NY’s elderly COVID-19 vaccination rate lags

 New York lags way behind the rest of the country when it comes to inoculating people over age 65 against the coronavirus, according to the latest CDC statistics.

The Empire State ranks 44th in the country on the percentage of folks over 65 who have gotten at least one COVID-19 vaccination shot, according to CDC data.

Across the country, older people have been given vaccination priority, and 73 percent of Americans over 65 have now received at least one dose.

But in NY, the number of seniors with one dose under their sleeves is just 67 percent.

New York is doing a much better job at immunizing residents ages 18 to 65. The state ranks 9th in the union on that metric.

New York also comes in 24th out of 50 states for vaccinating its total adult population, the federal data shows.

The contrast is cause for concern, public policy experts contend.

“The disparity suggests that New York’s vaccination policies and procedures are giving younger people an advantage relative to other states,” Bill Hammond, Senior Fellow for Health Policy at Empire Center, said in a press release Friday.

The think tank speculates that the Cuomo administration’s vaccine prioritization of essential workers in December led to the disparity, as high-risk jobs like hospital workers tend to be filled with younger people.

“This may relate to the number of younger New Yorkers who were competing for limited slots at any given time, and the process for finding and scheduling an appointment, which gives an edge to the computer-savvy,” Hammond said.

The only older people who could get initially get a vaccination shot when they first became available were residents of long-term care facilities, under Albany’s guidelines.

As of Tuesday, every New Yorker in the state aged 16 and over will be able to get vaccinated.

https://nypost.com/2021/04/02/nys-elderly-covid-19-vaccination-rate-lags-behind/

Common Meds Contain Animal Byproducts – No FDA Regs to Alert Patients

More physicians and pharmacists are advocating for patients to be made aware of animal byproducts contained in common medications, according to new research in the Journal of Osteopathic Medicine. Common medications, including widely used blood thinners and hormones, are often derived from animal byproducts and prescribed without consulting the patient about their beliefs.

“Patients deserve to know what their medications are made of, yet this information is rarely shared,” said Sara Reed, student doctor at Lincoln Memorial University (LMU) DeBusk College of Osteopathic Medicine and an author of the paper. “Putting the patient first means communicating with them about the medicine recommended for their care, and in some cases, prescribing an alternative option.”

Common Animal-derived Medications

Heparinoids are a class of medication primarily derived from pigs. These drugs are routinely used as a blood thinner to prevent blood clots and are given in many settings, including following surgery, a heart attack, or to prevent the further development of clots.

Also common are conjugated estrogens, which may be used to treat moderate to severe hot flashes and other symptoms of menopause. They are equine-derived hormones.

“Generally, patients who are prescribed various hormone treatments may want to consult their physician regarding the contents,” said Mary Beth Babos, PharmD, professor of pharmacology at LMU, and lead author of the paper. “For example, there are no completely animal-free oral thyroid hormones on the market.”

Existing Guidelines

While the U.S. does not have formal recommendations, other nations have published guidelines to address pharmaceuticals of animal origin. The United Kingdom’s first guidelines were published in 2004 and Australia’s guidelines were published in 2007 and updated again in 2019. However, guidelines from the FDA remain unavailable.

Cultural Competency

Because some patients adhere to religious doctrine that recommends avoiding certain animal byproducts, the study authors reviewed prior medical research to identify the stated positions of leadership of the major world religions. According to their findings, many religions discourage the use of products derived from animals when not required to save human life.

• Jewish and Muslim leaders agree that the use of products derived from pigs—normally prohibited by both religions—are acceptable only when needed to protect human life.
• The Hindu Council of Australia does not consider bovine products, including medications derived from cows, acceptable.
• Sikh leaders and leaders of the Hindu Vaishnav sect object to the use of medication or surgical dressing derived from animal sources, which is waived in emergency situations or in routine treatment where no alternative exists.
• Many Buddhists of the Theravada sect and Christians of the Seventh Day Adventist sect who practice vegetarianism as part of their faith may individually reject animal-derived medical products.
• Leaders of the Jehovah’s Witness sect emphasized that adherents to this faith would reject blood-derived products.

