Being infected with Covid-19 increases the risk of developing cardiovascular disease by 55% in the year following contamination. This is the finding of a study published on February 7 by American researchers. 

People with Covid-19 have an increased risk of cardiovascular disease

Researchers at Washington University in St. Louis, USA have been interested in the consequences of Covid-19 on the heart and blood circulation of Covid-19 infected patients. To carry out their research, they analyzed data from 153,760 infected people in the United States between March 2020 and January 15, 2021, which they compared to data from 5 million uninfected people.

According to the results published on February 7, 2022, in the journal Nature Medicine, people with Covid-19 have an increased risk of cardiovascular disease (cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease).

In detail, Covid-19 infection increases the risk of cardiac arrest by 63% and stroke by 52%. In total and all cardiovascular diseases combined, the infection increases the risk of developing cardiovascular disease by 55%. 

A risk that also concerns people without comorbidities

Although the risk of developing cardiovascular disease is greater in hospitalized people, it also increases in people infected without comorbidities, in those who have had mild forms and in those who have not been hospitalized.

According to University of Washington assistant professor of medicine and study author Ziyad Al-Aly, "Even people who have never had heart problems and are considered low risk can develop the cardiovascular disease after Covid. Our data show that the risk increases in young and old people, in those with diabetes and those without, in those who have had heart disease before and in those with no history of cardiovascular disease, in those who have been hospitalized for Covid-19 as well as in those with mild forms of Covid-19."

Covid has led to more than 15 million cardiovascular diseases worldwide

Researchers estimate that 15 million people are suffering from cardiovascular disease due to coronavirus infection. Indeed, the authors of the study note that cardiovascular diseases affected about 4% more people in the group of infected people. Given that there have been more than 380 million infected people worldwide, they conclude that Covid-19 may have caused more than 15 million cardiovascular diseases.

 After an infectious disease, fatigue is common. In the case of Covid-19, it is sometimes intense and can last for several months. Some patients need to undergo exercise rehabilitation sessions.

After the acute phase of Covid-19, fatigue persists very frequently. It is logically found in patients who leave the hospital after having presented a severe form of the disease, but also in some people who have suffered only mild symptoms. "Six weeks after infection, half of the patients have not regained their full capacity," says Professor Pierre Tattevin, president of the French-language Society of Infectious Pathology.

Why this post-Covid fatigue?

All infectious diseases can put the body flat for several weeks, and this is especially true with Covid-19. "The disease puts a lot of strain on the immune system, which could explain why fatigue is so marked after infection, especially in young and initially healthy patients, whose immune system is very reactive. This fatigue does not surprise us in patients who have been ventilated (placed on respiratory assistance, Editor's note) and who is released from resuscitation. It is more surprising in young people who have presented with a non-severe form of Covid. We do not see such a situation after the flu, "observes the infectiologist.

Is this fatigue different?

The High Health Authority (HAS) delivered its recommendations on the management of Covid-long in February 2021. In this practical document for doctors, she describes fatigue as "one of the most prevalent symptoms that can persist during the initial episode of Covid-19 or reappear abruptly after a phase of improvement". 

The HAS encourages not to neglect this seemingly banal symptom and to look for its cause as much as possible. "We must not put everything on the account of Covid-19," warns Professor Tattevin who invites patients to talk to their doctor. 

Fatigue during exertion, persistent shortness of breath are common. They may reveal a breathing problem that has not been resolved or a heart defect.

But other factors can trigger, or aggravate, this feeling of exhaustion: non-restorative sleep, stress, anxiety, even depression...

Why do we need to fight this fatigue?

In consultation, patients tell their doctor that they "can't take it anymore". The risk, in this context, is to fall into a vicious circle. When you are exhausted, you sit or lie down, you limit your activities. However, the less you move, the more you lose your muscles and respiratory abilities. 

After a Covid it is undeniable necessary to rest; but without, however, remaining inactive. On the contrary, it is important to regain a good physical condition as quickly as possible by strengthening your muscles and increasing your lung capacity. Another advantage is that by practising physical activity, you regain self-confidence and the body secretes endorphins, anti-stress hormones, which help overcome anxiety related to the disease.

What physical activity after Covid?

This physical activity must be progressive and adapted to the abilities of each person, for example walking or cycling. You have to train at your own pace, without trying to do too much.

It can be practised at home or under the supervision of a professional. On its website, the Aprèsj20 association, which brings together patients suffering from Covid-long, advises a gentle Aprèsj20, to be done at home, developed by the Pitié Salpêtrière Hospital (Paris).

For its part, the French Association of Chronic Fatigue Syndrome (a disease that has many points in common with Covid-long) offers practical advice to better recover. 

