninfected and in 6of 19 (31.6%) infected participants during the 6 weeks of observation.

Why the Research Is Interesting: With the onset of mass SARS-CoV-2 vaccination programs and the increasing proportion of previously infected individuals, the risk of reinfection after natural infection is an important question for modeling the pandemic, estimating herd immunity, and guiding vaccination strategies. And since young adults, of whom a high percentage are asymptomatically infected and become seropositive in the absence of known infection, can therefore be a source of transmission to more vulnerable populations, it’s important to evaluate protection against subsequent SARS-CoV-2 infection conferred by seropositivity to determine the need for vaccinating previously infected individuals in this age group.

Who: Scientists from the Icahn School of Medicine at Mount Sinai, in collaboration with researchers from the Naval Medical Research Center, utilized the COVID-19 Health Action Response for Marines (CHARM) study, a longitudinal, prospective cohort study that has been previously described and published in NEJM, to examine how protective detectable antibodies are to preventing subsequent infections with SARS-CoV-2, the virus that causes COVID-19. The study population consisted of 3,249 predominantly male, 18-20-year-old Marine recruits who, upon arrival at a Marine-supervised two-week quarantine prior to entering basic training, were assessed for baseline SARS-CoV-2 IgG seropositivity (defined as a 1:150 dilution or greater on receptor binding domain and full-length spike protein enzyme-linked immunosorbent [ELISA] assays.) The presence of SARS-CoV-2 was assessed by PCR at initiation, middle and end of quarantine. After appropriate exclusions, including participants with a positive PCR during quarantine, the study team performed three bi-weekly PCR tests in both seronegative and seropositive groups once recruits left quarantine and entered basic training.

When: All study data was collected between May and October, 2020. The prospective study observation period began when Marine recruits arrived at Marine Corps Recruit Depot – Parris Island (MCRDPI) to commence basic training.

What: The study evaluated protection against subsequent SARS-CoV-2 infection conferred by seropositivity in young adults to determine the need for vaccinating previously infected individuals in this age group.

How: After appropriate exclusions, including participants with a positive PCR during quarantine, the study team performed three biweekly PCR tests in both seropositive and in seronegative groups once recruits left quarantine and entered basic training and baseline neutralizing antibody titers on all subsequently infected seropositive and selected seropositive uninfected participants.

Study Conclusions: Seropositive young adults had about one-fifth the risk of subsequent infection compared with seronegative individuals. Although antibodies inducted by initial infection are largely protective, they do not guarantee effective SARS-CoV-2 neutralization activity or immunity against subsequent infection. These findings may be relevant for optimization of mass vaccination strategies.

Funding: Defense Health Agency and Defense Advanced Research Projects Agency (DARPA)

https://www.newswise.com/coronavirus/new-study-finds-reinfection-by-sars-cov-2-in-healthy-young-adults-is-common

Moderna needs more teens for COVID-19 vaccine trial

The Centers for Disease Control and Prevention reported Monday that more than 30 million Americans have received at least one dose of a coronavirus vaccine.

About 25 million people have received one shot and another 5 million have received both required doses in the United States.

Now that the vaccine is rolling out to more Americans, researchers are turning their attention to younger patients. Studies are firing up to focus on a safe vaccine for children as young as 12 years old.

Last month, the U.S. Food and Drug Administration approved the Pfizer-BioNTech vaccine trial for 16- and 17-year-olds. Since then, the company has had enough volunteers sign up to begin the trial.

Moderna still needs about 3,000 teenagers to volunteer for its COVID-19 vaccine trial. They are searching for teenagers from 12 to 17 years old. Anyone interested in this trial can find more information here.

Adolescents are typically not among the most serious cases of COVID-19, however, studies show they can still spread the virus to high-risk individuals. Since they make up about about a fifth of the U.S. population, it’s important for them to get vaccinated to achieve herd immunity, doctors say.

“It is really important that we have COVID-19 vaccines available for children,” Norton Healthcare’s Dr. Kris Bryant said. “Children make up 22 percent of the population, so if we really want to get control of the virus, ultimately we’re going to need to be able to vaccinate children.”

