COVID-19 mRNA vaccines are 94% effective in reducing symptomatic illness

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The mRNA vaccines are highly effective in protecting against symptomatic COVID-19 among the healthcare personnel (HCPs), according to interim results from the largest COVID-19 vaccine effectiveness study conducted by the CDC. Among fully vaccinated HCPs, the two FDA-approved mRNA vaccines – Pfizer-BioNTech and Moderna – reduced the risk of becoming sick with COVID-19 by 94%.

Data for this assessment come from a network covering 500,000 HCP across 33 sites in 25 states in the US, providing additional robust evidence that mRNA vaccines are effective against symptomatic illness in real-world conditions.

In this study, the vaccination status of COVID-19 positive cases (n=623) was compared with the vaccination status of those who tested negative, who served as controls (n=1220). Comparison of the odds of COVID-19 vaccination in cases and controls was used to calculate the vaccine effectiveness estimates.

The fully vaccinated (≥7days after receipt of a second vaccine dose) HCP had 94% less likelihood of developing symptomatic illness, whereas the partially vaccinated (≥14 days after receipt of dose one through six days after dose two) were 82% less likely to develop symptoms.

These observations support the recommendation that both doses (complete vaccination) are necessary to get maximum protection.

(Source: CDC Press Release, May 14, 2021)

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

Covid-19 patients with neurological complications have higher in-hospital mortality

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Neurological complications frequently occur in hospitalized COVID-19 patients and are associated with higher in-hospital mortality in comparison to patients who do not develop neurologic complications, according to findings from a global multi-cohort study.

This is the largest cohort study of neurological manifestations of COVID-19 to date, which included patients with clinically diagnosed or laboratory-confirmed COVID-19 at 28 centers, representing 13 countries and 4 continents. The study included consecutive patients in three cohorts who were hospitalized with Covid-19 between March 2020 and October 2020. The study population was derived from 2 large consortia: the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) and the European Academy of Neurology (EAN) Neuro-COVID Registry (ENERGY). The findings are published online May 11, 2021 in JAMA Network Open.

Some key observations of the study

82% of 3,744 hospitalized COVID-19 patients developed neurological manifestations.
Overall, 80% of these patients exhibited at least 1 new neurological symptom, sign, or syndrome, and 55% had at least 1 neurological sign or syndrome captured on clinical evaluation.
The most common self-reported symptom was headache (37%). The incidence of self-reported anosmia (loss of smell) or ageusia (loss of taste) was 26%.
Acute encephalopathy (49%) was the most commonly seen neurological sign or syndrome followed by coma (17%) and stroke (6%). The least common were meningitis and/or encephalitis (0.5%).
Presence of clinically captured neurologic signs and/or syndromes was associated with a 6-fold increased risk of dying during hospitalization.
Having a pre-existing neurological condition doubled the risk of developing Covid-related neurological complications.
(Source: JAMA Network Open, published May 11, 2021)

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

Not all sinusitis in the time of COVID-19 is bacterial; it could also be Black fungus sinus infection

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Mucormycosis, or Black fungus as it is referred to in common parlance, is being reported in patients with COVID-19. It is a rare but serious fungal infection caused by a group of fungi called the mucormycetes. The overall mortality rate of mucormycosis is 50%. It is usually found in air and soil and in association with decaying organic matter, such as leaves, compost piles, and animal dung.

The Health Ministry and Indian Council of Medical Research (ICMR) have released an advisory for the screening, diagnosis and management of mucormycosis. According to the advisory, this fungal infection mainly affects individuals with impaired immunity. The predisposing factors are uncontrolled diabetes mellitus, steroids, prolonged intensive care, comorbidities, immunocompromised state (cancer or post transplant). The sinuses or lungs are commonly affected after inhaling fungal spores from the air. Skin can also be affected after a cut, burn, or other type of skin injury.

The advisory has defined the warning signs and symptoms, which include:

  • Pain and redness around eyes and/or nose
  • Fever
  • Headache
  • Coughing
  • Shortness of breath
  • Bloody vomits
  • Altered mental status

A diagnosis of mucormycosis should be suspected in case of following clinical presentations:

  • Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone
  • One sided facial pain, numbness or swelling
  • Blackish discoloration over bridge of nose/palate
  • Toothache, loosening of teeth, jaw involvement
  • Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar)
  • Chest pain, pleural effusion, hemoptysis, worsening of respiratory symptoms

To prevent mucormycosis, the advisory recommends use of masks, especially in dusty construction sites, cover yourself well (wear shoes, long trousers, long sleeve shirts and gloves) when handling soil or manure and maintain personal hygiene. It further advocates monitoring of blood sugar in COVID patients after discharge as well as in patients with diabetes, judicious use of steroids/ antibiotics/antifungals and use of clean and sterile water for humidifiers.

Mucormycosis needs urgent attention and is best managed by a team of specialists comprising of a microbiologist, internal medicine specialist, intensivist, neurologist, ENT specialist, ophthalmologist, dentist, surgeon (maxillofacial/plastic) and biochemist.

Mucormycosis can be managed by controlling blood sugar levels (and ketoacidosis in diabetic patients), reducing steroids, stopping immunomodulating drugs and extensive surgical debridement to remove all necrotic materials. The advisory further recommends putting in a peripherally inserted central catheter, maintaining adequate systemic hydration, normal saline infusion and antifungal therapy for at least 4-6 weeks. The patient should be carefully monitored both clinically and with radio-imaging to evaluate response to treatment and to check if the disease is progressing.

The advisory cautions to stay alert for the warning signs and symptoms. Not all cases, especially in immunosuppressed and COVID-19 patients, with blocked nose should be thought of as having bacterial sinusitis.  Investigate for fungal etiology and start treatment at the earliest.

(Source: ICMR, Evidence based advisory in the times of Covid-19, Screening, diagnosis and management.

https://www.icmr.gov.in/pdf/covid/techdoc/Mucormycosis_ADVISORY_FROM_ICMR_In_COVID19_time.pdf, May 09, 2021)

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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