Corona-Info-Thread (nur Infos, KEINE DISKUSSION)

We analyzed data in this cross-sectional study from April 2020 through May 2021 from a cohort of patients with COVID-19 followed up through a Mount Sinai Health System registry. Study participants were 18 years or older, spoke English or Spanish, tested positive for SARS-CoV-2 or had serum antibody positivity, and had no history of dementia. Participant demographic characteristics (eg, age, race, and ethnicity) were collected via self-report. Cognitive functioning was assessed using well-validated neuropsychological measures: Number Span forward (attention) and backward (working memory), Trail Making Test Part A and Part B (processing speed and executive functioning, respectively), phonemic and category fluency (language), and the Hopkins Verbal Learning Test–Revised (memory encoding, recall, and recognition).

The most prominent deficits were in processing speed (18%, n = 133), executive functioning (16%, n = 118), phonemic fluency (15%, n = 111) and category fluency (20%, n = 148), memory encoding (24%, n = 178), and memory recall (23%, n = 170; Table 2).

In adjusted analyses, hospitalized patients were more likely to have impairments in attention (odds ratio : 2.8; 95% CI: 1.3-5.9), executive functioning (OR: 1.8; 95% CI: 1.0-3.4), category fluency (OR: 3.0; 95% CI: 1.7-5.2), memory encoding (OR: 2.3; 95% CI: 1.3-4.1), and memory recall (OR: 2.2; 95% CI: 1.3-3.8) than those in the outpatient group. Patients treated in the ED were more likely to have impaired category fluency (OR: 1.8; 95% CI: 1.1-3.1) and memory encoding (OR: 1.7; 95% CI: 1.0-3.0) than those treated in the outpatient setting. No significant differences in impairments in other domains were observed between groups.

In this study, we found a relatively high frequency of cognitive impairment several months after patients contracted COVID-19. Impairments in executive functioning, processing speed, category fluency, memory encoding, and recall were predominant among hospitalized patients. The relative sparing of memory recognition in the context of impaired encoding and recall suggests an executive pattern. This pattern is consistent with early reports describing a dysexecutive syndrome after COVID-194 and has considerable implications for occupational, psychological, and functional outcomes. It is well known that certain populations (eg, older adults) may be particularly susceptible to cognitive impairment after critical illness5; however, in the relatively young cohort in the present study, a substantial proportion exhibited cognitive dysfunction several months after recovering from COVID-19. The findings of this study are generally consistent with those of research on other viruses (eg, influenza).6

Limitations of this study include a potential sampling bias, as some participants may have presented to Mount Sinai Health System because of health concerns. Future studies should investigate long-term post–COVID-19 cognitive trajectories and the association with neuroimaging findings to assess potential mechanisms.

THREAD on the new variant B.1.1.529 summarising what is known from the excellent South African Ministry of Health meeting earlier today

TLDR: So much uncertain but what *is* known is extremely worrying & (in my opinion) we should revise red list immediately.

(...)

In South Africa it has been detected in Guateng province - positivity rates in Tshwane (part of Guateng) have increased massively in the last 3 weeks from less than 1% to over 30%.

Because of this increase, COVID sequencing has been concentrated on samples from Guateng.

Almost all recent samples from there (77) have been this new variant (blue dots) - taking over from a background of Delta (red) and C.1.2 (also a concerning variant, yellow).

The bias of sequences towards Guateng means that it looks as if B.1.1.529 is rapidly taking over from Delta (red) and C.1.2 (yellow) on chart of sequenced cases - but few samples.

"Die Impfung gegen COVID-19 mit Comirnaty von BioNTech/Pfizer wird 5-11-jährigen Kindern allgemein empfohlen, insbesondere auch für Kinder mit Risikofaktoren sowie Kinder mit engen Kontakten zu Personen mit erhöhtem Risiko für einen schweren Krankheitsverlauf von COVID-19.

