Europe on Wednesday passed a grim milestone, reporting more than 11 million coronavirus cases and almost 285,000 deaths, as the UK registered its highest daily increase in COVID-19 related deaths in five months.
As well as an update on global trends and analysis in the latest Croakey COVID-19 Wrap, public health researcher Alison Barrett looks at post-COVID-19 neurological syndrome, the launch of a SARS-CoV-2 human challenge trial, new WHO resources, and the risk of pandemic fatigue.
Post-COVID 19 Neurological Syndrome (PCNS); a novel syndrome with challenges for the global neurology community
Wijeratne, T & Crewther, S, Journal of Neurological Sciences, 12 October 2020
COVID-19 patients report experiencing long-term symptoms for months after the acute phase of the virus has passed and the long-term symptoms seem to vary greatly between patients, including persistent coughing, breathlessness, joint and chest pain (COVID-19 Wrap, 15 Jul).
In this article, Wijeratne and Crewther summarised a growing body of evidence about Post-COVID-19 Neurological Syndrome (PCNS), neurological symptoms that persist in patients and include dizziness, fatigue, headache, and anosmia, among many others.
A Dutch and Belgium study of 2,113 COVID-19 patients found that while the number of symptoms patients experienced reduced over time after the acute phase, only 0.7 percent of patients reported being free of symptoms 79 days after the infection. Fatigue and breathlessness were the most common long-term symptoms reported in this study.
Other reported neurological complications from COVID-19 include encephalitis (inflammation of the brain parenchyma), ischaemic stroke, and Guillain-Barre syndrome.
Neuropsychological symptoms are also common; one study in China found that nearly 97 percent of COVID-19 patients experienced symptoms of post-traumatic stress disorder, others have found psychosis and dementia-like symptoms in participants.
While SARS-CoV-2 is primarily a respiratory illness, Wijeratne and Crewther wrote: “ongoing hyperinflammation and endotheliitis contribute to the disruption of the blood-brain barrier, allowing entry of innate immune cells into the brain and further proinflammatory cytokine cascades,” thus damaging the central and peripheral nervous systems.
While much of the evidence on post-COVD-19 neurological conditions is based on case reports and small studies, they highlight the importance of ongoing monitoring for neurological symptoms.
They say a better understanding of the biological development of COVID-19 and increased vigilance for any sign of neurological symptoms “must become a priority for our global membership if successful acute and ongoing interventions are to be achieved.”
Previous articles in Croakey News and editions of the COVID-19 Wrap have discussed management of post-acute COVID-19 and the important role that GPs play in that.
Dozens to be deliberately infected with coronavirus in UK ‘human challenge’ trials
Callaway, E, Nature News, 20 October 2020
If regulatory and ethical approval is provided, from January 2021 a human challenge trial in the United Kingdom (UK) will begin recruiting participants to intentionally expose them with SARS-CoV-2, with the aim of helping vaccine development.
A human challenge trial is a trial in which healthy volunteers are deliberately exposed to an infectious virus. They have previously been used to learn more about other viruses, such as malaria and influenza.
While the study design has not yet been finalised, the researchers anticipate that 30-50 people aged from 18-30 years will be involved in the first trial, where they aim to identify a safe dose of SARS-CoV-2 that could be used in vaccine trials.
“Deliberately infecting volunteers with a known human pathogen is never undertaken lightly,” said Peter Openshaw, an investigator in the study and immunologist at Imperial College London, in a statement. “However, such studies are enormously informative about a disease,” he said.
“It is really vital that we move as fast as possible towards getting effective vaccines and other treatments for COVID-19, and challenge studies have the potential to accelerate and de-risk the development of novel drugs and vaccines.”
After a safe dose has been identified, vaccine trials could then be conducted on the infected participants. It’s not yet known which vaccine candidates might be included, but it is likely that some participants will receive a placebo instead of vaccine.
Andrew Catchpole, lead investigator in the UK COVID Challenge said the project “will take every precaution against participants in the initial trial developing severe disease”.
That will Include treating the infected participants with an antiviral drug such as Remdesivir and ensuring eligible participants are those at lowest-risk for developing severe COVID-19 (for example, young age and no known risk factors).
While a human challenge trial such as this can speed up vaccine development and potentially prevent many more deaths, some scientists argue it is too soon to conduct them safely.
Dr Meagan Deming from the University of Maryland School of Medicine, who has written recently on the ethical considerations of controlled human infection models, told Nature it would be better to wait until better treatments were available to mitigate the risks of someone developing severe COVID-19.
