Coronavirus (COVID-19) Research

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NHE
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As Hospitals Fear Being Overwhelmed By COVID-19, Do The Disabled Get The Same Access?
December 14, 2020 3:47 PM ET

https://www.npr.org/2020/12/14/94505617 ... e-same-acc

On the morning of April 21, Sarah McSweeney woke up with a temperature of 103 degrees — and it kept rising. Staff at her group home worried that the woman with multiple disabilities — she couldn't walk or speak words — had contracted COVID-19. They got her into her bright pink wheelchair and hurried to the hospital, just a block down the street from the group home in Oregon City, Ore.

That afternoon, Heidi Barnett got a phone call from the doctor in the emergency room.

He was puzzled, she says, by a one-page document that McSweeney's caregivers brought with her. It was a legal document that explained what medical care this disabled woman — who couldn't speak for herself — wanted.

"We had her at full code. So all treatment. Because she was young and vibrant and had a great life," says Barnett. "And that was her wishes, that's what we gathered from her. She wanted to be alive."

Barnett works for The Arc Oregon, the agency that was McSweeney's guardian. She had helped McSweeney fill out that document, called a POLST form, for a moment just like this.

It's normal for a doctor to want to understand a patient's wishes. However, Barnett, who kept daily notes on her conversations with medical workers about McSweeney, felt the doctor was challenging the order.

"They wanted it to be a DNR," says Barnett.

A Do Not Resuscitate Order is a medical order to doctors not to treat a patient — like McSweeney — if she stops breathing or her heart stops.

That emergency room doctor would be the first at the hospital to raise a question that would shadow decisions about McSweeney's care over nearly three weeks at the hospital: Why does a woman with significant and complex disabilities have a legal order that requires the hospital to take all measures to save her life?

McSweeney was 45 when she died on May 10. Her death would raise another question, one that people with disabilities and the elderly have worried about since the start of the coronavirus pandemic: Are they denied care when it gets scarce — like drugs or treatment, including ventilators — that might save their lives?

An NPR investigation looked into McSweeney's death and about a dozen reports of discrimination in Oregon: Of doctors and hospitals denying equipment like ventilators; insisting that an elderly or disabled person sign a DNR — maybe when they couldn't understand it and in the middle of a crisis — or even denying a COVID-19 test.

These decisions are made behind closed doors, NPR found, and as a result are little known and little understood. McSweeney's case offers a rare look at how those decisions are made.

[continued]
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Covid-19 vaccines: what they mean for people with MS

https://mstrust.org.uk/news/covid-19-va ... -people-ms

Q: Would a Covid-19 vaccine be safe for all people with MS? Are there any risks?

Having MS by itself does not mean that you shouldn't take the vaccine. There's no concern that a vaccine will cause MS, trigger a relapse or make your symptoms worse. I would really encourage everyone with MS to look forward to taking this vaccine, unless they're told that they shouldn't have it because of the drugs they're on. There are some disease modifying drugs (DMD) that are used to treat MS which would make some vaccines either unsafe or ineffective.

Q: For people with MS who are taking a DMD, how will they know whether a Covid-19 vaccine would be safe and effective for them?

The first key thing we need to discover is whether or not the vaccine that we're offered is a live virus or not. Many people who are on DMDs at the moment will have been told whether or not they can have a live vaccination. Polio, yellow fever and the measles, mumps and rubella (MMR) vaccines are all live. There are some DMDs that it’s just not safe to have a live vaccine on.

I think it’s quite unlikely that we’re going to get a live vaccine. Most of the vaccines we’re looking at are inactivated so they should be safe. So that’s the first thing – is the vaccine live or not? If the vaccine isn’t live then it should be safe for everyone to take, regardless of the DMD you’re on.

The other issue is whether the vaccine would be effective if you’re on a DMD. The whole point of a vaccine is that it triggers an immune response. It’s that immune response which is going to protect you against Covid-19. There are some DMDs which suppress the immune system to a level that means a vaccine may not be effective.

An example of this is the drug Lemtrada. This drug has a profound effect on your immune system for a few weeks. If you have a vaccine four weeks after Lemtrada, it will not make any difference to your immune system. But if you wait a year or two after Lemtrada, your immune system will recover enough to respond to a vaccine.

The other drug which causes some concern in this respect is Ocrevus. This is given every six months to deplete a particular part of the immune system – B cells. It's these B cells that produce antibodies that provide some, if not all, of the immunity against some vaccines. People who are on Ocrevus have a reduced ability to respond to vaccines all the time they’re on the drug, not just the first few months after taking it. We don’t yet know for sure, but it may well be that being on this DMD may mean that a Covid-19 vaccine will not be as effective as it could be for that particular person.
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Oregon Hospitals Didn't Have Shortages. So Why Were Disabled People Denied Care?
December 21, 2020 3:21 PM ET

https://www.npr.org/2020/12/21/94629211 ... enied-care

At the start of the coronavirus pandemic, a small group of disability rights advocates found itself in a race against time to save the life of a woman with an intellectual disability.