On Monday, Bryant explained to WAVE 3 New Now how the coronavirus could affect teenagers and children, what to expect with the vaccine trial, and when it could be available to them.

https://www.wave3.com/2021/02/01/moderna-needs-more-teens-covid-vaccine-trial/

Line cooks at highest risk of dying from COVID: UCSF study

 According to a new UCSF study, food and agricultural workers are at the highest risk of death from COVID-19 among working age Californians. The study, which analyzed deaths of essential workers between ages 18 to 65, found line cooks to be at the highest risk of all, more so than packaging machine operators, construction laborers and even nurses.

When Gov. Gavin Newsom announced on Monday that the state would be shifting its vaccine rollout to an age-based system, some worried that this meant restaurant workers would no longer be prioritized. However, as a California Department of Public Health spokesperson confirmed to the San Francisco Chronicle, this is not true — restaurant workers will be categorized under “food and agricultural workers,” an essential group that should be next in line for the vaccine.

The results of the UCSF study underline the importance of prioritizing cooks and other food workers for the vaccine: While working adults saw an overall 22% increase in deaths during the pandemic, food and agriculture workers saw an even more devastating increase of 39%.

Jobs associated w greatest risk of death during pandemic in CA?

Cooks
Packaging machine operators
Agricultural workers
Bakers
Construction workers
Production workers
Sewing machine operators
Shipping clerks

Full list in new preprint @UCSF_Epibiostat https://t.co/FGtLWaHFHB pic.twitter.com/PSBwU99hxA

— Kirsten Bibbins-Domingo (@KBibbinsDomingo) January 22, 2021

And while cooks have the highest "risk ratio for mortality," with 828 deaths between March and October of 2020, other food-related jobs were also found to be in the top riskiest channels of employment. Agricultural workers and bakers ranked in the top five, with chefs/head cooks and bartenders following close behind.

"Though non-occupational risk factors may be relevant, it is clear that eliminating COVID-19 will require addressing occupational risks," wrote the authors of the study. "... As jurisdictions struggle with difficult decisions regarding vaccine distribution, our findings offer a clear point of clarity: vaccination programs prioritizing workers in sectors such as food/agriculture are likely to have disproportionately large benefits for reducing COVID-19 mortality."

https://www.sfgate.com/food/article/Cooks-restaurant-workers-risk-death-COVID-UCSF-15905789.php

Cuomo: NY counties can vaccinate restaurant workers, taxi drivers

 New York Gov. Andrew Cuomo said Tuesday that he was giving county officials the authority to add taxi drivers and restaurant workers to the list of people eligible for a coronavirus vaccine.

The governor’s announcement came days after the governor slammed elected officials for pushing to vaccinate restaurant workers when supply is limited.

But Cuomo said Tuesday the federal government is signaling that it will send New York more doses in coming weeks, which could free up more doses. 

With the incoming increase, Cuomo says localities can also add developmentally disabled facilities to the 1B prioritization group.

"If a local government is now getting more, and they believe in their local circumstance, they want to prioritize taxi drivers, Uber drivers, -- because they think that’s been a problem – or developmentally disabled facilities, or restaurant workers, they have that flexibility," said Cuomo. "And again, they are getting more, so theoretically they would have additional supply to make those decisions. But that’s going to be up to the local government to add in the 1B category, if they think it makes sense."

The federal government is expected to increase state supply 20% for the next three weeks, up from the inital 16% announced last week.

Private pharmacies in the state focusing on vaccinating the 65-plus population will also receive an additional 10%, which is about 30,000 doses.

https://www.wktv.com/content/news/Cuomo-Counties-can-begin-vaccinating-restaurant-workers-taxi-drivers-573711671.html

White House plans to send vaccine doses to retail pharmacies

 The White House will launch a new program shipping coronavirus vaccines directly to retail pharmacies starting next week in an effort to increase Americans' access to shots, a top aide said on Tuesday.

