2/8—No herd immunity despite 76% of population infected; variants?
Resurgence of COVID-19 in Manaus, Brazil, despite high seroprevalence
In Manaus, Brazil, a study of blood donors indicated that 76% (95% CI 67–98) of the population had been infected with SARS-CoV-2 by October, 2020. In this context, the abrupt increase in the number of COVID-19 hospital admissions in Manaus during January, 2021 (3431 in Jan 1–19, 2021, vs 552 in Dec 1–19, 2020) is unexpected and of concern (figure). There are at least four non-mutually exclusive possible explanations for the resurgence of COVID-19 in Manaus. First, the SARS-CoV-2 attack rate could have been overestimated during the first wave. Second, immunity against infection might have already begun to wane by December, 2020. Third, SARS-CoV-2 lineages might evade immunity generated in response to previous infection. Three recently detected SARS-CoV-2 lineages (B.1.1.7, B.1.351, and P.1), are unusually divergent and each possesses a unique constellation of mutations of potential biological importance. Of these, two are circulating in Brazil (B.1.1.7 and P.1) and one (P.1) was detected in Manaus on Jan 12, 2021. Fourth, SARS-CoV-2 lineages circulating in the second wave might have higher inherent transmissibility than pre-existing lineages circulating in Manaus. The genetic, immunological, clinical, and epidemiological characteristics of these SARS-CoV-2 variants need to be quickly investigated. Conversely, if resurgence in Manaus is due to waning of protective immunity, then similar resurgence scenarios should be expected in other locations.
COVID-19 vaccination in athletes: ready, set, go…
Studies in the general population have shown heightened rates of vaccine efficacy, with an increased antibody titre, in individuals who undertook moderate intensity exercise before vaccination. Overall, the historical data does not appear to indicate that physical training undertaken around the time of vaccination will reduce efficacy, and could in fact improve vaccination response.
COVID-19 vaccination for people with severe mental illness: why, what, and how?
Psychiatric disorders, and especially severe mental illness, are associated with an increased risk of severe acute respiratory syndrome coronavirus 2 infection and COVID-19-related morbidity and mortality. People with severe mental illness should therefore be prioritised in vaccine allocation strategies. Here, we discuss the risk for worse COVID-19 outcomes in this vulnerable group, the effect of severe mental illness and psychotropic medications on vaccination response, the attitudes of people with severe mental illness towards vaccination, and, the potential barriers to, and possible solutions for, an efficient vaccination programme in this population.
COVID-19 and mental health
While the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the nervous system remain unclear, there is no doubt that the COVID-19 pandemic is bad for mental health. What is the effect of COVID-19 on risk of mental illness? A plethora of cross-sectional online surveys of convenience samples have reported that people who respond to such surveys are anxious and depressed. Fortunately, longitudinal studies, several using established cohorts with pre-pandemic data for comparison, are starting to provide more detailed and reliable evidence, including how different groups are affected. For example, in the UK, mental distress was higher than expected when accounting for previous trends, particularly in people aged 18–34 years, women, and people living with young children. So far, in high-income countries, suicide does not seem to have increased, and researchers have warned about the possible harmful effects of overly dramatic and under-researched reporting on the subject.
Avoiding a legacy of unequal non-communicable disease burden after the COVID-19 pandemic
As we enter 2021, we are now facing the risk that the health inequities wrought by COVID-19 will have long-tail, greater consequences for the burden of non-communicable disease for decades to come. COVID-19 was accompanied by a recession in many countries, occasioned by the economic fallout from the spread of the virus and efforts to contain it. This burden was not shared equally, and there is ample evidence that the COVID-19 recession has widened socioeconomic gaps.
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