NMCP COVID-19 Literature Report #77: Friday, 24 September 2021
Prepared By: Tracy C. Shields, MSIS, AHIP (Ms.; she/her) <tracy.c.shields2.civ@mail.mil>
Naval Medical Center Portsmouth; Library Services, Reference Medical Librarian
Purpose: These reports, published every other week on Fridays, are curated collections of
current research, evidence reviews, special reports, grey literature, and news regarding the
COVID-19 pandemic that may be of interest to medical providers, leadership, and decision
makers.
All reports are available online at https://nmcp.libguides.com/covidreport. Access is private;
you will need to use the direct link or bookmark the URL.
Disclaimer: | am not a medical professional. This document is current as of the date noted
above. While | make every effort to find and summarize available data, | cannot cover
everything in the literature on COVID-19. Please feel free to reach out with questions,
suggestions for future topics, or any other feedback.
TABLE OF CONTENTS
Topic..... page; click link to jump to section.
The Big Picture..... 2 Pediatric Population..... 24
SARS-CoV-2 Virus and Variants..... 3 Healthcare Workers ..... 26
COVID-19 Vaccines..... 4 Disparities and Health Equity..... 30
Breakthrough Infections, Reinfections, and Risk, Transmission, and Exposure.....
infections..... 14
— Health Messaging and Misinformation....
Treatments and Management..... 15 33
Pre-Existing Conditions, Comorbidities, and Other Infectious Diseases and Public
Impact on Other Health Issues..... 20 Health Threats ..... 34
Long COVID / Post-COVID Period..... 20 Statistics ..... 37
Women's Health, Pregnancy, and Perinatal References..... 37
NMCP COVID-19 Literature Report #77: Friday, 24 September 2021
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
The Big Picture
News in Brief
Grim Milestones
"1 in 500 Americans have died of Covid-19" (WP).
COVID-19 has overtaken the 1918 Spanish flu as deadliest disease in American history (STAT).
"American Samoa, one of the last places without coronavirus, has first infection" (WP).
Heads Up
BLUF from DHS: "Here's what we've learned about COVID-19—an update" (DHS; see also:
Master Question List [pdf]).
"Six things to understand about the pandemic now — The rules of the pandemic keep changing,
but these principles can guide your thinking through the seasons to come" (Atlantic).
"Winter is coming, again: What to expect from Covid-19 as the season looms" (STAT).
The current surge combined with supply chain stress is causing widespread shortages of
medical equipment such as exam tables, defibrillators, and crutches (Reuters).
Research Concerns
"Preprint advocates must also fight for research integrity — Efforts to share research with the
public must include mechanisms to prevent harm resulting from low-quality work" (Nature).
"Swedish research misconduct agency swamped with cases in first year. The newly formed
government organization tackled 46 research-fraud investigations in 2020 — three times as
many as expected" (Nature). Ed note: If you like podcasts, check out Dr. Death season 3 — this
agency was created after the events covered in that series.
Long read: "How the pandemic is changing the norms of science — Imperatives like skepticism
and disinterestedness are being junked to fuel political warfare that has nothing in common
with scientific methodology" (Tablet).
Journal Articles
PNAS: Excess mortality from COVID and non-COVID causes in minority populations (28
September 2021; online 21 September 2021)
"The 2020 US mortality totaled 2.8 million after early March, which is 17.3% higher than
age-population—weighted mortality over the same time interval in 2017 to 2019, for a total
excess death count of 413,592. We use data on weekly death counts by cause, as well as life
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NMCP COVID-19 Literature Report #77: Friday, 24 September 2021
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
tables, to quantify excess mortality and life years lost from both COVID-19 and non—COVID-
19 causes by race/ethnicity, age, and gender/sex. Excess mortality from non—COVID-19
causes is substantial and much more heavily concentrated among males and minorities,
especially Black, non-Hispanic males, than COVID-19 deaths. Thirty-four percent of the
excess life years lost for males is from non—COVID-19 causes. While minorities represent
36% of COVID-19 deaths, they represent 70% of non—COVID-19 related excess deaths and
58% of non—COVID-19 excess life years lost. Black, non-Hispanic males represent only 6.9%
of the population, but they are responsible for 8.9% of COVID-19 deaths and 28% of 2020
excess deaths from non—COVID-19 causes. For this group, nearly half of the excess life years
lost in 2020 are due to non—COVID-19 causes."
Clin Infect Dis: ls COVID-19 Less Deadly Now? -- Trends of In-Hospital Mortality Among
Hospitalized COVID-19 Patients in the United States (17 September 2021)
"After an initial decline from April through June 2020 (from 22.2% to 11.9%), adjusted in-
hospital mortality in COVID-19 inpatients peaked twice and was significantly higher than
June 2020 for subsequent months except in July and October 2020. Adjusted mortality
trends differed across age groups between November 2020 and February 2021."
SARS-CoV-2 Virus and Variants
News in Brief
"Delta has been brutal’: Covid-19 variant is decimating rural areas already reeling from the
pandemic" (STAT).
Virus Origins
"Closest known relatives of virus behind COVID-19 found in Laos — Studies of bats in China and
Laos show southeast Asia is a hotspot for potentially dangerous viruses similar to SARS-CoV-2"
(Nature; see also: preprint at Research Square).
"Did the coronavirus jump from animals to people twice? A preliminary analysis of viral
genomes suggests the COVID-19 pandemic might have multiple animal origins — but the
findings still have to be peer reviewed" (Nature; see also: preprint from virological.org).
"SARS-like viruses may jump from animals to people hundreds of thousands of times a year —
Study pinpoints Asian regions that could spark the next coronavirus pandemic" (Science; see
also: medRxiv preprint).
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NMCP COVID-19 Literature Report #77: Friday, 24 September 2021
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
Long read: "A virus-hunter's advice on dealing with China's resistance on Covid: Hardball is the
wrong technique to get China to open up about the early spread of the pandemic. A successful
but little-known global disease program offers a much smarter approach" (Politico).
Journal Articles
MMWR: Outbreak of SARS-CoV-2 B.1.617.2 (Delta) Variant Infections Among Incarcerated
Persons in a Federal Prison — Texas, July-August 2021 (24 September 2021)
"What is already known about this topic? Incarcerated populations have experienced
disproportionately higher rates of COVID-19-related illness and death.
What is added by this report? During a COVID-19 outbreak involving the Delta variant in a
highly vaccinated incarcerated population, transmission rates were high, even among
vaccinated persons. Although attack rates, hospitalizations, and deaths were higher among
unvaccinated than among vaccinated persons, duration of positive serial test results was
similar for both groups. Infectious virus was cultured from vaccinated and unvaccinated
infected persons.
What are the implications for public health practice? Even with high vaccination rates,
maintaining multicomponent prevention strategies (e.g., testing and masking for all persons
and prompt medical isolation and quarantine for incarcerated persons) remains critical to
limiting SARS-CoV-2 transmission in congregate settings where physical distancing is
challenging."
COVID-19 Vaccines
News in Brief
The FDA has authorized a single booster dose of the Pfizer COVID-19 vaccine in patients over 65
years old, in people aged 18-64 at high risk of severe COVID-19, or in individuals aged 18-64
whose risk of exposure puts them at high risk of serious complications from COVID-19 (FDA).
"In a statement released early Friday [24 September 2021], the [CDC] said those at high risk of
occupational exposure, such as healthcare workers, may receive the Pfizer booster shot at least
6 months after the two-dose primary series, based on their individual benefits and risks. On
Thursday [23 September 2021], the ACIP voted 6-9 against recommending a booster in this
population" (Medpage).
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NMCP COVID-19 Literature Report #77: Friday, 24 September 2021
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
"The tangled history of mRNA vaccines — Hundreds of scientists had worked on mRNA vaccines
for decades before the coronavirus pandemic brought a breakthrough" (Nature).
Shots in Arms
"The US was a world leader in vaccination. What went wrong? How most of Europe caught up
to — and then surpassed — the US in their Covid-19 vaccine drives" (Vox).
"Many unvaccinated people are not opposed to getting a shot. The challenge is trying to get it
to them" (WP).
Boosters
"J&J says second dose of their COVID vaccine boosts protection — Efficacy data promising, but
confidence intervals wide" (Medpage; see also: medRxiv preprint).
"What will the Covid-19 booster rollout look like? Public health groups plan as they await
details" (STAT).
Immune Response
"A preprint study using blood samples suggested that mutant-specific T-cell responses were
stronger after vaccination than they were in individuals who had been infected with SARS-CoV-
2 up to a year ago" (Medpage; see also: medRxiv preprint).
"COVID vaccine immunity is waning — how much does that matter? As debates about booster
shots heat up, what’s known about the duration of vaccine-based immunity is still evolving"
(Nature).
In Kids
"Pfizer Covid-19 vaccine generates robust antibody response in children, without serious safety
issues, Company says" (STAT; see also: Pfizer news release).
Events
WHAT: Developing the Oxford AstraZeneca COVID-19 vaccine: Elizabeth Blackwell
Annual Public Lecture 2021 with Professor Dame Sarah Gilbert
— free event
WHEN: Wednesday, 06 October 2021 0800-0900 ET
ABOUT: "Dame Sarah Gilbert is Professor of Vaccinology in the Nuffield Department of
Medicine at the University of Oxford, and is the Oxford Project Leader for
ChAdOx1 nCoV-19, the leading UK coronavirus vaccine.
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NMCP COVID-19 Literature Report #77: Friday, 24 September 2021
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
In this talk, Dame Sarah will take us on a journey from the moment she first
heard about a serious new illness affecting people in China, to her team
designing a successful COVID-19 vaccine which would save the lives of millions of
people. You will hear the behind-the-scenes story of how the AstraZeneca
COVID-19 vaccine - both cheaper and easier to distribute than some other
vaccines - was developed and approved at a pace, while the public waited
eagerly for science to find a way out of this major global health challenge.
She will look at the reasons some people are hesitant to get vaccinated and
discuss how people’s trust in science can be affected by how science is
communicated. What can we learn from this pandemic and the ways it could
help us plan for future health crises, as we look towards a post-COVID world?"
REGISTER: https://www.eventbrite.co.uk/e/dame-sarah-gilbert-developing-the-oxford-
astrazeneca-covid-19-vaccine-registration-162416757895
Journal Articles
Recommendations
MMWR: Use of Pfizer-BioNTech COVID-19 Vaccine in Persons Aged 216 Years:
Recommendations of the Advisory Committee on Immunization Practices — United States,
September 2021 (24 September 2021)
"What is already known about this topic? On August 23, 2021, the Food and Drug
Administration granted full approval of the Pfizer-BioNTech COVID-19 vaccine for persons
aged 216 years.
What is added by this report? On August 30, 2021, after a systematic review of the data, the
Advisory Committee on Immunization Practices revised its interim recommendation to a
standard recommendation for use of the Pfizer-BioNTech COVID-19 vaccine in persons aged
216 years for the prevention of COVID-19.
What are the implications for public health practice? Continued use of the Pfizer-BioNTech
COVID-19 vaccine, now fully approved by the FDA in persons aged 216 years, is
recommended based on increased certainty that its benefits (prevention of asymptomatic
infection, COVID-19, and associated hospitalization and death) outweigh vaccine-associated
risks."
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NMCP COVID-19 Literature Report #77: Friday, 24 September 2021
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
Effectiveness
MMWR: Comparative Effectiveness of Moderna, Pfizer-BioNTech, and Janssen (Johnson &
Johnson) Vaccines in Preventing COVID-19 Hospitalizations Among Adults Without
Immunocompromising Conditions — United States, March—August 2021 (24 September 2021)
"What is already known about this topic? Two 2-dose mRNA COVID-19 vaccines (from
Pfizer-BioNTech and Moderna) and a 1-dose viral vector vaccine (from Janssen [Johnson &
Johnson]) are currently used in the United States.
What is added by this report? Among U.S. adults without immunocompromising conditions,
vaccine effectiveness against COVID-19 hospitalization during March 11—August 15, 2021,
was higher for the Moderna vaccine (93%) than the Pfizer-BioNTech vaccine (88%) and the
Janssen vaccine (71%).
What are the implications for public health practice? Although these real-world data
suggest some variation in levels of protection by vaccine, all FDA-approved or authorized
COVID-19 vaccines provide substantial protection against COVID-19 hospitalization."
Lancet Infect Dis: Infections, hospitalisations, and deaths averted via a nationwide vaccination
campaign using the Pfizer—BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a
retrospective surveillance study (22 September 2021)
"Background: On Dec 20, 2020, Israel initiated a nationwide COVID-19 vaccination campaign
for people aged 16 years and older and exclusively used the Pfizer—-BioNTech BNT162b2
mRNA COVID-19 vaccine (tozinameran). We provide estimates of the number of SARS-CoV-
2 infections and COVID-19-related admissions to hospital (ie, hospitalisations) and deaths
averted by the nationwide vaccination campaign.
Methods: In this retrospective surveillance study, we used national surveillance data
routinely collected by the Israeli Ministry of Health from the first 112 days (Dec 20, 2020, up
to our data cutoff of April 10, 2021) of Israel's vaccination campaign to estimate the averted
burden of four outcomes: SARS-CoV-2 infections and COVID-19-related hospitalisations,
severe or critical hospitalisations, and deaths. As part of the campaign, all individuals aged
16 years and older were eligible for inoculation with the BNT162b2 vaccine in a two-dose
schedule 21 days apart. We estimated the direct effects of the immunisation programme
for all susceptible individuals (ie, with no previous evidence of laboratory-confirmed SARS-
CoV-2 infection) who were at least partly vaccinated (at least one dose and at least 14 days
of follow-up after the first dose). We estimated the number of SARS-CoV-2 infection-related
outcomes averted on the basis of cumulative daily, age-specific rate differences, comparing
rates among unvaccinated individuals with those of at least partly vaccinated individuals for
each of the four outcomes and the (age-specific) size of the susceptible population and
proportion that was at least partly vaccinated.
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NMCP COVID-19 Literature Report #77: Friday, 24 September 2021
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
Findings: We estimated that Israel's vaccination campaign averted 158 665 (95% Cl
144 640-172 690) SARS-CoV-2 infections, 24 597 (18 942-30 252) hospitalisations, 17 432
(12 770-22 094) severe or critical hospitalisations, and 5532 (3085-7982) deaths. 16 213
(65:9%) of 24 597 hospitalisations and 5035 (91:0%) of 5532 of deaths averted were
estimated to be among those aged 65 years and older. We estimated 116 000 (73-1%) SARS-
CoV-2 infections, 19 467 (79:1%) COVID-19-related hospitalisations, and 4351 (79%) deaths
averted were accounted for by the fully vaccinated population.
