Long COVID Appears to 'Impair' Survival in Cancer Patients

 More than 1 in 6 cancer patients experience long-term sequelae following SARS-CoV-2 infection, placing them at increased risk of discontinuing their cancer treatment or dying, according to European registry data.

Given the "high lethality" of COVID-19 in cancer patients and the risk for long-term complications following infection in the general population, Alessio Cortellini, MD, a consultant medical oncologist at Hammersmith Hospital and Imperial College London, London, United Kingdom, and colleagues wanted to explore the "prevalence and clinical significance of COVID-19 sequelae in cancer patients and their oncological continuity of care."

Cortellini presented the OnCovid registry research on September 21 at the European Society for Medical Oncology (ESMO) Annual Meeting 2021. He reported that overall, the data suggest that post-COVID-19 complications may "impair" patients' cancer survival as well as their cancer care.

The OnCovid registry data showed that the 15% of cancer patients who had long-term COVID-19 complications were 76% more likely to die than those without sequelae. Cancer patients with COVID-19 sequelae were significantly more likely to permanently stop taking their systemic anticancer therapy, and they were more than 3.5 times more likely to die than those who continued their treatment as planned. In terms of long-term complications, almost half of patients experienced dyspnea, and two fifths reported chronic fatigue.

"This data confirms the need to continue to prioritize cancer patients," commented Antonio Passaro, MD, PhD, Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy, in a press release. "In the fight against the pandemic, it is of the utmost importance that we do not neglect to study and understand the curves of cancer incidence and mortality."

Invited to discuss the results, Anne-Marie C. Dingemans, MD, PhD, a pulmonologist and professor of thoracic oncology at Erasmus Medical Center, Rotterdam, the Netherlands, said COVID-19 remains a "very important" issue for cancer patients.

Interestingly, Dingemans noted that COVID-19 sequelae in patients with cancer appear to occur slightly less frequently compared to estimates in the general population — which range from 13% to 60% — though patients with cancer tend to have more respiratory problems.

However, Dingemans added, the difficulty with comparing sequelae rates between cancer patients and the general population is that cancer patients "probably already have a lot of symptoms" associated with long COVID, such as dyspnea and fatigue, and may not be aware that they are experiencing COVID sequelae.

The Registry Results

To investigate the long-term impact of COVID-19 on survival and continuity of care, the team examined data from the OnCovid registry, which was established at the beginning of the pandemic to study consecutive patients aged 18 years and older with confirmed SARS-CoV-2 infection and a history of solid or hematologic malignancies.

At the data cutoff on March 1, 2021, the registry included 35 institutions in six European countries. The institutions collected information on patient demographics and comorbidities, cancer history, anticancer therapy, COVID-19 investigations, and COVID-19-specific therapies.

For the current analysis, the team included 1557 of 2634 patients who had undergone a clinical reassessment after recovering from COVID-19. Information sufficient to conduct multivariate analysis was available for 840 of these patients.

About half of the patients were younger than 60 years, and just over half were women. The most common cancer diagnoses were breast cancer (23.4%), gastrointestinal tumors (16.5%), gynecologic/genitourinary tumors (19.3%), and hematologic cancers (14.1%), with even distribution between local/locoregional and advanced disease.

The median interval between COVID-19 recovery and reassessment was 44 days, and the mean post-COVID-19 follow-up period was 128 days.

Fifteen percent of patients experienced at least one long-term sequela from COVID-19. The most common were dyspnea/shortness of breath (49.6%), fatigue (41.0%), chronic cough (33.8%), and other respiratory complications (10.7%).

Cortellini noted that cancer patients who experienced sequelae were more likely to be male, aged 65 years or older, to have at least two comorbidities, and to have a history of smoking. In addition, cancer patients who experienced long-term complications were significantly more likely to have had COVID-19 complications, to have required COVID-19 therapy, and to have been hospitalized for the disease.

Factoring in gender, age, comorbidity burden, primary tumor, stage, receipt of anticancer and anti-COVID-19 therapy, COVID-19 complications, and hospitalization, the team found that COVID-19 sequelae were independently associated with an increased risk for death (hazard ratio, 1.76).

Further analysis of patterns of systemic anticancer therapy in 471 patients revealed that 14.8% of COVID-19 survivors permanently discontinued therapy and that a dose or regimen adjustment occurred for 37.8%.

