Epidemiological update: Occurrence of variants of SARS-CoV-2 in the Americas

20 January 2021

Introduction

The appearance of mutations is a natural and expected event within the evolution of the virus. In fact, some specific mutations define the viral genetic groups (also called lineages) that are currently circulating globally. Due to various microevolution processes and selection pressures, some additional mutations may appear, generating differences within each genetic group (called variants).

Genomic characterization of SARS-CoV-2

Recent reports of different variants of SARS-CoV-2 have reawakened interest and concern about the impact of viral changes. In recent months, two different variants of SARS -CoV-2 have been reported to WHO as unusual public health events: VOC 202012/01, lineage B.1.1.7 in the United Kingdom (U.K.) and Northern Ireland and 501Y.V2, lineage B.1.351, in South Africa.

VOC 202012/01 variant, B.1.1.7 lineage

On 14 December 2020, the U.K. authorities notified WHO of a variant named by the U.K. as SARSCoV-2 VOC 202012/01. This variant contains 23 nucleotide substitutions and is not phylogenetically related to the SARS-CoV-2 virus circulating in the United Kingdom at the time it was detected. It is unclear how and where it originated. 

Findings and preliminary data, as much epidemiological, modeling, phylogenetic and clinical, suggest that SARS-CoV-2 VOC 202012/01 has higher transmissibility. However, preliminary analysis currently available suggest that there are no changes in the severity of the disease (measured by the duration of hospitalization and the 28-day case fatality rate), or the occurrence of reinfection among cases positive for this variant compared to cases by other SARS-CoV-2 lineages circulating in the U.K. Although no higher severity is observed among cases, the increase in transmissibility is of concern; the increase in cases in a limited time-period is associated with a significant public health impact.

As of 19 January 2021, 60 countries and territories outside of the U.K. in all six WHO Regions have reported either imported cases or community transmission of VOC 202012/013; this represents 20 additional countries and territories since the publication of the “Occurrence of variants of SARS-CoV-2 in the Americas, Preliminary Information as of 11 January 2021.”

Variant 501.V2, lineage B.1.351

On 18 December 2020, South African national authorities announced the detection of a new variant of SARS-CoV-2 that is spreading rapidly in three South African provinces. South Africa has named this variant 501Y.V2, due to a N501Y mutation. While the VOC 202012/01 variant also has the N501Y mutation, phylogenetic analysis has shown that the 501Y.V2 detected in South Africa is a different variant. 

Genomic data highlighted that the 501.V2 variant rapidly displaced other lineages circulating in South Africa. Preliminary studies suggest that this variant is associated with a higher viral load, which could suggest a potential for greater transmissibility. However, further investigation of this and other factors that influence transmissibility is necessary.

Also, at this stage of ongoing research, there is no clear evidence that the new variant is associated with more severe disease or worse outcome. More research is needed to understand the impact on transmission, clinical severity of infection, laboratory diagnostics, therapeutics, vaccines, or public health preventive measures. Although this new variant does not appear to cause more serious disease, the rapid increase in the number of cases has put health systems under pressure.

As of 19 January 2021, 23 countries outside of South Africa in four of the six WHO Regions have reported cases of 501Y.V2; this represents 17 additional countries and territories since the publication of the “Occurrence of variants of SARS-CoV-2 in the Americas, Preliminary Information as of 11 January 2021.” However, no increase in circulation or sustained increase in the spread of this variant has been reported in these countries or territories. 

Other variants of potential public health interest

In addition to the variants already mentioned, Brazil, Japan, and the United States of America, have reported the detection of variants. 

Lineage B.1.1.28

The lineage was described for the first time in Brazil on 5 March 2020 by the Adolfo Lutz Institute in a 22-year-old patient. This lineage has been circulating in the U.K (3.0%, in Australia (1.0%), in the United States (1.0%), and in Portugal (1.0%).  

Variant P.1, lineage B.1.1.28

On 9 January 2021, Japan notified WHO about a new variant of SARS-CoV-2, B.1.1.28 (initially reported as B.1.1.248), detected in four travelers from Brazil. This variant is not closely related to the SARS-CoV-2 VOC 202012/01 variant or to the 501Y.V2 variant.

This variant has 12 mutations to the spike protein, including three mutations of concern in common with 501Y.V2, i.e.: K417N/T, E484K and N501Y, which may impact transmissibility and host immune response. 

