UK trial finds no benefit from azithromycin in hospital COVID-19 patients Investigators with the United Kingdom’s RECOVERY trial reported yesterday that a preliminary analysis of data from the azithromycin arm of the trial showed the antibiotic had no impact on clinical outcomes in hospitalized COVID-19 patients. In the trial, which was conducted among COVID-19 patients…
States excitedly announced the arrival of their first COVID-19 vaccine shipments today, as the first Americans, mostly healthcare workers, appeared in front of cameras to receive the first doses on a day that the nation passed the grim threshold of 300,000 deaths. Developments moved quickly over the weekend with actions by federal agencies. The Food…
Two new studies show that political affiliation had much more influence on Americans’ decisions to stay home during the COVID-19 pandemic than did the relative numbers of infections in their communities.
Wide behavioral chasms
In the first study, led by Vanderbilt University researchers and published Dec 12 in Science Advances, researchers randomly surveyed 1,135,638 Americans from Apr 4 to Sep 10 about their political affiliation and if they had participated in social activities that could hasten the spread of COVID-19, such as eating at a restaurant, visiting family or friends, or shopping for groceries in person.
On average, 6,744 people responded to the survey each day. Using US Census Bureau American Community Survey estimates, the researchers weighted each day’s sample to be representative of the US adult population.
Democrats were 13.1% less likely, and Republicans 27.8% more likely, than independents to have social contacts during the pandemic. And while Democrats and Republicans initially indicated concern about coronavirus infection and said they understood the need to physical distance, the proportion of Republicans who said they were “very or somewhat worried about COVID-19” began to decline, but it remained at the same level in Democrats.
The reduced concern about the pandemic corresponded to a more rapid return to social activities among Republicans, despite rates of infection in their areas.
By September, Republicans reported participating in nearly twice the number of daily social activities than Democrats. The split was even more striking in terms of engaging in the riskiest activities, such as visiting a restaurant or mingling with friends or family. Republicans had increased their number of social activities by, on average, 75%, while independents reported a 60% increase, and Democrats reported a 47% increase.
“Suggestively, this increasing partisan divide accelerates the same week President Trump tweeted about the need to ‘liberate’ Michigan, Minnesota, and Virginia (April 17),” the researchers wrote. “By early June, only approximately 40% of Republicans report being concerned compared to around 80% of Democrats. Republicans’ concerns increased as the pandemic worsened through June and into July, but a large partisan gap persists.”
The authors said that the results show that in the United States, COVID-19 is as much or more of a political issue as it is a public health one, adding that strong political leadership, particularly by the Republican party, appears to be most crucial for changing Americans’ partisan-related behavioral differences during the pandemic.
The study “reveals not only that partisanship is more important than public health concerns for explaining individuals’ willingness to stay-at-home and reduce social mobility, but also that the effect of partisanship has grown over time—especially among Republicans,” the authors said. “All else equal, the relative importance of partisanship for the increasing (un)willingness of Republicans to stay-at-home highlights the challenge that politics poses for public health.”
Role of political affiliation in public health messaging
The second study, published today as a research letter in JAMA Internal Medicine, involved the results of an online survey of young adults originally recruited as ninth-grade students in Los Angeles in 2013 to answer semiannual questions about their health behaviors.
Led by researchers at the University of Southern California, this study was based on the most recent survey, which took place from May 18 to Aug 3. Of 2,179 respondents, 891 identified themselves as Democrats (43.1%), 148 (7.2%) as Republicans, and 320 as independents (15.5%), while 706 (34.2%) said they didn’t know or didn’t want to answer.
A larger share of Republicans reported infrequent physical distancing (36 [24.3%]) than Democrats (46 [5.2%]) and independents (21 [6.6%]) and those who said they didn’t know or declined to answer (40 [5.7%]).
Republicans reported a mean of 3.6 social activities in the 2 weeks before the survey, while Democrats reported 1.9, independents reported 2.2, and those who didn’t know or didn’t answer reported 2.2. Compared with other groups, Republicans were more likely to say they visited indoor public venues such as malls, restaurants, and bars and to attend or host gatherings of 10 or more people.
“In this study of young adults, predominantly living in Los Angeles County or elsewhere in California, self-reported Republican political party affiliation was associated with less frequent physical distancing and participating in social recreational activities that may perpetuate the COVID-19 pandemic,” the authors said. “Our findings suggest that efforts to promote physical distancing among young adults during the COVID-19 pandemic should consider the role of political affiliation.”
