1/27—"Realistic possibility" that UK variant ~30% more deadly
UK New and Emerging Respiratory Virus Threats Advisory Group paper on new coronavirus (COVID-19) variant B.1.1.7
The London School of Hygiene & Tropical Medicine reported that the relative hazard of death within 28 days of test for variant of concern (VOC)-infected individuals compared to non-VOC was 1.35 (95%CI 1.08-1.68). Imperial College London reported mean ratio of CFR for VOC-infected individuals compared to non-VOC was 1.36 (95%CI 1.18-1.56) by a case-control weighting method. University of Exeter reported mortality hazard ratio for VOC-infected individuals compared to non-VOC was 1.91 (1.35 - 2.71). An updated Public Health England matched cohort analysis has reported a death risk ratio for VOC-infected individuals compared to non-VOC of 1.65 (95%CI 1.21-2.25). Based on these analyses, there is a realistic possibility that infection with VOC B.1.1.7 is associated with an increased risk of death compared to infection with non-VOC viruses.
Herd immunity by infection is not an option
On page 288 of this issue, Buss et al. (1) describe the extent of the largely uncontrolled severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in Manaus, the capital of Amazonas state in Brazil. Their data show the impact on mortality rates of a largely unmitigated outbreak where even with an estimated 76% of the population being infected, herd immunity was not achieved.
Open Schools, Covid-19, and Child and Teacher Morbidity in Sweden
The number of deaths from any cause among the 1,951,905 children in Sweden (as of December 31, 2019) who were 1 to 16 years of age was 65 during the pre–Covid-19 period of November 2019 through February 2020 and 69 during 4 months of exposure to Covid-19 (March through June 2020). No child with Covid-19 died. Fewer than 10 preschool teachers and 20 schoolteachers in Sweden received intensive care for Covid-19. As compared with other occupations (excluding health care workers), this corresponded to sex- and age-adjusted relative risks of 1.10 (95% confidence interval [CI], 0.49 to 2.49) among preschool teachers and 0.43 (95% CI, 0.28 to 0.68) among schoolteachers. Despite Sweden’s having kept schools and preschools open, we found a low incidence of severe Covid-19.
Beyond Tuskegee — Vaccine Distrust and Everyday Racism
Every day, Black Americans have their pain denied, their conditions misdiagnosed, and necessary treatment withheld by physicians. In these moments, those patients are probably not historicizing their frustration by recalling Tuskegee, but rather contemplating how an institution sworn to do no harm has failed them. Unfortunately, there is even further reason for this belief. Infant mortality is halved when Black newborns are cared for by Black rather than White physicians. Physician–patient racial concordance makes the difference between life and death for these infants even though they cannot contemplate historical traumas: they can still experience everyday racism and disrespect. Recently, Anthony Fauci noted that the Moderna vaccine was “developed by an African American woman,” Kizzmekia Corbett. Though this recognition critically highlights the concordance between the Black population and the National Institutes of Health’s lead scientist for coronavirus vaccine research, we need more public health messaging coming directly from Black health leaders, a challenge given that only 5% of U.S. physicians are Black. Black scientists sharing their stories is paramount because they can more directly relate and speak to their communities’ needs.
Model-informed COVID-19 vaccine prioritization strategies by age and serostatus
Limited initial supply of SARS-CoV-2 vaccine raises the question of how to prioritize available doses. Here, we used a mathematical model to compare five age-stratified prioritization strategies. A highly effective transmission-blocking vaccine prioritized to adults ages 20-49 years minimized cumulative incidence, but mortality and years of life lost were minimized in most scenarios when the vaccine was prioritized to adults over 60 years old.
Missed an update? View past issues.