Almost 3,000 household members were given exposure prophylaxis within 96 hours of contact with an individual who was symptomatic and recently tested positive for SARS-CoV-2. The risk of infection was reduced by 32% and 37% in adults who received PAXLOVID for 5 and 10 days, respectively. These results were not statistically significant and, as such, the primary endpoint of reducing the risk of confirmed and symptomatic COVID-19 infection in adults who had been exposed to the virus through a household contact was not met. This is different from the drastic 89% reduction of severe disease in those receiving the drug.   

Furthermore, the White House COVID-19 coordinator, Dr. Ashish Jha stated that [preventing infection is] “not even a policy goal. The goal of our policies should be, obviously, minimize infections whenever possible, but to make sure people don’t get seriously ill.” 

Dr. Eric Topol, in his paper The Covid Capitulation, points out the increasing number of patients dying of COVID who have been vaccinated. Infection of many unvaccinated people during the last spike conferred immune protection, leading to equilibration of ratios between vaccinated and unvaccinated who are hospitalized or dying of COVID-19.  

Dr. Hamrick indicated that she has seen more positive cases in the past few weeks than in the entire pandemic, and with more people testing at home and not reporting, official numbers are highly underreported. So far, [there is no]spike in hospitalizations, see graph, but hospitalizations lag behind cases. 

Due to the risk of thrombosis with thrombocytopenia syndrome (TTS), the FDA has limited the authorized use of the Janssen COVID-19 Vaccine to those for whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate, and who elect to receive the Janssen COVID-19 Vaccine because they would otherwise not receive a COVID-19 vaccine. 

At the same time, a large cohort study showed that VTE in 792,010 patients before and after receiving a COVID-19 vaccination was not different among vaccines. Overall, 772 and 793 VTE events occurred in the 90 days before and after the vaccination, respectively. The incidence of VTE post vaccination was the highest in patients who received Moderna n = 326 aHR 1.02 (95% CI 0.87-1.19), followed by the Pfizer vaccine n = 425 aHR 1.00 (95% CI 0.87-1.15), and the least among patients who received the Janssen vaccine (n = 420 aHR 0.97 (95% CI 0.63-1.50). 

Early administration of aspirin in the hospital course of 112,269 patients with moderate COVID-19 improved survival without an increased risk of hemorrhagic complications in a cohort study. This effect is even more pronounced in patients 60 years or older and in those with at least one comorbidity. 

Another study showed no benefit of ivermectin on medical admission to a hospital due to progression of Covid-19 or of prolonged emergency department observation among 3515 randomized outpatients with an early diagnosis of Covid-19. Neither the intention to treat nor the per protocol analysis or 2° outcomes showed a difference. 

While the US reported having reached over 1 million COVID-19 deaths last week, the WHO reported 15 million. Interestingly, the highest case fatality rate of 6% was in Peru, a country that aggressively treated its population with ivermectin during the pandemic.  

Brain changes from COVID-19 were found in 401 patients from the UK biobank who had cognitive testing and MRI scans before and after being infected, of which only 4% were hospitalized. These patients were also compared to 384 controls who had MRI and testing but no COVID-19. People with COVID-19 had more reduction in gray matter thickness in the orbitofrontal cortex and parahippocampal gyrus, more tissue damage in regions connected to the olfactory cortex, greater reduction in global brain size, and greater cognitive decline. 

The study of 34 volunteers (age 18-29) inoculated with SARS-CoV-2 described many parameters in detail and substantiated what we already know: symptoms and test detection occur 2 days after inoculation, infectivity lasts about 6 days, and the virus is largely cleared by 12 days.  

Geriatric news: 

The National Academies published a report of recommendations for nursing home care, which can be summarized in 7 goals: 

1. Deliver comprehensive, person-centered, equitable care that ensures resident health, quality of life, and safety while promoting autonomy and managing risks

2. Ensure a well-prepared, empowered, and appropriately compensated workforce

3. Increase transparency and accountability of finances, operations, and ownership

4. Create a more rational and robust financing system

5. Design a more effective and responsive system of quality assurance

6. Expand and enhance quality measurement and continuous quality improvement

7. Adopt health information technology in all nursing homes (including financial support, incentive and evaluation). 

6 RCTs with 9,001 patients (age 65.5) showed that receipt of the influenza vaccination was associated with a 34% lower risk of major adverse cardiovascular events while individuals with recent ACS had a 45% lower risk. 

Patients living in the quartile with the least amount of greenspace had a 28% greater stroke risk than those living in the least deprived quartile (OR, 1.28). 

The article 'Facility characteristics and costs associated with meeting proposed minimum staffing levels in skilled nursing facilities' quantified the costs associated with meeting the proposed minimum staffing levels in NHS. Nationally, it would require: 35,804 RN, 3509 LPN, and 116,929 CNA FTEs at $7.25 billion annually in salary costs based on current wage rates and pre-pandemic resident census levels. 

Dr. Irene Hamrick is a professor at the University of Cincinnati College of Medicine. She is the Chief of Geriatrics Division, Dept Family and Community Medicine and Martha Betty Semmons Endowed Chair in Geriatric Medicine Education. 

About BASE10 Genetics

Located in Chicago, BASE10 is a healthcare software technology company whose platform creates turnkey disease management programs that can be deployed at scale for nursing home operators, pharmacies, payors, and self-funded employers.