For people who are particularly embarrassed about their respiratory level, exercise rehabilitation sessions, supervised by a sports doctor or a physiotherapist, are necessary. It is, at present, one of the few treatments for Covid-long validated by the High Authority of Health. "These rehabilitation programs, which start in the hospital, but can then be continued at home, are offered to patients à la carte, after assessing their difficulties: mainly muscle fatigue or breathing difficulties," explains Professor Tattevin.

Post-covid fatigue: getting out of the mental fog

Many patients come out of the Covid ordeal with a feeling of "mental fog". They complain of confusion, memory problems and lack of concentration. These different symptoms are often exacerbated by the stress and anxiety generated by the disease. 

To overcome these difficulties, some people need real psychological support. But most will get by respecting simple rules of lifestyle: avoid stimulants such as tea or coffee, ban screens after 6 pm to fall asleep more easily, sleep in a cool room, relax or even meditate if possible...

Most patients who feel exhausted after Covid will recover within a few weeks. For others, it will be longer. Evolution is often jagged, with ups and downs, at a different rate depending on the individual. As such, Professor Tattevin wants to convey a message of optimism: "It's long, but it always ends up getting better. Don't get discouraged! »

 Several variants (Alpha, Delta...) of the SARS-CoV-2 coronavirus have appeared since the beginning of the pandemic. Now, in France, it is the Omicron variant that is in the majority. How many cases? How effective are vaccines against this new variant?

Many variants of SARS-CoV-2 are circulating around the world. Some are referred to as 'variants of concern' (VOCs) or 'variants to be monitored' (VOI) because their impact (transmissibility, contagiousness, potential immune escape) justifies the implementation of special monitoring and specific management measures. Other variants remain classified as 'under evaluation', in the absence of virological, epidemiological, or clinical evidence in favour of a public health impact in France. In France, the Omicron variant became the majority only one month after the detection of the first case in metropolitan France.

The new variant "Deltacron", what is it?

The Delta and Omicron variants are the two strains that are currently circulating very actively in many countries. What if they combined? This is what a Cypriot researcher fears: he claims to have discovered a new strain of the coronavirus that combines Delta and Omicron, as reported by articles in the Cypriot press including the Cyprus Mail, taken up by the Bloomberg News agency. Leondios Kostrikis, professor of biological sciences at the University of Cyprus and head of the Laboratory of Biotechnology and Molecular Virology, says that the "Deltacron" strain, as he has nicknamed it, has already caused at least 25 cases on the island of Cyprus, where the incidence rate of COVID-19 cases is considered the highest in Europe.

Its particularity? The genetic signature of the Omicron variant and the genomes of the Delta variant. "There are currently Omicron and Delta co-infections and we have found this strain which is a combination of both," Said Leondios Kostrikis in an interview with Sigma TV. "We will see if this strain is more pathological or more contagious or if it will prevail over Delta and Omicron," he added. Not without estimating from a personal point of view that this possible new strain will be replaced by Omicron, much more contagious than other strains of SARS-CoV-2. It should be noted that the discovery of this new mutation is awaiting official confirmation since samples have been sent to the GISAID device of the Institut Pasteur for analysis.

The role of this international database is to list all the observed changes and mutations of Covid-19, which are subsequently made available to the global scientific community. The presence of "Deltacron" was updated following analyses of samples taken from both the general population and hospitalized patients. The results showed that its frequency is higher in patients hospitalized due to Covid-19 compared to non-hospitalized patients, which could mean that there is a correlation between Deltacron and hospitalizations. But other details are all the more expected on this subject as the analysis of the genetic sequences of the supposed 25 cases has led some scientists to pronounce themselves for a "false alarm".

The newspaper Libération reveals that the hypothesis of improper handling in a laboratory is evoked on Twitter by some scientists who have had access to Gisaid. This is the case of Tom Peacock, virologist at Imperial College London who explains that "the Cypriot Deltacron sequences seem to be quite clearly a contamination, they do not group on a phylogenetic tree". It would therefore be rather a "mixture" between several laboratory samples. The latter adds that "true recombinations appear a few weeks or even months after the simultaneous circulation of several variants. Omicron has only been circulating for a little over two weeks, I doubt that there could have already been recombinations... So cases to follow.

Variant Omicron (B.1.1.529): symptoms, severity...

This new variant of the coronavirus was detected on November 25 in South Africa, the African country officially most affected by the pandemic. Named 'Omicron' by the WHO (B.1.1.529), it has an extremely high number of mutations, according to South African scientists: no less than thirty, while the Delta variant has only two. This variant is now the majority among Covid-19 infections in France, two months after its appearance in metropolitan France.

What are the symptoms of the Omicron variant?

According to data collected by Public Health France, the most frequent symptoms that appear after Covid-19 contamination are: 

• cough;
• fatigue;
• fever;
• Congestion or runny nose. 