Interpretation: Without the national vaccination campaign, Israel probably would have had
triple the number of hospitalisations and deaths compared with what actually occurred
during its largest wave of the pandemic to date, and the health-care system might have
become overwhelmed. Indirect effects and long-term benefits of the programme, which
could be substantial, were not included in these estimates and warrant future research."
NEJM: Effectiveness of mRNA Covid-19 Vaccine among U.S. Health Care Personnel (22
September 2021)
"Background: The prioritization of U.S. health care personnel for early receipt of messenger
RNA (mRNA) vaccines against severe acute respiratory disease coronavirus 2 (SARS-CoV-2),
the virus that causes coronavirus disease 2019 (Covid-19), allowed for the evaluation of the
effectiveness of these new vaccines in a real-world setting.
Methods: We conducted a test-negative case-control study involving health care personnel
across 25 U.S. states. Cases were defined on the basis of a positive polymerase-chain-
reaction (PCR) or antigen-based test for SARS-CoV-2 and at least one Covid-19-like
symptom. Controls were defined on the basis of a negative PCR test for SARS-CoV-2,
regardless of symptoms, and were matched to cases according to the week of the test date
and site. Using conditional logistic regression with adjustment for age, race and ethnic
group, underlying conditions, and exposures to persons with Covid-19, we estimated
vaccine effectiveness for partial vaccination (assessed 14 days after receipt of the first dose
through 6 days after receipt of the second dose) and complete vaccination (assessed >7
days after receipt of the second dose).
Results: The study included 1482 case participants and 3449 control participants. Vaccine
effectiveness for partial vaccination was 77.6% (95% confidence interval [Cl], 70.9 to 82.7)
with the BNT162b2 vaccine (Pfizer-BioNTech) and 88.9% (95% Cl, 78.7 to 94.2) with the
mRNA-1273 vaccine (Moderna); for complete vaccination, vaccine effectiveness was 88.8%
(95% Cl, 84.6 to 91.8) and 96.3% (95% Cl, 91.3 to 98.4), respectively. Vaccine effectiveness
was similar in subgroups defined according to age (<50 years or 250 years), race and ethnic
group, presence of underlying conditions, and level of patient contact. Estimates of vaccine
effectiveness were lower during weeks 9 through 14 than during weeks 3 through 8 after
receipt of the second dose, but confidence intervals overlapped widely.
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NMCP COVID-19 Literature Report #77: Friday, 24 September 2021
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
Conclusions: The BNT162b2 and mRNA-1273 vaccines were highly effective under real-
world conditions in preventing symptomatic Covid-19 in health care personnel, including
those at risk for severe Covid-19 and those in racial and ethnic groups that have been
disproportionately affected by the pandemic."
NEJM: Efficacy of the mRNA-1273 SARS-CoV-2 Vaccine at Completion of Blinded Phase (22
September 2021)
"Background: At interim analysis in a phase 3, observer-blinded, placebo-controlled clinical
trial, the MRNA-1273 vaccine showed 94.1% efficacy in preventing coronavirus disease 2019
(Covid-19). After emergency use of the vaccine was authorized, the protocol was amended
to include an open-label phase. Final analyses of efficacy and safety data from the blinded
phase of the trial are reported.
Methods: We enrolled volunteers who were at high risk for Covid-19 or its complications;
participants were randomly assigned in a 1:1 ratio to receive two intramuscular injections of
mRNA-1273 (100 yg) or placebo, 28 days apart, at 99 centers across the United States. The
primary end point was prevention of Covid-19 illness with onset at least 14 days after the
second injection in participants who had not previously been infected with the severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2). The data cutoff date was March 26,
2021.
Results: The trial enrolled 30,415 participants; 15,209 were assigned to receive the mRNA-
1273 vaccine, and 15,206 to receive placebo. More than 96% of participants received both
injections, 2.3% had evidence of SARS-CoV-2 infection at baseline, and the median follow-
up was 5.3 months in the blinded phase. Vaccine efficacy in preventing Covid-19 illness was
93.2% (95% confidence interval [Cl], 91.0 to 94.8), with 55 confirmed cases in the mRNA-
1273 group (9.6 per 1000 person-years; 95% Cl, 7.2 to 12.5) and 744 in the placebo group
(136.6 per 1000 person-years; 95% Cl, 127.0 to 146.8). The efficacy in preventing severe
disease was 98.2% (95% Cl, 92.8 to 99.6), with 2 cases in the MRNA-1273 group and 106 in
the placebo group, and the efficacy in preventing asymptomatic infection starting 14 days
after the second injection was 63.0% (95% Cl, 56.6 to 68.5), with 214 cases in the mRNA-
1273 group and 498 in the placebo group. Vaccine efficacy was consistent across ethnic and
racial groups, age groups, and participants with coexisting conditions. No safety concerns
were identified.
Conclusions: The mRNA-1273 vaccine continued to be efficacious in preventing Covid-19
illness and severe disease at more than 5 months, with an acceptable safety profile, and
protection against asymptomatic infection was observed."
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NMCP COVID-19 Literature Report #77: Friday, 24 September 2021
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
NEJM: Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months (15
September 2021)
"Background: BNT162b2 is a lipid nanoparticle-formulated, nucleoside-modified RNA
vaccine encoding a prefusion-stabilized, membrane-anchored severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) full-length spike protein. BNT162b2 is highly
efficacious against coronavirus disease 2019 (Covid-19) and is currently approved,
conditionally approved, or authorized for emergency use worldwide. At the time of initial
authorization, data beyond 2 months after vaccination were unavailable.
Methods: In an ongoing, placebo-controlled, observer-blinded, multinational, pivotal
efficacy trial, we randomly assigned 44,165 participants 16 years of age or older and 2264
participants 12 to 15 years of age to receive two 30-ug doses, at 21 days apart, of BNT162b2
or placebo. The trial end points were vaccine efficacy against laboratory-confirmed Covid-19
and safety, which were both evaluated through 6 months after vaccination.
Results: BNT162b2 continued to be safe and have an acceptable adverse-event profile. Few
participants had adverse events leading to withdrawal from the trial. Vaccine efficacy
against Covid-19 was 91.3% (95% confidence interval [Cl], 89.0 to 93.2) through 6 months of
follow-up among the participants without evidence of previous SARS-CoV-2 infection who
could be evaluated. There was a gradual decline in vaccine efficacy. Vaccine efficacy of 86 to
100% was seen across countries and in populations with diverse ages, sexes, race or ethnic
groups, and risk factors for Covid-19 among participants without evidence of previous
infection with SARS-CoV-2. Vaccine efficacy against severe disease was 96.7% (95% Cl, 80.3
to 99.9). In South Africa, where the SARS-CoV-2 variant of concern B.1.351 (or beta) was
predominant, a vaccine efficacy of 100% (95% Cl, 53.5 to 100) was observed.
Conclusions: Through 6 months of follow-up and despite a gradual decline in vaccine
efficacy, BNT162b2 had a favorable safety profile and was highly efficacious in preventing
Covid-19."
JAMA Netw Open: Safety and Antibody Response After 1 and 2 Doses of BNT162b2 mRNA
Vaccine in Recipients of Allogeneic Hematopoietic Stem Cell Transplant (14 September 2021)
"This cohort study examines safety and antibody responses after 1 and 2 doses of
BNT162b2 mRNA vaccine in recipients of allogeneic hematopoietic stem cell transplant
(HSCT). ...
Despite the limitations inherent to an observational analysis and the fact that the cohort
was small and from a single center, this study found a high response rate of 83% in this
cohort of allogeneic HSCT recipients after 2 doses of BNT162b2 vaccine. Of note, 62% of the
patients achieved the highest IgG titer also reached by a concomitant healthy cohort."
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In Kids
Clin Infect Dis: Safety and immunogenicity of a recombinant adenovirus type-5-vectored COVID-
19 vaccine with a homologous prime-boost regimen in healthy participants aged 6 years and
above: a randomised, double-blind, placebo-controlled, phase 2b trial (22 September 2021)
"Background: We assessed the safety and immunogenicity of a recombinant adenovirus
type-5 (Ad5)-vectored COVID-19 vaccine with homologous prime-boost regimens in healthy
participants aged 6 years and above.
Methods: In this randomised, double-blind, placebo-controlled trial, participants received
low-dose vaccine, middle-dose vaccine or placebo. Prime-booster regimens were given
intramuscularly 56 days apart. ELISA antibodies to the receptor binding domain (RBD) and
pseudovirus neutralising antibodies were detected. Adverse events were monitored for 28
days following each vaccination.
Results: A total of 430 participants were enrolled in the study, with 30 participants aged 18-
55 years (MID cohort), 250 participants aged 56 years and older (OLD cohort), and 150
participants aged 6-17 years (MIN cohort). Ad5-vectored COVID-19 vaccine induced
significant RBD-specific ELISA antibodies which decreased with increasing age, with
geometric mean titres (GMTs) of 1037.5 in MIN cohort, 647.2 in MID cohort, and 338.0 in
OLD cohort receiving 5x10 10 viral particles on day 28 following boost vaccination.
Pseudovirus neutralising antibodies showed a similar pattern, with GMTs of 168.0 in MIN
cohort, 76.8 in MID cohort, and 79.7 in OLD cohort. A single dose in children and
adolescents induced higher antibody responses than that elicited by two doses in adults,
with GMTs of 1091.6 and 96.6 in ELISA antibody and neutralising antibody, respectively.
Homologous prime-boost vaccination was safety and tolerable.
Conclusions: Ad5-vectored COVID-19 vaccine with a single dose was safe and induced
robust immune responses in children and adolescents aged 6-17 years. A prime-boost
regimen needs further exploration for Ad5-vectored COVID-19 vaccine."
Boosters
NEJM: Protection of BNT162b2 Vaccine Booster against Covid-19 in Israel (15 September 2021)
"Background: On July 30, 2021, the administration of a third (booster) dose of the
BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) was approved in Israel for persons
who were 60 years of age or older and who had received a second dose of vaccine at least 5
months earlier. Data are needed regarding the effect of the booster dose on the rate of
confirmed coronavirus 2019 disease (Covid-19) and the rate of severe illness.
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Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
Methods: We extracted data for the period from July 30 through August 31, 2021, from the
Israeli Ministry of Health database regarding 1,137,804 persons who were 60 years of age
or older and had been fully vaccinated (i.e., had received two doses of BNT162b2) at least 5
months earlier. In the primary analysis, we compared the rate of confirmed Covid-19 and
the rate of severe illness between those who had received a booster injection at least 12
days earlier (booster group) and those who had not received a booster injection
(nonbooster group). In a secondary analysis, we evaluated the rate of infection 4 to 6 days
after the booster dose as compared with the rate at least 12 days after the booster. In all
the analyses, we used Poisson regression after adjusting for possible confounding factors.
Results: At least 12 days after the booster dose, the rate of confirmed infection was lower in
the booster group than in the nonbooster group by a factor of 11.3 (95% confidence interval
[Cl], 10.4 to 12.3); the rate of severe illness was lower by a factor of 19.5 (95% Cl, 12.9 to
29.5). In a secondary analysis, the rate of confirmed infection at least 12 days after
vaccination was lower than the rate after 4 to 6 days by a factor of 5.4 (95% Cl, 4.8 to 6.1).
Conclusions: In this study involving participants who were 60 years of age or older and had
received two doses of the BNT162b2 vaccine at least 5 months earlier, we found that the
rates of confirmed Covid-19 and severe illness were substantially lower among those who
received a booster (third) dose of the BNT162b2 vaccine."
NEJM: SARS-CoV-2 Neutralization with BNT162b2 Vaccine Dose 3 (15 September 2021)
This study " details the results of administration of a third Pfizer vaccine dose to 11
participants 18 to 55 years old and 12 participants 65 to 85 years 8 to 9 months after receipt
of the second dose....
A team led by University of Rochester researchers in New York collected serum samples
before each of the three doses and 7 days and 1 month after. From 7 days after dose 2 to
before dose 3, SARS-CoV-2 neutralizing antibody mean concentrations fell far faster in the
subgroup of phase 1 participants than vaccine effectiveness declined in phase 2/3 trial
participants.
But by 1 month after the third vaccine dose, antibody concentrations against the wild-type
virus rose five times as high as the concentrations 1 month after the second dose in the
group aged 18 to 55 years and seven times as high in the group aged 65 to 85.
Neutralizing antibody levels against the Beta (B1351) variant were more than 15 times
higher after the third dose than after the second dose compared with antibodies against the
wild-type virus in the younger group and more than 20 times higher in the older group.
Antibody concentrations declined from 7 days to 1 month after the second dose but
increased from 7 days to 1 month after the third dose. A comparable pattern of broader
neutralization and higher antibody concentrations against a combination of the Delta spike
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protein and a wild-type genetic background were observed after the third dose." (summary
taken from CIDRAP)
Adverse Events / Side Effects
JAMA Netw Open: Assessment of Allergic and Anaphylactic Reactions to mRNA COVID-19
Vaccines With Confirmatory Testing in a US Regional Health System (17 September 2021)
"Question: What risk factors and mechanisms can help explain documented allergic
reactions to Food and Drug Administration—authorized mRNA COVID-19 vaccines?
Findings: In this case series of 22 patients with suspected vaccine allergy receiving clinical
skin prick testing (SPT) and basophil activation testing (BAT) to the whole vaccine and key
components (ie, polyethylene glycol [PEG] and polysorbate 80), none exhibited
immunoglobulin (lg) E-mediated allergy to components via SPT. However, most had
positive BAT results to PEG, and all had positive BAT results to their administered MRNA
vaccine, with no patient sample having detectable PEG IgE.
Meaning: These findings suggest that non—IgE-mediated allergic reactions to PEG may be
responsible for many documented cases of allergy to MRNA vaccines."
Vaccine Development
iScience: Single-dose Intranasal Vaccination Elicits Systemic and Mucosal Immunity Against
SARS-CoV-2 (24 September 2021; online 26 August 2021)
"Despite remarkable progress in the development and authorization of vaccines against
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there is a need to validate
vaccine platforms for broader application. The current intramuscular vaccines are designed
to elicit systemic immunity without conferring mucosal immunity in the nasal compartment,
which is the first barrier that SARS-CoV-2 virus breaches before dissemination to the lung.
We report the development of an intranasal subunit vaccine that uses lyophilized spike
protein and liposomal STING agonist as an adjuvant. This vaccine induces systemic
neutralizing antibodies, IgA in the lung and nasal compartments, and T-cell responses in the
lung of mice. Single-cell RNA sequencing confirmed the coordinated activation of T/B-cell
responses in a germinal center-like manner within the nasal-associated lymphoid tissues,
confirming its role as an inductive site to enable durable immunity. The ability to elicit
immunity in the respiratory tract can prevent the establishment of infection in individuals
and prevent disease transmission."
