COVID Booster: mixing and matching boosters, delayed surgery, and testing recalcitrant children

It might be better to mix and match vaccines and boosters

While it’s recommended that your first two doses of a vaccine be from the same manufacturer, there’s no similar restriction on what brand your booster shot has to be.

In fact, a paper in the New England Journal of Medicine has suggested that it might be better to get a different booster to your original vaccine – although boosters of the same type provide ample protection.

The study, by Baylor College of Medicine US researchers, examined 458 people in a 1-2 phase clinical trial, each of whom had been fully vaccinated with either the Pfizer, Moderna, or one-dose Johnson & Johnson vaccine.

Each of the participants was given an extra dose of either their original vaccine, or a different one (a heterologous booster).

All participants had increased antibody levels, but levels were slightly higher in the heterologous groups.

Not this antibody cocktail

We see hopeful early treatments for COVID-19 pop up all the time, but the path to confirmed cure is long and winding – and these treatments often don’t get as much reporting when they fail.

One such case is the global trial funded by the US’s major medical research body, NIAID, on a combination of antibodies and antiviral drug remdesivir. Their findings are published in The Lancet.

“In our quest to find safe and effective treatments for COVID-19, we had hoped that adding anti-coronavirus hIVIG to a remdesivir regimen would give the immune system a boost to help suppress the virus early in the course of hospitalisation,” says Dr Anthony Fauci, director of NIAID.

“Unfortunately, the ITAC trial demonstrated that this strategy did not improve the health of adults hospitalised with COVID-19, and may be harmful for a certain subset of patients. Studies testing this strategy in non-hospitalised adults earlier in the course of infection are underway.”

The trial enrolled nearly 600 hospitalised patients around the world, and was led by an Australian: Dr Mark Polizzotto, head of the Clinical Hub for Interventional Research at the Australian National University.

Kids don’t mind getting tested

As schools reopen – on time or after a delay – there have been suggestions that kids get regularly screened for COVID-19. But COVID testing’s not the most pleasant of experiences, so a group of West Australian researchers have proposed a ‘minimally invasive’ swabbing method that was well tolerated by school students.

The researchers, who have published their findings in BMJ Open, ran a PCR screening program in 40 West Australian schools during 2020. They used OPNe swabs – a method of swabbing found to be more comfortable but less sensitive. Their program ran from Perth and the Southwest through to the Kimberley region in the north, and included a 50/50 split of primary and high schools, as well as a handful of residential colleges and education support settings.

They swabbed 5,903 asymptomatic students in total, along with 1,036 asymptomatic staff. Most children found the swabs highly acceptable: 71% stated they had no or minimal discomfort, while only 4% refused a second swab at a later date. Promisingly, the results were as sensitive as other tests.

“Here we report an approach to large-scale asymptomatic swabbing for SARS-CoV-2 leading to high levels of willingness to participate,” conclude the authors.

Nurses couldn’t sleep during the pandemic

Over half of US nurses had trouble sleeping in the first six months of the COVID-19 pandemic, according to research in the Journal of Occupational and Environmental Medicine.

Between June and August 2020, the researchers surveyed 629 nurses and interviewed 34 on their mental health and habits.

“Nurses are already at risk for higher rates of depression and insufficient sleep compared to other professions, thanks to the stress of patient care and the nature of shift work. The pandemic seems to have further exacerbated these issues to the detriment of nurses’ well-being,” says author Dr Amy Witkoski Stimpfel, assistant professor at NYU Rory Meyers College of Nursing, US.

“We found that sleep problems were interwoven with anxiety and depressive symptoms. Prior research supports this bidirectional relationship between sleep and mental health.

“We know that getting sufficient sleep fosters mental and emotional resilience, while not getting enough sleep predisposes the brain to negative thinking and emotional vulnerability.”

Elective surgery getting delayed longer during the pandemic

When elective surgeries shut down in March 2020, the backlog of patients on the waiting list expanded dramatically.

This has increased the overall wait time of elective surgeries during the pandemic, according to data from the Australian Institute of Health and Welfare (AIHW).

“To ensure the health system maintained adequate capacity to manage the COVID-19 pandemic, non-urgent elective surgery was suspended nationally in March 2020. This reduced the number of elective surgeries performed in the 2019–20 reporting period and contributed to creating a ‘backlog’ of surgeries that had been delayed,” says AIHW spokesperson, Dr Adrian Webster.

“Nationally, there were 754,600 admissions to hospital from the public elective surgery waiting lists in 2020–21, up from 688,000 admissions in 2019–20 but slightly lower than the 758,000 admissions in 2018–19.”

The average wait time has increased from 39 days pre-pandemic to 48 days in 2020-21. Aboriginal and Torres Strait Islander people have a longer wait time than the national average, of 57 days.

“While this release does not include information on the 2021–22 suspension of non-urgent elective surgery in some jurisdictions, it provides valuable insight into Australia’s public hospital system. This, and the AIHW’s ongoing monitoring, will contribute to the evidence-base and inform future decisions,” says Webster.

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