President Joe Biden's COVID-19 response coordinator, Jeff Zients, said the program will launch on Feb 11 and make 1 million doses available to 6,500 stores. As supply grows, the program could expand to as many as 40,000 stores, he said.

Biden said last month that the COVID-19 vaccine rollout has been a "dismal failure" so far and vowed to boost the speed at which shots are given to Americans, with a focus on ensuring equitable access regardless of geography, race, or ethnicity.

The federal government will distribute a million vaccine doses to the 6,500 stores next week, Zients said, adding that the amount will grow over time.

That is in addition to 10.5 million doses that the federal government plans to ship weekly to states and territories for the next three weeks, he added.

"This will provide more sites for people to get vaccinated in their communities," Zients said, adding that supply constraints will limit the program in its early days.

The initial pharmacy locations were selected to improve access to vaccines in hard to reach areas and among socially vulnerable communities, Zients said.

CVS Health Corp said in a news release that its pharmacies will be participating in the program.

Zients also said the Federal Emergency Management Agency (FEMA) will reimburse states for some COVID-related costs they had taken on since the pandemic began last January, such as for personal protective equipment and deployment of the national guard.

He said Congress does not need to approve funds for FEMA to do this and that the total payments to states will be between $3 billion and $5 billion.

Zients added that the federal government has acquired supplies of equipment healthcare providers need to get six doses from each vial of Pfizer Inc's COVID-19 vaccine rather than five.

The Biden administration has said it is willing to use emergency wartime powers if necessary to secure the specialized low dead space syringes and other supplies needed to eliminate vaccine waste and improve administration efficiency.

The major winter storm that hit the east coast of the United States this week has not disrupted vaccine deliveries but has forced some vaccine administration sites to shut down or reduce operating hours, Zients said.

https://www.marketscreener.com/quote/stock/WALGREENS-BOOTS-ALLIANCE-19356230/news/White-House-plans-to-send-vaccine-doses-to-retail-pharmacies-32339246/

Oxford Covid vaccine study shows jab can halt transmission

 The AstraZeneca vaccine requires two doses for the highest efficacy against coronavirus infection, but new research has shown the first dose provides 76 percent protection. A new study shows the jab has 76 percent efficacy after a single dose, with efficacy improving further after a second shot was given. Oxford University also found the jab also has "substantial effect" on reducing transmission of coronavirus.

Oxford University said the findings of the pre-print paper, which had not been peer-reviewed, supported Britain's decision to extend the interval between initial and booster doses of the shot to 12 weeks.

The UK has decided to give as many people as possible some protection from the deadly virus by lengthening the amount of time given between the first and second shot of the vaccines. 

AstraZenca, the Anglo-Swedish pharmaceutical firm, has welcomed the findings and said flexibility to extend the time between doses is the best strategy for the vaccine.

Oxford academics said: "Vaccine efficacy after a single standard dose of vaccine from day 22 to day 90 post vaccination was 76 percent, and modelled analysis indicated that protection did not wane during this initial 3 month period."

Oxford academics said: "Vaccine efficacy after a single standard dose of vaccine from day 22 to day 90 post vaccination was 76 percent, and modelled analysis indicated that protection did not wane during this initial 3 month period."

The results were gathered from trials in Britain, Brazil and South Africa, and showed some protection was given after one dose and that immune responses were boosted after the second shot, among participants aged 18-55 years old. 

The university also found the vaccine can stop transmission of COVID-19.

They added: “Analyses of PCR positive swabs in UK population suggests vaccine may have substantial effect on transmission of the virus with 67 percent reduction in positive swabs among those vaccinated.”

The report states the vaccine “may have a substantial impact on transmission by reducing the number of infected individuals in the population”.

In December the Government announced the second dose would be given towards the end of 12 weeks rather than in the previously recommended 3-4 weeks.

They said they want to give a single dose of the jab to as many members of priority groups as possible.

The UK’s Joint Committee on Vaccination and Immunisation (JCVI) said: “Given data indicating high efficacy from the first dose of both Pfizer-BioNTech and AstraZeneca vaccines, the committee advises that delivery of the first dose to as many eligible individuals as possible should be initially prioritised over delivery of a second vaccine dose.