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Breakthrough Infections, Reinfections, and Coinfections
Journal Articles
Clin Infect Dis: Prior infection and age impacts antibody persistence after SARS-CoV-2 mRNA
vaccine (22 September 2021)
"Determining the duration of immunity to SARS-CoV-2 vaccines is critical for informing the
timing of booster immunization. Many host factors could influence both the magnitude and
persistence of the antibody response. Here, we showed that SARS-CoV-2 infection before
vaccination and age affected the decay of antibody responses to the SARS-CoV-2 mRNA
vaccine."
Emerg Infect Dis: Multinational Observational Cohort Study of COVID-19—Associated Pulmonary
Aspergillosis (15 September 2021)
"We performed an observational study to investigate intensive care unit incidence, risk
factors, and outcomes of coronavirus disease—associated pulmonary aspergillosis (CAPA).
We found 10%-15% CAPA incidence among 823 patients in 2 cohorts. Several factors were
independently associated with CAPA in 1 cohort and mortality rates were 43%-52%."
Lancet Regional Health: Vaccination reduces need for emergency care in breakthrough COVID-
19 infections: A multicenter cohort study (09 September 2021)
"Background: While recent literature has shown the efficacy of the SARS-CoV-2 vaccine in
preventing infection, its impact on need for emergency care/hospitalization in breakthrough
infections remain unclear, particularly in regions with a high rate of variant viral strains. We
aimed to determine if vaccination reduces hospital visits in breakthrough COVID-19.
Methods: This observational cohort analysis compared unvaccinated (UV), partially
vaccinated (PV), and fully vaccinated (FV) adult patients with SARS-CoV-2 infection requiring
emergency care(EC)/hospitalization within an eight-hospital system in Michigan.
Demographic and clinical variables were obtained from the electronic record. Vaccination
data was obtained from the Michigan Care Improvement Registry and Centers for Disease
Control vaccine tracker. Primary endpoint was rate of emergency care/hospitalization
encounters among patients diagnosed with COVID-19. Secondary outcome was severe
disease-composite outcome (ICU, mechanical ventilation, or in-hospital death).
Findings: Between December 15,2020 and April 30,2021, 11,834 EC encounters were
included:10,880 (91.9%) UV, 825 (7%) PV, 129 (1.1%) FV. Average age was 53.0 + 18.2 and
52.8% were female. Accounting for the SARS-CoV-2 vaccination population groups in
Michigan, the ED encounters/hospitalizations rate relevant to COVID-19 was 96% lower in
FV versus UV (multiplicative effect:0.04, 95% Cl 0.03 to 0.06, p < 0.001) in negative binomial
regression. COVID-19 EC visits rate peaked at 22.61, 12.88, and 1.29 visits per 100000 for
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the UV, PV, and FV groups, respectively. In the propensity-score matching weights analysis,
FV had a lower risk of composite disease compared to UV but statistically insignificant (HR
0.84, 95% Cl 0.52 to 1.38).
Interpretation: The need for emergency care/hospitalization due to breakthrough COVID-19
is an exceedingly rare event in fully vaccinated patients. As vaccination has increased
regionally, EC visits amongst fully vaccinated individuals have remained low and occur much
less frequently than unvaccinated individuals. If hospital-based treatment is required,
elderly patients with significant comorbidities are at high-risk for severe outcomes
regardless of vaccination status."
Treatments and Management
News in Brief
"Remdesivir reduces Covid hospitalizations when given early, study shows" (STAT; see also:
Gilead press release).
Around the Country
Alaska joins Idaho in shifting to crisis standards of care because of the volume of covid cases
needing medical intervention (CIDRAP).
One in four hospitals in the south have more than 95% of its ICU beds are occupied (NYT).
"Tennessee limiting monoclonal antibody treatment to unvaccinated residents" (NBC).
Animals Get Care, Too
"Gorillas at Zoo Atlanta are being treated after initial tests showed they were positive for the
coronavirus — and the zoo plans to vaccinate them once they recover" (\WP).
"9 lions and tigers at the National Zoo are being treated for COVID" (NPR).
Events
WHAT: COVID-19 and Crisis Standards of Care: The Fourth Wave and the Future Webinar
WHEN: held 17 September 2021, 2 hours long
DETAILS: "COVID-19 has fundamentally changed the delivery of health care services
worldwide, forcing difficult choices on health professionals and laying bare many
pre-existing health, medical, and public health sector frailties. A fourth wave of
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the pandemic, driven by the Delta variant, extreme shortages of key resources
have again brought the necessity of crisis standards of care to the forefront of
the minds of many clinicians and patients.
This webinar featured discussions on past and current challenges in ethically
allocating scarce resources in the face of surging demand, the health care
staffing crisis seen across the country, and identify possible solutions to real-time
issues and ways to ensure fair decisions are made even when systems are
strained."
WATCH: Links to YouTube channel and more at https://nam.edu/event/covid-19-and-
crisis-standards-of-care-the-fourth-wave-and-the-future-webinar
Journal Articles
Diving Hyperb Med: Efficacy and safety of hyperbaric oxygen treatment in SARS-COV-2 (COVID-
19) pneumonia: a systematic review (30 September 2021; accessed 24 September 2021)
"Introduction: The need for intubation and mechanical ventilation among COVID-19
patients is associated with high mortality rates and places a substantial burden on the
healthcare system. There is a strong pathophysiological rationale suggesting that hyperbaric
oxygen treatment (HBOT), a low-risk and non-invasive treatment, may be beneficial for
COVID-19 patients. This systematic review aimed to explore the potential effectiveness and
safety of HBOT for treating patients with COVID-19.
Methods: Medline, Embase, Scopus, and Google Scholar were searched from December
2019 to February 2021, without language restrictions. The grey literature was searched via
an internet search engine and targeted website and database searches. Reference lists of
included studies were searched. Independent reviewers assessed studies for eligibility and
extracted data, with disagreements resolved by consensus or a third reviewer. Risk of bias
was assessed using the Newcastle Ottawa Scale. Data were summarised descriptively.
Results: Six publications (one cohort study, five case reports/series) met the inclusion
criteria with a total of 37 hypoxaemic COVID-19 patients treated with HBOT. Of these 37
patients, the need for intubation and mechanical ventilation and in-hospital survival were
assessed for 26 patients across three studies. Of these 26 patients, intubation and
mechanical ventilation were not required for 24, and 23 patients survived. No serious
adverse events of HBOT in COVID-19 patients were reported. No randomised trials have
been published.
Conclusions: Limited and weak evidence from non-randomised studies including one
propensity-matched cohort study suggests HBOT is safe and may be a promising
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intervention to optimise treatment and outcomes in hypoxaemic COVID-19 patients.
Randomised controlled studies are urgently needed."
Clin Infect Dis: A Multi-center, Prospective, Observational-cohort controlled study of Clinical
Outcomes following COVID-19 Convalescent plasma therapy in hospitalized COVID-19 patients
(21 September 2021)
"Background: The SARS-CoV2 pandemic has caused high inpatient mortality and morbidity
throughout the world. COVID19 convalescent plasma has been utilized as a potential
therapy for patients hospitalized with COVID19 pneumonia. This study evaluated the
outcomes of hospitalized COVID19 patients treated with COVID19 convalescent plasma ina
prospective, observational multicenter trial.
Methods: From April 2020 through August 2020, hospitalized COVID19 patients at 16
participating hospitals in Colorado were enrolled and treated with COVID19 convalescent
plasma (CCP) and compared to hospitalized patients with COVID19 who were not treated
with convalescent plasma. Plasma antibody levels were determined following the trial given
that antibody tests were not approved at the initiation of the trial. CCP-treated and
untreated COVID19 hospitalized patients were matched using propensity scores followed by
analysis for length of hospitalization and inpatient mortality.
Results: 542 total hospitalized COVID19 patients were enrolled at 16 hospitals across the
region. A total of 468 hospitalized COVID19 patients were entered into propensity score
matching with 188 patients matched for analysis in the CCP-treatment and control arms.
Fine-Gray models revealed increased length of hospital stay in CCP-treated patients and no
change in inpatient mortality compared to controls. In subgroup analysis of CCP-treated
patients within 7 days of admission, there was no difference in length of hospitalization and
inpatient mortality.
Conclusions: These data show that treatment of hospitalized COVID19 patients with CCP did
not significantly improve patient hospitalization length of stay or inpatient mortality."
Clin Infect Dis: Randomized study of rivaroxaban vs. placebo on disease progression and
symptoms resolution in high-risk adults with mild COVID-19 (15 September 2021)
"Background: SARS-CoV-2 infection may be associated with a prothrombotic state,
predisposing patients for a progressive disease course. We investigated whether
rivaroxaban, a direct oral anticoagulant factor Xa inhibitor would reduce COVID-19
progression.
Methods: Adults (N=497) symptomatic with mild COVID-19 and at high-risk for COVID-19
progression based on age, body mass index, or comorbidity were randomized 1:1 to either
daily oral rivaroxaban 10 mg (N=246) or placebo-equivalent (N=251) for 21 days and
followed to Day 35. Primary endpoints were safety and progression to moderate or severe
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disease, per the Gates MRI scale. Absolute difference in progression risk was assessed using
a stratified Miettinen and Nurminen method.
Results: The study was terminated after 497 of target 600 participants were enrolled due to
a pre-specified interim analysis of the first 200 participants which crossed the futility
boundary for the primary efficacy endpoint in the Intent to Treat population. Enrollees were
85% aged < 65 years old, 60% female, 27% Hispanic, Black or other minorities and 69% with
>2 comorbidities. Rivaroxaban was well-tolerated. Disease progression rates were 46/222
(20.7%) in rivaroxaban vs. 44/222 (19.8%) in placebo groups, with a risk difference of -1.0,
95% Cl, -6.4 to 8.4; P = 0.78.
Conclusions: Our study did not demonstrate an impact of rivaroxaban on disease
progression in high-risk adults with mild COVID-19. There remains a critical public health
gap in identifying scalable effective therapies for high-risk people in the outpatient setting
to prevent COVID-19 progression."
Lancet Infect Dis: Remdesivir plus standard of care versus standard of care alone for the
treatment of patients admitted to hospital with COVID-19 (DisCoVeRy): a phase 3, randomised
controlled, open-label trial (14 September 2021)
"Background: The antiviral efficacy of remdesivir against SARS-CoV-2 is still controversial.
We aimed to evaluate the clinical efficacy of remdesivir plus standard of care compared
with standard of care alone in patients admitted to hospital with COVID-19, with indication
of oxygen or ventilator support.
Methods: DisCoVeRy was a phase 3, open-label, adaptive, multicentre, randomised,
controlled trial conducted in 48 sites in Europe (France, Belgium, Austria, Portugal,
Luxembourg). Adult patients (aged >18 years) admitted to hospital with laboratory-
confirmed SARS-CoV-2 infection and illness of any duration were eligible if they had clinical
evidence of hypoxaemic pneumonia, or required oxygen supplementation. Exclusion criteria
included elevated liver enzymes, severe chronic kidney disease, any contraindication to one
of the studied treatments or their use in the 29 days before random assignment, or use of
ribavirin, as well as pregnancy or breastfeeding. Participants were randomly assigned
(1:1:1:1:1) to receive standard of care alone or in combination with remdesivir, lopinavir—
ritonavir, lopinavir-ritonavir and interferon beta-1a, or hydroxychloroquine. Randomisation
used computer-generated blocks of various sizes; it was stratified on severity of disease at
inclusion and on European administrative region. Remdesivir was administered as 200 mg
intravenous infusion on day 1, followed by once daily, 1-h infusions of 100 mg up to 9 days,
for a total duration of 10 days. It could be stopped after 5 days if the participant was
discharged. The primary outcome was the clinical status at day 15 measured by the WHO
seven-point ordinal scale, assessed in the intention-to-treat population. Safety was assessed
in the modified intention-to-treat population and was one of the secondary outcomes. This
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trial is registered with the European Clinical Trials Database, EudraCT2020-000936-23, and
ClinicalTrials.gov, NCT04315948.
Findings: Between March 22, 2020, and Jan 21, 2021, 857 participants were enrolled and
randomly assigned to remdesivir plus standard of care (n=429) or standard of care only
(n=428). 15 participants were excluded from analysis in the remdesivir group, and ten in the
control group. At day 15, the distribution of the WHO ordinal scale was: (1) not hospitalised,
no limitations on activities (61 [15%] of 414 in the remdesivir group vs 73 [17%] of 418 in
the control group); (2) not hospitalised, limitation on activities (129 [31%] vs 132 [32%]); (3)
hospitalised, not requiring supplemental oxygen (50 [12%] vs 29 [7%]); (4) hospitalised,
requiring supplemental oxygen (76 [18%] vs 67 [16%]); (5) hospitalised, on non-invasive
ventilation or high flow oxygen devices (15 [4%] vs 14 [3%]); (6) hospitalised, on invasive
mechanical ventilation or extracorporeal membrane oxygenation (62 [15%] vs 79 [19%]); (7)
death (21 [5%] vs 24 [6%]). The difference between treatment groups was not significant
(odds ratio 0-98 [95% Cl 0:77-1:25]; p=0-85). There was no significant difference in the
occurrence of serious adverse events between treatment groups (remdesivir, 135 [33%] of
406 vs control, 130 [31%] of 418; p=0-48). Three deaths (acute respiratory distress
syndrome, bacterial infection, and hepatorenal syndrome) were considered related to
remdesivir by the investigators, but only one by the sponsor's safety team (hepatorenal
syndrome).
Interpretation: No clinical benefit was observed from the use of remdesivir in patients who
were admitted to hospital for COVID-19, were symptomatic for more than 7 days, and
required oxygen support."
Nat Commun: New-onset IgG autoantibodies in hospitalized patients with COVID-19 (14
September 2021)
"COVID-19 is associated with a wide range of clinical manifestations, including autoimmune
features and autoantibody production. Here we develop three protein arrays to measure
IgG autoantibodies associated with connective tissue diseases, anti-cytokine antibodies, and
anti-viral antibody responses in serum from 147 hospitalized COVID-19 patients.
Autoantibodies are identified in approximately 50% of patients but in less than 15% of
healthy controls. When present, autoantibodies largely target autoantigens associated with
rare disorders such as myositis, systemic sclerosis and overlap syndromes. A subset of
autoantibodies targeting traditional autoantigens or cytokines develop de novo following
SARS-CoV-2 infection. Autoantibodies track with longitudinal development of IgG antibodies
recognizing SARS-CoV-2 structural proteins and a subset of non-structural proteins, but not
proteins from influenza, seasonal coronaviruses or other pathogenic viruses. We conclude
that SARS-CoV-2 causes development of new-onset IgG autoantibodies in a significant
proportion of hospitalized COVID-19 patients and are positively correlated with immune
responses to SARS-CoV-2 proteins."
