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People with substance-use disorder may be at higher risk for breakthrough COVID cases, study finds

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Vaccinated people with substance use disorders may be at higher risk of suffering a breakthrough COVID-19 case, a new study shows.

Research carried out at the beginning of the pandemic showed that people with addictions were already more likely to develop COVID-19 and suffer severe complications from it. Now that the vaccines are widely available, the same population is still at risk, according to the study, which was conducted by researchers from Case Western University and the National Institute on Drug Abuse.

The past year and a half have been particularly difficult for addicts, between the increased risk of COVID and a rapidly escalating overdose crisis – exacerbated by the pandemic – that killed more than 93,000 people in 2020 alone. (Overdoses killed 1,214 Philadelphians in 2020, the second worst year on record.)

Although the vaccine is still highly effective and the risk of breakthrough infection is relatively low, researchers believe that the high prevalence of other concurrent health problems in people with addiction may be the increased risk of breakthrough infection. When the study authors controlled adverse socioeconomic health determinants – such as problems with employment and housing – and comorbidities, the risk of breakthrough infections was the same for people with and without substance use disorder.

The only exception were patients diagnosed with cannabis use disorder – a generally younger group of patients who were still found to be more likely to have a breakthrough infection even after the researchers checked for other factors.

“This could suggest that additional variables such as behavioral factors or adverse effects of cannabis on lung and immune function could contribute to the higher risk of breakthrough infection in this group,” the study authors write.

The study looked at more than 579,000 people who were fully vaccinated against COVID between December 2020 and August 2021. Of this group, 30,183 patients had been diagnosed with substance use disorder. The study found that 7% of people with a SUD had a breakthrough infection at least 14 days after their second vaccination, compared with 3.6% of those with no substance use disorder.

Researchers found that people with substance use disorder are also more likely to have serious breakthrough infections.

The study’s authors acknowledged some caveats, including the fact that COVID-19 vaccines taken outside of health organizations – such as a mass vaccination clinic or pharmacy – may not appear in the electronic health records used to conduct the study . And the researchers couldn’t tell from the data whether a particular breakthrough COVID-19 case was asymptomatic, symptomatic, or severe, or whether the cases they studied were caused by the highly contagious Delta variant.

Still, according to Rong Xu, professor of biomedical informatics at Case Western and one of the study’s authors, the results show that an already vulnerable group is still at risk from the virus.

“The substance use disorder population – they have a lot of comorbidities, which makes them prone to other diseases,” Xu said. It is important to treat substance use from both a physical and a behavioral perspective.

“We don’t focus so much on the long-term health effects of substance use on many of our body systems, including the immune system,” she said.

In a press release last week, NIDA director Nora Volkow, another author on the study, stressed that people with addictions should still be vaccinated and that the overall risk of COVID-19 among vaccinated members of the group is still very low.

“We must continue to promote and facilitate COVID-19 vaccination in people with substance use disorders while recognizing that this group is at increased risk even after vaccination and should continue to take protective measures against COVID-19,” she said.

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Early Omicron Reports Say Illness May Be Less Severe

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JOHANNESBURG – The Covid-19 virus is spreading faster than ever in South Africa, the country’s president said on Monday, an indication of how the new Omicron variant is fueling the pandemic, but there are early signs that Omicron is causing less serious diseases than other forms of the virus.

Researchers at a large Pretoria hospital complex reported that their patients with the coronavirus are much less sick than those they treated before, and that other hospitals are seeing the same trends. In fact, most of their infected patients were admitted for other reasons and had no Covid symptoms.

However, scientists cautioned against placing too much emphasis on potential good news of lesser severity or bad news such as early evidence that previous coronavirus infection offers Omicron little immunity. The variant was only discovered last month, and more study is needed before experts can say much about it with confidence. Additionally, the real effects of coronavirus aren’t always immediately felt as hospital admissions and deaths often lag well behind the first outbreaks.

Dr. Emily S. Gurley, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, said of the signs the variant is less severe, “It wouldn’t be shocking if that were true, but I’m not sure we do can still conclude. “.”

In the absence of more detailed information, governments have responded to Omicron with severe restrictions on international travel and new vaccination regulations. World leaders who have been accused of reacting too slowly or weakly at the start of the pandemic would like to be viewed as measures, although some experts doubt the travel restrictions are an overreaction.