In an emergency session today, the vaccine advisory panel for the Centers for Disease Control and Prevention (CDC) voted to recommend that Americans receive the Pfizer-BioNTech COVID-19 vaccine, a key step that allows healthcare workers to begin administering the vaccine to people.
The interim recommendation covers people ages 16 years and older under the Food and Drug Administration (FDA) emergency use authorization (EUA).
The decision comes a day after the FDA issued its EUA, a step that cleared the way for the vaccine to begin shipping.
The vote from the CDC’s Advisory Committee on Immunization Practices (ACIP) passed with 11 votes in favor and 3 recusals. A separate vote to amend the adult and child immunization schedule passed unanimously by the full voting group.
During the public comment session ahead of the vote, some groups spoke out against the vaccine, but most supported it and wanted specific groups included in future prioritization decisions, such as people in incarceration settings, those in senior living centers, teachers, and food workers. Public health groups also asked for more resources to help administer the vaccine.
Earlier during today’s deliberations, CDC officials clarified some issued related to the vaccine, including that the Pfizer-BioNTech vaccine isn’t interchangeable with other COVID-19 vaccines.
They also said the vaccine should be offered to people who were previously infected, though people with current infections should wait until they have recovered. Officials also said those with known exposure should wait until their quarantine period expires to avoid potentially exposing healthcare workers and others at immunization sites.
ACIP reviews vaccine data before recommending any vaccine and issues guidance for their use.
The Food and Drug Administration (FDA) last night announced it has issued an emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine, allowing shipments to begin and marking a significant milestone in the country’s battle against the virus.
At a briefing today, FDA Commissioner Stephen Hahn, MD, said the EUA marks an unparalleled achievement of different groups working together without external pressure to find efficiencies without cutting any safety corners. He also praised the work of career FDA staff who have been working around the clock to move the assessment of the vaccine forward.
An independent FDA panel on Dec 10 recommended that the vaccine be approved for emergency use in people ages 16 and older. The FDA typically follows the recommendations of its Vaccines and Related Biological Products Advisory Committee (VRBPAC), and Hahn had said that the agency would move quickly on its decision.
Peter Marks, MD, PhD, director of the FDA’s Center for Biologics Evaluation and Research, said the EUA issuance makes the vaccine available and holds the promise of altering the course of the pandemic. He also said the FDA’s review of the vaccine doesn’t end with the EUA and that it will continue to comb through the data and collaborate on safety monitoring as the company seeks full approval for the vaccine.
The EUA paves the way for shipments to begin, and FDA officials said they are already moving to deliver the vaccine across the country.
Addressing concerns over allergies, pregnant women
Officials fielded questions and offered clarifications about two groups, people with a history of allergies and pregnant women.
Though two allergic reactions were reported in the United Kingdom on the first day of vaccination on Dec 7, Marks said FDA regulators didn’t see a concerning signal in larger datasets from the studies. He noted that the vaccine is contraindicated for people who have a history of severe allergic reactions to vaccines or vaccine components. He added that, as standard procedure, vaccination sites will have tools on hand, such as EpiPens and diphenhydramine, to handle any events.
More than 1.6% of the population has a history of severe reaction to items such as food or environmental substances, Marks said, adding that the FDA doesn’t want that population excluded from receiving the vaccine. With its continuous safety and clinical trial monitoring, he said the FDA feels comfortable moving forward.
Marks said there weren’t enough pregnant women in the trial to assess safety, but women can work with their medical providers to weigh the benefits and risks.
FDA officials also addressed a debate a few days ago in its advisory group meeting about 16- and 17-year-olds getting the vaccine. Marks said the numbers of teens in the study wasn’t as large as for other age-groups, but that FDA has a fair amount of history about pediatric age range extrapolation.
He said older teens are known to transmit the disease when asymptomatic and that they have significant interaction with the community and that known potential benefits outweigh the potential risks.
CDC advisers to vote today
A remaining question about the vaccine is whether it prevents transmission, and Marks said it will take a few more months to get that data.
He also addressed suggestions that officials should stretch vaccine supplies by giving one dose instead of the two recommended doses. He said there’s been a lot of noise about the issue, but the trials focused on effectiveness and duration of protection after two doses. “It would be foolhardy to conjecture that one dose may be okay without knowing,” he said.