In Zulassungsstudien konnte gezeigt werden, dass der Impfstoff Comirnaty von
BioNTech/Pfizer auch bei Kindern ab 5 Jahren eine vergleichbare Immunantwort wie bei
Jugendlichen und jungen Erwachsenen auslöst und daher von einer ebenso hohen
Wirksamkeit ausgegangen werden kann2. Daher wurde er mittlerweile von der EMA für
Kinder ab 5 Jahren zugelassen3. In den USA wurden zudem mit Stand 24.11.2021 über 3,6
Mio. Kinder 5-11 Jahre einmalig mit Comirnaty geimpft und etwas über 134.000 Kinder
bereits zweimal, es sind keine neuen Sicherheitsbedenken bekannt4. Für Kinder von 5-11
Jahren wird eine geringere Menge von mRNA eingesetzt, dafür gibt es eine spezielle
Kinder-Formulierung des Impfstoffes (Comirnaty 10 Mikrogramm, Impfstoff-Fläschchen
orange). Diese Kinderformulierung ist geringer konzentriert und hat einen anderen Puffer
zur besseren Haltbarkeit, unterscheidet sich ansonsten aber nicht von der derzeitigen
Erwachsenenformulierung. 0,2 mL dieser Kinder-Formulierung enthalten 10 μg mRNA. Die
Kinderformulierung „Comirnaty 10 Mikrogramm“ wird voraussichtlich gegen Ende des
Jahres 2021 in der EU und somit auch in Österreich verfügbar sein. Für einen ersten
Impfschutz sind 2 Impfungen im Abstand von 21 Tagen notwendig (19-42 Tage möglich).
Auf Grund des derzeitigen epidemiologischen Geschehens empfiehlt das Nationale
Impfgremium, bis zur Verfügbarkeit der Kinder-Formulierung die Comirnaty-
Formulierung für Erwachsene (Comirnaty 30 Mikrogramm, Impfstoff-Fläschchen lila) zu
verwenden. Dabei soll ein Drittel der Menge, nämlich 0,1 mL; 10 μg, verwendet werden,
die für Erwachsene (nämlich 0,3 mL; 30 μg) eingesetzt wird, Anwendungsdetails siehe
unten. Diese off-Label-Anwendung (Erwachsenen-Formulierung für Kinder), welche in
der derzeitigen epidemiologischen Situation gerechtfertigt ist, wird für Kinder von 5-11
Jahren, besonders für Risikokinder sowie für alle Kinder, bei denen eine Impfung gegen
COVID-19 gewünscht ist, empfohlen."

Moore’s team — which provided some of the first data on Beta’s ability to dodge immunity — has begun work on B.1.1.529. They plan to test the virus’s ability to evade infection-blocking antibodies, as well as other immune responses. The variant harbours a high number of mutations in regions of the spike protein that antibodies recognize, potentially dampening their potency. “Many mutations we know are problematic, but many more look like they are likely contributing to further evasion,” says Moore. There are even hints from computer modelling that B.1.1.529 could dodge immunity conferred by another component of the immune system called T cells, says Moore. Her team hopes to have its first results in two weeks.

The epidemiological relevance of the COVID-19-vaccinated population is increasing

South Africa's health minister says, based on a small sample of Omicron cases, the majority of hospital patients are unvaccinated: "It indicates that the vaccines are providing protection"

Die Nationale Akademie der Wissenschaften Leopoldina empfiehlt angesichts des dynamischen Corona-Infektionsgeschehens sofortige umfassende Kontaktbeschränkungen. "Unmittelbar wirksam ist es aus medizinischer und epidemiologischer Sicht, die Kontakte von Beginn der kommenden Woche an für wenige Wochen deutlich zu reduzieren", heißt es in einer am Samstag veröffentlichten Stellungnahme.

"Aufgrund der nachlassenden Immunität müssten diese Maßnahmen vorübergehend auch für Geimpfte und Genesene gelten, die in dieser Zeit eine Auffrischungsimpfung erhalten müssen." Die Impfkampagne müsse massiv verstärkt und eine Impfpflicht stufenweise eingeführt werden.

Dr Angelique Coetzee said she was first alerted to the possibility of a new variant when patients in her busy private practice in the capital Pretoria started to come in earlier this month with Covid-19 symptoms that did not make immediate sense.

They included young people of different backgrounds and ethnicities with intense fatigue and a six-year-old child with a very high pulse rate, she said. None suffered from a loss of taste or smell.

“Their symptoms were so different and so mild from those I had treated before,” said Dr Coetzee, a GP for 33 years who chairs the South African Medical Association alongside running her practice.

On November 18, when four family members all tested positive for Covid-19 with complete exhaustion, she informed the country’s vaccine advisory committee.

She said, in total, about two dozen of her patients have tested positive for Covid-19 with symptoms of the new variant. They were mostly healthy men who turned up “feeling so tired”. About half of them were unvaccinated.

Dr Coetzee, who was briefing other African medical associations on Saturday, made clear her patients were all healthy and she was worried the new variant could still hit older people – with co-morbidities such as diabetes or heart disease – much harder.

“What we have to worry about now is that when older, unvaccinated people are infected with the new variant, and if they are not vaccinated, we are going to see many people with a severe disease,” she said.