On 12 January 2021, researchers in Brazil reported on the detection of a variant of the B.1.1.28 lineage that, like the P.1 variant, has the E484K mutation, which has probably evolved independently of the variant detected among the travelers reported by Japan. The detection was carried out in the state of Amazonas.

Additionally, other researchers from Brazil reported 148 sequences of the complete SARS -CoV2 genome from the state of Amazonas, in which 69 (47%) B.1.1.28 sequences were identified among the samples from different municipalities between 13 April and 13 November 2020, making this variant the most prevalent variant in that Brazilian state.

Variant L452R

In the United States, the California Department of Public Health (CDPH), in coordination with Santa Clara County and the University of California, San Francisco (UCSF), announced on 17 January 2021 that the SARS-CoV-2 variant, L452R, is detected more frequently, by genomic sequencing of the virus in several counties of the state of California. 

Genetic variants of SARS-CoV-2 in the Americas

The Region of the Americas has contributed to the generation of genomic sequencing data through the Regional Network for Genomic Surveillance of COVID-1913, which is open to all countries in the region, through the National Public Health Laboratories or equivalent public institutions. This Network includes two Regional Sequencing Laboratories (Fiocruz-Brazil and the Institute of Public Health-Chile), which provide external sequencing for participating laboratories in the network that do not have the capacity to sequence. 

As of 19 January 2021, countries and territories of the Americas have published 87,851 SARSCoV-2 genomes on the GISAID platform, collected between February 2020 and January 2021. The countries and territories that have contributed are Antigua and Barbuda, Argentina, Aruba, Belize, Bermuda, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Curaçao, the Dominican Republic, Ecuador, El Salvador, Guadeloupe, Guatemala, Jamaica, Mexico, Panama, Peru, Saint Barthelemy, Saint Eustatius, Saint Kitts and Nevis, Saint Martin, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, United States of America, Uruguay, and Venezuela.

As of 19 January 2021, the United States is the country in the Region of the Americas that has reported the highest number of cases in which the variant SARS -CoV-2 VOC 202012/01 has been detected (122 cases), distributed among 20 states; California and Florida States concentrate 70% of the reported cases. 

As of 15 January 2021, Canada and Chile have reported 23 cases and 20 cases of the variant SARS-CoV-2 VOC 202012/01, respectively.

Additionally, as of 15 January 2021 in the Region of the Americas, only in Canada has the 501.V2 variant, lineage B.1.35, been detected (2 cases).

Conclusions and guidance for national authorities

National and local authorities should continue to strengthen existing disease control activities, including monitoring their epidemics closely through ongoing epidemiological surveillance and strategic testing; conducting outbreak investigation and contact tracing; and where appropriate, adjusting public health and social measures to reduce transmission of SARS -CoV2. 

The data and information available indicate that both variants of interest (VOC 202012/01 and 501Y.V2) have been identified in the Americas. The frequency of detection of these variants is still very limited to date. Nonetheless, there is a possibility that the detection of these variants will gradually increase in the coming weeks and months.

PAHO/WHO has supported strengthening the capacity of each country to carry out genomic surveillance since March 2020 within the framework of the Regional Network for Genomic Surveillance of COVID-19 and urges Member States to participate in this Network and carry out sequencing, in accordance with the recommended samples and the technical approaches of this Network.

PAHO/WHO recommends that in the event of symptoms suggesting acute respiratory illness during or after travel, travelers are advised to seek medical attention and share their travel history with their healthcare provider. Health authorities should work with the transport and tourism sectors to provide travelers with information to reduce the risk of infection.

In line with the advice provided by the Emergency Committee on COVID-19 at its most recent meeting, WHO recommends that States Parties should regularly re-consider measures applied to international travel in compliance with Article 43 of the International Health Regulations (2005) and continue to provide information and rationale to WHO on measures that significantly interfere with international traffic. Countries are encouraged to implement coordinated, timelimited, risk-based, and evidence-based approaches for health measures in relation to international travel. 

In all circumstances, essential travel (e.g., emergency responders; providers of public health technical support; critical personnel in transport and security sector such as seafarers; repatriations; and cargo transport for essential supplies such as food, medicines and fuel) identified by countries should always be prioritized and facilitated.

The following are links to a series of guides, scientific reports, and other resources published by PAHO/WHO and WHO.

