January 25 | Daily COVID-19 LST Report


· How do we prevent inequities in COVID-19 Vaccine Injuries? Health lawyers at Case Western Reserve University School of Law and Harvard Law School advocate that the COVID-19 vaccine should be covered by the National Vaccine Injury Compensation Program (VICP). This would encourage those who are disproportionately impacted by the COVID-19 pandemic, people of color and low-income individuals, to get the vaccine when available as they would be compensated if there are any complications. This study proposes making CDC recommended vaccines immediately fall under the VICP and adding the same 75 cent tax already utilized for childhood vaccines to provide funds for the Vaccine Injury Compensation Trust Fund.

Understanding the Pathology

· Shorter telomere lengths are associated with severe COVID-19 disease. Experts in telomere research from the Spanish National Cancer Centre evaluated the telomere length of DNA in mononuclear cells from the peripheral blood of 89 COVID-19 patients from a field hospital in Madrid. They found patients with a higher proportion of short telomeres (<11.68 kb) had higher severity scores than those with longer telomeres (p=0.049), with Pearson correlation analysis showing an inverse correlation between mean telomere length and severity score (r=-0.405; p=0.0001). Because shorter telomeres were associated with more severe disease even between patients of similar age, authors propose short telomeres are associated with more severe COVID-19 independent of age and suggest therapeutics targeting telomerase may help reduce disease severity.

· Autopsy findings after long-term treatment of COVID-19 patients find microbiological correlation with fungal infections. A study conducted at University Hospital of Regensburg involved autopsy of 4 female and 4 male patients who expired during their hospitalization for COVID-19 treatment in the ICU. Cause of death was determined to be multi-organ failure sepsis in 6/8 patients, 4 of which were due to systemic fungal infection suggesting that 50% of test subjects died of fungal sepsis. Authors suggest that clinically undetected fungal infections are a significant cause of death in COVID-19 patients and emphasize the importance of utilizing autopsies and collaboration between pathologists, microbiologists, and clinicians to guide future diagnostics and therapeutics.

Transmission & Prevention

· Environmental virus detection is associated with asymptomatic SARS-CoV-2-infected individuals with positive anal swabs. An observational study conducted by an interdisciplinary group of researchers from Nanjing, China studied certain features of asymptomatic carriers of SARS-CoV-2, and postulated mechanisms by which they possibly might spread the virus. The 19 study patients were recruited from the Nanjing Number 2 Hospital and confirmed SARS-CoV-2 positive via nasopharyngeal swabs. The researchers collected the following samples to measure the possible secretion pathways of the virus: the bedside table, the bedside handrails, the mobile phone screen, the palm of the patient's hand, the double sides of the mask, their fog mask, the cell phone shelves and toilet pads. They found positive environmental samples (via nucleoprotein measurement) on the cell phone screen, the telephone shelf in the patient bathrooms, and the patient bedside rails. Authors suggest that SARS-CoV-2 can be found on external surfaces that have come into contact with carriers of the virus, which can be a means by which asymptomatic carriers are able to spread the virus.

· Allergic reactions including anaphylaxis are found after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine. A case series conducted by the Immunization Safety Office at the Centers for Disease Control and Prevention in Atlanta, Georgia and the Office of Biostatistics and Epidemiology at the Food and Drug Administration in Bethesda, Maryland identified 21 cases from December 14-23, 2020 submitted to the Vaccine Adverse Event Reporting System (VAERS) after the first dose of Pfizer-BioNTech COVID-19 vaccine. The cases include 17/21 patients with documented history of allergies/allergic reactions, 4 patients hospitalized, 17 treated in the emergency department with symptoms of urticaria, angioedema, rash, and sense of throat closure, however no deaths were reported. Authors urge that vaccination locations should have access to epinephrine for managing anaphylaxis, screen for contraindications and precautions, observe vaccine recipients for 15 or 30 minutes afterwards, and acknowledge the importance of recognizing/reporting adverse effects of vaccine administration to VAERS.

Adjusting Practice During COVID-19

· Hand sanitizer can result in ocular injury in children. Physicians at the Grewal Eye Institute and Postgraduate Institute of Medical Education in Chandigarh, India present cases of toxic keratopathy in two children who were exposed to alcohol-based hand rubs (ABHRs). This study suggests that the ABHR stations used to reduce SARS-CoV-2 transmission are often at eye level for younger children and in order to prevent such injuries, children should be taught how to properly use hand sanitizers and encouraged to wash hands with soap and water. Authors suggest that hand sanitizing stations should have warnings and separate dispensers at a lower level for children.

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