COVID-19 Update: Booster Effectiveness, Asymptomatic Cases and Vaccination Spike

Coronavirus

New data is coming out every day about COVID-19 and the body’s response to vaccines. Here’s a look at some of the top stories.

Study: Asymptomatic COVID-19 May Still Cause Damage

research study published in the Annals of Internal Medicine by Eric Topol and Daniel Oran from Scripps Research Translational Institute suggests that even asymptomatic COVID-19 infections may cause lung damage. The research began by evaluating data from patients aboard the cruise ship Diamond Princess which was quarantined off the coast of Japan in the earliest part of the pandemic. Of the 104 patients who tested positive on the ship, 76 were asymptomatic. However, CT scans found that 54% had lung abnormalities known as ground-glass opacities, indicative of fluid build-up in the lungs. It also included data from other parts of the world.

Topol, founder and director of Scripps wrote that the CT scans were “disturbing” and “if confirmed, this finding suggests that the absence of symptoms might not necessarily mean the absence of harm.”

In the U.S., about 35% of all COVID-19 infections are asymptomatic. Topol and Oran’s conclusions are that asymptomatic infections are likely under-diagnosed and that research into their effects has largely been ignored. 

The authors wrote, “Despite concerns about distinguishing asymptomatic from presymptomatic persons, data from 4 of 5 of the cohorts with longitudinal reporting suggest that a small fraction of asymptomatic persons may eventually develop symptoms.”

For example, in Italian and Japanese cohorts, 0% of asymptomatic people became symptomatic. In Greece and New York, 10.4% went on to develop symptoms. A particular outlier was a skilled nursing facility in King County, where 88.9% of people developed symptoms requiring recategorization from asymptomatic to presymptomatic.

3rd Shot of Pfizer-BioNTech Vaccine Improves Protection in Older People

New data from Israel found that a third dose of the Pfizer-BioNTech COVID-19 vaccine significantly increased protection from infection and severe disease in people 60 and older compared to those who received the standard two shots. These data were similar to a separate report last week offered by Israel’s Maccabi healthcare provider. The new data found that in people 60 and older, the protection ten days after the third shot was four times higher than what was observed after the second shot.

Understanding Bacterial and Viral Infections in Ventilated COVID-19 Patients

Patients who end up on mechanical ventilation with COVID-19 have very poor outcomes. Investigators with New York University Grossman School of Medicine, NYU Langone Health, and the National Institutes of Health (NIH) conducted a prospective study of 589 critically ill adults on mechanical ventilation. A subset of 142 of those patients underwent bronchoscopy. 

In those patients, they analyzed the viral load of SARS-COV-2, as well as an analysis of the lower respiratory tract microbiome using metagenomics and metatranscriptomics and to study the immune response. They found that hospital-acquired respiratory pathogens were not associated with death, although a poor outcome was associated with an oral commensal Mycoplasma salivarium infection. However, the primary cause of death was related to the viral load and not driven by secondary respiratory infections.

Routine MMR & Tdap Vaccines May Prevent Severe COVID-19

Data from a Harvard Medical School study suggests that the childhood vaccines for Measles-Mumps-Rubella (MMR) and Tetanus-Diphtheria-Pertussis (Tdap) may prevent severe COVID-19. They theorize these vaccines might generate cross-reactive memory T cells that respond to antigens to a few microorganisms, including the viral antigens in SARS-CoV-2.

“Our Cleveland Clinic colleagues observed an association where individuals with COVID-19 who had either MMR or Tdap vaccines had a much lower frequency of going to the intensive care unit or dying,” said co-author Andrew Lichtman, an immunology and senior investigator in the Brigham and Women’s Hospital Department of Pathology and professor of Pathology at Harvard Medical School. “Although previous smaller studies suggested a similar link, our in-depth epidemiological analyses, together with our basic research results, suggest that these commonly given vaccines may protect against severe disease.”

Vaccination Rates Improved in August

The pace of the first COVID-19 vaccines picked up in August, with over 14 million shots, according to Jeff Zients, White House COVID-19 Response Coordinator. There are also signs that the pace has accelerated in Europe, with about 70% of the European Union’s adults fully vaccinated. However, that varies greatly depending on the country. Although about 250 million people in the EU have been vaccinated, the rates range from 20% in Bulgaria to 85.5% in Ireland. Other levels include 32.8% for Romania, 49% in Slovakia, 58.1% in Poland, 72.5% in France, 70.6% in Germany and 76.7% in Spain.

Rigel Pharma’s Fostamatinib Showed Improvements in Hospitalized COVID-19 Patients

Rigel Pharmaceuticals published results from a Phase II trial of fostamatinib for hospitalized COVID-19 patients. The trial was sponsored by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institute of Health (NIH), in partnership with the Inova Health System. The data was from 59 patients and showed that adding fostamatinib to the standard of care (SOC), including Gilead’s remdesivir and the steroid dexamethasone, was well tolerated and linked to clinically meaningful improvements in patients who required supplemental oxygen.

“As cases of COVID continue to surge across the world, improved therapies for patients hospitalized with COVID-19 are urgently needed,” said Richard Childs, Clinical Director of the NHLBI. “We are encouraged to see that for COVID-19 patients requiring hospitalization, fostamatinib in combination with the standard of care was shown to be well tolerated in the study. Patients treated with fostamatinib not only had less severe adverse events, but were observed to have improved clinical outcomes compared to those receiving placebo and standard of care.”

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