WHO resources, available at: https://bit.ly/30zjmCj   PAHO/WHO resources available at: https://bit.ly/36DJi3B	WHO resources, available at: https://bit.ly/3li6wQB   PAHO/WHO resources available at: https://bit.ly/3sadTxQ
WHO resources, available at: https://bit.ly/3d3TJ1g   PAHO/WHO resources available at: https://bit.ly/3oD2Qen	WHO resources, available at: https://bit.ly/3d2ckuV   PAHO/WHO resources available at: https://bit.ly/3nwyOaN
WHO resources, available at: https://bit.ly/3ljWHBT   PAHO/WHO resources available at: https://bit.ly/36DJi3B	WHO resources, available at: https://bit.ly/3ivDivW   PAHO/WHO resources available at: https://bit.ly/36DJi3B
WHO resources, available at: https://bit.ly/3d66iJO   PAHO/WHO resources available at: https://bit.ly/36DJi3B	WHO resources, available at: https://bit.ly/33zXgRQ   PAHO/WHO resources available at: https://bit.ly/36DJi3B

Adapted from: 

https://iris.paho.org/bitstream/handle/10665.2/53219/EpiUpdate20January2021_eng.pdf?sequence=1&isAllowed=y

What we know so far about COVID-19 variants worldwide

By Dr. Sean Llewellyn │ Wednesday, January 27, 2021

Scientists around the world are on the lookout for new COVID-19 variants, which are caused by mutations of the virus when its replication machinery makes an error. Experts say these mutations and the new variants are normal and to be expected.

In recent months, so-called variants of concern have been identified in the U.K., South Africa, Brazil and in the U.S. And it's not a coincidence they're appearing in these countries, which have been overwhelmed by the sheer number of COVID-19 cases.

Finding variants by screening COVID-19-infected patients with genomic sequencing is the easy part. The difficult part is then figuring out what these mutations mean. Researchers are studying the variants daily to gain a better understanding of their differences.

While we still don't know a lot about how the mutations in these variants change the virus, we do have evidence that some might be more transmissible. But there's no strong, solid evidence to date demonstrating that these variants are more deadly or resistant to current vaccines.

UK variant (B.1.1.7)

The U.K. variant was one of the first identified "variants of concern." It's estimated to have first emerged in September, and it quickly gained a foothold, spreading like wildfire throughout the U.K. and then other parts of the world. At least 293 cases have been reported in the U.S., according to the Centers for Disease Control and Prevention, which said the actual tally probably exceeds that.

There's good evidence this variant is more transmissible, spreading more easily and more quickly. This increased transmissibility is believed to be due to mutations in the spike protein -- the part of the virus that allows it to "stick" to cells. This spike protein is what the vaccines target.

The most worrying part about mutations in the spike protein is concern over it potentially rendering vaccines ineffective. Reassuringly, Pfizer now has two studies -- neither peer reviewed -- that demonstrate the vaccine is effective against laboratory-made viruses that have the mutations of this variant.

Last week, the U.K. said that there's concern that the variant might be more deadly. Sir Patrick Vallance, the U.K.'s chief scientific adviser, said early evidence suggests the variant could be about 30% more deadly, but there was "a lot of uncertainty around these numbers."

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to President Joe Biden, told ABC News that U.K. researchers "became convinced that it's more virulent ... so I believe their data."

Still, other scientists say it is also possible that the increased mortality rate is from the U.K. medical system being completely overrun by patients falling ill with the virus, leading to more deaths. More research is underway to determine if this strain truly is more deadly.

South African variant (B.1.351)

In South Africa, another "variant of concern" was discovered in a patient sample from October. It shares some of the mutations of the U.K. variant, but it developed independently in South Africa, from which it has spread to neighboring countries and a few others off the continent.

Like the U.K. variant, it has mutations in the spike protein. Evidence has shown it to be more transmissible, which is most likely due to these mutations in the spike protein.

But unlike the U.K. variant, preliminary findings indicate that current vaccines could have slightly diminished efficacy.

"This South African variant is somewhat less susceptible to those antibodies [produced after vaccination]," said Dr. David Montefiori, a professor and virologist at Duke University Medical Center. "It's not completely resistant, but it is somewhat less susceptible ... maybe only 85% or 90% effective."

Monday, Moderna released data showing its vaccine still produces "protective" antibody levels for both the U.K. and South African variants, but those antibody levels were diminished in the South African variant. The company is now launching studies of an experimental booster shot of its vaccine adjusted to address this.