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Pre-Existing Conditions, Comorbidities, and Impact on Other Health Issues
News in Brief
"Alabama heart patient dies after hospital contacts 43 ICUs in 3 states — 'He would not want
any other family to go through what his did,’ his family said" (NBC).
"A boy went to a COVID-swamped ER. He waited for hours. Then his appendix burst — Non-
COVID patients are paying a price as the delta variant and low-vaccination rates overwhelm
hospitals across the country. 'Wait times can now be measured in days,’ said an expert"
(ProPublica).
Journal Articles
JAMA Netw Open: Trends in Outpatient Antibiotic Prescriptions in the United States During the
COVID-19 Pandemic in 2020 (22 September 2021)
"This cross-sectional study examines the prescription fills of commonly prescribed
outpatient antibiotics in the US through the end of 2020."
JAMA Netw Open: Association of Health Care Factors With Excess Deaths Not Assigned to
COVID-19 in the US (13 September 2021)
"In this cross-sectional study, a greater proportion of excess deaths were not assigned to
COVID-19 in counties with reduced access to health insurance and primary care and in
counties with more at-home deaths. Reduced access to health care may prevent a patient
from receiving COVID-19 testing and diagnosis, which may reduce the probability of valid
cause-of-death assignment. Counties in which residents were more likely to die at home
may have been places where indirect deaths, such as deaths from drug overdose, were
more likely to have occurred; however, these factors were beyond the scope our study."
Long COVID / Post-COVID Period
News in Brief
"'Post-vax COVID' is a new disease — Eventually we might all have to deal with COVID-19—but
a shorter, gentler version, thanks to vaccines" (Atlantic).
"Study of up to 40,000 people will probe mysteries of Long Covid — Award of $470 million from
the National Institutes of Health will enroll volunteers with long-term symptoms after
coronavirus infection" (Science).
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Upcoming Events
WHAT:
WHEN:
OVERVIEW:
WEBSITE:
Evaluating and Supporting Patients Presenting With Fatigue Following COVID-19
— free; can earn continuing education
Thursday, 30 September 2021 1400-1500 ET
"During this COCA Call, presenters will discuss Post-COVID conditions (PCC), an
umbrella term for the wide range of health consequences present four or more
weeks after infection with SARS-CoV-2, which includes Long-COVID. It can be
difficult to distinguish symptoms of fatigue and post-exertional malaise caused
by PCC from symptoms that occur for other reasons. The American Academy of
Physical Medicine and Rehabilitation (AAPM&R) has recently published a Multi-
Disciplinary Collaborative Consensus Guidance Statement on the Assessment
and Treatment of Fatigue in PCC. It provides practical guidance to clinicians
when assessing and treating individuals with fatigue and a history consistent
with PCC. The burden of PCC is expected to reflect the disproportionate burden
of infection by race, ethnicity, and socioeconomic status and to highlight ongoing
inequities in healthcare. The Health Equity Work Group of the AAPM&R has
developed guidance to highlight the central role that principles of diversity,
equity, and inclusion play in delivering quality healthcare."
https://emergency.cdc.gov/coca/calls/2021/callinfo 093021.as
Journal Articles
JAMA Netw Open: Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults: A
Systematic Review (22 September 2021)
"Question: What are the clinical characteristics of multisystem inflammatory syndrome in
adults (MIS-A)?
Findings: This systematic review of patients with MIS-A reported in the literature and to the
US Centers for Disease Control and Prevention identified 221 patients worldwide. The
syndrome presented approximately 4 weeks after acute COVID-19 with hyperinflammation
and extrapulmonary multiorgan involvement that may be difficult to discern from acute
biphasic COVID-19 and postacute sequelae of SARS-CoV-2 infection.
Meaning: These findings suggest that MIS-A occurs in the postacute COVID-19 period with a
heterogeneous clinical presentation likely owing to a dysregulated immune response."
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MMWR: Post-Acute Sequelae of SARS-CoV-2 Infection Among Adults Aged 218 Years — Long
Beach, California, April 1-December 10, 2020 (17 September 2021)
"What is already known about this topic? The term “long COVID” is used to describe post-
acute sequelae and long-term symptoms that can be experienced from weeks to months by
persons recovering from COVID-19.
What is added by this report? In a random sample of recovered COVID-19 patients in Long
Beach, California, one third of participants reported post-acute sequelae 2 months after
their positive test result, with higher rates reported among persons aged 240 years,
females, persons with preexisting conditions, and Black persons.
What are the implications for public health practice? Identification of populations
disproportionately affected by COVID-19 and long COVID can help guide efforts to prioritize
prevention and treatment."
JACC Basic Transl Sci: Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2
Infection: A State-of-the-Art Review (15 September 2021)
"The vast majority of patients (>99%) with severe acute respiratory syndrome coronavirus 2
survive immediate infection but remain at risk for persistent and/or delayed multisystem.
This review of published reports through May 31, 2021, found that manifestations of
postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC)
affect between 33% and 98% of coronavirus disease 2019 survivors and comprise a wide
range of symptoms and complications in the pulmonary, cardiovascular, neurologic,
psychiatric, gastrointestinal, renal, endocrine, and musculoskeletal systems in both adult
and pediatric populations. Additional complications are likely to emerge and be identified
over time. Although data on PASC risk factors and vulnerable populations are scarce,
evidence points toa RG Neurologic Psychiatric/mental health A a My
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Women's Health, Pregnancy, and Perinatal Care
Journal Articles
Clin Infect Dis: Congenital infection of SARS-CoV-2 with intrauterine foetal death: a
clinicopathological study with molecular analysis (23 September 2021)
"Observations of vertical transmission of SARS-CoV-2 infection from mother to foetus have
recently been described in the literature. However, the consequences of such transmission,
whether foetal or neonatal, are poorly understood. From a case of in utero foetal death at
24 +2 weeks of gestation that occurred seven days after the diagnosis of symptomatic SARS-
CoV-2 infection in the mother, we isolated the incriminating virus by immunochemistry and
molecular techniques in several foetal tissues, with a variant analysis of the SARS-CoV-2
genome. Moreover, the foetal demise could be explained by the presence of placental
histological lesions, such as histiocytic intervillositis and trophoblastic necrosis, in addition
to foetal tissue damage. We observed mild foetal growth retardation and visceral damage
to the liver, causing hepatocellular damage and haemosiderosis. To the best of our
knowledge, this is the first report in the literature of foetal demise secondary to maternal-
foetal transmission of SARS-CoV-2 with a congenital infection and a pathological description
of placental and foetal tissue damage. SARS-CoV-2 was identified in both specimens by
three independent techniques (immunochemistry, RT-qPCR and RT-dPCR). Furthermore, the
incriminating variant has been identified."
JAMA Netw Open: Factors Associated With Changes in Pregnancy Intention Among Women
Who Were Mothers of Young Children in New York City Following the COVID-19 Outbreak (15
September 2021)
"Question: Were there changes in pregnancy intentions anong women who were mothers
of young children around the peak of the first wave of COVID-19 in New York City?
Findings: In this cross-sectional study of 1179 women in New York City who were mothers
of young children, nearly half of those who had been attempting to become pregnant and
more than a third who had been thinking about trying before the COVID-19 pandemic
stopped in the first few months of the outbreak. Women who responded to a survey during
the lockdown were more likely to cease attempts or plans to become pregnant.
Meaning: The results of this study suggest that the outbreak of the COVID-19 pandemic was
associated with fewer women planning or attempting to become pregnant; these findings
may have long-term effects on fertility rates."
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Pediatric Population
News in Brief
The Pfizer vaccine could be authorized for children aged 5-11 as early as October, according to
sources (Reuters).
"Covid likely led to a rare disorder that left 8-year-old girl paralyzed" (NBC).
The CDC has developed print materials on multisystem inflammatory syndrome in children to
educate physicians and fact sheets for parents (CDC).
"We know students are struggling with their mental health. Here's how you can help" (NPR).
"Scientists examine kids' unique immune systems as more fall victim to Covid" (KHN).
Journal Articles
MMWR: Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic
Among Persons Aged 2-19 Years — United States, 2018-2020 (17 September 2021)
"What is already known about this topic? The COVID-19 pandemic led to school closures,
disrupted routines, increased stress, and less opportunity for physical activity and proper
nutrition, leading to weight gain among children and adolescents.
What is added by this report? Among a cohort of 432,302 persons aged 2-19 years, the rate
of body mass index (BMI) increase approximately doubled during the pandemic compared
to a prepandemic period. Persons with prepandemic overweight or obesity and younger
school-aged children experienced the largest increases.
What are the implications for public health practice? Obesity prevention and management
efforts during and following the COVID-19 pandemic could include health care provider
screening for BMI, food security, and social determinants of health, and increased access to
evidence-based pediatric weight management programs and food assistance resources."
JAMA Ophthalmol: Rates of Myopia Development in Young Chinese Schoolchildren During the
Outbreak of COVID-19 (16 September 2021)
"Question: Were environmental changes during the outbreak of COVID-19 associated with
increased development of myopia in young schoolchildren in China?
Findings: In this observational study longitudinally monitoring 2114 students from grade 2
to grade 3, myopia incidence doubled from November and December 2019 to November
and December 2020 compared with the same period from 2018 to 2019. The proportion of
children without myopia and with spherical equivalent refraction greater than -0.50 D and
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less than or equal to +0.50 D in grade 3 had increased by 18% by November and December
2020 compared with the same period in 2019.
Meaning: These data suggest that development of myopia in young Chinese schoolchildren
may have increased during the COVID-19 outbreak; the long-term impact of environmental
changes during the COVID-19 outbreak period on the development of myopia in children
needs further investigation."
J Hosp Med: Factors Associated With COVID-19 Disease Severity in US Children and Adolescents
(15 September 2021)
"BACKGROUND: Little is known about the clinical factors associated with COVID-19 disease
severity in children and adolescents.
METHODS: We conducted a retrospective cohort study across 45 US children’s hospitals
between April 2020 to September 2020 of pediatric patients discharged with a primary
diagnosis of COVID-19. We assessed factors associated with hospitalization and factors
associated with clinical severity (eg, admission to inpatient floor, admission to intensive
care unit [ICU], admission to ICU with mechanical ventilation, shock, death) among those
hospitalized.
RESULTS: Among 19,976 COVID-19 encounters, 15,913 (79.7%) patients were discharged
from the emergency department (ED) and 4063 (20.3%) were hospitalized. The clinical
severity distribution among those hospitalized was moderate (3222, 79.3%), severe (431,
11.3%), and very severe (380, 9.4%). Factors associated with hospitalization vs discharge
from the ED included private payor insurance (adjusted odds ratio [aOR],1.16; 95% Cl, 1.1-
1.3), obesity/type 2 diabetes mellitus (type 2 DM) (aOR, 10.4; 95% Cl, 8.9-13.3), asthma
(aOR, 1.4; 95% Cl, 1.3-1.6), cardiovascular disease, (aOR, 5.0; 95% Cl, 4.3-5.8),
immunocompromised condition (aOR, 5.9; 95% Cl, 5.0-6.7), pulmonary disease (aOR, 5.3;
95% Cl, 3.4-8.2), and neurologic disease (aOR, 3.2; 95% Cl, 2.7-5.8). Among children and
adolescents hospitalized with COVID-19, greater disease severity was associated with Black
or other non-White race; age greater than 4 years; and obesity/type 2 DM, cardiovascular,
neuromuscular, and pulmonary conditions.
CONCLUSIONS: Among children and adolescents presenting to US children’s hospital EDs
with COVID-19, 20% were hospitalized; of these, 21% received care in the ICU. Older
children and adolescents had a lower risk for hospitalization but more severe illness when
hospitalized. There were differences in disease severity by race and ethnicity and the
presence of selected comorbidities. These factors should be taken into consideration when
prioritizing mitigation and vaccination strategies."
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Healthcare Workers
News in Brief
"CDC to invest $2.1 billion to protect patients and healthcare workers from COVID-19 and
future infectious diseases" (CDC).
"Cincinnati area hospitals boost security against ‘violence, vile words,' key leader says"
(Cincinnati Enquirer; see also: Health Security review articles, below).
The Pause app, based on a movement introduced by Jonathan Bartels RN, is to "honor a patient
and the caregiver team" by offering a 15-30 second period of silence after a death (Pause app).
Special Reports and Other Resources
JHCHS: Mental Health and Social Support for Healthcare and Hospital Workers During the
COVID-19 Pandemic (23 September 2021)
"Healthcare and hospital workers providing care and support to infected patients during a
pandemic are at increased risk for mental distress. Factors impacting their mental health
include high risk of exposure and infection, financial insecurity due to furloughs, separation
from and worries about loved ones, a stressful work environment due to surge conditions
with scarce supplies, traumatic experiences due to witnessing the deaths of patients and
colleagues, and other acute stressors. Finding ways for institutions to support the mental
wellbeing of healthcare and hospital workers in an acute pandemic-related crisis situation is
of critical importance. The factors affecting mental health are deeply connected to work-
related motivation and attendance. Willingness to come to work is multifactorial and is
dependent upon an individual’s self-perception of risk, as well as having the skills and
resources necessary to perform work tasks given the nature of the public health emergency.
Social and material support for healthcare workers in a variety of high-stress and high-risk
settings is important for supporting workers' mental health and in maintaining their
commitment in challenging conditions.
The impact of the COVID-19 pandemic on healthcare workers has been profound,
characterized by death, disability, and an untenable burden on mental health and
wellbeing. Lost on the Frontline, a report published by The Guardian and Kaiser Health
Network in April 2021, revealed that more than 3,600 healthcare workers in the United
States had died of COVID-19. While the median age of death due to COVID-19 was 78 years,
in healthcare workers, it was 59. Two-thirds of deceased healthcare workers were people of
color, revealing the deep inequities tied to race, ethnicity, and economic status in America's
healthcare workforce. Lower-paid workers who handled everyday patient care, including
nurses, support staff, and nursing home employees, were far more likely to die in the
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pandemic than physicians. Only 30% of the deaths were among hospital workers, with few
employed by well-funded academic medical centers. Healthcare workers were 3 times more
likely to contract COVID-19 than the general public. Detrimental effects also experienced by
healthcare and hospital workers included financial hardship, stress related to known and
unknown information, and fear of the uncertainty regarding continued progression of the
pandemic. As of August 2021, the COVID-19 pandemic is far from over and its full impact
upon hospital and healthcare workers remains unknown.
The Johns Hopkins Health System (JHHS) operates in 2 states and the District of Columbia.