With its EUA issuance, the FDA also posted several background documents, including fact sheets for medical providers and patients.
The FDA EUA approval sets the stage for immunization to begin with the first doses, which will target healthcare workers and nursing home residents. This afternoon, the vaccine advisory group of the Centers for Disease Control and Prevention (CDC) is meeting in an emergency session and will vote on whether Americans should receive the vaccine.
The White House gave the Food and Drug Administration (FDA) an ultimatum to officially approve an emergency use authorization (EUA) today for the Pfizer-BioNTech COVID-19 vaccine, a day after the agency’s advisory panel recommended approval, and with a separate decision still needed from a Centers for Disease Control and Prevention (CDC) panel.
The pressure over the EUA approval raises worries that the process has been rushed, which could feed into people’s doubts about the vaccine. Vaccine decisions also come amid what could be the start of the feared post-Thanksgiving surge of illnesses and deaths.
And as the first vaccine sails through EUA approval in the United States and a few other countries, two vaccines that are in development hit snags during clinical trials.
White House threat raises vaccine tensions
White House chief of staff Mark Meadows today told FDA Commissioner Stephen Hahn, MD, that he needed to approve the Pfizer-BioNTech EUA by the end of the day or submit his resignation, the Washington Post reported.
Hahn responded in a statement to the Post that the report doesn’t accurately portray his phone call with Meadows, who encouraged the FDA to continue working quickly on the EUA request. He said the FDA remains committed to issuing the authorization quickly.
Meanwhile, Health and Human Services (HHS) Secretary Alex Azar told Good Morning America today that vaccinations could start as early as Monday or Tuesday.
The threat from the White House came a day after an outside vaccine advisory group recommended EUA approval, though the FDA has the final say. Hahn had said that the FDA would make its decision soon after the Vaccines and Related Biological Products Advisory Committee (VRBPAC) weighed in, and he said in a statement this morning that the agency informed Pfizer that it was rapidly working toward finalizing and issuing the EUA, which would pave the way for Operation Warp Speed (OWS) to begin shipping the vaccine to states.
The CDC’s panel of vaccine advisors, the Advisory Committee on Immunization Practices (ACIP), is meeting in emergency sessions today and Sunday, with a vote on Sunday on whether the vaccine should be given to Americans. That’s the final step before the vaccine can be given to the first two priority groups: healthcare workers and nursing home residents.
US hospitalizations hit new high
Yesterday, the United States reported 224,452 new cases and 2,768 deaths, according to the Johns Hopkins online dashboard. And a record 107,258 Americans are currently in the hospital for COVID-19, according to the COVID Tracking Project.
CDC Director Robert Redfield, MD, said during a Council on Foreign Relations event that that the country will likely see the death toll worsen over the next 60 to 90 days and that the vaccine probably won’t have an immediate impact on the death toll, according to The Hill.
In other US developments:
American women are more wary of getting the COVID-19 vaccine than men, according to a new Reuters/Ipsos poll. Overall, 61% of Americans said they are open to getting the vaccine, with 55% of women saying they are “very” or “somewhat” interested, compared to 68% of men.
In its survey of COVID-19 infections in college athletes, coaches, and staff, the New York Times reports 6,629 cases, which it says is likely an underestimate, given that it got complete data from only 78 of 130 schools.
Senate Republicans yesterday signaled that they would not accept a coronavirus relief package crafted by a bipartisan group of lawmakers, according to the Wall Street Journal. The main sticking points are aid to state and local governments as well as liability protections.
The US COVID-19 total has climbed to 15,746,026 cases, with 293,785 deaths, according to the Johns Hopkins tracker.
Setbacks for 2 other vaccines in early trials
Two COVID-19 vaccines in development hit setbacks in clinical trials. Sanofi and GSK announced today that the phase 1/2 clinical trial of its adjuvanted recombinant protein-based COVID-19 vaccine showed an immune response comparable to disease recovery in adults ages 18 to 49, but the response wasn’t as strong in older adults. They said they plan to begin a phase 2b study with an improved antigen formulation in February.
In July, OWS signed a $2 billion deal with the two companies to support vaccine development and obtain 100 million doses.