Patients who permanently discontinued anticancer therapy were more likely to be former or current smokers, to have had COVID-19 complications or been hospitalized for COVID-19, and to have had COVID-19 sequelae at reassessment. The investigators found no association between permanent discontinuation of therapy and cancer disease stage.

Cortellini and colleagues reported that permanent cessation of systemic anticancer therapy was associated with an increased risk for death. A change in dose or regimen did not affect survival.

The most common reason for stopping therapy permanently was deterioration of the patient's performance status (61.3%), followed by disease progression (29.0%). Dose or regimen adjustments typically occurred to avoid immune suppression (50.0%), hospitalization (25.8%), and intravenous drug administration (19.1%).

Cortellini concluded his presentation by highlighting the importance of increasing awareness of long COVID in patients with cancer as well as early treatment of COVID-19 sequelae to improve patient outcomes.

The study was funded by the Imperial College Biomedical Research Center. Cortellini has relationships with MSD, BMS, Roche, Novartis, AstraZeneca, Astellas, Sun Pharma. Dingemans has relationships with Roche, Eli Lilly, Boehringer Ingelheim, AstraZeneca, Jansen, Chiesi, Amgen, Pfizer, Bayer, Takeda, Pharmamar, and Sanofi.

European Society for Medical Oncology (ESMO) Annual Meeting 2021: Abstract 1560O. Presented September 21, 2021.

https://www.medscape.com/viewarticle/959251

MIND diet linked to better cognitive performance

 Aging takes a toll on the body and on the mind. For example, the tissue of aging human brains sometimes develops abnormal clumps of proteins that are the hallmark of Alzheimer's disease. How can you protect your brain from these effects?

Researchers at Rush University Medical Center have found that older adults may benefit from a specific diet called the MIND diet even when they develop these protein deposits, known as amyloid plaques and tangles. Plaques and tangles are a pathology found in the brain that build up in between nerve cells and typically interfere with thinking and problem-solving skills.

Developed by the late Martha Clare Morris, ScD, who was a Rush nutritional epidemiologist, and her colleagues, the MIND diet is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. Previous research studies have found that the MIND diet may reduce a person's risk of developing Alzheimer's disease dementia.

Now a study has shown that participants in the study who followed the MIND diet moderately later in life did not have cognition problems, according to a paper published on Sept. 14 in the Journal of Alzheimer's Disease.

"Some people have enough plaques and tangles in their brains to have a postmortem diagnosis of Alzheimer's disease, but they do not develop clinical dementia in their lifetime," said Klodian Dhana, MD, PhD, lead author of the paper and an assistant professor in the Division of Geriatrics and Palliative Medicine in the Department of Internal Medicine at Rush Medical College .

"Some have the ability to maintain cognitive function despite the accumulation of these pathologies in the brain, and our study suggests that the MIND diet is associated with better cognitive functions independently of brain pathologies related to Alzheimer's disease.

In this study, the researchers examined the associations of diet -- from the start of the study until death -- brain pathologies and cognitive functioning in older adults who participated in the Rush Alzheimer's Disease Center's ongoing Memory and Aging Project, which began in 1997 and includes people living in greater Chicago. The participants were mostly white without known dementia, and all of them agreed to undergo annual clinical evaluations while alive and brain autopsy after their death.

The researchers followed 569 participants, who were asked to complete annual evaluations and cognitive tests to see if they had developed memory and thinking problems. Beginning in 2004, participants were given an annual food frequency questionnaire about how often they ate 144 food items in previous year.

Using the questionnaire answers, the researchers gave each participant a MIND diet score based on how often the participants ate specific foods. The MIND diet has 15 dietary components, including 10 "brain-healthy food groups" and five unhealthy groups -- red meat, butter and stick margarine, cheese, pastries and sweets, and fried or fast food.

To adhere to and benefit from the MIND diet, a person would need to eat at least three servings of whole grains, a green leafy vegetable and one other vegetable every day -- along with a glass of wine -- snack most days on nuts, have beans every other day or so, eat poultry and berries at least twice a week and fish at least once a week. A person also must limit intake of the designated unhealthy foods, limiting butter to less than 1 1/2 teaspoons a day and eating less than a serving a week of sweets and pastries, whole fat cheese, and fried or fast food.

Based on the frequency of intake reported for the healthy and unhealthy food groups, the researchers calculated the MIND diet score for each participant across the study period. An average of the MIND diet score from the start of the study until the participant's death was used in the analysis to limit measurement error. Seven sensitivity measures were calculated to confirm accuracy of the findings.