Johns Hopkins Medicine (JHM) is the robust partnership between JHHS and the Johns
Hopkins University School of Medicine, with a workforce of approximately 53,000
employees and a very limited number of contract workers. JHHS and JHM have played a
leadership role during the COVID-19 response both nationally, by producing and sharing
data to inform decisionmaking and evidence-based guidelines for response, and regionally,
in accepting large numbers of patients during the surge. Prior to the onset of the pandemic,
JHHS and JHM leadership had established a commitment to employee mental health and
wellbeing through substantial investments and the implementation of numerous programs
to support employees. However, even with the presence of these dedicated resources,
clinical and nonclinical staff have reported high levels of stress, anxiety, and burnout.
To identify the issues most critical to healthcare workers' mental health, wellbeing, and
motivation during the COVID-19 pandemic, we conducted a cross-sectional survey (1,189
responses) and 73 semistructured interviews with individuals currently employed at JHHS
and JHM hospitals located in Maryland and the District of Columbia. Our study population
included healthcare providers and direct support services staff, including workers in
frontline environmental services, food services, and security.
The responses from our survey and interviews revealed that the trauma of witnessing
COVID-19 death was exacerbated by the general stress of working during the pandemic and
that the significant mental health burden created by the pandemic/infectious disease
environment itself was characterized by the ongoing uncertainty and ambiguity about the
scientific understanding of the virus. Additionally, stressors negatively impacting employee
mental health stemmed from the workplace, resulting in reduced trust of and increased
perceptions of betrayal in the institution.
Although our findings are specific to one academic health system, they may be relevant to
other hospitals and health systems. Studies such as this offer an important window into
learning more about employee health from the unique stress and trauma of the COVID-19
pandemic and can facilitate progress toward a health system that communicates value and
prioritizes safety for all staff."
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Journal Articles
Infect Control Hosp Epidemiol: COVID-19 Vaccine Hesitancy among Physicians, Physician
Assistants, Nurse Practitioners, and Nurses in Two Academic Hospitals in Philadelphia (20
September 2021)
"Objective: To evaluate COVID-19 vaccine hesitancy among health care personnel (HCP)
with significant clinical exposure to COVID-19 at two large, academic hospitals in
Philadelphia.
Design, setting and participants: HCP were surveyed between November-December 2020
about their intention to receive the COVID-19 vaccine.
Methods: The survey measured the intent among HCP to receive a COVID-19 vaccine, timing
of vaccination, and reasons for or against vaccination. Among patient-facing HCP,
multivariate regression evaluated the associations between healthcare positions (MD,
NP/PA, RN) and vaccine hesitancy (intending to decline, delay, or were unsure about
vaccination), adjusting for demographic characteristics, reasons why or why not to receive
the vaccine, and prior receipt of routine vaccines.
Results: Among 5,929 HCP (2,253 MDs/DOs, 582 NPs, 158 PAs, and 2,936 nurses), a higher
proportion of nurses (47.3%) were COVID-vaccine hesitant compared with 30.0% of
PAs/NPs and 13.1% of MDs/DOs. The most common reasons for vaccine hesitancy included
concerns about side effects, the newness of the vaccines, and lack of vaccine knowledge.
Regardless of position, Black HCP were more hesitant than White HCP (OR~5) and females
were more hesitant than males (OR~2).
Conclusion: Although a majority of clinical HCP intended to receive a COVID-19 vaccine,
intention varied by healthcare position. Consistent with other studies, hesitancy was also
significantly associated with race/ethnicity across all positions. These results underline the
importance of understanding and effectively addressing reasons for hesitancy, especially
among frontline HCP who are at increased risk of COVID exposure and play a critical role in
recommending vaccines to patients."
Disaster Med Public Health Prep: Occupational Health and Safety Measures in Healthcare
Settings During COVID-19: Strategies for Protecting Staff, Patients and Visitors (14 September
2021)
"The COVID-19 (SARS-CoV-2) pandemic has profoundly impacted almost every aspect of
healthcare systems worldwide, placing the health and safety of frontline healthcare workers
at risk and still continues to remain an important public health challenge. Several hospitals
have put in place strategies to manage space, staff, and supplies in order to continue to
deliver optimum care to patients while at the same time protecting the health and safety of
staff and patients. However, the emergence of the second and third waves of the virus with
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the influx of new cases continue to add an additional level of complexity to the already
challenging situation of containing the spread and lowering the rate of transmission and
thus pushing healthcare systems to the limit.
In this narrative review paper we describe various strategies including administrative
controls, environmental controls and use of personal protective equipment implemented by
occupational health and safety departments for the protection of healthcare workers,
patients and visitors from SARS-CoV-2 virus infection. The protection and safeguard of the
health and safety of healthcare workers and patients through the implementation of
effective infection control measures, adequate management of possible outbreaks and
minimization of risk of nosocomial transmission is an important and effective strategy of
SARS-CoV-2 pandemic management in any healthcare facility. High quality patient care
hinges on ensuring that the care providers are well protected and supported so they can
provide the best quality of care to their patients."
Threats
Health Secur: Terrorist Attacks Against Vaccinators: A Review (16 September 2021)
"Vaccinators fulfill an important role in a nation's public health by reducing the burden of
disease on the population. Understanding patterns of attack employed against vaccinators
is important to determine how to protect them. We conducted a search of the Global
Terrorism Database for terrorist attacks against vaccinators that occurred between the
years 1970 and 2018.
Using the search terms "hospital," "healthcare," "clinic," "doctor," "nurses,
and "vaccinations," 2,322 healthcare-related entries were identified. We then manually
searched the dataset for incidents related to attacks on vaccinators, which resulted in the
identification of 133 attacks against vaccinators. The majority (128 out of 133) of attacks
occurred during or after 2010. Every attack except one has occurred in the Middle East,
South Asia, or sub-Saharan Africa. Pakistan has seen the most attacks against vaccinators,
with 112 incidents recorded. Vaccinators continue to be vulnerable to terrorist attacks.
Protection of healthcare personnel during mass vaccination efforts is critical so that they
can continue their life saving mission."
vaccinators,"
See also: Terrorist Attacks Against Healthcare Facilities: A Review
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Disparities and Health Equity
News in Brief
Long read: "'Health equity tourists': How white scholars are colonizing research on health
disparities" (STAT).
Upcoming Events
WHAT: 13th Annual Fighting Asthma Disparities Summit
Collaborating to Break Down Barriers in Pediatric Asthma Care
WHEN: Tuesday, 05 October 2021 0830-1400 EDT
— free, virtual event
ABOUT: "The Virtual 13th Annual Fighting Asthma Disparities Summit will focus on
breaking down barriers in pediatric asthma care. Experts will discuss the physical
and emotional impact of housing insecurity on children’s health as well as
environmental asthma triggers in urban schools. A thorough overview of SMART
therapy, a relatively novel approach to managing asthma, will also be presented.
Breakout Session Topics:
e Caring for a child with asthma during the pandemic
e How Medicaid Managed Care Organizations are navigating the pandemic
e Improving asthma outcomes through structural home repairs
e Coordinating home- and school-based asthma care - prior to the
pandemic"
Register at: https://www.eventbrite.com/e/13th-annual-fighting-asthma-
disparities-summit-tickets-169177050111
Journal Articles
JAMA Health Forum: Disparities in SARS-CoV-2 Vaccination-to-Infection Risk During the COVID-
19 Pandemic in Massachusetts (17 September 2021)
"In this cohort study, analysis of SARS-CoV-2 vaccination indicated structural disparity in
vaccine distribution with lower vaccine coverage to infection risk in communities with
increased socioeconomic vulnerability and larger proportions of Black and Latinx
individuals."
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JAMA Health Forum: Prioritizing Equity and Diversity in Academic Medicine Faculty Recruitment
and Retention (10 September 2021)
"This essay examines groups that are underrepresented in the medical workforce, how the
COVID-19 pandemic may affect these groups, and suggests strategies for addressing these
issues."
Risk, Transmission, and Exposure
News in Brief
"FDA authorizes bamlanivimab and etesevimab monoclonal antibody therapy for post-exposure
prophylaxis (prevention) for COVID-19" (FDA; see also: Lilly press release).
"Israel's struggles to contain COVID-19 may be a warning for other nations — Widespread
boosters don't dent case rate as schools, holidays foster spread" (Science).
Travel
"Coronavirus-sniffing dogs unleashed at Miami airport to detect virus in employees" (WP).
"TSA is doubling fines for those who refuse to wear a mask while flying" (NPR).
"Can 'zero COVID' countries continue to keep the virus at bay once they reopen? Successful
strategies used in Asia and the Pacific may not be sustainable in the long run" (Science).
Journal Articles
Clin Infect Dis: Risk of SARS-CoV-2 Transmission among Air Passengers in China (21 September
2021)
"Background: Modern transportation plays a key role in the spread of SARS-CoV-2 and new
variants. However, little is known about the exact transmission risk of the virus on airplanes.
Methods: Using the itinerary and epidemiological data of COVID-19 cases and close contacts
on domestic airplanes departing from Wuhan city in China before the lockdown on January
23, 2020, we estimated the upper and lower bounds of overall transmission risk of COVID-
19 among travellers.
Results: 175 index cases were identified among 5797 passengers on 177 airplanes. The
upper and lower attack rates (ARs) of a seat were 0.60% (34/5622, 95%Cl 0.43%-0.84%) and
0.33% (18/5400, 95%Cl 0.21%-0.53%), respectively. In the upper- and lower-bound risk
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estimates, each index case infected 0.19 (SD 0.45) and 0.10 (SD 0.32) cases respectively. The
seats immediately adjacent to the index cases had an AR of 9.2% (95%CI 5.7%-14.4%), with
a relative risk 27.8 (95%CI 14.4-53.7) compared to other seats in the upper limit estimation.
The middle seat had the highest AR (0.7%, 95%CI 0.4%-1.2%). The upper-bound AR
increased from 0.7% (95%Cl 0.5%-1.0%) to 1.2% (95%Cl 0.4%-3.3%) when the co-travel time
increased from 2.0 hours to 3.3 hours.
Conclusions: The ARs among travellers varied by seat distance from the index case and joint
travel time, but the variation was not significant between the types of aircraft. The overall
risk of SARS-CoV-2 transmission during domestic travel on planes was relatively low. These
findings can improve our understanding of COVID-19 spread during travel and inform
response efforts in the pandemic."
Clin Infect Dis: Infectious SARS-CoV-2 in Exhaled Aerosols and Efficacy of Masks During Early
Mild Infection (14 September 2021)
"Background: SARS-CoV-2 epidemiology implicates airborne transmission; aerosol
infectiousness and impacts of masks and variants on aerosol shedding are not well
understood.
Methods: We recruited COVID-19 cases to give blood, saliva, mid-turbinate and fomite
(phone) swabs, and 30-minute breath samples while vocalizing into a Gesundheit-ll, with
and without masks at up to two visits two days apart. We quantified and sequenced viral
RNA, cultured virus, and assayed sera for anti-spike and anti-receptor binding domain
antibodies.
Results: We enrolled 49 seronegative cases (mean days post onset 3.8 +2.1), May 2020
through April 2021. We detected SARS-CoV-2 RNA in 45% of fine (<5 um), 31% of coarse (>5
um) aerosols, and 65% of fomite samples overall and in all samples from four alpha-variant
cases. Masks reduced viral RNA by 48% (95% confidence interval [Cl], 3 to 72%) in fine and
by 77% (95% Cl, 51 to 89%) in coarse aerosols; cloth and surgical masks were not
significantly different. The alpha variant was associated with a 43-fold (95% Cl, 6.6 to 280-
fold) increase in fine aerosol viral RNA, compared with earlier viruses, that remained a
significant 18-fold (95% Cl, 3.4 to 92-fold) increase adjusting for viral RNA in saliva, swabs,
and other potential confounders. Two fine aerosol samples, collected while participants
wore masks, were culture-positive.
Conclusion: SARS-CoV-2 is evolving toward more efficient aerosol generation and loose-
fitting masks provide significant but only modest source control. Therefore, until
vaccination rates are very high, continued layered controls and tight-fitting masks and
respirators will be necessary."
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Health Messaging and Misinformation
News in Brief
"No, vaccinated people are not ‘just as likely' to spread the coronavirus as unvaccinated people.
This has become a common refrain among the cautious—and it's wrong" (Atlantic).
"Doctors warn consuming Betadine won't cure COVID, could be deadly" (OKC Fox; see also:
JAMA Otolaryngol Head Neck article that could be problematic and misunderstood).
Nebulized hydrogen peroxide is also being pushed on Facebook and other groups
(@oneunderscore_Twitter thread).
"How ivermectin became the new focus of the anti-vaccine movement" (NPR).
Misinfo and Docs
"Oregon doc loses license for not wearing a mask, spreading misinformation" (Medpage).
Meanwhile... "Ohio Medical Board renews license of Sherri Tenpenny, doctor who claims
vaccines make you magnetic" (USA Today).
And... "This doctor spread false information about COVID. She still kept her medical license"
(NPR).
In Florida, the new surgeon general opposes mask and vaccine mandates (Miami Herald).
Journal Articles
JAMA Psychiatry: Ways That Mental Health Professionals Can Encourage COVID-19 Vaccination
(23 September 2021)
"This Viewpoint reviews what little is known about mental health and vaccination behavior
and addresses 3 areas for intervention by mental health professionals, based on the
Increasing Vaccination Model. ...
Although mental health is not the first thing that comes to mind when thinking about
vaccination, strategic use of mental health professionals' expertise could provide new
opportunities to encourage COVID-19 vaccination. A better understanding of how mental
health affects receipt of COVID-19 vaccines and better defining how mental health
professionals can help, particularly for disproportionately affected communities, is
fundamentally important now and could strengthen vaccination efforts."
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Commun: Disinformation about COVID-19 Preventions and Treatments: Analysis of USFDA
Warning Letters (20 September 2021)
"COVID-19 poses a challenge beyond the virus itself, in that lockdown has been associated
increased use of the internet and social media. Disinformation about prevention and
treatment strategies for COVID-19 can have lethal consequences. The United States Food
and Drug Administration (USFDA) is currently monitoring the compliance of manufacturing
firms as well as medicinal product advertisers to the Federal Food, Drug, and Cosmetic Act,
21 USC § 321(h) regulations. In the event of noncompliance in the form of advertising
products without prior USFDA approval for specific indications, doses, or route of
administration, warning letters (WLs) are issued. WLs are intended to address the concerns
identified by USFDA and encourage the recipient to take corrective steps to avoid similar
instances in the future. We analyzed 182 WLs that were issued for noncompliance with
drugs/devices related to either treatment, prevention, or testing of COVID-19 infections.