Also, the University of Queensland today announced that a phase 1 trial of a COVID-19 vaccine that it is developing with CSL will not progress to phase 2 trials after it was found that the vaccine interfered with certain HIV tests, yielding some false-positives. They said to introduce the vaccine, significant changes in well-established HIV testing procedures would have been needed, so the company and Australia’s government decided not to proceed with studying the vaccine.
At a World Health Organization (WHO) media briefing today, officials addressed the successes and challenges of COVID-19 vaccine development. Bruce Aylward, MD, MPH, senior advisor to the WHO’s director-general, said the ups and downs are a reminder that the beam of light is getting brighter over time, but the pandemic is still a long tunnel.
At today’s briefing, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, hailed the flurry of EUA approvals for the Pfizer-BioNTech vaccine in a handful of countries and the start of vaccination in some. However, he said there’s an urgent need for $4.3 billion to address a funding gap to ensure that low- and middle-income countries receive vaccines, a key strategy for stamping out the pandemic across all corners of the globe.
“We have all seen images of people being vaccinated against COVID-19. We want to see these same images all over the world, and that will be a true sign of solidarity,” he said.
WHO urges caution over holidays
WHO officials also urged countries and their citizens to take precautions over the holidays to keep people safe, especially in areas with high transmission. “That could be the best gift you could give—the gift of health, life love, joy, and hope,” Tedros said.
In other global headlines:
In Germany, where COVID-19 cases aren’t decreasing as much as inother European countries that ordered strict measures, officials braced for tougher lockdowns ahead of Christmas, according to Reuters. The state of Baden-Wuerttemburg has already made its lockdown stricter, banning people from going outside between 8 pm and 5 am except for work and essential tasks.
AstraZeneca said they would work with collaborators from Russia on its Sputnik V vaccine trials, according to CNN. The effort will see if combined vaccines from the two companies may help generate broader protection and be more accessible.
The global total today passed 70 million cases and is at 70,000,538 cases with 1,589,964 deaths, according to the Johns Hopkins tracker.
Biogen conference linked to hundreds of thousands of COVID cases
A study published yesterday in Science by researchers in Massachusetts suggests that a coronavirus outbreak linked to an international biotech conference in Boston in February is linked to more than 300,000 national and international infections with SARS-CoV-2, the virus that causes COVID-19.
The findings stem from an analysis of 772 genomes from SARS-CoV-2 nasopharyngeal samples led by scientists with Harvard, the Massachusetts Institute of Technology, and Massachusetts General Hospital (MGH). The samples were collected by the Massachusetts Department of Health and MGH from Mar 4 through May 9 and included samples from two putative superspreading events—one at a skilled nursing facility and the other at the Biogen conference, held in Boston on Feb 26 and 27.
Initial public health investigation and contact tracing identified approximately 100 cases associated with the conference. Viral sequencing of 28 conference-associated genomes revealed the presence of a single mutation (C2416T) not previously found in Massachusetts and likely introduced by a European conference attendee. C2416T and another conference-associated variant, C2416T/G26233T, accounted for more than half of the 772 SARS-CoV-2 genomes from Massachusetts.
Using the C2416T variant as a marker for tracking the spread of SARS-CoV-2 from the conference and comparing the conference-associated genomes with a dataset of 4,011 SARS-CoV-2 genomes from the United States and other countries, the researchers found that the conference-associated lineage began to appear in multiple states in early March and increased rapidly in frequency. By Nov 1, viruses containing C2416T could be found in 29 states.
The researchers estimate that a total of 245,000 cases (205,000 to 300,000) marked by C2416T occurred through Nov 1, with Florida accounting for the greatest proportion of those cases (29.2%). In addition, they estimate that 88,000 cases (56,000 to 139,000) were caused by C2416T/G26233T, which spread to 18 states and other countries.
“Because SARS-CoV-2 viruses circulating at the conference happened to be marked by distinct genomic signatures, we were able to track its downstream effects far beyond the superspreading event itself, tracing the descendants of the virus as they made a large contribution to the local outbreak in the Boston area and as they spread throughout the US and the world, likely causing hundreds of thousands of cases,” the authors of the study wrote.Dec 10 Science study
CDC: Emergency visits for child abuse down during pandemic
Data published today in the Centers for Disease Control and Prevention’s (CDC’s) Morbidity and Mortality Weekly Report (MMWR) show fewer emergency department (ED) visits for child abuse and neglect during the first 6 months of the pandemic, but the proportion of these visits increased.