“In the absence of governmental guidance, we hope this research will help physicians and prescribers start the conversation with patients about whether they accept animal-derived products,” said Reed. “Ultimately, it is the patient who should determine if a medication is appropriate for their lifestyle.”

Reference: “Animal-derived medications: cultural considerations and available alternatives” by
Mary Beth Babos, Joseph D. Perry, Sara A. Reed, Sandra Bugariu, Skyler Hill-Norby, Mary Jewell Allen, Tara K. Corwell, Jade E. Funck, Kaiser F. Kabir, Katherine A. Sullivan, Amber L. Watson and K. Kelli Wethington, 8 March 2021, Journal of Osteopathic Medicine.

DOI: 10.1515/jom-2020-0052

https://scitechdaily.com/common-medications-contain-animal-byproducts-no-fda-regulations-to-alert-patients/

In Severe COVID-19, Cytokine 'Hurricane' in Lung Attracts Damaging Inflammatory Cells

 A cytokine “hurricane” centered in the lungs drives respiratory symptoms in patients with severe COVID-19, a new study by immunologists at Columbia University Vagelos College of Physicians and Surgeons suggests.

Two cytokines, CCL2 and CCL3, appear critical in luring immune cells, called monocytes, from the bloodstream into the lungs, where the cells launch an overaggressive attempt to clear the virus. 

Targeting these specific cytokines with inhibitors may calm the immune reaction and prevent lung tissue damage. Currently, one drug that blocks immune responses to CCL2 is being studied in clinical trials of patients with severe COVID-19.

Survivors of severe COVID-19, the study also found, had a greater abundance of antiviral T cells in their lungs than patients who died, suggesting these T cells may be critical in helping patients control the virus and preventing a runaway immune response.

The study, published online on March 12, 2021, in the journal Immunity, is one of the first to examine the immune response as it unfolds in real time inside the lungs and the bloodstream in patients who are hospitalized with severe COVID-19. 

Treatments for Severe COVID-19 Needed

In patients with severe COVID-19, the lungs are damaged, and patients need supplemental oxygen. The risk of mortality is over 40%.

“We wanted to look at the immune response in the lung in severe disease, because it’s those responses that are either protecting the organ or causing the damage,” says Donna Farber, PhD, professor of microbiology & immunology and the George H. Humphreys II Professor of Surgical Sciences in the Department of Surgery, who led the study. “Even though individuals are getting vaccinated, severe COVID-19 remains a significant risk for certain individuals and we need to find ways to treat people who develop severe disease.”

Numerous COVID studies have focused on identifying immune responses in blood; a few have looked at airway samples from a single time point or from autopsies. Few studies have examined the immune response to SARS-CoV-2 in the respiratory tract as the response unfolds, because obtaining such samples from patients is challenging. But the Columbia researchers learned several years ago that they can retrieve respiratory immune cells from the routine daily saline washes of the endotracheal tubes that connect intubated patients to a ventilator.

Paired Airway and Blood Samples Show Complete Immune Response in Real Time

In this new study, the researchers collected respiratory immune cells from 15 COVID-19 patients who had been intubated. Each patient spent four to seven days on a ventilator, and airway and blood samples were obtained daily.

All the samples were examined for the presence of cytokines and different types of immune cells. For four of the patients, the researchers measured gene expression in every immune cell to get a detailed picture of the cells’ activities.

“It seems obvious that the immune response in the respiratory tract would drive a disease caused by a respiratory virus, but we didn’t know what the processes were and how they worked together with systematic responses,” Farber says. “What’s new here is that we’ve been able to simultaneously sample both the respiratory tract and the blood over time and put together a more complete picture of the responses involved and how local and systemic responses work together.”

Two Cytokines Appear to Drive Lung Damage

Though the researchers found elevated levels of many cytokines in the blood, many more types of cytokines were present in the lungs and at highly elevated levels. 

“People refer to patients experiencing a cytokine storm in the blood, but what we’re seeing in the lungs is on another level,” Farber says. “The immune cells in the lung went into overdrive releasing these cytokines.”

No cytokines were found in the blood that weren’t also found in the lung, suggesting that the signals causing the severe inflammation are driven by lung cytokines rather than systemic ones. 

“It has been suggested that systemic cytokines are driving severe disease, but our results suggest that inflammatory processes that perpetuate disease are coming from the lungs,” Farber says.