The medicinal product website was identified as the major source of disinformation,
followed by disseminated information on Facebook, Twitter, and Instagram. Nearly four-
fifths were related to drugs, followed by devices and biologicals. Several biologicals, as well
as allopathic, herbal, and non-herbal drugs were identified in the WLs. We observed that
noncompliance with the USFDA regulations in terms of advertising a variety of products for
prevention and treatment of COVID-19 infection was widely prevalent. More efforts are
required by the respective national drug regulatory authorities to initiate or continue their
monitoring of disinformation that may have lethal consequences."
Other Infectious Diseases and Public Health Issues
News in Brief
The CDC has issued guidance to clinicians who are caring for Afghan refugees (CDC).
By executive order, measles is now on the list of quarantinable communicable diseases
(WH.gov).
Speaking of measles, Nigeria reported 10K suspected cases since beginning of the year (ONT).
Officials have reported 2 new cases of Alaskapox, a novel orthopox first reported in Fairbanks in
2015 (ADHSS [pdf]).
Thirty cases of pneumonic plague have been reported in Madagascar (ECDC [pdf]); there was
also one (assumed to be unrelated) case reported in Wyoming in a person who had contact
with sick pet cats (WDH).
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Dozens of people, many of them children, have died in a dengue outbreak in India (Al Jazeera).
Also in India: "Why the world should be more than a bit worried about India's Nipah virus
outbreak" (NPR).
"The next health threat is here — action is needed on anti-microbial resistance" (Hill).
"Artemisinin-resistant malaria detected in Uganda" (CIDRAP; see also: NEJM article).
"Two-dose J&J Ebola vaccine gives strong immune response" (CIDRAP; see also: Lancet Infect
Dis article 1, article 2, and commentary).
Some good news: "Guinea declares end of Marburg virus disease outbreak" (WHO).
Journal Articles
Philos Trans R Soc Lond B Biol Sci: The future of zoonotic risk prediction (20 September 2021)
"In the light of the urgency raised by the COVID-19 pandemic, global investment in wildlife
virology is likely to increase, and new surveillance programmes will identify hundreds of
novel viruses that might someday pose a threat to humans. To support the extensive task of
laboratory characterization, scientists may increasingly rely on data-driven rubrics or
machine learning models that learn from known zoonoses to identify which animal
pathogens could someday pose a threat to global health. We synthesize the findings of an
interdisciplinary workshop on zoonotic risk technologies to answer the following questions.
What are the prerequisites, in terms of open data, equity and interdisciplinary
collaboration, to the development and application of those tools? What effect could the
technology have on global health? Who would control that technology, who would have
access to it and who would benefit from it? Would it improve pandemic prevention? Could
it create new challenges?"
NOTE: This article is part of the theme issue 'Infectious disease macroecology: parasite
diversity and dynamics across the globe’.
Emerg Infect Dis: Novel Outbreak-Associated Food Vehicles, United States (15 September 2021)
"Novel outbreak-associated food vehicles (i.e., foods not implicated in past outbreaks) can
emerge as a result of evolving pathogens and changing consumption trends. To identify
these foods, we examined data from the Centers for Disease Control and Prevention
Foodborne Disease Outbreak Surveillance System and found 14,216 reported outbreaks
with information on implicated foods. We compared foods implicated in outbreaks during
2007-2016 with those implicated in outbreaks during 1973-2006. We identified 28 novel
food vehicles, of which the most common types were fish, nuts, fruits, and vegetables; one
third were imported. Compared with other outbreaks, those associated with novel food
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vehicles were more likely to involve illnesses in multiple states and food recalls and were
larger in terms of cases, hospitalizations, and deaths. Two thirds of novel foods did not
require cooking after purchase. Prevention efforts targeting novel foods cannot rely solely
on consumer education but require industry preventive measures."
Nature: Resurgence of Ebola virus in 2021 in Guinea suggests a new paradigm for outbreaks (15
September 2021)
"Seven years after the declaration of the first epidemic of Ebola virus disease in Guinea, the
country faced a new outbreak—between 14 February and 19 June 2021—near the
epicentre of the previous epidemic. Here we use next-generation sequencing to generate
complete or near-complete genomes of Zaire ebolavirus from samples obtained from 12
different patients. These genomes form a well-supported phylogenetic cluster with
genomes from the previous outbreak, which indicates that the new outbreak was not the
result of a new spillover event from an animal reservoir. The 2021 lineage shows
considerably lower divergence than would be expected during sustained human-to-human
transmission, which suggests a persistent infection with reduced replication or a period of
latency. The resurgence of Zaire ebolavirus from humans five years after the end of the
previous outbreak of Ebola virus disease reinforces the need for long-term medical and
social care for patients who survive the disease, to reduce the risk of re-emergence and to
prevent further stigmatization."
Nat Commun: Twenty-year trends in antimicrobial resistance from aquaculture and fisheries in
Asia (10 September 2021)
"Antimicrobial resistance (AMR) is a growing threat to human and animal health. However,
in aquatic animals—the fastest growing food animal sector globally—AMR trends are
seldom documented, particularly in Asia, which contributes two-thirds of global food fish
production. Here, we present a systematic review and meta-analysis of 749 point
prevalence surveys reporting antibiotic-resistant bacteria from aquatic food animals in Asia,
extracted from 343 articles published in 2000-2019. We find concerning levels of resistance
to medically important antimicrobials in foodborne pathogens. In aquaculture, the
percentage of antimicrobial compounds per survey with resistance exceeding 50% (P50)
plateaued at 33% [95% confidence interval (Cl) 28 to 37%] between 2000 and 2018. In
fisheries, P50 decreased from 52% [95% Cl 39 to 65%] to 22% [95% Cl 14 to 30%]. We map
AMR at 10-kilometer resolution, finding resistance hotspots along Asia’s major river systems
and coastal waters of China and India. Regions benefitting most from future surveillance
efforts are eastern China and India. Scaling up surveillance to strengthen epidemiological
evidence on AMR and inform aquaculture and fisheries interventions is needed to mitigate
the impact of AMR globally."
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Statistics
Total Cases Total Deaths Total Vaccine Doses
Administered
Global 230,706,705 4,730,896 6,057,700,104
United States 42,674,611 684,367 386,435,012
JHU CSSE as of 1000 EDT 24 September 2021
Virginia Total Bs sats
cases Chesapeake Hampton ae Norfolk Portsmouth Suffolk al
(state)
Cases 849,865 26,864 | 13,970 | 19,005 | 22,747 11,683 | 10,082 | 46,668
Hospitalizations 36,132 1,226 623 723 1,396 856 630 2,436
Deaths 12,511 327 214 269 301 219 210 487
VA DOH as of 1000 EDT 24 September 2021
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R, Bradley T. Prior infection and age impacts antibody persistence after SARS-CoV-2 mRNA
vaccine. Clin Infect Dis. 2021 Sep 22:ciab850. doi: 10.1093/cid/ciab850. Epub ahead of print.
PMID: 34551091. Link: https://academic.oup.com/cid/advance-
article/doi/10.1093/cid/ciab850/6373987
Clin Infect Dis: Hu M, Wang J, Lin H, Ruktanonchai CW, Xu C, Meng B, Zhang X, Carioli A, Feng Y,
Yin Q, Floyd JR, Ruktanonchai NW, Li Z, Yang W, Tatem AJ, Lai S. Risk of SARS-CoV-2
Transmission among Air Passengers in China. Clin Infect Dis. 2021 Sep 21:ciab836. doi:
10.1093/cid/ciab836. Epub ahead of print. PMID: 34549275. Link:
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Clin Infect Dis: Lesieur E, Torrents J, Fina F, Zandotti C, Blanc J, Collardeau-Frachon S, Gazin C,
Sirgant D, Mezouar S, Otmani Idrissi M, Lepidi H, Bretelle F, Mege JL, Daniel L, Fritih R.
Congenital infection of SARS-CoV-2 with intrauterine foetal death: a clinicopathological study
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Clin Infect Dis: Moon RC, Mackey RH, Cao Z, Emont S, Schott LL, Gayle J, Lipkin C, Rosenthal N. Is
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Patients in the United States. Clin Infect Dis. 2021 Sep 17:ciab830. doi: 10.1093/cid/ciab830.
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Clin Infect Dis: Zhu F, Jin P, Zhu T, Wang W, Ye H, Pan H, Hou L, LiJ, Wang X, Wu S, Wang Y, Gou
J, Huang H, Wu H, Wang X, Chen W. Safety and immunogenicity of a recombinant adenovirus
type-5-vectored COVID-19 vaccine with a homologous prime-boost regimen in healthy
participants aged 6 years and above: a randomised, double-blind, placebo-controlled, phase 2b
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article/doi/10.1093/cid/ciab845/6374123
Disaster Med Public Health Prep: Anmad IA, Osei E. Occupational Health and Safety Measures in
Healthcare Settings During COVID-19: Strategies for Protecting Staff, Patients and Visitors.
Disaster Med Public Health Prep. 2021 Sep 14:1-27. doi: 10.1017/dmp.2021.294. Epub ahead of
print. PMID: 34517932. Link: https://www.cambridge.org/core/journals/disaster-medicine-and-
ublic-health-preparedness/article/occupational-health-and-safety-measures-in-healthcare-
settings-during-covid19-strategies-for-protecting-staff-patients-and-
visitors/9020BB396F446B9AD2A056F5A157627F
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Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
Diving Hyperb Med: Boet S, Etherington C, Djaiani G, Tricco AC, Sikora L, Katznelson R. Efficacy
and safety of hyperbaric oxygen treatment in SARS-COV-2 (COVID-19) pneumonia: a systematic
review. Diving Hyperb Med. 2021 Sep 30;51(3):271-281. doi: 10.28920/dhm51.3.271-281.
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Emerg Infect Dis: Janssen NAF, Nyga R, Vanderbeke L, Jacobs C, Ergin M, Buil JB, et al.
Multinational observational cohort study of COVID-19—associated pulmonary aspergillosis.
Emerg Infect Dis. 2021 Nov [15 September 2021]. https://doi.org/10.3201/eid2711.211174
Link: https://wwwnc.cdc.gov/eid/article/27/11/21-1174 article
Emerg Infect Dis: Whitham HK, Sundararaman P, Dewey-Mattia D, Manikonda K, Marshall KE,
Griffin PM, et al. Novel outbreak-associated food vehicles, United States. Emerg Infect Dis. 2021
Oct [15 September 2021]. https://doi.org/10.3201/eid2710.204080 Link:
https://wwwnc.cdc.gov/eid/article/27/10/20-4080 article
Health Commun: Sridharan K, Sivaramakrishnan G. Disinformation about COVID-19 Preventions
and Treatments: Analysis of USFDA Warning Letters. Health Commun. 2021 Sep 20:1-7. doi:
10.1080/10410236.2021.1980254. Epub ahead of print. PMID: 34544300. Link:
https://www.tandfonline.com/doi/abs/10.1080/10410236.2021.1980254
Health Secur: Jasani GN, Alfalasi R, Cavaliere GA, Lawner BJ, Liang SY. Terrorist Attacks Against
Vaccinators: A Review. Health Secur. 2021 Sep 16. doi: 10.1089/hs.2021.0078. Epub ahead of
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J Hosp Med: Antoon JW, Grijalva CG, Thurm C, et al. Factors Associated With COVID-19 Disease
Severity in US Children and Adolescents. J Hosp Med. Published Online First September 15,
2021. DOI: 10.12788/jhm.3689 | 10.12788/jhm.3689 Link:
https://www.journalofhospitalmedicine.com/jhospmed/article/245964/hospital-
medicine/factors-associated-covid-19-disease-severity-us-children
Infect Control Hosp Epidemiol: Browne S, Feemster K, Shen A, Green-McKenzie J, Momplaisir F,
Faig W, Offit PA, Kuter BJ. COVID-19 Vaccine Hesitancy among Physicians, Physician Assistants,
Nurse Practitioners, and Nurses in Two Academic Hospitals in Philadelphia. Infect Control Hosp
Epidemiol. 2021 Sep 20:1-24. doi: 10.1017/ice.2021.410. Epub ahead of print. PMID: 34538290.
Link: https://www.cambridge.org/core/journals/infection-control-and-hospital-
epidemiology/article/covid19-vaccine-hesitancy-among-physicians-physician-assistants-nurse-
practitioners-and-nurses-in-two-academic-hospitals-in-
philadelphia/67850CD6D463446FD33997DB4D94F303
iScience: An X, Martinez-Paniagua M, Rezvan A, Sefat SR, Fathi M, Singh S, Biswas S, Pourpak M,
Yee C, Liu X, Varadarajan N. Single-dose intranasal vaccination elicits systemic and mucosal
immunity against SARS-CoV-2. iScience. 2021 Sep 24;24(9):103037. doi:
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Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
10.1016/j.isci.2021.103037. Epub 2021 Aug 26. PMID: 34462731; PMCID: PMC83881838. Link:
https://www.sciencedirect.com/science/article/pii/S2589004221010051
JACC Basic Transl Sci: Jiang DH, Roy DJ, Gu BJ, Hassett LC, McCoy RG. Postacute Sequelae of
Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A State-of-the-Art Review. JACC
Basic Transl Sci. 2021 Sep 15. doi: 10.1016/j.jacbts.2021.07.002. Epub ahead of print. PMID:
34541421; PMCID: PMC8442719. Link: https://www.jacc.org/doi/10.1016/j.jacbts.2021.07.002
JAMA Health Forum: Ajayi AA, Rodriguez F, de Jesus Perez V. Prioritizing Equity and Diversity in
Academic Medicine Faculty Recruitment and Retention. JAMA Health Forum.
2021;2(9):e212426. doi:10.1001/jamahealthforum.2021.2426 Link:
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JAMA Health Forum: Drydren-Peterson S, Velasquez GE, Stopka TJ, et al. Disparities in SARS-
CoV-2 Vaccination-to-Infection Risk During the COVID-19 Pandemic in Massachusetts. JAMA
Health Forum. 2021;2(9):e212666. doi:10.1001/jamahealthforum.2021.2666 Link:
https://jamanetwork.com/journals/jama-health-forum/fullarticle/2784387
JAMA Netw Open: Buehrle DJ, Wagener MM, Nguyen MH, Clancy CJ. Trends in Outpatient
Antibiotic Prescriptions in the United States During the COVID-19 Pandemic in 2020. JAMA
Netw Open. 2021 Sep 1;4(9):e2126114. doi: 10.1001/jamanetworkopen.2021.26114. PMID:
34550387. Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784433
JAMA Netw Open: Kahn LG, Trasande L, Liu M, Mehta-Lee SS, Brubaker SG, Jacobson MH.
