The Friday Report – Issue 20
By Dan Ryan and Nicola Oliver
COVID-19 Actuaries Response Group – Learn. Share. Educate. Influence.
COVID-19 is still one of the hottest topics for scientific papers and articles. The COVID‑19 Actuaries Response Group will provide you with a regular Friday update with a curated list of the key papers and articles that we’ve looked at recently.
This week, a selection of medical news for your bank holiday reading.
Clinical and Medical News
Synthetic DNA vaccines from University of Cambridge
Five different COVID-19 vaccines are taking part in Phase III multi-centre trials across China, USA, UK, Brazil, UAE, Iran and South Africa. These are the leading contenders from the 39 different vaccines that are currently undergoing human clinical trials. from almost different studies around the world.
A more recent candidate, DIOS CoVax2, has been developed by DIOSynVax, the University of Cambridge and Southampton NHS Trust. The vaccine uses synthetic DNA rather than RNA or adenovirus vectors, and has been demonstrated to be safe in other phase I/II trials. The vaccine does not require a needle injection and does not need to be cold-stored. This would make a significant difference to the effective distribution of vaccines in low- and middle-income countries.
Trials will start in late autumn this year.
Importance of superspreading events
Superspreading is when one or a few infected individuals infect a significant number of others, and this can have a profound impact at the outset of an epidemic. Superspreading has been identified at a number of events, such a Biogen conference that take place in Boston on 26/27 February. It has been suggested that this conference could have been responsible for 40% of all confirmed cases seen in Boston up until 1 July.
A further study has suggested that the higher probability of superspreading events for COVID-19 compared with influenza is not because of the longer period of viral shedding but rather because SARS-CoV-2 is more likely to be infective with equivalent contact because of aerosolization of the virus. These findings support the continued need for limits on crowd sizes in indoor settings.
Flagging the possibility of re-infection with COVID-19
Three cases have now been identified of confirmed re-infection with COVID-19 in the last few days. In each case, re-infection was confirmed through genetic sequencing as each had evidence of two different strains of COVID-19. The cases in Hong Kong, Belgium and the Netherlands in Hong Kong, Belgium and Netherlands have raised concerns about the effectiveness of potential vaccines. However, the view of the WHO is that these are likely to be rare cases given extensive population testing in places such as Hong Kong. In further details, it was confirmed that the Belgian woman had only experienced mild symptoms in her first infection, and that the Dutch individual had had a weakened immune system, questioning whether a sufficient antibody reaction had been developed initially.
Preventing and Mitigating SARS-CoV-2 Transmission
Nonpharmaceutical interventions (NPIs) have been shown to be effective in reducing the transmission of SARS-CoV-2. This CDC release reports on the effectiveness of NPIs on the prevention and mitigation of SARS-CoV-2 transmission in a number of US summer, overnight camps. The measures taken included a combination of pre-camp quarantine, pre- and post-arrival testing and symptom screening, cohorting, and physical distancing between cohorts.
Introducing a multi-layered use of NPIs allowed camps to prevent transmission and quickly identify campers or staff members with SARS-CoV-2 infection to successfully mitigate spread.
Early authorisation of convalescent plasma therapy in USA
The US Food and Drug Administration (FDA) approved the use of convalescent plasma therapy (CPT) for the treatment of COVID-19 patients on 23 August. The treatment has been used for the treatment of infections, such as pandemic influenza, for more than 100 years, using the antibodies in the plasma of recovered patients to provide passive immunity.
A number of trials had been set up around the world to determine the efficacy of CPT, with the largest study led by the Mayo Clinic in the US seeing 71,000 patients receiving treatment over the last five months. In the UK, the NHS Blood and Transplant (NHSBT) is carrying out two clinical trials of the treatment and so far just over 18,000 units of plasma have been collected.
Data from a pre-print study on 35,000 patients taken from the Mayo Clinic cohort found that those treated with plasma with higher levels of antibodies were less likely to die, with the benefit stated to be a 35% relative reduction in 30-day mortality. However, significant concerns have been raised over the conclusions as the trial was not established as a randomised control trial (no patients received a placebo). Senior health officials, including Dr Anthony Fauci, have questioned the premature authorisation and regretted the decision to bring the trial to an end following the authorisation
Rapid COVID test BinaxNOW COVID-19 Ag Card
The US FDA has given approval for a portable COVID-19 antigen test that provides results in 15 minutes. The test kit, produced by Abbot Laboratories, is about the size of a credit card, requires no additional equipment to operate, and can be conducted using a less invasive nasal swab than traditional lab tests. It is likely to cost around $5 per test kit and will be particularly useful for people participating in larger gatherings, such as those returning to schools or workplaces. The results are downloaded to an app allowing those who have taken the test to present their result before entering venues.
And finally …
If the thought of a second lockdown is stressing you, then perhaps have a go at ‘scream therapy’. Iceland is marketing itself as the perfect place to let your frustrations out and is offering interested parties to let off steam by recording their screams and having them played over a loudspeaker in a remote part of the country.
Psychotherapist Zoe Aston says that using a scream as a way to release pent up emotion allows you to reconnect with yourself, hear your own voice and reclaim the power that is inside you. scream!