The woman was taken to the hospital with COVID-19. But the hospital, in a small Oregon town, denied the ventilator she needed. Instead, a doctor, citing her "low quality of life," wanted her to sign a legal form to allow the hospital to deny her care.

Out of that quiet fight in early spring, the advocates — staff at a disability rights legal group, a state lawmaker and a few others — discovered something disturbing: There were many cases in Oregon of health care being rationed to people with disabilities.

At the same moment, across the United States, disability groups and even a civil rights office of the U.S. government were raising a similar warning: that behind closed doors, people with disabilities, as well as elderly people, were in danger of being denied health care.

NPR was looking for cases, too, and heard about the woman in Pendleton while she was in the hospital.

There's no reason that these examples would occur more frequently in Oregon than in other states. But the fight for that anonymous woman with an intellectual disability peeled back the curtain on health care decision-making in Oregon in a way that did not happen in other states.

That activism led to change in Oregon — including anti-discrimination legislation and new statewide policies.

It was late March when the woman with an intellectual disability contracted COVID-19. She struggled to breathe.

In the hospital, a medical provider wrote do-not-resuscitate (DNR) and do-not-intubate orders for the woman. Those are medical instructions to health care providers to withhold potentially painful interventions, like a ventilator or CPR, if a patient stops breathing or the patient's heart stops. The woman was alone in the hospital and did not understand what the doctor and medical staff wanted her to agree to.

In addition, the hospital staff sent word to the woman's group home: Fill out DNRs in advance for your other residents, in case one of them comes to the hospital.

People who worked with the woman were angry that the doctor and the hospital seemed to be discounting the lives of people with disabilities.

Someone tracked down lawyers for help.

The lawyers work for Disability Rights Oregon (DRO), a federally funded legal group that protects the rights of people with disabilities. State Sen. Sara Gelser, who chairs Oregon's Senate Committee on Human Services, was notified too.

[continued]
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How COVID-19 Attacks The Brain And May Cause Lasting Damage
January 5, 2021 6:13 PM ET

https://www.npr.org/sections/health-sho ... ing-damage

Early in the pandemic, people with COVID-19 began reporting an odd symptom: the loss of smell and taste.

The reason wasn't congestion. Somehow, the SARS-CoV-2 virus appeared to be affecting nerves that carry information from the nose to the brain.

That worried neurologists.

"We were afraid that SARS CoV-2 was going to invade the brain," says Dr. Gabriel de Erausquin, an investigator at the Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases at the University of Texas Health Science Center at San Antonio.

Their fears proved well-founded — though the damage may come from the body and brain's response to the virus rather than the virus itself.

Many patients who are hospitalized for COVID-19 are discharged with symptoms such as those associated with a brain injury. These include "forgetfulness that impairs their ability to function," de Erausquin says. "They complain about trouble with organizing their tasks, and that entails things such as being able to prepare a meal."

But COVID-19 also appears to produce many other brain-related symptoms ranging from seizures to psychosis, a team reports in the Jan. 5 issue of the journal Alzheimer's & Dementia. The team, which included de Erausquin, says severe COVID-19 may even increase a person's risk of developing Alzheimer's disease.

For many affected patients, brain function improves as they recover. But some are likely to face long-term disability, de Erausquin says.

"Even if the proportion, the rate, is not very high, the absolute number of people who will suffer these consequences is likely to be high," he says, because so many people have been infected.

Scientists are still trying to understand the many ways in which COVID-19 can damage the brain.

It's been clear since early in the pandemic that the infection can lead to blood clots that may cause a stroke. Some patients also suffer brain damage when their lungs can no longer provide enough oxygen.

To understand other, less obvious mechanisms, though, scientists needed brain tissue from patients with COVID-19 who died. And early in the pandemic they couldn't get that tissue, says Dr. Avindra Nath of the National Institute of Neurological Disorders and Stroke.

"Because it was such an infectious organism, people were not conducting autopsies at most places," Nath says. They simply lacked the protective gear that would allow them to remove a brain safely.

That's changing, though, says Nath, who was part of a team that studied brain tissue from 19 COVID-19 patients.

The team saw widespread evidence of inflammation and damage, they reported Dec. 30 in The New England Journal of Medicine.

They also found a possible explanation for the damage.

"What we found was that the very small blood vessels in the brain were leaking," Nath says. "And it wasn't evenly — you would find a small blood vessel here and a small blood vessel there."

