COVID Booster: vaccination payments, fluvoxamine and cancer care

Cancer care improved (on average) during the pandemic

A consensus statement by 30 Australian cancer experts has found that cancer care changed during the pandemic, and – while there were some negative effects – many elements of cancer medicine got better. Telehealth and in-home care, patient access to information, and scientific collaboration all improved, but some screening programs and diagnoses were severely disrupted.

The statement, which is published in the Medical Journal of Australia, identifies 12 key changes in cancer care following the pandemic and subsequent lockdowns.

“Health systems and health care professionals have demonstrated a remarkable ability to rapidly adapt or modify care practices to deliver optimal cancer care, while minimising risk of SARS-CoV-2 infection and optimising health system resources,” says Professor Dorothy Keefe, CEO of Cancer Australia.

“Regular and ongoing review of health care practices, underpinned by clear documentation of changes in practice and learnings, will be critical to maintaining optimal and sustainable value-based cancer care into the future.”

More than 97% of COVID-19 cases went undetected in March 2020

We know that the official case count of COVID-19 in early 2020 is far lower than the actual number of cases, with most countries testing only symptomatic arrivals from China and missing local transmission.

A modelling study published in Nature has estimated the extent of undetected COVID transmission in the US and Europe early in the pandemic. The analysis suggests that local infections were present in both regions in January 2020, and by early March, official numbers reported were between 1-3% of actual COVID cases.

The researchers, who are based at Northeastern University in the US, say that their model implies local transmission was happening in Italy by around 6 January, whereas it took until late January and early February to hit the US.

They believe there is a very low, but not insignificant, chance of local COVID infections in Europe and the US in December 2019.

Paying people to get vaccinated works

Small incentives can drive up vaccine uptake for any disease, and COVID is no exception. In the US, many states and counties have introduced lotteries and competitions, in order to encourage people to get vaccinated.

A pilot program in the state of North Carolina has shown that guaranteed financial incentives – a U$25 (~A$33) cash payment – can also be effective at driving COVID vaccine uptake.

The program offered cash cards to adults who either received their first dose of a vaccine, or drove someone else to their first vaccine appointment.

The researchers found that the incentive worked across the board, but it was particularly effective for older people, and those with lower incomes.

The results of the trial are published in JAMA Internal Medicine.

People who feel invulnerable to COVID-19 are less likely try and protect others

A study published in PLOS One has found that people who don’t think a COVID-19 infection will seriously affect their health are less likely to follow social distancing measures, or to get vaccinated.

The researchers examined online survey data for 218,956 people from 51 countries. Those who perceived themselves as invincible to COVID-19 were also less concerned about preventing spread of the virus, and less enthusiastic about being vaccinated. This was particularly the case in countries that place a high value on individual freedoms, like the US, UK, and Canada.

The researchers say that public health communications in these places should focus on the benefits a whole community will reap from following public health orders.

“To increase COVID-19 vaccination uptake in less collectivistic cultures, we recommend policy and health communications promote feelings of interdependence among community members by highlighting their shared goals, beliefs, and values,” write the researchers in their paper.

Antidepressant might help dodge severe COVID-19

A double-blind, randomised controlled trial has found that the antidepressant drug fluvoxamine could reduce the severity of COVID-19 in people with a high risk of complications.

The study, which was run in Brazil as part of the international TOGETHER trial, gave either fluvoxamine or a placebo to 1497 COVID-positive people in emergency departments.

Of the 741 participants who received fluvoxamine, 79 (10.6%) needed an extended stay in emergency. In comparison, 119 (15.7%) of the placebo participants needed to stay for a longer period of time.

“Our results are consistent with earlier, smaller trials,” says Dr Gilmar Reis, co-author on a paper in the Lancet describing the trial.

“Given fluvoxamine’s safety, tolerability, ease of use, low cost, and widespread availability, these findings may have an important influence on national and international guidelines on clinical management of COVID-19.”

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