"We found that a higher MIND diet score was associated with better memory and thinking skills independently of Alzheimer's disease pathology and other common age-related brain pathologies. The diet seemed to have a protective capacity and may contribute to cognitive resilience in the elderly." Dhana said.

"Diet changes can impact cognitive functioning and risk of dementia, for better or worse," he continued. "There are fairly simple diet and lifestyle changes a person could make that may help to slow cognitive decline with aging, and contribute to brain health."

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Story Source:

Materials provided by Rush University Medical Center. Original written by Nancy Di Fiore. Note: Content may be edited for style and length.

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Journal Reference:

1. Klodian Dhana, Bryan D. James, Puja Agarwal, Neelum T. Aggarwal, Laurel J. Cherian, Sue E. Leurgans, Lisa L. Barnes, David A. Bennett, Julie A. Schneider. MIND Diet, Common Brain Pathologies, and Cognition in Community-Dwelling Older Adults. Journal of Alzheimer's Disease, 2021; 83 (2): 683 DOI: 10.3233/JAD-210107

https://www.sciencedaily.com/releases/2021/09/210921172721.htm

Adjusting fatty acid intake may help with mood variability in bipolar disorders

 Can specific dietary guidelines help people living with bipolar disorders better manage their health? Maybe someday, according to a new study by Penn State College of Medicine researchers. Clinical trial results showed that a diet designed to alter levels of specific fatty acids consumed by participants may help patients have less variability in their mood.

Bipolar disorders, which affect up to 2.4% of the population, are mental health conditions where individuals experience cyclic and abnormally elevated and/or depressed mood states. During acute episodes, parts of the brain that regulate emotions are underactive, leading to either manic highs or depressive lows. Researchers are identifying ways to help patients with the symptoms they experience between episodes, which can include pain, anxiety, impulsivity and irritability.

"As clinicians, we understand that if we can help our patients better control these symptoms between episodes, it could help reduce the number of times they relapse into acute episodes," said Dr. Erika Saunders, Shively-Tan Professor and chair of the Department of Psychiatry and Behavioral Health at Penn State Health Milton S. Hershey Medical Center. "Our goal with this trial was to see if specific dietary interventions could help patients with mood variability between episodes."

Saunders and her colleagues designed a diet to alter the levels of specific polyunsaturated fatty acids -- nutrients found in many foods -- participants consumed while participating in usual care for bipolar disorders, including mood-stabilizing medication. Prior research showed that medications for treating bipolar disorders change the way bodies break down, or metabolize, fatty acids. The byproducts of this process activate different parts of the immune system and include other chemical processes that affect how the body perceives pain, a common symptom reported by people living with bipolar disorders.

The researchers hypothesized that by changing the type and amount of fatty acids consumed, the body would generate metabolites with specific purposes, such as reducing pain or inflammation. The experimental diet decreased omega-6 fatty acid consumption by limiting red meat, eggs and certain oils, and increased omega-3 fatty acid consumption by adding flax seed and fatty fishes like tuna and salmon. To keep participants unaware of which group they were in, the team gave participants specific meal plans with instructions on how to prepare their food as well as unlabeled cooking oils and specially prepared snack foods and baked products.

More than 80 people with bipolar disorders participated in diet counseling and were given specific foods to eat for a 12-week period. Twice a day they completed surveys on their mobile devices about their mood, pain and other symptoms. Throughout the study participants also had bloodwork taken so researchers could measure fatty acid levels and how the food was affecting their bodies. According to the researchers, the experimental diet improved mood variability in patients with bipolar disorders. The results were published in the journal Bipolar Disorders.

"At this time, we can't yet recommend this type of diet for patients with bipolar disorders, although we found the diet to be safe," said Saunders, noting that follow-up studies are needed. "This carefully constructed nutrition plan shows promise for regulating mood between manic and depressive episodes, but we're not sure if this could be widely adopted since it would be challenging for patients to follow this rigorous program."

In the future, the research team will continue to assess how fatty acid metabolites may affect pain in bipolar disorders. Saunders said that by replicating the study, they hope to make sound, scientific dietary recommendations for people with bipolar disorders that could be more easily implemented in their everyday lives.

"This diet isn't meant to be a treatment for people with bipolar disorders who are experiencing acute, severe depression or mania," Saunders said. "Rather, our goal is to develop solutions to help patients have better long-term management of their symptoms, including pain."