Factors Associated With Changes in Pregnancy Intention Among Women Who Were Mothers of
Young Children in New York City Following the COVID-19 Outbreak. JAMA Netw Open. 2021 Sep
1;4(9):e2124273. doi: 10.1001/jamanetworkopen.2021.24273. PMID: 34524437. Link:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784116
JAMA Netw Open: Le Bourgeois A, Coste-Burel M, Guillaume T, Peterlin P, Garnier A, Béné MC,
Chevallier P. Safety and Antibody Response After 1 and 2 Doses of BNT162b2 mRNA Vaccine in
Recipients of Allogeneic Hematopoietic Stem Cell Transplant. JAMA Netw Open. 2021 Sep
1;4(9):e2126344. doi: 10.1001/jamanetworkopen.2021.26344. PMID: 34519770. Link:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784061
JAMA Netw Open: Patel P, DeCuir J, Abrams J, Campbell AP, Godfred-Cato S, Belay ED. Clinical
Characteristics of Multisystem Inflammatory Syndrome in Adults: A Systematic Review. JAMA
Netw Open. 2021 Sep 1;4(9):e2126456. doi: 10.1001/jamanetworkopen.2021.26456. PMID:
34550381. Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784427
JAMA Netw Open: Stokes AC, Lundberg DJ, Bor J, Elo IT, Hempstead K, Preston SH. Association
of Health Care Factors With Excess Deaths Not Assigned to COVID-19 in the US. JAMA Netw
Open. 2021 Sep 1;4(9):e2125287. doi: 10.1001/jamanetworkopen.2021.25287. PMID:
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34515787; PMCID: PMC8438594. Link:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783986
JAMA Netw Open: Warren CM, Snow TT, Lee AS, Shah MM, Heider A, Blomkalns A, Betts B,
Buzzanco AS, Gonzalez J, Chinthrajah RS, Do E, Chang I, Dunham D, Lee G, O'Hara R, Park H,
Shamji MH, Schilling L, Sindher SB, Sisodiya D, Smith E, Tsai M, Galli SJ, Akdis C, Nadeau KC.
Assessment of Allergic and Anaphylactic Reactions to mRNA COVID-19 Vaccines With
Confirmatory Testing in a US Regional Health System. JAMA Netw Open. 2021 Sep
1;4(9):e2125524. doi: 10.1001/jamanetworkopen.2021.25524. PMID: 34533570. Link:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784268
JAMA Ophthalmol: Hu Y, Zhao F, Ding X, Zhang S, Li Z, Guo Y, Feng Z, Tang X, Li Q, Guo L, Lu C,
Yang X, He M. Rates of Myopia Development in Young Chinese Schoolchildren During the
Outbreak of COVID-19. JAMA Ophthalmol. 2021 Sep 16:e213563. doi:
10.1001/jamaophthalmol.2021.3563. Epub ahead of print. PMID: 34529002; PMCID:
PMC8446907. Link: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2 784174
JAMA Psychiatry: Brewer NT, Abad N. Ways That Mental Health Professionals Can Encourage
COVID-19 Vaccination. JAMA Psychiatry. 2021 Sep 23. doi: 10.1001/jamapsychiatry.2021.2951.
Epub ahead of print. PMID: 34554210. Link:
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2 784457
Lancet Infect Dis: Ader F, Bouscambert-Duchamp M, Hites M, Peiffer-Smadja N, Poissy J, Belhadi
D, Diallo A, L6 MP, Peytavin G, Staub T, Greil R, Guedj J, Paiva JA, Costagliola D, Yazdanpanah Y,
Burdet C, Mentré F; DisCoVeRy Study Group. Remdesivir plus standard of care versus standard
of care alone for the treatment of patients admitted to hospital with COVID-19 (DisCoVeRy): a
phase 3, randomised, controlled, open-label trial. Lancet Infect Dis. 2021 Sep 14:S1473-
3099(21)00485-0. doi: 10.1016/S1473-3099(21)00485-0. Epub ahead of print. PMID: 34534511;
PMCID: PMC8439621. Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-
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Lancet Infect Dis: Haas EJ, McLaughlin JM, Khan F, et al. Infections, hospitalisations, and deaths
averted via a nationwide vaccination campaign using the Pfizer—BioNTech BNT162b2 mRNA
COVID-19 vaccine in Israel: a retrospective surveillance study. Lancet Infect Dis. Published:
September 22, 2021 DOI: https://doi.org/10.1016/S1473-3099(21)00566-1 Link:
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00566-1/fulltext
Lancet Regional Health: Bahl A, Johnson S, Maine G, et al. Vaccination reduces need for
emergency care in breakthrough COVID-19 infections: A multicenter cohort study. Lancet
Regional Health. Published: September 09, 2021 DOI:
https://doi.org/10.1016/j.lana.2021.100065 Link:
https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00061-2/fulltext
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Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at NMCP, Library Services)
MMWR: Dooling K, Gargano JW, Moulia D, et al. Use of Pfizer-BioNTech COVID-19 Vaccine in
Persons Aged 216 Years: Recommendations of the Advisory Committee on Immunization
Practices — United States, September 2021. MMWR Morb Mortal Wkly Rep. ePub: 21
September 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7038ez2 Link:
https://www.cdc.gov/mmwr/volumes/70/wr/mm7038e2.htm
MMWR: Hagan LM, McCormick DW, Lee C, et al. Outbreak of SARS-CoV-2 B.1.617.2 (Delta)
Variant Infections Among Incarcerated Persons in a Federal Prison — Texas, July-August 2021.
MMWR Morb Mortal Wkly Rep. ePub: 21 September 2021. DOI:
http://dx.doi.org/10.15585/mmwr.mm7038e3 Link:
https://www.cdc.gov/mmwr/volumes/70/wr/mm7038e3.htm
MMWR: Lange SJ, Kompaniyets L, Freedman DS, et al. Longitudinal Trends in Body Mass Index
Before and During the COVID-19 Pandemic Among Persons Aged 2-19 Years — United States,
2018-2020. MMWR Morb Mortal Wkly Rep 2021;70:1278-1283. DOI:
http://dx.doi.org/10.15585/mmwr.mm7037a3 Link:
https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a3.htm
MMWR: Self WH, Tenforde MW, Rhoads JP, et al. Comparative Effectiveness of Moderna,
Pfizer-BioNTech, and Janssen (Johnson & Johnson) Vaccines in Preventing COVID-19
Hospitalizations Among Adults Without Immunocompromising Conditions — United States,
March—August 2021. MMWR Morb Mortal Wkly Rep. ePub: 17 September 2021. DOI:
http://dx.doi.org/10.15585/mmwr.mm7038e1 Link:
https://www.cdc.gov/mmwr/volumes/70/wr/mm7038e1.htm
MMWR: Yomogida K, Zhu S, Rubino F, Figueroa W, Balanji N, Holman E. Post-Acute Sequelae of
SARS-CoV-2 Infection Among Adults Aged 218 Years — Long Beach, California, April 1—
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https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a2.htm
Nat Commun: Chang SE, Feng A, Meng W, Apostolidis SA, Mack E, Artandi M, Barman L,
Bennett K, Chakraborty S, Chang I, Cheung P, Chinthrajah S, Dhingra S, Do E, Finck A, Gaano A,
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Nat Commun: Schar D, Zhao C, Wang Y, Larsson DGJ, Gilbert M, Van Boeckel TP. Twenty-year
trends in antimicrobial resistance from aquaculture and fisheries in Asia. Nat Commun. 2021
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Sep 10;12(1):5384. doi: 10.1038/s41467-021-25655-8. PMID: 34508079. Link:
https://www.nature.com/articles/s41467-021-25655-8
Nature: Keita AK, Koundouno FR, Faye M, Dix A, Hinzmann J, Diallo H, Ayouba A, Le Marcis F,
Soropogui B, Ifono K, Diagne MM, Sow MS, Bore JA, Calvignac-Spencer S, Vidal N, Camara J,
Keita MB, Renevey A, Diallo A, Soumah AK, Millimono SL, Mari-Saez A, Diop M, Doré A, Soumah
FY, Kourouma K, Vielle NJ, Loucoubar C, Camara |, Kourouma K, Annibaldis G, Bah A, Thielebein
A, Pahlmann M, Pullan ST, Carroll MW, Quick J, Formenty P, Legand A, Pietro K, Wiley MR,
Tordo N, Peyrefitte C, McCrone JT, Rambaut A, Sidibé Y, Barry MD, Kourouma M, Saouromou
CD, Condé M, Baldé M, Povogui M, Keita S, Diakite M, Bah MS, Sidibe A, Diakite D, Sako FB,
Traore FA, Ki-Zerbo GA, Lemey P, Giinther S, Kafetzopoulou LE, Sall AA, Delaporte E, Duraffour
S, Faye O, Leendertz FH, Peeters M, Toure A, Magassouba NF. Resurgence of Ebola virus in 2021
in Guinea suggests a new paradigm for outbreaks. Nature. 2021 Sep 15. doi: 10.1038/s41586-
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NEJM: Bar-On YM, Goldberg Y, Mandel M, Bodenheimer O, Freedman L, Kalkstein N, Mizrahi B,
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NEJM: El Sahly HM, Baden LR, Essink B, Doblecki-Lewis S, Martin JM, Anderson EJ, Campbell TB,
Clark J, Jackson LA, Fichtenbaum CJ, Zervos M, Rankin B, Eder F, Feldman G, Kennelly C, Han-
Conrad L, Levin M, Neuzil KM, Corey L, Gilbert P, Janes H, Follmann D, Marovich M, Polakowski
L, Mascola JR, Ledgerwood JE, Graham BS, August A, Clouting H, Deng W, Han S, Leav B, Manzo
D, Pajon R, Schédel F, Tomassini JE, Zhou H, Miller J; COVE Study Group. Efficacy of the mRNA-
1273 SARS-CoV-2 Vaccine at Completion of Blinded Phase. N Engl J Med. 2021 Sep 22. doi:
10.1056/NEJMoa2113017. Epub ahead of print. PMID: 34551225. Link:
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NEJM: Falsey AR, Frenck RW Jr, Walsh EE, Kitchin N, Absalon J, Gurtman A, Lockhart S, Bailey R,
Swanson KA, Xu X, Koury K, Kalina W, Cooper D, Zou J, Xie X, Xia H, Tureci O, Lagkadinou E,
Tompkins KR, Shi PY, Jansen KU, Sahin U, Dormitzer PR, Gruber WC. SARS-CoV-2 Neutralization
with BNT162b2 Vaccine Dose 3. N Engl J Med. 2021 Sep 15. doi: 10.1056/NEJMc2113468. Epub
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NEJM: Pilishvili T, Gierke R, Fleming-Dutra KE, Farrar JL, Mohr NM, Talan DA, Krishnadasan A,
Harland KK, Smithline HA, Hou PC, Lee LC, Lim SC, Moran GJ, Krebs E, Steele MT, Beiser DG,
Faine B, Haran JP, Nandi U, Schrading WA, Chinnock B, Henning DJ, Lovecchio F, Lee J, Barter D,
Brackney M, Fridkin SK, Marceaux-Galli K, Lim S, Phipps EC, Dumyati G, Pierce R, Markus TM,
Anderson DJ, Debes AK, Lin MY, Mayer J, Kwon JH, Safdar N, Fischer M, Singleton R, Chea N,
Magill SS, Verani JR, Schrag SJ; Vaccine Effectiveness among Healthcare Personnel Study Team.
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Effectiveness of MRNA Covid-19 Vaccine among U.S. Health Care Personnel. N Engl J Med. 2021
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NEJM: Thomas SJ, Moreira ED Jr, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, Pérez
Marc G, Polack FP, Zerbini C, Bailey R, Swanson KA, Xu X, Roychoudhury S, Koury K,
Bouguermouh §, Kalina WV, Cooper D, Frenck RW Jr, Hammitt LL, Tureci O, Nell H, Schaefer A,
Unal S, Yang Q, Liberator P, Tresnan DB, Mather S, Dormitzer PR, Sahin U, Gruber WC, Jansen
KU; C4591001 Clinical Trial Group. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine
through 6 Months. N Engl J Med. 2021 Sep 15. doi: 10.1056/NEJMoa2110345. Epub ahead of
print. PMID: 34525277. Link: https://www.nejm.org/doi/full/10.1056/NEJMoa2110345
Philos Trans R Soc Lond B Biol Sci: Carlson CJ, Farrell MJ, Grange Z, Han BA, Mollentze N, Phelan
AL, Rasmussen AL, Albery GF, Bett B, Brett-Major DM, Cohen LE, Dallas T, Eskew EA, Fagre AC,
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PNAS: Cronin CJ, Evans WN. Excess mortality from COVID and non-COVID causes in minority
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Special Reports and Other Resources
JHCHS: The Johns Hopkins Center for Health Security. Veenema TG, Closser S, Thrul J, et al.
Mental Health and Social Support for Healthcare and Hospital Workers During the COVID-19
Pandemic (23 September 2021). Link: https://www.centerforhealthsecurity.org/our-
work/publications/mental-health-and-social-support-for-healthcare-and-hospital-workers-
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News in Brief
ADHSS: Alaska Department of Health and Social Services. State of Alaska Epidemiology Bulletin.
Additional Cases of Orthopoxvirus Infection in Fairbanks-area Residents, 2021 (09 September
2021). Link: http://dhss.alaska.gov/dph/epi/bulletins/docs/b2021 13.pdf
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Al Jazeera: Al Jazeera. Dengue suspected of killing dozens in India’s Uttar Pradesh state (13
September 2021). Link: https://www.aljazeera.com/news/2021/9/13/dengue-deaths-dozens-
india-uttar-pradesh
Atlantic: The Atlantic. Craig Soencer. No, Vaccinated People Are Not ‘Just as Likely’ to Spread
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https://www.theatlantic.com/ideas/archive/2021/09/the-vaccinated-arent-just-as-likely-to-
spread-covid/620161/
Atlantic: The Atlantic. Katherine J. Wu. 'Post-Vax COVID' Is a New Disease (21 September 2021).
Link: https://www.theatlantic.com/science/archive/2021/09/post-vaccination-covid/620140/
Atlantic: The Atlantic. Katherine J. Wu, Ed Yong, and Sarah Zhang. Six Things to Understand
About the Pandemic Now (20 September 2021). Link:
now/620129/
CDC: Centers for Disease Control and Prevention. CDC to Invest $2.1 Billion to Protect Patients
and Healthcare Workers from COVID-19 and Future Infectious Diseases (17 September 2021).
