COVID-19 Vaccination Update

A modeling study "Global impact of the first year of COVID-19 vaccination" has estimated that 19.8 million COVID-19 deaths were averted with vaccinations.  

Paxlovid

Of the 5,287 persons aged ≥12 years who received Paxlovid in the 1^st 5 months of 2022, 73% had received >3 doses of COVID-19 vaccine and 8% were unvaccinated and found 6 hospitalizations (0.11%) (2 died) and 39 emergency department encounters (0.74%) for COVID during the 5-15 days after Paxlovid treatment.

In 78,474 patients in Bostin >50 years old, Paxlovid cuts the odds for Hospitalization after Omicron Infection by 45%. Among 30,322 outpatients, 39 deaths occurred within 28 days of COVID-19 diagnosis, all among the placebo arm. 

COVID-19 and Cardiovascular Disease

428,650 COVID-19 patients without DM or CVD were matched with the same number control participants all were followed to January 2022. There was a net incidence of DM in the first four weeks after COVID-19, which remained elevated from five to 12 weeks but not from 13 to 52 weeks.

An increase was also seen in net CVD incidence in the acute phase, including pulmonary embolism, atrial arrhythmias, and venous thromboses.

There was a decline noted in CVD incidence after 5 weeks. 

mRNA Vaccine

Of 912 individuals who received ≥3 mRNA vaccine doses and were subsequently diagnosed with COVID-19 during the Omicron surge, 145 (15.9%) required hospitalization. 

In multivariable analyses,  factors significantly associated with the risk of hospitalization for Omicron infection included older age, hypertension, CKD, and MI or CHF, as well as longer duration between the last vaccination and infection.

Hypertension was associated with the greatest magnitude of risk, even more than age, obesity, CKD, MI, CHF, and time since the last dose of the vaccine.

COVID-19 and dementia

According to the study "Factors associated with hospital admission and severe outcomes for older patients with COVID-19", of 31,770 ambulatory older patients, age of 74 years, those who had dementia and those without ambulatory care histories, compared to those with, had significantly higher adjusted rates of COVID-19 hospitalization and severe outcomes, with strongest effect in the oldest group.

Hair loss and long COVID 

Long COVID has been associated with hair loss (OR 6.94), headache (OR 3.37) and sore throat (OR 3.56). Hair loss is a common symptom of vitamin B-12 deficiency and the 2 seem to have many common symptoms. It would be interesting to see if vitamin B-12  supplementation would help.  

ED Encounters

Of 4536 emergency department (ED) encounters, avg. age 55 years, and 34% Black, younger patients presented more with respiratory symptoms.  Lack of cough, fever, and/or shortness of breath in older ED patients was not associated with greater odds of severe COVID-19, but could challenge timely diagnosis without widely available, timely testing.

CDC on Monkeypox

The CDC has developed a comprehensive guidance on monkeypox for healthcare providers. It provides some information on monkeypox, vaccines: ACAM2000 is a live Vaccinia virus inoculated into the skin by pricking the skin surface. The virus growing at the site of the inoculation lesion can be spread to other parts of the body and other people. 

For more information on monkeypox, please check the  UC Health flyer.

COVID-19 Hospitalizations

Of 1877 adolescents aged 12-17 years, 284 (15%) were hospitalized within 28 days of their COVID-19 diagnosis. The following comorbidities were associated with increased odds of hospitalization in adolescents: 

• Sickle cell disease (aOR, 6.9),

• Immunocompromising condition (aOR, 6.4)

• Obesity (aOR, 3.2)

• Diabetes (aOR, 3.0)

• Neurologic disease (aOR, 2.8)

• Pulmonary disease (excluding mild asthma) (aOR, 1.9).

• Heart disease and kidney disease were not independently associated with hospitalization.

Implicit Bias in Healthcare

The article "Tackling Implicit Bias in Health Care" by Janice A. Sabin, Ph.D., M.S.W. on implicit bias suggests that clinicians can do the following: 

• Include practicing conscious, positive formal and informal role modeling;

• Taking active-bystander training to learn how to address or interrupt microaggressions and other harmful incidents;

• Undergoing training aimed at eliminating negative patient descriptions and stigmatizing words in chart notes and direct patient communications. 

The article lists a number of resources, and actions several institutions are taking, including the NIH effort on scientific workforce diversity, led by Dr. Barnard, a geriatrician. 

In Geriatric News

The CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that adults aged ≥65 years preferentially receive one of the following influenza vaccines: 

• Quadrivalent high-dose inactivated influenza vaccine (HD-IIV4);

• Quadrivalent recombinant influenza vaccine (RIV4);

• Quadrivalent adjuvanted inactivated influenza vaccine (aIIV4).

Dementia 

The adverse effect of modifiable dementia risk factors on cognition amplifies across the adult lifespan. This study of 22,117 (age 64 years) 69% female, showed that each additional risk factor was equivalent to 3 years of cognitive aging, more as age increased. No risk factors at age 40-80, was equivalent to cognitive performance of people 10-20 years younger with risk factors. 

• low education

• hypertension

• hearing loss

• substance abuse

• traumatic brain injury

• smoking

• depression

• diabetes