CCL2 and CCL3 cytokines released by the lung appeared to be particularly important in severe disease, because the monocytes drawn into the lung expressed receptors for these molecules. “Normally, these cells never make it to the airway, but in severe COVID patients, they accumulate throughout the lung and clog up the alveolar spaces,” Farber says.

The findings also may explain why trials of other cytokine inhibitors, including tocilizumab, have shown variable efficacy. Tocilizumab inhibits the cytokine IL-6, which is elevated in patients with severe COVID but does not appear to be a major component of inflammation in the lung, Farber says. 

Survivors Have High Level of T Cells in Lung 

Of the study’s 15 patients, eight died and all survivors were under 60 years of age.

The lungs of those survivors had significantly more T cells, which are mobilized to the lung to clear virus, and a lower proportion of inflammatory macrophages and monocytes.

In general, younger people have a more robust T cell response while older people have a higher baseline level of inflammatory cells; both factors may help explain why older patients with severe COVID fare worse.

The cell differences between patients who lived and those who died could potentially lead to a way to predict which patients are more likely to develop severe disease, although the differences are only apparent in the lung, not the blood. Importantly, the predictive value of airway immune cell frequencies was better than standard clinical measurements of lung and organ damage.

“Our next step is to try to find a more accessible biomarker that predicts severe COVID so we can try to give treatments earlier to patients who are most at risk,” Farber says.

“Understanding the immune response in severe COVID is really critical at this point,” Farber adds, “because we could see this again with the next coronavirus outbreak. This is what coronaviruses do at their worst; this is their M.O.”

Reference: “Longitudinal profiling of respiratory and systemic immune responses reveals myeloid cell-driven lung inflammation in severe COVID-19” by Peter A. Szabo, Pranay Dogra, Joshua I. Gray, Steven B. Wells, Thomas J. Connors, Stuart P. Weisberg, Izabela Krupska, Rei Matsumoto, Maya M.L. Poon, Emma Idzikowski, Sinead E. Morris, Chloé Pasin, Andrew J. Yates, Amy Ku, Michael Chait, Julia Davis-Porada, Xinzheng V. Guo, Jing Zhou, Matthew Steinle, Sean Mackay, Anjali Saqi, Matthew R. Baldwin, Peter A. Sims and Donna L. Farber, 11 March 2021, Immunity.
DOI: 10.1016/j.immuni.2021.03.005

Other authors (all from Columbia unless noted): Peter A. Szabo, Pranay Dogra, Joshua I. Gray, Steven B. Wells, Thomas J. Connors, Stuart P. Weisberg, Izabela Krupska, Rei Matsumoto, Maya M.L. Poon, Emma Idzikowski, Sinead E. Morris, Chloé Pasin, Andrew J. Yates, Amy Ku, Michael Chait, Julia Davis-Porada, Xinzheng V. Guo, Jing Zhou (IsoPlexis Corporation), Matthew Steinle (IsoPlexis), Sean Mackay (IsoPlexis), Anjali Saqi, Matthew R. Baldwin, and Peter A. Sims.

The research was supported by the U.S. National Institutes of Health (grants AI128949, AI06697, R01AI093870, K23A1141686, and K08DK122130); a Chan Zuckerberg Initiative COVID-19 grant; a CRI-Irvington Postdoctoral Fellowship; and a Canadian Institutes of Health Research Fellowship. Research reported in this publication was performed in the Human Immune Monitoring Core, the Columbia Single Cell Analysis Core, and the Sulzberger Columbia Genome Center, which are supported by an NCI cancer center support grant P30CA013696.

Jing Zhou, Matthew Steinle, and Sean Mackay are employees of IsoPlexis.

https://scitechdaily.com/in-severe-covid-19-cytokine-hurricane-in-lung-attracts-damaging-inflammatory-cells/

Mystery Condition Can Spur Sudden Paralysis – Possible Link to microRNA

 Researchers believe they may have discovered a possible cause of a mystery condition that can leave sufferers suddenly unable to walk, talk, or see.

It’s hoped the study — led by the University of York and Hull York Medical School and supported by Tees, Esk and Wear Valley NHS Trust — will pave the way for new treatments for Conversion disorder which affects around 800,000 people in the UK alone.