Pandemics are linked to an increased risk of child abuse and neglect because of stress and less contact with mandated reporters. Preliminary reports from some facilities during COVID-19 have shown increased severity of abuse and neglect, but official reports to child protection agencies have declined by 20% to 70%, the authors note.
CDC researchers analyzed national data representing approximately 73% of all US ED visits from Jan 6 to Sep 6 and stratified them by age-group (0 to 4, 5 to 11, and 12 to 17 years old).
Beginning Mar 15—and coinciding with the president’s declaration of a national emergency—the total number of ED visits meeting the definition for child abuse and neglect decreased below 2019 levels for all age-groups. At the same time, the proportion of ED visits related to child abuse and neglect (per 100,000 ED visits) began increasing above 2019 levels—likely related to a decrease in the overall number of ED visits and a pandemic-related shift in healthcare use, the authors suggest.
The researchers found 53% fewer overall ED visits for child abuse and neglect from Mar 29 to Apr 4 compared with the same period in 2019, with the largest proportional declines in children aged 5 to 11 years (61%). But the number of ED visits for child abuse and neglect resulting in hospitalization did not decline in 2020, suggesting that injury severity did not decrease.
Although weekly visits resulting in hospitalization for children of all ages remained stable for 2020, the overall percentage of such visits increased from 2.1% in 2019 to 3.2% in 2020 (P < 0.001), with the largest increase in children aged 0 to 4 years (5.3% in 2020 vs 3.5% in 2019; P < 0.001). The authors conclude, "Implementation of strategies to prevent child abuse and neglect is important, particularly during public health emergencies."Dec 11 MMWR study
A combination of the antiviral drug remdesivir and the anti-inflammatory drug baricitinib reduced recovery time and accelerated improvement, especially among patients receiving supplemental oxygen without invasive ventilation, according to a large, international study of hospitalized COVID-19 patients published in the New England Journal of Medicine today.
Severe COVID-19 appears to be associated with an exaggerated inflammatory response in some patients, leading researchers to consider anti-inflammatory medications like baricitinib as potential therapies. Remdesivir, approved by the US Food and Drug Administration on Oct 22 to treat hospitalized COVID patients, has thus far met with mixed results when used alone.
Researchers at 67 trial sites in eight countries, including the United States, randomly assigned 1,033 patients hospitalized with COVID-19–related pneumonia to a treatment group (515) receiving a combination of the two drugs, and a control group (518) receiving only remdesivir and placebo.
Patients were assessed for time to recovery, defined as the first day after enrollment in the 28-day trial on which the patient attained a 1, 2, or 3 score on a scale of disease severity—ranging from “not hospitalized and no restrictions in activity” (1) to death (8). Secondary outcomes included clinical status at day 15 and mortality at day 28.
Faster recovery, lower death rates
Patients of all disease severities who received the combination treatment recovered a median of 1 day faster than those who received only remdesivir and a placebo (median recovery, 7 days vs 8 days; rate ratio for recovery [RR], 1.16; 95% confidence interval [CI], 1.01 to 1.32; P = 0.03).
The combination treatment was most beneficial for patients receiving noninvasive ventilation or high-flow oxygen (ordinal score of 6), with a median time to recovery of 10 days for the treatment group and 18 days for the control group (RR, 1.51; 95% CI, 1.10 to 2.08).
The combination group had 30% higher odds of improvement in clinical status at day 15 compared with the control group (odds ratio for improvement [OR], 1.3; 95% CI, 1.0 to 1.6). This effect was highest for patients with a severity score of 6 (OR, 2.2; 95% CI, 1.4 to 3.6).
Mortality at day 28 was 5.1% for the treatment group and 7.8% for the control group, with the greatest difference in mortality among patients with a baseline ordinal score of 5 or 6—though the authors noted that the study was not powered to detect differences in death rates.
The median time to improvement by one category was 6 days for the drug combination group and 8 days for the control group (RR, 1.21; 95% CI, 1.06 to 1.39).
Fewer side effects in combo-drug group
Similar rates of adverse events occurred in both treatment groups, with fewer serious adverse events in the combination group.