Dahlia Mukherjee, Tiffany Myers, Emily Wasserman, Ahmad Hameed, Venkatesh Bassappa Krishnamurthy and Ming Wang of Penn State College of Medicine; Beth MacIntosh of University of North Carolina; and Anthony Domenichiello and Christopher Ramsden of the National Institute on Aging also contributed to this research. The authors report no conflicts of interest.

This project was funded by the Stanley Medical Research Institute (grant #13T-013). Additional support was provided by the National Institutes of Health through the National Institute on Aging, the National Institute on Alcohol Abuse and Alcoholism and the National Center for Advancing Translational Sciences through Penn State Clinical and Translational Science Institute (grant UL1 TR002014).

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Story Source:

Materials provided by Penn State. Original written by Zachary Sweger. Note: Content may be edited for style and length.

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Journal Reference:

1. Erika F. H. Saunders, Dahlia Mukherjee, Tiffany Myers, Emily Wasserman, Ahmad Hameed, Venkatesh Bassappa Krishnamurthy, Beth MacIntosh, Anthony Domenichiello, Christopher E. Ramsden, Ming Wang. Adjunctive dietary intervention for bipolar disorder: a randomized, controlled, parallel‐group, modified double‐blinded trial of a high n‐3 plus low n‐6 diet. Bipolar Disorders, 2021; DOI: 10.1111/bdi.13112

https://www.sciencedaily.com/releases/2021/09/210923115615.htm

Radiation therapy reprograms heart muscle cells to younger state

 New research from Washington University School of Medicine in St. Louis suggests that radiation therapy can reprogram heart muscle cells to what appears to be a younger state, fixing electrical problems that cause a life-threatening arrhythmia without the need for a long-used, invasive procedure.

In that invasive procedure -- catheter ablation -- a catheter is threaded into the heart, and the tissue that triggers the life-threatening irregular heart rhythm -- ventricular tachycardia -- is burned, creating scars that block the errant signals. The new study, however, shows that noninvasive radiation therapy normally used to treat cancer can reprogram the heart muscle cells to a younger and perhaps healthier state, fixing the electrical problem in the cells themselves without needing scar tissue to block the overactive circuits. The study also suggests that the same cellular reprogramming effect could be achieved with lower doses of radiation, opening the door to the possibility of wider uses for radiation therapy in different types of cardiac arrhythmias.

The study appears Sept. 24 in the journal Nature Communications.

Physician-scientists at Washington University showed in 2017 that radiation therapy typically reserved for cancer treatment could be directed at the heart to treat ventricular tachycardia.

In theory, radiation therapy could reproduce the scar tissue usually created through catheter ablation but with a much shorter and totally noninvasive procedure, making the treatment available to more severely ill patients. Surprisingly, the doctors found that patients experienced large improvements in their arrhythmias a few days to weeks after radiation therapy, much quicker than the months it can take scar tissue to form after radiation therapy, suggesting that a single dose of radiation reduces the arrhythmia without forming scar tissue. The data indicated that radiation treatment worked just as well, if not better, than catheter ablation for certain patients with ventricular tachycardia but in a different and unknown way.

"Traditionally, catheter ablation creates scar tissue to block the electrical circuits that are causing ventricular tachycardia," said senior author and cardiologist Stacey L. Rentschler, MD, PhD, an associate professor of medicine, of developmental biology and of biomedical engineering. "To help us understand whether the same thing was happening with radiation therapy, some of the first patients to have this new treatment gave us permission to study their heart tissue -- following heart transplantation or if they had passed away for another reason, for example. We saw that scar tissue alone could not explain the remarkable clinical effects, suggesting that radiation improves the arrhythmia in some other way, so we delved into the details of that."

The scientists found that radiation treatment triggered heart muscle cells to begin expressing different genes. They measured increased activity in a signaling pathway called Notch, which is known for its vital role in early development, including in forming the heart's electrical conduction system.

Notch is usually switched off in adult heart muscle cells. But the researchers found that a single dose of radiation temporarily activates Notch signaling, leading to a long-term increase in sodium ion channels in the heart muscle, a key physiologic change that can reduce arrhythmias.

"Arrhythmias are associated with slow electrical conduction speeds," Rentschler said. "Radiation therapy seems to kick up the speed faster by activating early developmental pathways that revert the heart tissue back into a healthier state."

The researchers studied these effects in mice and in donated human hearts. In the human heart samples, the researchers found that these changes in heart muscle cells were only present in areas of the heart that received the targeted radiation dose.