The variant has spread rapidly and has so far been detected in more than 30 countries on six continents. Health officials and researchers say it could be the most contagious form of the virus to date, and that it could soon displace the Delta variant, which emerged as the predominant form last year. This has fueled fears that a world eager to overcome two years of pandemic hardship could slip into yet another cycle of disease, lockdown, and economic suffering.

In Europe as well as in South Africa there are first signs that Omicron cases can be relatively mild, albeit easily ill.

In the UK, the government said Monday that the number of Omicron cases there had risen to 336, two and a half times as many as on Friday. Denmark reported 261 cases, quadrupling the number on Friday, and local media has reported that a holiday lunch for high school students may have been a superspread event with dozens of people catching the new variant.

The UK and Denmark are doing an unusually large amount of genomic sequencing of virus samples to distinguish one variant from another and detect changes, suggesting that many Omicron cases in other countries simply go undetected.

On Monday, the United States required international travelers arriving in the country to show evidence of a negative coronavirus test, which was done no more than 24 hours before their flight, a standard that can be difficult to meet. Previously, fully vaccinated travelers could show negative test results up to 72 hours before departure.

China, a key part of the global travel and tourism industry, announced that it would keep international flights at 2.2 percent pre-Covid levels during the winter in order to maintain its zero-covid approach. The issuance of new passports has been almost completely stopped since August, arriving travelers have to be quarantined for 14 days and extensive papers and several virus tests have to be presented.

In South Africa, where scientists say Omicron is already dominant, the pandemic is picking up again. A month ago, South Africa had fewer than 300 new virus cases a day; on Friday and Saturday there were more than 16,000. It fell slightly on Sunday and Monday, but this may be due to a reporting delay often seen on weekends.

“As the country enters a fourth wave of Covid-19 infections, we are experiencing an infection rate that we have not seen since the beginning of the pandemic,” wrote President Cyril Ramaphosa in an open letter to the country. He added: “Almost a quarter of all Covid-19 tests are now positive. Compare that with two weeks ago, when the proportion of positive tests was around 2 percent. “

A report released this weekend by doctors at the Steve Biko Academic and Tshwane District Hospital Complex in Pretoria, South Africa’s administrative capital, offers the strongest support yet for a more hopeful view of Omicron, despite its author, Dr. Fareed Abdullah, Reasons Cited Be careful with conclusions.

Updated

Dec. 2/6/2021, 6:55 p.m. ET

Dr. Abdullah, director of the HIV / AIDS and Tuberculosis Research Bureau at the South African Medical Research Council, examined the 42 coronavirus patients who were hospitalized last Thursday and found that 29 of them, 70 percent, were breathing ordinary air. Of the 13 who used supplemental oxygen, four had it for non-Covid-related reasons.

Only one of the 42 patients was in the intensive care unit, in line with numbers released last week by the National Institute for Communicable Diseases, which showed that despite the surge in infections, only 106 patients were in the intensive care unit in the past two weeks .

Most patients were admitted “for diagnoses unrelated to Covid-19,” the report said, and their infection “is an incidental finding in these patients and is largely driven by hospital policy that requires testing of all patients”. It is said that two other large hospitals in Gauteng Province, which include Pretoria and Johannesburg, had an even lower percentage of infected patients who needed oxygen.

Dr. Abdullah said in an interview that he went to a Covid station and found a scene unrecognizable from earlier phases of the pandemic when it was full of the buzzing and beeping of oxygen devices.

The Coronavirus Pandemic: Important Things You Should Know

“Out of 17 patients, four received oxygen,” he said. “For me, it’s not in a Covid ward, it’s like a normal ward.”

Dr. Johns Hopkins’ Gurley noted that the severity of the disease reflects not only the variant, but who it infects. Two years into the pandemic, far more people have some immunity to the virus through vaccination, natural infection, or both, and this could lead to milder cases.

“We don’t know how to read the genetic sequences to tell exactly how this variant will develop,” she said. “We are now getting more information from South Africa, a particular population with a particular profile of pre-existing immunity.”

Dr. Maria D. van Kerkhove, the World Health Organization’s technical director for Covid, told CBS News on Sunday that even if a smaller percentage of Omicron cases were found to be severe, it means a larger number of cases could make up for it more hospitalizations and deaths.