“This should maximise the short-term impact of the programme. The second dose of the Pfizer-BioNTech vaccine may be given between three to 12 weeks following the first dose.

“The second dose of the AstraZeneca vaccine may be given between four to 12 weeks following the first dose.”

The four UK chief medical officers agreed to follow the JCVI advice, as they believe the benefit of vaccinating more people outweighs the risk of individuals not having as strong protection against infection as they might have with two doses.

https://www.express.co.uk/news/uk/1392491/Oxford-Covid-vaccine-latest-news-Astrazeneca-protection-transmission-coronavirus-update

Primary care docs key to speeding COVID-19 vaccine rollout: study

 Vaccinating millions of Americans against the COVID-19 virus is proving to be a complicated process already plagued with many setbacks.

But there's already a ready-made vaccine distribution system that can be tapped into to accelerate the rollout, some experts say: primary care doctors.

Primary care doctors provide nearly half of all vaccines in the U.S. and their role may help assure successful delivery of the COVID-19 vaccines to communities across the nation, including rural and remote communities, according to a preprint study published in the Annals of Family Medicine."Bottom line, if we engage and activate the ready-made primary care practices, we can accelerate COVID-19 vaccine distribution and reach herd immunity through immunization sooner," said John Westfall, M.D., a co-author of the study and director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

"Vaccine manufacturers already know who orders vaccines and could deliver vaccines to those same primary care offices. Medicare knows who provides COVID-19 to Medicare beneficiaries and actually know how many beneficiaries get their vaccines from these practices. They could ship out that number of vaccines to each primary care practice for their seniors. Or do so in waves," Westfall said.

There’s growing frustration among medical groups about being shut out of the vaccine distribution process with primary care docs even missing out on getting the vaccines themselves.

The Medical Group Management Association (MGMA) is urging the Biden administration to include medical group practices in COVID-19 vaccine distribution strategies moving forward. A survey reflecting responses from 403 medical group practices showed 85% of independent practices actively seeking the COVID-19 vaccine for their patients received some as of Jan. 21-24. Nearly half (45%) of hospital- or health system-owned practices seeking vaccines still hadn't gotten any. Meanwhile, the majority of practices that have gotten the vaccine (54%) say they only received enough to vaccinate 1% or less of their patients.

The COVID-19 pandemic recovery will require a broad and coordinated effort for infection testing, immunity determination, and vaccination, the study authors said.

The study evaluated the delivery of vaccinations, using 2017 Medicare Part B Fee-For-Service data and the 2013-2017 Medical Expenditure Panel Survey at the service, physician, and visit level. The data shows that primary care physicians have played a crucial role in delivery of vaccinations to the U.S. population, including the elderly, between 2012-2017.

Overall, PCPs provided the most vaccinations (46%), followed closely by mass immunizers (45%), then nurse practitioners/physician assistants (5%). There were clusters of counties that had over 50% of vaccinations provided by PCPs throughout states such as Louisiana, Pennsylvania and Massachusetts, the study found.

In addition to physically administering vaccinations, PCPs can provide clinical and personal support to enable patients to understand their current COVID-19 immunologic status, how that may impact their vaccine decisions, and to counter vaccine hesitancy and misinformation, the study said.

There continues to be a high level of distrust in the COVID-19 vaccine among some populations. The new vaccines may face more vaccine hesitancy, misinformation, and refusal than other vaccines, the study said.

It's important to leverage the trusted relationship that primary care physicians have with patients when distributing the COVID-19 vaccine.

"Primary care practices may play an even more important role in vaccine counseling, building local community trust, and serving as a source of scientific knowledge about the COVID-19 vaccine," the study authors said.

Given its historic role in immunization counseling and vaccine delivery, primary care, in concert with public health agencies and community health organizations, is essential for immediate and sustainable population health efforts to address COVID-19 recovery, the study said.

https://www.fiercehealthcare.com/practices/primary-care-docs-could-be-key-to-accelerating-covid-19-vaccine-rollout-study