"Radiation does cause a type of injury, but it's different from catheter ablation," said co-author and radiation oncologist Julie K. Schwarz, MD, PhD, a professor of radiation oncology and director of the Cancer Biology Division in the Department of Radiation Oncology. "As part of the body's response to that injury, cells in the injured portion of the heart appear to turn on some of these early developmental programs to repair themselves. It's important to understand how this works because, with that knowledge, we can improve the way we're treating these patients and then apply it to other diseases."

The researchers also found that the beneficial effects of radiation continued for at least two years in surviving patients. And importantly, they were able to demonstrate in mice that a lower dose of the radiation produced the same effect. A lower radiation dose could minimize long-term side effects and open the door to this type of treatment in other types of heart arrhythmias. And while Notch was a big player in these effects, Schwarz said it's not the only pathway involved. The researchers are continuing to investigate how radiation triggers heart cells to revert to a healthier state.

Added first author David M. Zhang, an MD/PhD student in Rentschler's lab: "This was an exciting collaboration not only between basic scientists and clinicians but also cardiologists and radiation oncologists. Historically, radiation oncologists are focused on cancer and try to avoid irradiating the heart, so this study opens up a whole new area of research and collaboration between these two fields."

This work was supported by the National Institutes of Health (NIH), grant numbers T32 HL134635, T32 GM07200, R01 HL130212, UH3 HL141800 and S10 OD020136. This study received seed funding from the Department of Radiation Oncology, Cancer Biology Division, at Washington University. Schwarz holds a Female Investigator Award from AACR-Bristol Meyers Squibb and funding from the Radiological Society of North America. Rentschler holds a Career Award for Medical Scientists from the Burroughs Wellcome Fund and funding from The Foundation for Barnes-Jewish Hospital that directly supported this work.

Washington University co-authors Clifford Robinson, MD, and Phillip Cuculich, MD, have filed two institution-owned patents: Noninvasive Imaging and Treatment System for Cardiac Arrhythmias that relates to overall methods for delivery of cardiac radiation in patient; and System and Method for Determining Segments for Ablation that relates to use of cardiac segments for cardiac radiation targeting. They also provide consulting services to Varian, which produces linear accelerators for radiation treatment delivery.

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Story Source:

Materials provided by Washington University School of Medicine. Original written by Julia Evangelou Strait. Note: Content may be edited for style and length.

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Journal Reference:

1. Zhang, D.M., Navara, R., Yin, T. et al. Cardiac radiotherapy induces electrical conduction reprogramming in the absence of transmural fibrosis. Nat Commun, 2021 DOI: 10.1038/s41467-021-25730-0

https://www.sciencedaily.com/releases/2021/09/210924104055.htm

Moderna Chief Executive Sees Pandemic Over in a Year

 Moderna Inc Chief Executive Stéphane Bancel thinks the coronavirus pandemic could be over in a year as increased vaccine production ensures global supplies, he told the Swiss newspaper Neue Zuercher Zeitung.

"If you look at the industry-wide expansion of production capacities over the past six months, enough doses should be available by the middle of next year so that everyone on this earth can be vaccinated. Boosters should also be possible to the extent required," he told the newspaper in an interview.

Vaccinations would soon be available even for infants, he said.

"Those who do not get vaccinated will immunize themselves naturally, because the Delta variant is so contagious. In this way we will end up in a situation similar to that of the flu. You can either get vaccinated and have a good winter. Or you don't do it and risk getting sick and possibly even ending up in hospital."

Asked if that meant a return to normal in the second half of next year, he said: "As of today, in a year, I assume."

Bancel said he expected governments to approve booster shots for people already vaccinated because patients at risk who were vaccinated last autumn "undoubtedly" needed a refresher.

Its booster shot had half the dose of the original dose, which meant more of them would be available.

"The volume of vaccine is the biggest limiting factor. With half the dose, we would have 3 billion doses available worldwide for the coming year instead of just 2 billion," he said.

The composition of the booster shot remains the same as the original for this year because Moderna had not had enough time to change it.

"We are currently testing Delta-optimized variants in clinical trials. They will form the basis for the booster vaccination for 2022. We are also trying out Delta plus Beta, the next mutation that scientists believe is likely."