“The consistently lower incidence of adverse events with baricitinib may be related to its action in reducing inflammatory-mediated lung injury and improving lymphocyte counts, its antiviral properties, or its associated shorter recovery time and faster clinical improvement, all of which could have reduced the risk of nosocomial infection,” the authors suggest.
The authors conclude, “Baricitinib plus remdesivir was superior to remdesivir alone in reducing recovery time and accelerating improvement in clinical status, notably among patients receiving high-flow oxygen or noninvasive mechanical ventilation.”
They add, “Our results and the characteristics of baricitinib, including the fact that it is an oral drug with few drug–drug interactions and a good safety profile, lend itself to use in low-to-middle-income countries.” They note that baricitinib is being studied by itself for its effect on hospitalized COVID-19 patients in a separate ongoing clinical trial.
Dec 3 CIDRAP News story “WHO trial finds no benefit of 4 drugs for hospital COVID patients”
Oct 16 CIDRAP News story “Large trial shows little benefit for remdesivir; pandemic total tops 39 million”
Oct 9 CIDRAP News story: “New COVID studies: Remdesivir yes, hydroxychloroquine no”
Two new studies highlight a greater illness burden of COVID-19 in black cancer patients, with one showing a 57% higher rate of hospitalization for gynecologic cancer and the other demonstrating a 58% higher COVID-19 rate among all cancer patients and a 29% higher risk of a hospital stay.
Disparities in NYC gynecology cancer patients
Nearly 72% of black patients with gynecologic cancer and COVID-19 were hospitalized compared with 46% of non-black patients, a 56.5% higher level, according to the first study, which was published in Cancer. Black patients made up only 34.7% of the study cohort.
Out of 193 New York City adult patients who had gynecologic cancer and COVID-19, 106 (54.9%) needed hospitalization from Mar 1 to May 20. Black patients had a 71.6% hospitalization rate, compared with 46.0% for non-blacks and a 20.9% death rate, versus 15.9% for non-blacks.
Compared with non-black patients younger than 65, black patients younger were 4.87 times more likely to be hospitalized if they were younger than 65 and 3.44 times more likely if they were 65 or older (both adjusted for comorbidities, cancer conditions, and sociodemographics). Non-black older patients had a 2.64 adjusted odds ratio.
Black patients were also more likely to have three or more comorbidities (81.1% vs 59.2%), and the researchers noted that black patients under 65 were just as likely as older non-black patients to have more than three comorbidities (46.9% vs 48.4%). Overall, the black patients in the study had higher rates of high blood pressure (74.6% vs 51.6%), obesity (62.7% vs 44.4%), and diabetes (47.8% vs 30.2%).
Although smoking status was not a comorbidity, the study notes that it was the only factor significantly associated with mortality after adjustment, raising the likelihood 2.93-fold. Smoking history was comparable in both racial groups, with 24.6% of non-black patients and 26.9% of black patients identifying as former or current smokers.
Although the study authors note the higher prevalence of these underlying conditions in these black cancer patients, they note that many factors are at play.
“The underlying causes of racial disparities are multifactorial and include limited access to healthcare, social determinants of health, racism, and discrimination,” said senior author Bhavana Pothuri, MD, MS, of NYU Langone Health in a press release from Wiley, the journal’s publisher. “The COVID-19 pandemic has only heightened these and brought awareness.”
Black cancer patients 58% more likely to get COVID-19
In the second study, published yesterday in JAMA Oncology, patients with a cancer diagnoses in the past year had higher rates of COVID-19 hospitalization (47.5%) and related mortality (14.9%) compared with patients who didn’t have cancer (24.3% and 5.3%, respectively).
While any cancer diagnosis increased the risk for COVID-19 infection 1.46 times, a recent one increased the risk 7.14 times. The study also noted a higher COVID burden in black cancer patients.
The researchers looked at data via the IBM Watson Health Explorys system up through Aug 14, including in the study 16,570 patients with COVID-19, of whom 1,200 (7.2%) had any cancer diagnosis and 690 (4.2%) had one within the past year.
The highest rate of COVID-19 infection was in patients who had leukemia (adjusted odds ratio [AOR], 12.16), non-Hodgkin lymphoma (AOR, 8.54), and lung cancer (AOR, 7.66). However, even the least associated of the 13 cancers measured, thyroid cancer, increased the likelihood 3.10-fold. The researchers hypothesize that this variance is due to which body system is affected by the cancer and how it relates to COVID-19.