Brazilian variants (B1.1.248 & P.1)

Two variants have been detected in Brazil. The first (B1.1.248) was detected in four Japanese travelers traveling from Brazil. The second variant (P.1) appears to be the major variant in Brazil, in particular in the Amazonian Manaus region. The two variants are related, but scientists are more concerned about P.1 because evidence suggests it's more transmissible given its spread and dominance in Brazil.

Scientists also are concerned that P.1 might escape a person's natural immunities after an individual recovers from a COVID-19 infection, leaving them more vulnerable to reinfection. That's because some people are getting reinfected with this variant after a prior infection. Some experts believe that it might have the ability to escape previously generated antibodies. But at the moment, these are just theories and no solid evidence has demonstrated this, and current vaccines should remain effective.

US Midwest variant (20C-US or COH.20G/501Y)

Over the last month, there have been three variants that have been discovered in the US, the first of which was found by two groups in the Midwest (20C-US or COH.20G/501Y). It was traced back to a patient sample in May and has taken over the Midwest and much of the country -- possibly now in half of all U.S. samples.

This variant has spike protein mutations different from both the U.K. and South African variants. Little is known about this variant and more research is needed to characterize it, but some researchers believe it could be more transmissible. Current vaccines should still work, they said.

US San Francisco Bay Area variant (L452R)

In hard-hit California, two variants were identified last week. The U.S. San Francisco Bay Area Variant was identified in patient samples from October. It's believed to be the culprit of multiple large outbreaks throughout the Bay Area, and with increasing numbers around California, there's concern it has increased transmissibility.

"It's still very early in terms of what we know about this particular variant," said Dr. Charles Chiu, director of the UCSF-Abbott Viral Diagnostics and Discovery Center and associate director of the UCSF Clinical Microbiology Laboratory. "What we can say is that it is increasing in number ... and in frequency, in terms of the proportion of infections that are caused by this."

US Southern California variant (CAL.20C)

Another variant was found in Southern California, the epicenter of the U.S. pandemic. It first appeared in July and is now the predominant variant in the region. Dr. Jasmine Plummer, Ph.D., associate director of the Genomics Core at Cedars Sinai told ABC News that in December about 40% of all samples contained that variant and "it's still rising."

Little is still known about both California variants. Experts still aren't sure if they're more transmissible or if the variants are responsible for more cases because of the severity of the pandemic in California.

Fauci said that more transmissible variants are a concern because more transmission leads to more cases and more hospitalizations, which means that "you ultimately will get more deaths."

Sean Llewellyn, M.D., Ph.D., a family medicine resident physician at the University of Colorado, is a contributor to the ABC News Medical Unit.

Source: https://abc13.com/how-does-the-covid-vaccine-work-against-new-variants-many-of-19-are-there-variant-in-us-moderna/10065186/

Stay in quarantine until you get COVID results

Article by sherrylynclarke@nationnews.com

Manager of Quarantine Facilities for COVID-19, Alvin Hart. (GP)

People who were tested for COVID-19 must quarantine at home until they receive their results.

This appeal has come from Manager of Quarantine Facilities for COVID-19, Alvin Hart, who said some Barbadians were still not doing what they should to help break the chain of COVID-19 infections.

In an interview with the Barbados Government Information Service, Hart disclosed that health authorities were picking up entire families with COVID-19, in some cases, because people who were awaiting test results were still mixing with family members instead of quarantining. He added that some of them were also shopping at supermarkets and going about their usual routines while they waited to find out if they were COVID-19 positive or negative.

Stating that over 90 per cent of the COVID-19 cases recorded daily were Barbadians, he cautioned members of the public to take the rules and directives seriously.

The requirement for people waiting on results, he pointed out, was that they quarantine at home, or at a designated quarantine facility until their results were ready. If quarantining at home, individuals should isolate themselves in a room and limit contact with other members of the household; practise proper hand hygiene; wear masks and disinfect items and surfaces with which they come into contact.

“All of these components, we need to work all of them together. If one cog in this wheel or one link in this chain is weak, we will continue to have challenges. And one of the challenges we are having is when persons get tested, they don’t go home and quarantine until they get back results,” he explained.

Hart advised Barbadians who could not quarantine at home for any reason, to disclose this to the health care professionals at the polyclinics, or wherever they are tested for COVID-19.

He said people could instead quarantine at one of the government facilities, such as Paragon, or at one of the designated hotels. Another option, he suggested, would be for members of households to lodge somewhere else until the results came back.

