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‘Constellation’ of post-COVID symptoms will impact global healthcare

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Far more research is needed into the “constellation” of sometimes debilitating symptoms among people who’ve recovered from COVID-19, the World Health Organization (WHO) said on Friday, adding that it “will impact” global health systems. 

“We know that this post-COVID-19 condition – or as some patients also call it ‘long COVID’ and some clinicians call it ‘long COVID’ – is a heterogenous group of symptoms that occur after the acute illness”, said Dr. Janet Diaz, Team Lead, Health Care Readiness at WHO

“So, these are symptoms or complications that can happen potentially a month after, three months after, or even six months after, and as we are learning more, we are trying to understand the real duration of this condition.” 

Mental and physical ills are ‘real’ 

Citing reported symptoms such as neurological and physical illness, Dr. Diaz noted that an unspecified number of sufferers had been unable to return to work, once they had recovered from the acute sickness caused by the new coronavirus

“We are concerned obviously with the numbers of patients infected with SARS-CoV-2 virus that the numbers…just by the magnitude of the pandemic, will impact health systems.” 

Although comprehensive data on the condition is not yet available, the WHO official insisted that “these (symptoms) were real”.  

“Some of the “more common” ailments were “fatigue, exhaustion and post-exertional malaise, cognitive disfunction”, along with what some patients called “brain fog”, Dr Diaz said, describing a “constellation of symptoms”.  

Complications 

Further research is also needed to drill down into how many COVID-19 sufferers who did not require intensive care unit (ICU) treatment still went on to develop the condition. 

“What we know this far is that patients experiencing (a) post-COVID-19 condition could have been hospitalized patients, those in the ICU. So, we do know that has happened in patients who are very sick, but also in patients who were not managed inside the hospital…they have had complications and they have had persistent symptoms or new symptoms…or symptoms that waxed and waned, that came and went after their acute illness.” 

To promote a better understanding of post-COVID sickness and support patient care and public health interventions, the WHO has called on clinicians and patients to report data on symptoms to the Organization’s Clinical Platform.  

The case report form – which is available in multiple languages – has been designed to report standardized clinical data from individuals after they have left hospital or after recovering from acute illness. 

“What we don’t know is why it’s happening, so what is the pathophysiology … of this condition…the researchers are really working hard to get to the answers of these questions,” Dr. Diaz said. 

Vaccine deal inked 

In a related development, UN Children’s Fund UNICEF announced on Friday a deal to distribute the Pfizer-BioNTech COVID-19 vaccine, potentially before the end of March.  

The agreement is on behalf of the COVAX platform, primarily for developing nations, set up by the WHO,  The Coalition for Epidemic Preparedness Innovations (CEPI) and GAVI, the Vaccine Alliance. 

“This supply agreement allows UNICEF to procure up to 40 million doses that have been secured under the COVAX Facility’s Advance Purchase Agreement with Pfizer/BioNTech to be available throughout 2021”, the UN agency said in a statement.  

Emergency use approved 

The Pfizer-BioNTech jab was the first to receive WHO Emergency Use Listing (EUL) on 31 December 2020.  

It requires ultra-cold chain storage facilities which UNICEF has secured with partners to support governments in their roll-out of a variety of COVID-19 vaccines, it said. 

As of Friday 12 February 2021, WHO’s coronavirus tracker reported 107,252,265 confirmed cases of COVID-19, including 2,355,339 deaths. 

Regionally, the Americas have seen most cases to date, with 47,814,602 infections, followed by Europe (36,132,951), South-East Asia (13,141,859), Eastern Mediterranean (5,951,021), Africa (2,694,171) and Western Pacific (1,516,916).

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Health & Wellness

UN-backed COVAX mechanism delivers its 1 billionth COVID-19 vaccine dose

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photo © UNICEF/Aimable Twiringiyima

With a 1.1 million jab delivery in Rwanda this weekend, the World Health Organization’s multilateral initiative to provide equal access to vaccines for all reached the one billion milestone.