Black COVID-19 patients who were recently diagnosed as having cancer were also at higher risk, with 55.6% requiring hospitalization, versus 43.2% of non-black patients, reflecting a 28.7% increased risk. After adjusting for comorbidities, they also were 58% more likely to develop COVID-19, and they had a higher—although statistically insignificant—COVID-19 mortality rate (18.5% vs 13.5%).
Unlike other findings, the study’s results did not implicate age as a significant factor.
“It is becoming quite clear that the solutions for disparities observed with COVID-19 relate primarily to public policy,” said three US experts in a related JAMA Oncology commentary.
“Needed solutions require (1) large-scale, high-quality epidemiologic data; (2) policies that mitigate socioeconomic risk factors as well as health care access disparities; and (3) validated risk prediction tools to identify patients at greatest risk from COVID-19 and its complications.”
The Center for Infectious Disease Research and Policy (CIDRAP) launched the “Stop Swapping Air” public service messaging campaign this week in partnership with Clear Channel Outdoor Holdings, Inc., a New York–based national outdoor billboard advertising company.
The phrase “Stop Swapping Air” was coined on an episode of the Osterholm Update: COVID-19 podcast, hosted by infectious disease expert Dr. Michael Osterholm, PhD, MPH, director of CIDRAP at the University of Minnesota and newly appointed member of President-elect Joe Biden’s coronavirus task force. CIDRAP publishes CIDRAP News.
The campaign is based on the idea that the best way to protect yourself and others from COVID-19 is to avoid sharing air by not spending time in enclosed spaces with people who are not in your “pod”—a small number of trusted people who are also not having contact with others, most commonly immediate family.
8-week billboard campaign
The 8-week campaign will feature billboards in the Minneapolis–St. Paul metro area with the phrase, “Stop Swapping Air,” to reinforce the message that not swapping air is the most effective step you can take right now to protect yourself, your family, friends, and colleagues. If successful, Clear Channel may expand the campaign to other national markets.
SARS-CoV-2, the virus that causes COVID-19, can be spread from person to person through the air. When people breathe, talk, yell, laugh, or sing, they create aerosols, which are tiny particles that can float in the air for minutes to hours, like the floating dust particles that you can see in sun streaming through a window.
Sharing indoor air with someone who is infected with the virus raises the risk of breathing in the virus and becoming infected. Special forms of breathing protection, such as N95 respirators, can protect you from breathing in aerosols. But cloth face coverings are not designed to filter out such small particles, and they also may enter through the gaps around the cloth.
Need for more effective messaging
“It’s clear that public health messaging is having, at best, limited impact on the transmission of the virus,” Osterholm said. “What I kept hearing from people in the public is ‘what should we be doing?’ People were confused about the mode of transmission.”
“It’s about breathing air that has the virus floating in it, and that happens when someone has just exhaled the virus in close proximity to you. It’s swapping air. That’s the main thrust of the transmission challenge today, and we’re trying to draw attention to that. If you stop swapping air you won’t get infected,” he said.
Osterholm highlighted the importance of the “Stop Swapping Air” message as we move into the holiday season. “The ultimate act of love this year will be not sharing this virus with loved ones, and one of the ways to do that is to stop swapping air with others who are infected,” he said.
Resources to support organizations
CIDRAP is building content on an accompanying website with information about how to spread the message via social media—#StopSwappingAir—resources for how to stay connected with loved ones without swapping air, and links to support pandemic-related organizations.
The campaign partnership arose out of an existing relationship between Clear Channel and the University of Minnesota Foundation (UMF), a fundraising and philanthropic nonprofit organization supporting University of Minnesota initiatives.
Clear Channel is one of the world’s largest outdoor advertising companies.
“Our goal is to be a responsible member of the communities we serve by taking a proactive role in making our neighborhoods better places to live,” said Dan Ballard, president of Clear Channel Outdoor, Minneapolis/St. Paul. “We believe addressing the challenges, big and small, that affect people’s daily lives is critical for influencing greater societal change.”
Gov. Andrew M. Cuomo said New York’s first allocation of the Pfizer-BioNtech vaccine could arrive as soon as this weekend if it’s approved. Nursing home residents and staff members would be the first to get doses, followed by high-risk medical workers.