The condition, also known as functional neurological disorder (FND), causes physical symptoms that would appear neurological but doctors can’t find an injury or physical condition to explain them.

Professor Christina van der Feltz-Cornelis from the Department of Health Sciences is leading the Conversion And Neuro-inflammation Disorder Observational (CANDO) study. This pilot study is the first in a program of research to explore how conversion disorder/FND can be caused, and to develop and evaluate new treatments.

The first findings suggest that conversion disorder could be caused by a low grade inflammation process that influences gene expression, which is the process by which the instructions in our DNA are converted into a functional product, such as a protein. Protein does most of the work in cells and is required for the structure, function, and regulation of the body’s tissues and organs.

Professor van der Feltz-Cornelis said: “This is a very difficult condition for people to live with and one which is often overlooked because the medical profession doesn’t have the answers.”

“People living with the condition can become very distressed and isolated, often losing jobs and social networks through being unable to communicate or being unwell. Patients can also suffer from memory and concentration problems.”

“We made the discovery by examining levels of inflammation in blood samples from patients with FND that mimicked stroke-like symptoms. They were found to be higher than normal. Also, microRNA levels in the blood seemed to play a role and this influences the expression of genes in the cell.”

“These preliminary results deserve further exploration and replication in larger samples before we can draw firm conclusions.”

The CANDO researchers hope the new study will help in the development of new treatments, as treatments previously given to people with conversion disorder have often not helped ease the symptoms.

Annie, a patient involved in the CANDO study, says: “It is a relief to suddenly find that there may be a reason for this condition. I can’t wait for treatments that may be developed as a result of this work.”

“Assessment of Cytokines, microRNA and patient related outcome measures in Conversion Disorder/Functional Neurological Disorder (CD/FND): the CANDO clinical feasibility study” by Christina van der Feltz-Cornelis, Sally Brabyn, Jonathan Ratcliff, Danielle Varley, Victoria Allgar, Simon Gilbody, Chris Clarke and Dimitris Lagos, 24 February 2021, Brain, Behavior, & Immunity – Health.
DOI: 10.1016/j.bbih.2021.100228

https://scitechdaily.com/mystery-condition-can-leave-people-suddenly-paralyzed-possible-link-to-microrna-discovered/

Viagra May Prolong Life for Men With Coronary Artery Disease

 Men with stable coronary artery disease who are on Viagra due to impotence seem to live longer and have a lower risk of experiencing a new heart attack, a study from Karolinska Institutet in Sweden published in the Journal of the American College of Cardiology reports.

Impotence can be an early warning sign of cardiovascular disease in healthy men and is treated either locally with alprostadil, which dilates the blood vessels so that the penis stiffens, or with so-called PDE5 inhibitors, such as Viagra or Cialis, which are taken in tablet form orally before sex, inhibiting the enzyme phosphodiesterase5 (PDE5) in the penis to increase the blood flow.

Since PDE5 inhibitors decrease blood pressure, they were previously not recommended for men with coronary artery disease due to the risk of heart attack.

However, in 2017 Martin Holzmann and colleagues showed that men who have had a heart attack tolerate the drug well and that it even prolongs life expectancy and protects against new infarctions and heart failure.

In their new study, the researchers sought to compare the effect of alprostadil and PDE5 inhibitors in men with stable coronary artery disease. The patients were to have had either an infarction, balloon dilation or a coronary artery bypass surgery at least six months before the onset of treatment for erectile dysfunction.

“The risk of a new heart attack is greatest during the first six months, after which we consider the coronary artery disease to be stable,” says lead author Martin Holzmann, adjunct professor at the Department of Medicine, Solna, Karolinska Institutet.

The registry study comprised 16,500 men treated with PDE5 inhibitors and just under 2,000 who received alprostadil. The data was collected from the patient, drug, and cause of death registries.

The study shows that the men who received PDE5 inhibitors lived longer and had a lower risk of new heart attack, heart failure, balloon dilation, and bypass surgery than those who received alprostadil. The protection was dose-dependent, so that the more frequent the dose of PDE5 inhibitor, the lower the risk.