Dr. Abdullah also examined all 166 patients with the coronavirus admitted to the Biko-Tshwane complex between November 14 and November 29, and found that their average hospital stay was just 2.8 days and less than 7 percent died . Over the past 18 months, the mean length of stay for these patients was 8.5 days, and 17 percent died. Shorter stays would take the pressure off the hospitals.

Eighty percent of the 166 patients were under 50 years of age, and similar numbers were reported across Gauteng – a sharp contrast to previous cohorts of hospitalized Covid patients who were usually older. This could be because South Africa has a relatively high vaccination rate in people over 50 and a low one in younger people, but one of the big unknowns at Omicron is whether existing vaccines offer strong protection against it.

Part of the caution in interpreting Dr. Abdullah’s report is that the numbers are small, the results haven’t been peer-reviewed, and he doesn’t know how many of the patients had Omicron, unlike other variants of the coronavirus – although the government reported last week that they already had three Accounted for quarter of the virus samples in South Africa.

Dr. Abdullah acknowledged these drawbacks, noting that there could be a delay between the first appearance of Omicron and an increase in serious illness and death. But despite the huge increase in cases, the number of Covid deaths in South Africa has not yet increased.

Lynsey Chutel reported from Johannesburg, Richard Pérez-Peña and Emily Anthes from New York. Coverage was contributed by Megan Specia, Isabella Kwai, Sui-Lee Wee, Juston Jones and Jenny Gross.

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Miller awarded prestigious grant to research policy impacts, health disparities

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Contact: Sarah Nicholas

Gabe Miller (Photo by Robby Lozano)

STARKVILLE, Miss. — A Mississippi State Sociology faculty member is awarded a prestigious Robert Wood Johnson Foundation grant to study how policy affects the health outcomes of members of the LGBT community and other marginalized groups.

Gabe H. Miller, assistant professor of sociology and faculty member in MSU’s African American Studies program, has received the $ 248,431 two-year scholarship from the Robert Wood Johnson Foundation, the nation’s largest philanthropy devoted exclusively to health. The scholarship is part of the RWJF’s Health Equity Scholars for Action initiative. Since 1972, the organization has supported research and programs targeting America’s most pressing health problems – from substance abuse to improving access to quality health care. More information can be found at https://www.rwjf.org/en/how-we-work/building-a-culture-of-health.html

Miller’s Prize is awarded for his proposal “Investigating the Effects of Political and Political Determinants of Health on the Health Outcomes of Lesbian, Gay, Bisexual and Transgender People”. He said he would use his research to guide policymakers towards data-driven policies promoting the health, wellbeing and equal opportunities of the population, and to work on building a “health culture,” which is a core theme at RWJF.

“Racism, homophobia and transphobia affect the health of people of color and LGBT people through discrimination, stigma and minority stress,” said Miller, noting that LGBT people are at greater risk for depression, anxiety, post-traumatic stress disorder, alcohol problems and suicide psychiatric difficulties.

“An intersectional approach to health advocates considering how systems of inequality combine or overlap to produce different health outcomes based on where individuals fall across multiple structures of inequality,” Miller said.

“I will examine the effects of more than 40 different LGBT protections in all 50 states from 2013-2020 to examine how those protections at the federal level affect mental health, physical health, chronic illness, access to health and people’s health behaviors affect LGBT populations. Additionally, I will examine whether these guidelines have different implications when we consider the racial and sexual orientation overlap, ”he said.

Deputy Dean of Research Giselle Thibaudeau said: “Given our commitment to health equity, the MSU is fortunate to have Dr. To have Miller’s passion and expertise in the health inequalities of marginalized communities. We are proud of the recognition and funding of his research by the RWJF. More importantly, we are very proud and hopeful of the impact of Dr. Miller’s efforts on these communities and health equality in general are. “

Born in Texas, he has been a faculty member since 2020 and received his Ph.D. in Sociology from Texas A&M University. His research and teaching interests at MSU include medical sociology and health disparities.

As part of the MSU’s College of Arts and Sciences, the Sociology Department is available at www.sociology.msstate.edu. Further information on the African American Studies course can be found at www.aas.msstate.edu.