As the challenge trials will be conducted in young, healthy populations, they will be unable to determine the effectiveness of vaccines in older people or those at higher risk, the people that would benefit most from an effective vaccine.
“We don’t yet know enough about this disease to say for this person: you will not die. We’ve learned so much in the past nine months. In a year, we will be able to do this safely,” she said.
COVID-19: an update on global trends and analyses
Toole, M et al, Burnet Institute, October 2020
The past fortnight has seen another great surge in COVID-19 cases around the world. Since the last COVID-19 Wrap was published, just two weeks ago, another 6.9 cases had been reported as at 3 November.
On 30 October, the United States (US) reached nine million cases, reporting 91,744 cases in a single day. A recent report by the Centers for Disease Control and Prevention (CDC) estimated 299,028 excess deaths in the US between January and 3 October, with the largest proportion of increase in excess death among 25 to 44-year-old Hispanic and Latinos.
In other countries in the Americas, Canada is experiencing a second wave in Montreal and Toronto, with gyms, cinemas, casinos, and indoor dining closing for at least 28 days from mid-October in Ontario and Quebec provinces; Latin American countries, Brazil, Colombia, Peru, Argentina, Mexico and Chile account for one-quarter of the world’s cases.
Many countries in Europe are experiencing a second wave worse than their first: on 21 October, the United Kingdom reported 26,688 COVID-19 cases, its highest number of daily cases during the pandemic; over 1,000 people are in intensive care in hospitals across France; and Spain has surpassed 1.3 million cases.
Lockdowns, curfews and preventive measures have been reintroduced in France, Germany, Italy, Spain, Belgium, Portugal, Netherlands, Czech Republic, Denmark, Ireland and Greece.
In India, while upcoming Hindu festivals are being warned as likely hotspots, daily new cases have decreased from 90,000 in September to 50,000 at the end of October; daily new cases have also fallen in the Philippines in the same time frame from 5,000 to 2,500.
Indonesia’s average daily cases are increasing; since 19 September, they have reported an average 4,000 cases per day; cases in Bali have increased dramatically since it reopened to domestic visitors in September.
In good news, no locally transmitted cases have been reported in Taiwan and Mauritius for six months, with Taiwan marking 200 days without locally acquired cases on 30 October.
This week, after a long lockdown, Victoria has achieved five consecutive days of zero new COVID-19 cases and a 14-day rolling average of 1.7 cases, down from 725 in August; its efforts in fighting a second wave hailed as a success and inspiration to other countries around the globe.
Resources and strategies:
The World Health Organization and Wikimedia Foundation expand access to trusted information about COVID-19 on Wikipedia
World Health Organization, News Release, 22 October 2020
In a bid to counter the misinformation on COVID-19, the World Health Organization (WHO) is collaborating with the Wikimedia Foundation, the group that runs Wikipedia to enable easy access to free images, public health information and infographics, like the one below, designed by WHO with messages that address common myths about COVID-19.
By World Health Organization, CC BY-SA 3.0 IGO, CC BY-SA 3.0 igo, https://commons.wikimedia.org/w/index.php?curid=94894754
“Equitable access to trusted health information is critical to keeping people safe and informed during the COVID-19 pandemic,” said Dr Tedros, Director-General of the World Health Organization. “Our new collaboration with the Wikimedia Foundation will increase access to reliable health information from WHO across multiple countries, languages, and devices.”
Since the start of the pandemic, over 5,000 articles have been created about COVID-19 on Wikipedia, and been translated into 175 languages. Wikipedia editors have been monitoring the COVID-19 information in the articles to ensure it is reliable and regularly updated.
WHO and the Wikimedia Foundation intend to collaborate further with the Wikipedia editors to gain a better idea of gaps in information in COVID-19 articles to use the WHO’s resources to reliably update them.
“Access to information is essential to healthy communities and should be treated as such,” said Katherine Maher, CEO at the Wikimedia Foundation.
Social trends: Pandemic fatigue
Burnet Institute, October 2020
In its October update, the Burnet Institute provide some strategies for preventing pandemic fatigue, which it says may occur from social and financial losses occurred from periods in lockdown.
Pandemic fatigue may result in declining trust in authorities, an increase in complacency and decreased perceptions of risk, and likely to impede benefits of the public health measures in place to manage the COVID-19 pandemic.
The recommendations include:
- Implementing policies based on current evidence
- Addressing individual experiences and cultural contexts
- Engaging all sectors, not only medical and public health
- Collaborating and consulting with community
- Tailoring communication to specific groups, especially to those less motivated to adhere to restrictions
- Implementing creative approaches for social activities, while protecting communities.
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
See previous editions of the COVID wrap.
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