Along with the Coalition for Epidemic Preparedness Innovations (CEPI), the Vaccine Alliance GAVI, and partners, WHO has led the largest vaccine procurement and supply operation in history with deliveries to 144 countries to date.

According to a press release published on Sunday, as of 13 January 2022, out of 194 countries members of WHO, 36 have vaccinated less than 10% of their population, and 88 less than 40%.

COVAX’s ambition was compromised by hoarding/stockpiling in rich countries, catastrophic outbreaks leading to borders and supply being locked. And a lack of sharing of licenses, technology, and know-how by pharmaceutical companies meant manufacturing capacity went unused”, the agency explained.

On 24 February 2021, Ghana became the first country in the world to receive vaccines through COVAX when 600,000 doses of the Oxford–AstraZeneca vaccine were delivered to Accra. 

The work that remains

COVAX is currently working with governments, manufacturers and partners to ensure that when countries receive vaccines, they can get them to people quickly.

“The work that has gone into this (1 billion) milestone is only a reminder of the work that remains”, the UN’s health agency underscored.

They added that with updated vaccines in the pipeline, citizens should demand that governments and pharmaceutical companies share health tools globally and “bring an end to the death and destruction cycles of this pandemic, limit new variants and drive a global economic recovery”.

COVAX is one of three pillars of the Access to COVID-19 Tools (ACT) Accelerator, which was launched by WHO in April 2020 in response to the pandemic.

The ACT Accelerator is a ground-breaking global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. 

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WHO recommends two new drugs to treat patients with COVID-19 

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Around two million doses of Sotrovimab are being produced globally in the first half of 2022. © GlaxoSmithKline

The World Health Organization (WHO) on Thursday reccommended two new drugs to treat patients with COVID-19, one for patients with critical disease, and another deemed effective for non-severe cases.

The first drug, baricitinib, is a Janus kinase (JAK) inhibitor- a class of drugs used to treat autoimmune conditions, blood and bone marrow cancers, and rheumatoid arthritis.

According to the WHO Guideline Development Group, it is “strongly recommended” for patients with severe or critical disease in combination with corticosteroids.

The group of international experts based their recommendation on “moderate certainty evidence” that it improves survival and reduces the need for ventilation.

There was no observed increase in adverse effects.

The experts note that it has a similar effectas other arthritis drugs called interleukin-6 (IL-6) inhibitors. Because of that, when both drugs are available, they suggest choosing the best option based on cost, availability, and clinician experience.

It is not recommended to use both drugs at the same time.

The experts also advise against the use of two other JAK inhibitors (ruxolitinib and tofacitinib) for patients with severe or critical cases of COVID-19 infection.

According to them, trials undergone using these drugs failed to show any benefits arising using either drug,and suggested a possible increase in serious side effects with tofacitinib.

Non-severe cases

In the same update, WHO makes a conditional recommendation for the use of a monoclonal antibody known as sotrovimab in patients with non-severe cases.

According to them, the drug should only be administered to patients at the highest risk of hospitalisation. In those at lower risk, it onlyshowed “trivial benefits”. 

A similar recommendation has been madepreviously, for another monoclonal antibody drug, casirivimab-imdevimab, and the experts say there is insufficient data to recommend one over the other.

For both, the effectiveness against new variants, like Omicron, is still uncertain. 

The group will update their guidelines for monoclonal antibodies when more data becomes available.

Recommendations

These recommendations are based on new evidence from seven trials involving over 4,000 patients with non-severe, severe, and critical infections.

Developed by WHO with the methodological support of MAGIC Evidence Ecosystem Foundation, the guidelinesprovide trustworthy guidance and help doctors make better decisions with their patients.

According to the agency, the guidelines are useful in fast moving research areas, because they allow researchers to update evidence summaries as new information becomes available.