MSU is the premier university in Mississippi, available online at www.msstate.edu.

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The link between cytokine storms and cardiovascular problems in COVID-19 patients

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Increased inflammation from cytokine storms has led to several heart complications in infections with coronavirus disease 2019 (COVID-19). But to treat these cardiovascular problems, doctors need to better understand the relationship between cytokine storms and cardiovascular proteins.

New research suggests that the Th1, Th2, and Th17 inflammatory pathways are involved in the overproduction of cardiovascular proteins in COVID-19 infections. Th1 cytokines have an established role as mediators against viral infections. Th2 and Th17 inflammatory pathways are signals during a severe autoimmune reaction.

The results can help clinicians select effective treatment regimens for patients with cardiac complications. They suggest using immunomodulators to reduce cardiovascular inflammation and prevent the immune system’s ability to fight the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Study: Th1, Th2 and Th17 inflammatory pathways correlate synergistically with cardiometabolic processes. A case study on COVID-19. Image source: Corona Borealis Studio / Shutterstock

The study was recently published on the preprint server bioRxiv *, while the article is being peer-reviewed.

Cytokine levels in T helper cell signaling pathways

The researchers compared the cytokines in patients who were or were infected with SARS-CoV-2. In COVID-19 cases, an increasing trend in protein expression was seen in most Th1 and Th17 mediators (and in more than half of Th2 mediators). Protein levels rose from non-severe infections to patients who died from COVID-19 illness. Deceased COVID-19 patients had significantly high Th1, Th2, and Th17 levels. Patients with non-COVID respiratory infections did not show increasing trends in protein expression in inflammatory pathways.

Relationship between cardiometabolic protein and COVID-19 disease severity

In the second research phase, every existing relationship between cardiometabolic protein and COVID-19 infection was examined. Of the 335 cardiometabolic proteins examined, around 35 were strongly linked to the severity of COVID-19 disease. In addition, all 35 proteins were expressed at significantly increased levels in patients who died of COVID-19 disease. Ten cardiometabolic proteins were highly expressed in intubated patients with COVID-19 compared to patients with mild disease.

Cytokine storms contribute to COVID-19-related heart complications

Next, the research team tested its hypothesis that Th1, Th2, and Th17 cytokines are involved in altering cardiometabolic proteins. They grouped immune markers for each pathway and analyzed their frequency of expression for each cardiometabolic protein present in patients with COVID-19 infection.

The results showed 186 links between cytokines and cardiometabolic proteins expressed in COVID-19 infection. In particular, a synergistic effect between the immune pathways and proteins of Th1, Th2 and Th17 was observed.

The research stated that

Most of the compounds on our networks were positive compounds, suggesting that increased production of cytokines stimulates the overall production of cardiometabolic proteins. “

Of the 35 cardiometabolic proteins correlated with severe COVID-19 infection, 31 were predictive factors for cytokine storms. In fact, 20 of the 31 proteins have also been linked to cardiovascular inflammation and high blood pressure in other research studies. The 20 proteins were most strongly associated with IFNGR1 of the Th1 pathway. In the TH2 pathway, the most common association was with CCL11 and CCL7. In the Th17 pathway, the 20 cardiovascular markers were strongly linked to the cytokines PI3, LCN2 and IL6.

Study restrictions and future directions

The study used limited OLINK assay analysis to identify associations between immune mediators in inflammatory pathways and cardiometabolic proteins. An alternative technique that may have provided more descriptive and accurate results is whole genome sequencing.

A second limitation is that due to the many unknowns surrounding SARS-CoV-2 at the beginning of the pandemic, many COVID-19 cases were initially misdiagnosed. Incorrect diagnoses can alter the predictive power of cardiovascular markers with the severity of COVID-19.

Future research is needed to examine the relationship between helper T cells and heart inflammation. This should focus on a more detailed comparison between the cardiovascular and immune pathways and their interaction with viral infections beyond SARS-CoV-2.

Further studies examining the relationships between two systems could provide a complete picture of the immune-cardiovascular interaction in disease and health.

*Important NOTE

bioRxiv publishes preliminary scientific reports that have not been peer reviewed and therefore should not be considered conclusive, that guide clinical practice / health-related behavior or should be treated as established information.

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