The injuries resembled those from a series of tiny strokes occurring in many different areas of the brain, Nath says.

The finding may explain why COVID-19 patients have such a wide range of brain-related symptoms, Nath says, including some related to brain areas that control functions such as heart rate, breathing and blood pressure.

[continued]
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2020 Dec 21
Serra Húnter Fellow, Department of Statistics and Operations Research, Universitat Politècnica de Catalunya-BarcelonaTech, Spain
Are environmental pollution and biodiversity levels associated to the spread and mortality of COVID-19? A four-month global analysis
https://pubmed.ncbi.nlm.nih.gov/33412447/

Abstract

On March 12th, 2020, the WHO declared COVID-19 as a pandemic. The collective impact of environmental and ecosystem factors, as well as biodiversity, on the spread of COVID-19 and its mortality evolution remain empirically unknown, particularly in regions with a wide ecosystem range. The aim of our study is to assess how those factors impact on the COVID-19 spread and mortality by country. This study compiled a global database merging WHO daily case reports with other publicly available measures from January 21st to May 18th, 2020. We applied spatio-temporal models to identify the influence of biodiversity, temperature, and precipitation and fitted generalized linear mixed models to identify the effects of environmental variables. Additionally, we used count time series to characterize the association between COVID-19 spread and air quality factors. All analyses were adjusted by social demographic, country-income level, and government policy intervention confounders, among 160 countries, globally. Our results reveal a statistically meaningful association between COVID-19 infection and several factors of interest at country and city levels such as the national biodiversity index, air quality, and pollutants elements (PM10, PM2.5, and O3). Particularly, there is a significant relationship of loss of biodiversity, high level of air pollutants, and diminished air quality with COVID-19 infection spread and mortality. Our findings provide an empirical foundation for future studies on the relationship between air quality variables, a country's biodiversity, and COVID-19 transmission and mortality. The relationships measured in this study can be valuable when governments plan environmental and health policies, as alternative strategy to respond to new COVID-19 outbreaks and prevent future crises.
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Re: Coronavirus (COVID-19) Research

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Hi,

Although this is not directly related to MS, I feel those of you who are interested in following Covid developments will find this man does a very good daily update. If you are concerned that people you know are not taking the issue seriously then this particular update might be of use.
Regards,

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Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis
Ann Neurol. 2021 Jan 21.

Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS).

Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results.

Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses.

Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists.
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2021 Feb 10
Neurology Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
Could SARS-CoV-2 herald a surge of multiple sclerosis?

Abstract

During the current COVID-19 pandemic, many queries are raised regarding its nature, outcome, and sequelae. This letter raises the concern of potential impact on increasing the incidence of multiple sclerosis whose pathology involves a possible viral etiology. Besides, the potential neurotropism of the acute respiratory distress syndrome corona virus-2 (SARS-CoV-2), which is still not established, may raise concerns about the use of certain disease modifying therapies namely natalizumab.
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Re: Coronavirus (COVID-19) Research

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2021 Feb 20
Fioravante Capone,corresponding author1 Elisabetta Ferraro
COVID-19 in multiple sclerosis patients treated with dimethyl fumarate
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896828/

...Recently, Olagnier et al. [8] demonstrated that the activation of the nuclear factor erythroid-derived 2-like 2 (NRF2) pathway by agonists such as DMF induces an antiviral program, distinct from the interferon pathway, that is effective in limiting virus replication and in suppressing the inflammatory responses induced by SARS-CoV2...
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Re: Coronavirus (COVID-19) Research

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We've reached 30 million covid19 cases in the US. Fortunately, the rate of new cases is finally starting to slow down a bit (from 250,000/day to 62,500/day). In addition, in the last 16 days there were about 10,400 fewer deaths than in the prior 16 days (19,463 vs. 29,897 respectively, though 20K deaths is still too many).

7 million to 8 million cases: 25 days
8 million to 9 million cases: 13 days
9 million to 10 million cases: 9 days
10 million to 11 million cases: 6 days
11 million to 12 million cases: 5 days
12 million to 13 million cases: 7 days
13 million to 14 million cases: 6 days
14 million to 15 million cases: 4 days
15 million to 16 million cases: 4 days
16 million to 17 million cases: 4 days
17 million to 18 million cases: 3 days
18 million to 19 million cases: 5 days
19 million to 20 million cases: 5 days
20 million to 21 million cases: 4 days
21 million to 22 million cases: 4 days
22 million to 23 million cases: 4 days
23 million to 24 million cases: 6 days
24 million to 25 million cases: 5 days
25 million to 26 million cases: 7 days
26 million to 27 million cases: 7 days
27 million to 28 million cases: 13 days
28 million to 29 million cases: 16 days
29 million to 30 million cases: 16 days
10/18/2020
10/31/2020
11/9/2020
11/16/2020
11/21/2020
11/28/2020
12/4/2020
12/9/2020
12/13/2020
12/18/2020
12/21/2020
12/26/2020
1/1/2021
1/5/2021
1/9/2021
1/13/2021
1/19/2021
1/24/2021
1/31/2021
2/7/2021
2/20/2021
3/8/2021
3/24/2021
Source: https://coronavirus.jhu.edu/map.html
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Re: Coronavirus (COVID-19) Research