The latest guidance also updates recommendations for the use of interleukin-6 receptor blockers and systemic corticosteroids for patients with severe or critical COVID-19; conditional recommendations for the use of casirivimab-imdevimab (another monoclonal antibody treatment) in selected patients; and against the use of convalescent plasma, ivermectin and hydroxychloroquine, regardless of disease severity.

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Omicron fuels record weekly COVID-19 cases, but deaths ‘stable’

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Fuelled by Omicron, more than 15 million new cases of COVID-19 were reported around the world last week, by far the most cases reported in a single seven day period, the World Health Organization (WHO) informed on Wednesday. 

Briefing reporters in Geneva, the UN health agency chief, Tedros Adhanom Ghebreyesus, said the “huge spike” is being driven by the Omicron variant, which is rapidly replacing Delta in almost all countries. 

Despite the number of cases, the weekly reported deaths have “remained stable” since October last year, Tedros added, at an average of 48,000. The number of patients being hospitalized is also increasing in most countries, but it is not at the level seen in previous waves.

He told reporters this is possibly due to the reduced severity of Omicron, and widespread immunity from vaccination or previous infection.

‘50 thousand deaths too many’

For the WHO chief, while Omicron causes less severe disease than Delta, it remains a dangerous virus, particularly for those who are unvaccinated.

Almost 50 thousand deaths a week is 50 thousand deaths too many”, Tedros said. “Learning to live with this virus does not mean we can, or should, accept this number of deaths.”

For him, the world cannot “allow this virus a free ride” when so many people around the world remain unvaccinated.

In Africa, for example, more than 85 per cent of people are yet to receive a single dose of vaccine.

“We cannot end the acute phase of the pandemic unless we close this gap”, he said. 

Making progress

Tedros then listed some progress towards reaching the target of vaccinating 70 per cent of the population of every country by the middle of this year. 

In December, COVAX shipped more than double the number of doses it distributed in November. In the coming days, the initiative should ship its one billionth vaccine dose. 

Some of the supply constraints from last year are also starting to ease, Tedros said, but there’s still have a long way to go. 

So far, 90 countries have still not reached the 40 per cent target, and 36 of those countries have vaccinated less than 10 per cent of their populations.

New vaccines

Tedros also highlighted an interim statement from the WHO Technical Advisory Group on COVID-19 Vaccine Composition, released on Tuesday, stressing that further vaccines are needed that have a greater impact on preventing infection. 

Until such vaccines are developed, the experts explained, the composition of current vaccines may need to be updated. 

The Group also said that a vaccination strategy based on repeated booster doses is “unlikely to be sustainable.”

A heavy toll

According to Tedros, the overwhelming majority of people admitted to hospitals around the world are unvaccinated.

At the same time, while the immunizations remain very effective at preventing severe disease and death, they do not fully prevent transmission.

“More transmission means more hospitalizations, more deaths, more people off work, including teachers and health workers, and more risk of another variant emerging that is even more transmissible and more deadly than Omicron”, Tedros explained. 

The sheer number of cases also means more pressure on already overburdened and exhausted health workers.

A study published last year showed that more than one in four health workers have experienced mental health issues during the pandemic. Data from several countries also show that many have considered leaving or have left their jobs.

Pregnant women

On Tuesday, WHO hosted a global webinar, attended by clinicians from around the world, on the clinical management of the virus during pregnancy, childbirth and the early postnatal period. 

As stated earlier in the pandemic, pregnant women are not at higher risk of contracting COVID-19, but if they are infected, they are at higher risk for severe disease.

That’s why it’s vital that pregnant women in all countries have access to vaccines to protect their own lives, and those of their babies”, Tedros said. 

The agency chief also called for pregnant women to be included in clinical trials for new treatments and vaccines. 

He also stressed that, fortunately, mother to baby transmission in utero or during birth is very rare, and no active virus has been identified in breast milk. 

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