Link: https://www.cdc.gov/media/releases/2021/p0917-COVID-19-funding.html
CDC: Centers for Disease Control and Prevention. Guidance for Clinicians Caring for Individuals
Recently Evacuated from Afghanistan (20 September 2021). Link:
https://emergency.cdc.gov/han/2021/han00452.as
CDC: Centers for Disease Control and Prevention. Multisystem Inflammatory Syndrome in
Children (MIS-C) Healthcare Provider Resources (17 September 2021). Link:
https://www.cdc.gov/mis/mis-c/hcp/provider-resources/index.html
CIDRAP: Center for Infectous Disease Research and Policy. Chris Dall. Artemisinin-resistant
malaria detected in Uganda (23 September 2021). Link: https://www.cidrap.umn.edu/news-
perspective/2021/09/artemisinin-resistant-malaria-detected-uganda
CIDRAP: Center for Infectious Disease Research and Policy. Lianna Matt McLemon. Two-dose
J&J Ebola vaccine gives strong immune response (15 September 2021). Link:
strong-immune-response
CIDRAP: Center for Infectious Disease Research and Policy. Stephanie Soucheray. Alaska, Idaho
using crisis standards of care over COVID-19 (15 September 2021). Link:
care-over-covid-19
Cincinnati Enquirer: Cincinnati Enquirer at Cincinnati.com. Ann Saker. Cincinnati area hospitals
boost security against 'violence, vile words,' key leader says (14 September 2021). Link:
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https://www.cincinnati.com/story/news/2021/09/13/cincinnati-hospitals-covid-19-stepping-
up-security-because-violence-vile-words-local-leader-say/8317461002/
DHS: US Department of Homeland Security, Science and Technology Directorate. Here's What
We've Learned About COVID-19—An Update (21 September 2021). Link:
https://www.dhs.gov/science-and-technology/news/2021/09/21/feature-article-here-s-what-
we-ve-learned-about-covid-19-an-update
ECDC: European Centre for Disease Prevention and Control. Communicable Disease Threats
Report, week 36 (10 September 2021). Link:
https://www.ecdc.europa.eu/sites/default/files/documents/communicable-disease-threats-
report-10-09-2021-public.pdf
FDA: US Food & Drug Administration. FDA Authorizes Booster Dose of Pfizer-BioNTech COVID-
19 Vaccine for Certain Populations (22 September 2021). Link: https://www.fda.gov/news-
events/press-announcements/fda-authorizes-booster-dose-pfizer-biontech-covid-19-vaccine-
certain-populations
FDA: US Food & Drug Administration. FDA authorizes bamlanivimab and etesevimab
monoclonal antibody therapy for post-exposure prophylaxis (prevention) for COVID-19 (16
September 2021). Link: https:
bamlanivimab-and-etesevimab-monoclonal-antibody-therapy-post-exposure-prophylaxis
Hill: The Hill. John B. Lynch. The next health threat is here — action is needed on anti-microbial
resistance (10 September 2021). Link: https://thehill.com/opinion/healthcare/571664-the-next-
health-threat-is-here-action-is-needed-on-anti-microbial
KHN: Kaiser Health News. Liz Szabo. Scientists Examine Kids' Unique Immune Systems as More
Fall Victim to Covid (17 September 2021). Link: https://khn.org/news/article/scientists-
examine-kids-unique-immune-systems-as-more-fall-victim-to-covid
Medpage: Medpage Today. Cheryl Clark. Oregon Doc Loses License for Not Wearing a Mask,
Spreading Misinformation (20 September 2021). Link:
https://www.medpagetoday.com/special-reports/exclusives/94593
Medpage: Medpage Today. Judy George. COVID-19 update. Don't Drink Betadine! Unvaxxed
Hospital Care Tops $5B; 'Downright Cruel Behavior' (15 September 2021). Link:
https://www.medpagetoday.com/infectiousdisease/covid19/94517
Medpage: Medpage Today. Molly Walker. J&J Says Second Dose of Their COVID Vaccine Boosts
Protection (21 September 2021). Link:
https://www.medpagetoday.com/infectiousdisease/covid19vaccine/94618
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Miami Herald: Miami Herald. Lawrence Mower and Kirby Wilson. Florida's next surgeon general
opposes mask, vaccine mandates (21 September 2021). Link:
https://www.miamiherald.com/news/coronavirus/article254412224.html
Nature: Nature. Elie Dolgin. COVID vaccine immunity is waning — how much does that matter?
(17 September 2021). Link: https://www.nature.com/articles/d41586-021-02532-4
Nature: Nature. Elie Dolgin. The tangled history of mRNA vaccines (14 September 2021). Link:
https://www.nature.com/articles/d41586-021-02483-w
Nature: Nature. Holly Else. Swedish research misconduct agency swamped with cases in first
year (13 September 2021). Link: https://www.nature.com/articles/d41586-021-02451-4
Nature: Nature. Gowri Gopalakrishna. Preprint advocates must also fight for research integrity
(13 September 2021). Link: https://www.nature.com/articles/d41586-021-02481-y
Nature: Nature. Smriti Mallapaty. Closest known relatives of virus behind COVID-19 found in
Laos (24 September 2021). Link: https://www.nature.com/articles/d41586-021-02596-2
Nature: Nature. Smriti Mallapaty. Did the coronavirus jump from animals to people twice? (16
September 2021). Link: https://www.nature.com/articles/d41586-021-02519-1
NBC: NBC News. Janhvi Bhojwani. Covid likely led to a rare disorder that left 8-year-old girl
paralyzed (16 September 2021). Link: https://www.nbcnews.com/news/us-news/covid-likely-
led-rare-disorder-left-8-year-old-girl-n1279336
NBC: NBC News. Corky Siemaszko. Tennessee limiting monoclonal antibody treatment to
unvaccinated residents (21 September 2021). Link: https://www.nbcnews.com/news/us-
monoclonal-antibody-treatment-unvaccinated-residents-n1279740
news/tennessee-limitin
NBC: NBC News. Tim Stelloh. Alabama heart patient dies after hospital contacts 43 ICUs in 3
states (12 September 2021). Link: https://www.nbcnews.com/news/us-news/alabama-heart-
patient-dies-after-hospital-contacts-43-icus-3-n1279025
NPR: National Public Radio. Geoff Brumfiel. This Doctor Spread False Information About COVID.
She Still Kept Her Medical License (14 September 2021). Link:
https://www.npr.org/sections/health-shots/2021/09/14/1035915598/doctors-covid-
misinformation-medical-license
NPR: National Public Radio. Rhitu Chaterjee. We Know Students Are Struggling With Their
Mental Health. Here's How You Can Help (17 September 2021). Link:
https://www.npr.org/sections/back-to-school-live-updates/2021/09/17/1038022995/we-
know-students-are-struggling-with-their-mental-health-heres-how-you-can-help
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NPR: National Public Radio. Pien Huang. How Ivermectin Became The New Focus Of The Anti-
Vaccine Movement (19 September 2021). Link: https://www.npr.org/sections/health-
shots/2021/09/19/1038369557/ivermectin-anti-vaccine-movement-culture-wars
NPR: National Public Radio. Sharon Pruitt-Young. TSA Is Doubling Fines For Those Who Refuse
To Wear A Mask While Flying (10 September 2021). Link:
https://www.npr.org/2021/09/10/1035877886/tsa-doubles-fines-airline-airplane-flying-mask-
mandates-biden
NPR: National Public Radio. Sharon Pruitt-Young. 9 Lions And Tigers At The National Zoo Are
Being Treated For COVID (17 September 2021). Link:
https://www.npr.org/sections/coronavirus-live-updates/2021/09/17/1038295149/national-
zoo-tigers-lions-covid-coronavirus
NPR: National Public Radio. Kamala Thiagarajan. Why The World Should Be More Than A Bit
Worried About India's Nipah Virus Outbreak (12 September 2021). Link:
https://www.npr.org/sections/goatsandsoda/2021/09/12/1035571714/why-the-world-should-
be-more-than-a-bit-worried-about-indias-nipah-virus-outbrea
NYT: New York Times. Charlie Smart. Covid Hospitalizations Hit Crisis Levels in Southern I.C.U.s
(updated 14 September 2021). Link:
https://www.nytimes.com/interactive/2021/09/14/us/covid-hospital-icu-south.html
OKC Fox: Oklahoma City Fox 25 News. Rebecca Pryor. Doctors warn consuming Betadine won't
cure COVID, could be deadly (14 September 2021). Link:
https://okcfox.com/news/local/doctors-warn-consuming-betadine-wont-cure-covid-could-be-
deadly
ONT: Outbreak News Today. Nigeria measles: 10K suspected cases since beginning of the year
(14 September 2021). Link: http://outbreaknewstoday.com/nigeria-measles-10k-suspected-
cases-since-beginning-of-the-year-58376/
Politico: Politico. Michael Callahan. A Virus-Hunter's Advice on Dealing with China's Resistance
on Covid (15 September 2021). Link:
https://www. politico.com/news/magazine/2021/09/15/covid-origin-investigation-china-
cooperation-511898
ProPublica: ProPublica. Jenny Deam. A Boy Went to a COVID-Swamped ER. He Waited for
Hours. Then His Appendix Burst. (15 September 2021). Link:
https://www.propublica.org/article/a-boy-went-to-a-covid-swamped-er-he-waited-for-hours-
then-his-appendix-burst
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Reuters: Reuters. Timothy Aeppel. COVID creates shortages of an array of U.S. medical supplies
(20 September 2021). Link: https://www.reuters.com/world/the-great-reboot/covid-creates-
shortages-an-array-us-medical-supplies-2021-09-20/
Reuters: Reuters. Marisa Taylor and Dan Levine. U.S. could authorize Pfizer COVID-19 shot for
kids age 5-11 in October -sources (10 September 2021). Link:
https://www.reuters.com/business/healthcare-pharmaceuticals/exclusive-us-decision-pfizer-
covid-19-shot-kids-age-5-11-could-come-october-2021-09-10
Science: Science. Jocelyn Kaiser. Study of up to 40,000 people will probe mysteries of Long
Covid (15 September 2021). Link: https://www.science.org/content/article/study-40-000-
people-will-probe-mysteries-long-covid
Science: Science. Kai Kupferschmidt. SARS-like viruses may jump from animals to people
hundreds of thousands of times a year (15 September 2021). Link:
https://www.science.org/content/article/sars-viruses-may-jump-animals-people-hundreds-
thousands-times-year
Science: Science. Dennis Normile. Can 'zero COVID' countries continue to keep the virus at bay
once they reopen? (14 September 2021). Link: https://www.science.org/content/article/can-
zero-covid-countries-continue-keep-virus-bay-once-they-reopen
Science: Science. Meredith Wadman. Israel's struggles to contain COVID-19 may be a warning
for other nations (21 September 2021). Link: https://www.science.org/content/article/israel-s-
struggles-contain-covid-19-may-be-warning-other-nations
STAT: STATnews. Helen Branswell. Covid-19 set to overtake 1918 Spanish flu as deadliest
disease in American history (20 September 2021). Link:
https://www.statnews.com/2021/09/20/covid-19-set-to-overtake-1918-spanish-flu-as-
deadliest-disease-in-american-history/
STAT: STATnews. Helen Branswell. Winter is coming, again: What to expect from Covid-19 as
the season looms (20 September 2021). Link: https://www.statnews.com/2021/09/20/winter-
is-coming-again-what-to-expect-from-covid-19-as-the-season-looms
STAT: STATnews. Olivia Goldhill. 'Delta has been brutal’: Covid-19 variant is decimating rural
areas already reeling from the pandemic (21 September 2021). Link:
https://www.statnews.com/2021/09/21/delta-variant-covid19-decimating-rural-areas
STAT: STATnews. Matthew Herper. Pfizer Covid-19 vaccine generates robust antibody response
in children, without serious safety issues, company says (20 September 2021). Link:
https://www.statnews.com/2021/09/20/pfizer-covid-19-vaccine-children
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STAT: STATnews. Matthew Herper. Remdesivir reduces Covid hospitalizations when given early,
study shows (22 September 2021). Link: https://www.statnews.com/2021/09/22/remdesivir-
reduces-covid-hospitalizations-when-given-early-in-stud
STAT: STATnews. Andrew Joseph. What will the Covid-19 booster rollout look like? Public health
groups plan as they await details (17 September 2021). Link:
https://www.statnews.com/2021/09/17/covid19-vaccine-booster-rollout-september,
STAT: STATnews. Usha Lee McFarling. 'Health equity tourists': How white scholars are
colonizing research on health disparities (23 September 2021). Link:
https://www.statnews.com/2021/09/23/health-equity-tourists-white-scholars-colonizing-
health-disparities-research/
Tablet: Tablet. John P.A. loannidis. How the Pandemic Is Changing the Norms of Science (08
September 2021). Link: https://www.tabletmag.com/sections/science/articles/pandemic-
science
USA Today: USA Today. Jake Zuckerman Ohio Capital Journal. Ohio Medical Board renews
license of Sherri Tenpenny, doctor who claims vaccines make you magnetic (20 September
Vox: Vox. Dylan Scott. The US was a world leader in vaccination. What went wrong? (09
September 2021). Link: https://www.vox.com/coronavirus-covid19/2021/9/9/22662421/us-
world-covid-19-vaccine-rates-biden-mandate
WDH: Wyoming Department of Health. Wyoming Detects Rare Human Case of Pneumonic
Plague (15 September 2021). Link: https://health.wyo.gov/wyoming-detects-rare-human-case-
of-pneumonic-plague/
WH.gov: White House Briefing Room. Executive Order on Adding Measles to the List of
Quarantinable Communicable Diseases (17 September 2021). Link:
disease-outbreak
WP: Washington Post. Kim Bellware and Adela Suliman. Coronavirus-sniffing dogs unleashed at
Miami airport to detect virus in employees (09 September 2021). Link:
https://www.washingtonpost.com/nation/2021/09/09/covid-sniffer-dogs
WP: Washington Post. Paulina Firozi. A group of gorillas is being treated for covid. The great
apes will soon get their shots, too, zoo says (12 September 2021). Link:
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https://www.washingtonpost.com/nation/2021/09/12/zoo-atlanta-gorillas-coronavirus-
vaccine/
WP: Washington Post. Paulina Firozi and Brittany Shammas. American Samoa, one of the last
places without coronavirus, has first infection (19 September 2021). Link:
https://www.washingtonpost.com/health/2021/09/19/american-samoa-first-covid-case
WP: Washington Post. Dan Keating, Akilah Johnson, and Monica Ulmanu. The pandemic marks
another grim milestone: 1 in 500 Americans have died of covid-19 (15 September 2021). Link:
WP: Washington Post. Meryl Kornfield. Many unvaccinated people are not opposed to getting a
shot. The challenge is trying to get it to them (23 September 2021). Link:
https://www.washingtonpost.com/health/2021/09/23/covid-unvaccinated-but-willin
Statistics
JHU CSSE: Johns Hopkins Center for Systems Science and Engineering. Coronavirus COVID-19
Global Cases. Link: https://coronavirus.jhu.edu/map.html
VA DOH: Virginia Department of Health. COVID-19 in Virginia. Link:
https://www.vdh.virginia.gov/coronavirus/covid-19-in-virginia
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