“This suggests that there’s a causal relationship, but a registry study can’t answer that question,” Holzmann says. “It is possible that those who received PDE5 inhibitors were healthier than those on alprostadil and therefore had a lower risk. To ascertain whether it is the drug that reduces the risk, we would need to randomly assign patients to two groups, one that takes PDE5 and one that doesn’t. The results we have now give us very good reason to embark on such a study.”

As PDE5 inhibitors are available by prescription only in Sweden, they cannot be bought over the counter, but Holzmann hopes that men with coronary artery disease do not shy away from addressing the matter with their doctor.

“Potency problems are common in older men and now our study also shows that PDE5 inhibitors may protect against heart attack and prolong life,” he says.

Reference: “Association of Phosphodiesterase-5 Inhibitors vs. Alprostadil with Survival in Men with Coronary Artery Disease” by Daniel P Andersson, Laura Landucci, Ylva Trolle Lagerros, Alessandra Grotta, Rino Bellocco, Mikael Lehtihet and Martin J Holzmann, 22 March 2021, Journal of the American College of Cardiology.
DOI: 10.1016/j.jacc.2021.01.045

The study was conducted in collaboration with the Obesity Centre in Stockholm and the University of Milano-Bicocca. Martin Holzmann receives funding from the Swedish Heart and Lung Foundation and Region Stockholm. Daniel Andersson has received a grant through a collaboration between Region Stockholm and Karolinska Institutet. Martin Holzmann has previously received consultancy fees from the pharmaceutical company Idorsia. No other potential conflicts of interest have been reported.

https://scitechdaily.com/viagra-may-prolong-life-for-men-with-coronary-artery-disease-lower-risk-of-experiencing-a-new-heart-attack/

France sees biggest jump in COVID-19 intensive care patients in months

 France reported on Friday that 5,254 people were in intensive care units with COVID-19, an increase of 145 people in one day and the highest daily increase in five months.

The risk of emergency wards being unable to cope was one of the main reasons for President Emmanuel Macron to order a third nationwide lockdown this week, after unsuccessfully trying for months to contain the epidemic with a curfew and regional lockdowns.

From next week, France starts a third lockdown, with schools and non-essential businesses closed nationwide for four weeks.

Announcing the lockdown on Wednesday, Macron said the number of ICU beds will be raised from 7,000 to over 10,000.

At the peak of the first lockdown in spring 2020, France saw a high of 7,148 COVID-19 patients in ICUs, but that fell back to a few hundred in August following the strict first lockdown.

During November’s less restrictive lockdown, ICU numbers peaked at just under 5,000, but since then they have only briefly dipped below 3,000 in December.

With new infections rising sharply, doctors expect the third wave of the virus will peak in the coming two weeks, with a further increase in ICU numbers.

On Friday, new confirmed cases jumped by the highest week-on-week rate since the end of November, when France was in its second nationwide lockdown.

The ministry reported 46,677 new cases, 6.2% more than a week ago, taking the total to 4.74 million cases.

France on Friday also reported 332 new deaths from COVID-19, taking the toll to 96,280, but the new death tally included only 32 deaths in retirement care homes over three days.

Death rates in retirement homes, which were several hundreds per week at the end of 2021, have fallen sharply as the government focused its vaccination campaign on the elderly.

The health ministry said 12.13 million people had received a vaccine so far, including just over three million second doses.

https://www.reuters.com/article/us-health-coronavirus-france/france-sees-biggest-jump-in-covid-19-intensive-care-patients-in-months-idUSKBN2BP1EN

India's daily coronavirus infections hit six-month high

 India’s daily coronavirus infections hit another record on Saturday for the highest tally since September, while daily deaths reached a five-month high, a Reuters count based on data from the health ministry showed.

The south Asian nation recorded 89,129 new infections and 714 deaths, the ministry said. That was the biggest single-day rise since September 20 last year and the most deaths since October 21, according to a Reuters tally.

Infections have surged in India since the beginning of March, with its richest state of Maharashtra, home to the financial capital of Mumbai, the worst hit.

Late on Friday, the state’s chief minister warned of a full lockdown to curb infections if people did not limit their movements.

https://www.reuters.com/article/us-health-coronavirus-india-cases/indias-daily-coronavirus-infections-hit-six-month-high-idUSKBN2BQ04D