“What we are seeing in this current outbreak and at this phase is that we are not breaking the chain of infection after persons are tested. What is happening is that after persons are tested, they’re going home, but they’re going to stop by the shop; they’re going into the supermarkets.

“Some people get tested and don’t say anything. They know they’ve been exposed and they go back to work and they go on the block. And some of these villages or areas are so densely populated…. I’ve heard about cases of people saying: ‘Well when I finish this test I am going to visit my aunt, my sister, or I’m going to look for my mother’. You are now exposing all of those persons to COVID-19,” Hart lamented.

He warned people who are primary contacts – those who come into direct contact with a COVID-19 positive individual – to get tested immediately and self-isolate. While he noted that secondary and tertiary contacts were at less risk of contracting the virus, he said the risk was still very much there, and they too, should take precautions.

The Quarantine Facilities Manager said another problem health authorities faced was dishonesty from some people who were being tested for COVID-19.

“What I encourage persons to do, is from the time you have that test you must be honest. And we’ve been having serious challenges with that. People give their addresses and telephone numbers but when you call them either they don’t answer the phone, or the number is wrong, or when we go into their district they run; we can’t find them,” he revealed.

Hart maintained that the only way Barbados would be successful in the fight against COVID-19 was for every single person in each household to play their part by stepping up infection control practices within their homes.

“Too many families are going to the Harrison Point [Isolation Facility] together. Over the next couple of weeks, we would like to see that broken,” he said.

Source: https://www.nationnews.com/2021/02/24/stay-quarantine-get-covid-results/

Coronavirus, schools and children - what are the risks?

7 March

All pupils in England - and many in Scotland, Wales and Northern Ireland - can now be taught face-to-face in school classrooms.

What is known about how the virus is transmitted among children and the risk to pupil, teachers and the rest of the community?

What's the risk to children and young people?

The risk of children becoming seriously ill from the virus is tiny. This hasn't changed even with a new, more contagious variant of coronavirus circulating.

Despite a rise in the number of children infected during the winter, there was not a substantial rise in hospital admissions.

"As cases in the community rise there will be a small increase in the number of children we see with Covid-19, but the overwhelming majority of children and young people have no symptoms or very mild illness only," says Prof Russell Viner, president of Royal College of Paediatrics and Child Health.

Do children spread the virus?

Among pupils in primary schools, evidence shows that there is limited spread of coronavirus.

But teenagers - particularly older teens - are probably more like adults in the way they transmit the virus.

In the second wave of England's epidemic in the autumn and early winter, schoolchildren and young adults experienced a much faster rise in infections than other age groups - most likely because they had more opportunities to mingle.

During England's November lockdown, schools remained open and operated normally, when many other places had shut down.

What role do schools play in spreading coronavirus?

This is difficult to say. When schools are open, there is more spread among schoolchildren, particularly those at secondary level. There have also been signs that transmission dips after school holidays, such as half-term.

But it's hard to say whether children are catching the virus in the classroom, or on the bus or hanging out with friends after school.

Rates of infection in schools tend to reflect rates of infection elsewhere.

An ONS survey of 100 schools in England, which tested random pupils and staff without symptoms, found 1.24% of pupils and 1.29% of staff tested positive for the infection in November, mirroring an estimated 1.2% infection rate in the general population.

Jenny Harries, England's deputy chief medical officer, has said schools are "not a significant driver" of cases of Covid in communities, although she said children could definitely transmit the infection in schools and elsewhere.

Sage, the government's scientific advisory group, has suggested opening schools could increase the virus's reproduction rate or R number by as much as 30%.

But this is highly uncertain and depends a lot in factors like testing, masks and ventilation.

What's the risk to teachers?

Teachers do not seem to be at significantly higher risk than other occupations.

In December, 15% of teaching and support staff tested positive for antibodies, giving them an average risk for their age.

In contrast, between 25% and 50% of hospital staff had antibodies, while in care homes that had at least one Covid outbreak, two-thirds (66%) of staff had antibodies by the end of the first wave.

And overall, teaching and education professionals are no more likely to die of Covid than their peers.

• Teachers 'not at higher risk' from Covid
• When will I get a Covid vaccine?

Nurses, cleaners, social workers, restaurant staff, taxi drivers and security workers are all at greater risk than teachers, according to the Office for National Statistics.

That doesn't tell the whole story, of course - your ethnic background, underlying health conditions, where you live and who you live with are all factors too.

Teachers tend to be younger and healthier on average than some other occupations and they're also more likely to be female - all factors which put them in lower risk groups.