Moderna can use existing production lines for the new variants as for the original COVID-19 vaccine. The price of vaccination will stay the same, he said.

https://www.usnews.com/news/top-news/articles/2021-09-23/moderna-chief-executive-sees-pandemic-over-in-a-year-newspaper

NY may recruit Filipinos to replace health care workers who refuse Covid shots

 New York may recruit medical workers from the Philippines, other countries and states to replace unvaccinated staff at hospitals and nursing homes who face being fired if they don’t get Covid-19 vaccine shots by Monday.

Gov. Kathy Hochul said today that’s one strategy her administration may pursue if New York sees a significant exodus of health care workers as a result of the Covid-19 vaccination mandate.

Under the mandate, health care workers must get at least one dose of the vaccine by Monday. If they don’t, the state won’t let them do their jobs, and hospitals and nursing homes can fire them.

State data shows 17% of nursing home and 16% of hospital workers remain unvaccinated.

Hospital and nursing home industry officials have warned the loss of unvaccinated workers could hurt the quality of care at their facilities. Many hospitals and nursing homes are already short staffed.

Hochul said New York is talking to federal officials about relaxing Visa requirements to make it easier for medical personnel the Philippines and other countries to come here to work.

New York also is considering changing its licensing requirements to make it easier for health care workers from other states to come here.

Hochul said New York would not be able to implement those strategies immediately.

She thanked state health care workers who’ve already received the vaccine.

The governor also said she hopes unvaccinated workers get the shot by Monday so New York won’t have to take those steps.

“What is looming for Monday is completely avoidable. And there’s no excuses,” she said. “It would be phenomenally unfair to your coworkers, the people entrusted to your care and all of New Yorkers that we will have our recovery held back by individuals who choose not to get vaccinated.”

https://www.syracuse.com/coronavirus/2021/09/ny-may-recruit-filipinos-to-replace-health-care-workers-who-refuse-covid-shots.html

Hundreds of DC Firefighters Seek Religious Exemption From COVID-19 Vaccine Mandate

 D.C. is requiring its employees to get vaccinated against COVID-19, but hundreds of D.C. Fire and EMS employees are requesting religious exemptions.

Of the more than 2,100 D.C. Fire and EMS employees, 419 are filing a religious accommodation form with the city.

“They’re requests at this point,” Fire Chief John Donnelly said. “They will be ruled on by the Department of Health. We don’t rule on them. There’s a process for that.”

Those unvaccinated employees are tested daily, pending a ruling.

“When the ruling is made, they’ll have a series of choices,” Donnelly said. “They’ll either have to come into compliance or they will not have a medical license anymore, and that will prevent them from having a job.”

While the overall number of city employees requesting exemptions is down, the fire department’s number has stayed steady.

“The real question isn’t how many people it is, but you gotta really think about why people aren’t getting the vaccine, and that’s what we’re focused on,” Donnelly said. “We want to alleviate people’s fears; we want to educate them. The vaccine’s safe, it’s good, it’s effective. We know it works.”

Donnelly said they also know the dangers of contracting COVID-19 are real, especially for those in the firefighting industry.

“Across the nation, more firefighters have died in the last two months than any two-month period across COVID, so this is a very dangerous disease for firefighters,” Donnelly said.

D.C. Fire and EMS is not alone in having resistance in the ranks.

“We’re not the worst but we’re not the best,” Donnelly said. “But we will be the best.”

A group of firefighters called DC Firefighters Bodily Autonomy Affirmation Group pledged to push back against the mandate, arguing for routine, before-duty testing of unvaccinated firefighters instead of a vaccine mandate.

"We want to forcefully push back against the harassment, bullying and now doxing that our members are experiencing for standing for their sincerely held religious beliefs," the group said in a statement. "We have members of all demographic and spiritual backgrounds whose sincerely held religious beliefs prevent them from taking the vaccine. As we have courageously served throughout the pandemic, our members have drawn closer to their spiritual sources of strength, fortifying their faith as together we are on the frontlines of not only the pandemic, but of the many daily traumatic events that we witness. Whether this is the ever-increasing murders, tragic deaths of kids or the times we are required to put our own lives on the line."

D.C. set a Sept. 30 deadline for city employees to get at least one shot or face termination.

Earlier this week, D.C. Mayor Muriel Bowser also announced an expansion of the mandate: All employees at schools and day cares, including those run privately, will be required to be vaccinated by November.

https://www.nbcwashington.com/news/coronavirus/coronavirus-in-dc/hundreds-of-dc-firefighters-seek-religious-exemption-from-covid-19-vaccine-mandate/2811577/