COVID-19 Update #91 for 7/14/2021

COVID-19 Vaccines
 
The World Health Organization’s Global Advisory Committee on Vaccine Safety found the benefits of mRNA COVID-19 vaccines outweigh the risksin reducing hospitalizations and deaths from COVID-19. The risk for myocarditis and pericarditis is very low. The estimate in patients 12 to 29 is 40.6 cases per million second doses among males and 4.2 cases per million among females. In patients over 30, the rate drops to 2.4 per million second doses in males and one per million second doses in females in patients.
 
The FDA has added Guillain-Barre syndrome to the Warning section of the Fact Sheet for the Johnson & Johnson COVID-19 vaccine. Most cases occurred within 42 days after vaccination. The occurrence is very low at 100 cases per 12.5 million doses.
 
The FDA, CDC, and NIH have issued a joint statement that a booster vaccination is not currently needed for people that are fully vaccinated for COVID-19.  
 
A retrospective analysis of the outcomes of 15,060 pregnant women in an Israeli database found the estimated effectiveness of the Pfizer-BioNTech COVID-19 vaccine to be 78%.
 
Updated NIH Treatment Summary
 
Current treatment recommendations from NIH are organized by severity of disease in an easy-to-use graphic.
 

• Non-hospitalized patients not requiring supplemental oxygen that are at high risk of progressing to more severe disease should receive an anti-COVID-19 monoclonal antibody with either the combination of casirivimab and imdevimab (Regeneron) or sotrovimab (VIR), but not the combination of bamlanivimab and etesevimab (Lilly) due to concern over resistance with virus mutations. 
• Non-hospitalized or hospitalized patients not on supplemental oxygen should not receive remdesivir or dexamethasone.
• Hospitalized patients requiring supplemental oxygen, but not high flow oxygen or ventilation should receive remdesivir. Dexamethasone alone can be used if remdesivir is not available. Remdesivir and dexamethasone should be used together in patients with an increased need for oxygen.
• Hospitalized patients requiring high-flow oxygen or non-invasive ventilation should receive remdesivir and dexamethasone or dexamethasone alone. Baricitinib or tocilizumab should be added in recently hospitalized patients with increasing oxygen requirement and systemic inflammation.
• Hospitalized patients requiring mechanical ventilation or ECMO should receive dexamethasone. Tocilizumab should be added in patients admitted to an ICU.

 
NIH found there is insufficient evidence to recommend either for or against the use of GM-CSF inhibitors (lenzilumab, otilimab, or mavrilimumab) for the treatment of hospitalized patients with COVID-19.
 
COVID-19 Antivirals
 
An analysis of oropharyngeal specimens from 181 patients that were collected during the Norwegian arm of the WHO Solidarity study did not find a decrease in SARS-CoV-2 viral load with remdesivir or hydroxychloroquine compared to standard of care.