Will opening schools have an effect?

According to Dr Shamez Ladhani, the chief investigator of the ONS schools survey and a consultant at Public Health England, the long-term harm of keeping children out of school is "enormous", but adds that "the risks are not zero".

Sage says policymakers need to weigh up the benefits and harms of closing schools. This includes reducing the direct health risks to staff, and the negative impact on children's mental health, education, development and wellbeing.

Many experts agree this is a difficult balancing act.

Source: https://www.bbc.com/news/health-52003804

IMAGE SOU

Covid: How does the Oxford-AstraZeneca vaccine work?

9 February

People under the age of 40 are to be offered an alternative to the Oxford-AstraZeneca vaccine in the UK as a precaution, after a review of all the latest evidence by vaccine advisers and safety experts.

The UK's medicine regulator - the MHRA - says the benefits of the vaccine still outweigh the risks for the vast majority of people.

• Under 40s to be offered alternative to AZ vaccine

What is the latest advice?

The Joint Committee on Vaccination and Immunisation (JCVI) - the body which advises the government - has now recommended that "adults aged 18- 39 years with no underlying health conditions are offered an alternative to the Oxford-AstraZeneca vaccine, if available, and if it does not cause delays in having the vaccine".

Data from the MHRA suggests there's a very small - but slightly higher than normal - incidence of a rare type of clot in younger adult age groups, particularly when the risk of being infected with coronavirus is very low, as it is now.

The risk of a clot is roughly one in 100,000 for people in their 40s, and rises to one in 60,000 for people in their 30s.

Based on the current data, the following is advised:

• Anyone who experiences clotting after a first dose of the vaccine should not receive a second dose

• People with a history of blood disorders (at risk of clotting) should only have the AstraZeneca when the benefits outweigh the risks

• Pregnant women should talk to their GPs about the benefits and risks

What's known about the risk?

The MHRA looked into UK cases of rare blood clots in people who had recently received the Oxford-AstraZeneca vaccine.

It found 242 cases of clotting cases and 49 deaths after an estimated 28.5 million AstraZeneca vaccines doses were administered across the UK up to 28 April.

The MHRA said about four people in a million would normally be expected to develop this particular kind of blood clot - though the fact they are so rare makes the usual rate hard to estimate.

And the regulator said it had not been proven that the jab had caused the clots.

Its head, Dr June Raine, said while the link was "firming up", more evidence would be needed.

The benefits of the AstraZeneca vaccine outweigh the risks of the virus - hospitalisation and death - for the vast majority of people, she said. But for younger age groups it was more "finely balanced".

• 'Encouraging' antibody boost after both Covid jabs

What are these rare blood clots?

The MHRA study looked at people who had developed clots associated with a low level of platelets after receiving the Oxford-AstraZeneca vaccine.

Platelets are tiny blood cells that help your body form clots to stop bleeding.

Among these clots is a type called a Cerebral Venous Sinus Thrombosis (CSVT).

CVST occurs when a blood clot forms in large veins in the head - stopping blood from draining out of the brain.

As a result, blood cells may break and leak into brain tissue - ultimately leading to a stroke.

The clot can occur naturally and are more common, but still very rare, in younger women.

What symptoms should I watch out for?

The MHRA says anyone who has these symptoms four or more days after receiving the Oxford-AstraZeneca vaccine should seek prompt medical advice:

• A severe or persistent headache
• Blurred vision
• Chest pain
• Shortness of breath
• Swollen legs
• Persistent abdominal pain
• Unusual skin bruising
• Pinpoint spots (not including the injection site)

Covid infection itself can make clots more likely, stresses the MHRA.

What have other countries said about the AstraZeneca vaccine?

The European Medicines Agency (EMA) has said clotting should be listed as a very rare vaccine side effect.

After a study looking at 86 such cases in the EU, the EMA concluded the benefits of the vaccine outweighed the risk and that there was no definite causal link.

Nevertheless, Denmark has stopped its AstraZeneca rollout completely - and Germany, Spain, Italy and Ireland have suspended use of the vaccine in people under 60.

France is recommending it only be given to those aged 55 or over, while Australia says people aged under 50 should get the Pfizer jab instead.

How does the Oxford-AstraZeneca vaccine work?

It is made from a weakened version of a common cold virus (known as an adenovirus) from chimpanzees. It has been modified to contain genetic material shared by the coronavirus - although it can't cause the illness.

Once injected, it teaches the body's immune system how to fight the real virus.