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Here's an interesting article from MIT's Technology Review that discusses the development of Moderna's mRNA vaccine.

https://www.technologyreview.com/2021/0 ... covid-hiv/
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Outcomes and Risk Factors Associated With SARS-CoV-2 Infection in a North American Registry of Patients With Multiple Sclerosis
JAMA Neurol. 2021 Mar 19.

Importance: Emergence of SARS-CoV-2 causing COVID-19 prompted the need to gather information on clinical outcomes and risk factors associated with morbidity and mortality in patients with multiple sclerosis (MS) and concomitant SARS-CoV-2 infections.

Objective: To examine outcomes and risk factors associated with COVID-19 clinical severity in a large, diverse cohort of North American patients with MS.

Design, setting, and participants: This analysis used deidentified, cross-sectional data on patients with MS and SARS-CoV-2 infection reported by health care professionals in North American academic and community practices between April 1, 2020, and December 12, 2020, in the COVID-19 Infections in MS Registry. Health care professionals were asked to report patients after a minimum of 7 days from initial symptom onset and after sufficient time had passed to observe the COVID-19 disease course through resolution of acute illness or death. Data collection began April 1, 2020, and is ongoing.

Exposures: Laboratory-positive SARS-CoV-2 infection or highly suspected COVID-19.

Main outcomes and measures: Clinical outcome with 4 levels of increasing severity: not hospitalized, hospitalization only, admission to the intensive care unit and/or required ventilator support, and death.

Results: Of 1626 patients, most had laboratory-positive SARS-CoV-2 infection (1345 [82.7%]), were female (1202 [74.0%]), and had relapsing-remitting MS (1255 [80.4%]). A total of 996 patients (61.5%) were non-Hispanic White, 337 (20.8%) were Black, and 190 (11.7%) were Hispanic/Latinx. The mean (SD) age was 47.7 (13.2) years, and 797 (49.5%) had 1 or more comorbidity. The overall mortality rate was 3.3% (95% CI, 2.5%-4.3%). Ambulatory disability and older age were each independently associated with increased odds of all clinical severity levels compared with those not hospitalized after adjusting for other risk factors (nonambulatory: hospitalization only, odds ratio [OR], 2.8 [95% CI, 1.6-4.8]; intensive care unit/required ventilator support, OR, 3.5 [95% CI, 1.6-7.8]; death, OR, 25.4 [95% CI, 9.3-69.1]; age [every 10 years]: hospitalization only, OR, 1.3 [95% CI, 1.1-1.6]; intensive care unit/required ventilator support, OR, 1.3 [95% CI, 0.99-1.7]; death, OR, 1.8 [95% CI, 1.2-2.6]).

Conclusions and relevance: In this registry-based cross-sectional study, increased disability was independently associated with worse clinical severity including death from COVID-19. Other risk factors for worse outcomes included older age, Black race, cardiovascular comorbidities, and recent treatment with corticosteroids. Knowledge of these risk factors may improve the treatment of patients with MS and COVID-19 by helping clinicians identify patients requiring more intense monitoring or COVID-19 treatment.
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Urgent Preliminary Yellow Card Report on Data up to 26 May 2021

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Re: Coronavirus (COVID-19) Research

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active members shape site content. if there is a problem, speak up!
use the report button to flag problematic post content to volunteer moderators' attention.
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https://www.reuters.com/article/factche ... SL2N2NX2BC
“Many suspected ADRs reported on a Yellow Card do not have any relation to the vaccine or medicine and it is often coincidental that they both occurred around the same time,” an MHRA representative told Reuters in a previous fact check (here).

The MHRA says (here) that since underlying or previously undiagnosed illness can be a factor in the reports, the relative number and nature of reports should not be used to compare the safety of the different vaccines.

These reports are instead used to monitor and to be kept under continual review so that possible new risks can be identified.
The exact same thing is true of the US VAERS database which is also taken out of context and improperly cited.
The MHRA notes that the vast majority of reports relate to sore arms at the site of injection and generalised symptoms, such as fatigue, headache and chills. It adds that this is a normal response to a vaccine and reflects the immune system getting to work.
I had the exact same reaction to a Whooping Cough (Pertussis) vaccine once. My shoulder was too sore to sleep on my side as I usually do. It went away after a day and was not an issue.
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