• How do we know Covid vaccines are safe?

• How do the Covid vaccines compare?

Does the vaccine protect against new variants?

Experts are studying all of the current coronavirus vaccines to check how well they work against new, mutated variants of the virus.

The government's deputy chief medical officer, Jonathan Van Tam, says there is "plenty of evidence" the vaccines appear to be effective against the Kent variant which is dominant in the UK.

There is less evidence about protection against other variants, such as those identified in Brazil and South Africa.

However a study of around 2,000 people suggests, while the Oxford-AstraZeneca vaccine may offer more limited protection against mild and moderate disease caused by the South Africa variant. it should still protect against severe disease.

Does the vaccine protect against new variants?

Experts are studying all of the current coronavirus vaccines to check how well they work against new, mutated variants of the virus.

The government's deputy chief medical officer, Jonathan Van Tam, says there is "plenty of evidence" the vaccines appear to be effective against the Kent variant which is dominant in the UK.

There is less evidence about protection against other variants, such as those identified in Brazil and South Africa.

However a study of around 2,000 people suggests, while the Oxford-AstraZeneca vaccine may offer more limited protection against mild and moderate disease caused by the South Africa variant. it should still protect against severe disease.

Source: https://www.bbc.com/news/health-55302595

Can You Get COVID-19 More Than Once?

Despite what you've heard, no one is truly immune

December 10, 2020 / Infectious Disease

By this point in the pandemic, you probably heard the following facepalm-worthy statements from friends or family members…

“I’ve already had COVID-19. I can’t get it again.” 

“You know, I did get really sick after going on vacation last fall. That probably was the coronavirus.”

“I’ve been around crowds without a mask and nothing. I must be immune.”

Sorry, but these statements simply aren’t true in many cases. The thing with COVID-19 is that there are still a lot of unknowns. With that being said, we can’t assume that we know how it all works. So, with the help of pediatric infectious disease specialist Frank Esper, MD, we’ll get to the bottom of those statements and learn why it’s still important to observe the protocols put in place to stay safe. 

Can you get COVID-19 twice — or more?

There seems to be a lot of misconceptions around this question. While the CDC has said that cases of reinfection have been reported but remain rare, that doesn’t mean you’re totally in the clear should you contract COVID-19. And since things are always changing, the “rare” status for cases could always change as well. 

Dr. Esper explains. 

“It’s very premature to make the assumption that just because you had COVID-19 that you’re safe from it. I don’t think anyone wants to be infected with COVID-19, whether it’s the first time or the second time or the third time — nobody wants it. Your previous infection may prevent you from getting sick, but that doesn’t necessarily mean that you can’t become infected and then spread it to others. You might think you’re safe because your antibodies are there, but if you’re still able to spread it to others for a short period of time, that’s doing no one any good either.”

Dr. Esper adds that being infected once is not a hall pass to ignore all of the protocols put in place — masking, hand washing and physical distancing. If anything, to protect yourself and others, you need to stay on top of those recommendations. 

Your bad illness last fall most likely wasn’t COVID-19

Many people have pinned their terrible illnesses that popped up right before the pandemic on the coronavirus. But Dr. Esper says this is highly unlikely. Why? Because a lot of viruses can cause similar symptoms to those of COVID-19.

“It is way too early for you to assume that you’re out of the woods if you had COVID-19 or you think you had it but weren’t tested. There are a lot of other viruses out there that cause similar symptoms. You could have had a really tremendous cold or flu, or you could have had any number of viruses — adenovirus, etc. You can’t really tell the difference between the coronavirus infection and adenovirus infection or any of these other viral infections. They can all be bad. So, I would not just assume that you’ve already been infected with COVID-19,” says Dr. Esper.

He adds that while we might be under the impression that many have already been infected, most people to this point have not. That means a great deal of us remain susceptible to COVID-19. 

“If most people to this point had already been infected we wouldn’t be seeing the skyrocketing case numbers every day, beating the last day’s record. It just tells you how many susceptible people are out there and that we all have to work together to try to minimize how many people get infected.” 

Being around people without a mask and not getting sick — so far — does not mean you’re immune to COVID-19

According to the CDC, 4.5 million Americans get bitten by dogs every year. Where are we going with this? We’re getting there. 

You might be around dogs regularly or you might even own a dog. If you’ve never been bit by one, you’re most likely thinking, “What does that statistic have to do with me?” Well, just because you haven’t been bitten yet doesn’t mean that you’ll never experience a dog bite. Also, your personal experience doesn’t change the fact that millions of others have these painful encounters throughout the course of a year. 

With COVID-19, it kind of plays out in a similar manner. You might be doing all the things and hanging around everyone without a mask or social distancing and feel like you’re invincible because you have yet to show any symptoms of the virus. However, you could actually be infected and spreading the coronavirus to others. And when you think about it, are you really OK with the idea of making your friends and family sick or possibly being the reason why they’re no longer here? Most likely not. 

Dr. Esper explains. 

“Even if you don’t get sick, it doesn’t necessarily mean that you couldn’t spread COVID-19 to other members of your family, your neighbors, or your friends. And so, it is still very important that everyone masks up regardless. The masking recommendations from the CDC and state and local health departments don’t say that masks are only for people who have not had the illness. They’re saying masks are for everybody. The best thing for us to do is come together as a group — the people who have thankfully survived the infection and those who have not been infected or diagnosed — and all work together in order to prevent further infection especially now when the numbers skyrocketing.”

With the rare cases of reinfection, what exactly is happening to the immune system?

Dr. Esper says that the medical community it still examining these rare cases. For instance, a recent study out of Oxford showed that antibodies offered about a six-month window of protection for study subjects. However, it’s worth noting that this study still has yet to be evaluated and peer-reviewed. While this might seem like encouraging news, it doesn’t mean that we should start disregarding everything we’ve been doing to stay safe.  

“The vast majority of individuals who have effective antibodies against this virus are probably protected for several months. But like with many coronaviruses, these antibodies just don’t seem to last very long. So we expect that immunity to wane over time,” says Dr. Esper.

This also brings into question how vaccines will work. 

“Right now, we don’t necessarily know exactly how long the immunity lasts. That’s one thing that we need to take a closer look at. We’re not seeing tremendous numbers of reinfection, so that might suggest that once you get an immune response, you’re likely to be safe. So, if we get an effective vaccine, you’re likely to be safe against reinfection or infection. That good since this virus doesn’t mutate. That could also mean it’s likely that the vaccine response is going to last a little bit longer.” 

Dr. Esper says that he wouldn’t be surprised if a drop of antibodies in vaccines occurs over time and requires us to get yearly coronavirus vaccinations like we do with flu vaccinations. But right now he says the main goal is to start getting the virus under control and to keep fine tuning the process as we head into 2021. 

If you’ve had COVID-19, should you get vaccinated?

While the CDC and the vaccine manufacturers still haven’t answered this question, Dr. Esper says given the fact that antibodies drop over time, he feels that many people will get the vaccine. 

“I expect that mostly everyone, including people who may have had a bout with the virus earlier on in this pandemic, are probably going to get vaccinated. Again, antibodies are waning and the immune system is going down. So, maybe the vaccine will give your immune system a boost. And we definitely know that the immune system loves boosting your first infection — it has a big response, but then it goes away fairly quickly. But if you get a second infection, that tells your immune system, ‘Hold on. This is something I’m going to be seeing a lot of.’ When that happens, your immune system goes into a second round of protection that lasts a lot longer than the first round of protection. And so giving the immune system a boost, even if you’ve had the infection, is probably going to be something that’s going to happen.” 

Dr. Esper adds that he hasn’t seen any vaccine trials that currently address children and pregnant women, but this is mainly because these two very vulnerable groups present new sets of challenges that can often hold up the trial process. Since COVID-19 has hit older people harder, vaccine manufacturers have been working to get a vaccine out fast to get things under control, but will continue working on solutions for children and pregnant women in the meantime.

Now is not the time to give up

If you’ve been taking the proper precautions to keep yourself and your family safe, Dr. Esper strongly encourages you to keep doing so. Keep washing your hands, wearing a mask in public and even private places (especially when you’re around people who don’t live with you) and keep physically distancing when possible. The science behind it all has been proven to work despite what your neighbor, uncle or former classmate says in person or on social media.

“We’re getting close. Now is not the time to take your foot off the gas. It’s not the time to unlearn everything that we have done over the last eight months — everything that we’ve been through over the last eight months. Let’s not stumble at the finish line. We have to really keep up everything that we’re doing while we wait for these vaccines to get up in production to ensure that they’re safe first and foremost. And once we can get distribution up, we can get people some extra protection against this virus.”

Source: https://health.clevelandclinic.org/can-you-get-covid-19-more-than-once/