Cases of nausea, vomiting, shortness of breath, and diarrhea have also been reported, but to a lesser extent. During the weekly update of January 6 of Public Health France, the loss of smell and taste is cited by only 10% of the 338 people interviewed by Public Health France.

In France, more than half of covid-19 deaths in hospitals are now linked to this variant

Between 17 and 23 January 2022, the Directorate of Research, Studies, Evaluation, and Statistics (Drees) estimates that the Omicron variant concerns 57% of deaths occurring in hospitals with Covid-19.

The results, published on Friday, Jan. 28, and updated weekly, also indicate that Omicron is responsible for 99 percent of positive PCR tests, 88 percent of conventional hospital admissions, and 79 percent of critical care admissions.

"The lower representation of the Omicron variant in hospitalized people than in those who tested positive therefore remains, even if this difference in prevalence is decreasing week after week," reports Drees. It would be the fact of the 'temporality of these events (which) differs since infections precede hospitalizations by about a week, themselves preceding deaths by about a week'.

A lower hospitalization rate with the Omicron variant than with Delta

According to a study published on January 10, 2022, by the Assistance Publique-hôpitaux de Paris (AP-HP), the probability of using critical care is "three times higher in patients infected with the Delta variant than with the Omicron variant". The AP-HP studied the share of the Delta variant and the Omicron variant in new patients hospitalized in its departments for Covid-19 between December 1, 2021, and January 4, 2022, in critical care and conventional hospitalization.

• "On average over the last week of 2021, about 19% of daily entrants with Omicron in critical care and 54% in conventional hospitalization," notes the AP-HP. 
• Conventional hospitalizations that correspond to stays of less than one day represent '19% of stays for incoming patients infected with Delta and 43% for incoming patients infected with Omicron'.

According to two British studies published on December 22, the risk of hospitalization related to an infection with the Omicron variant is 70% lower than during infection with the Delta variant.

Their results also showed that the Omicron variant would be less dangerous for the elderly than the Delta variant. "First of all, more of them have made their recall. But also for anatomical reasons. The Hong Kong researchers showed that with the Delta variant we had a lot of variants and viruses that went down into the lungs and it makes serious forms. While with Omicron it goes down less into the lungs, there are fewer serious forms," explained Dr. Damien Mascret on the set of France 2 on December 23.

Is the booster dose needed to protect against the Omicron variant?

In an opinion published on 16 December 2021, the Scientific Council confirms that a booster dose of vaccine would increase vaccine efficacy against Covid-19 and the development of a severe form of the disease. The booster dose (3rd dose) restores an immune response to the Omicron variant. It protects, probably at a good level, against the occurrence of severe and severe forms, but only partially protects against infection with the Omicron variant. According to the researchers, vaccine efficacy would remain at 70% after a booster dose.  

Getting out of the pandemic phase?

On Tuesday 11 January, the European Medicines Agency estimated that Omicron would transform Covid-19 into an endemic disease. From now on, we will have to learn to live with it.

"Nobody knows exactly when we will be at the end of the tunnel, but we will get there," said Marco Cavaleri, head of vaccine strategy at the Amsterdam-based European Medicines Agency (EMA). "With the increase in immunity in the population – and with Omicron, there will be a lot of natural immunity in addition to vaccination – we will move quickly towards a scenario that will be closer to endemicity." This is encouraging news that should not make us forget that the world is still in a pandemic.

A higher reinfection rate for the Omicron variant?

WHO Director-General Tedros Adhanom Ghebreyesus had announced that the reinfection rate of the Omicron variant would be much higher than other variants of Covid-19. "Preliminary data from South Africa suggest a higher risk of reinfection with Omicron, but more data are needed to draw firmer conclusions.

A data confirmed by the Scientific Council (opinion published on December 16, 2021): 'The transmission is significantly increased compared to the Delta variant.'

What is known about the Subvariant of Omicron, BA.2, detected in France?

The BA.2 sublineage of the Omicron variant has been detected in several countries, including France. Already the majority in India and Denmark, it has several mutations that could modify the characteristics of the virus. Most of them are found in the Spike protein, the key to the virus' entry into cells. 

"We know neither its origin, nor its virulence, nor its ability to escape immunity, including that conferred by Omicron. On the other hand, it seems to be more contagious," explained Antoine Flahaut, epidemiologist and director of the Institute of Global Health at the University of Geneva.

In France, in mid-January, only about fifteen cases of BA.2 subvariants have been sequenced for the moment. The authorities remain cautious: the subvariant BA.2 'corresponds to the characteristics we know of Omicron (...) It does not change the situation," assured the Minister of Health, Olivier Véran, Thursday, January 20. For its part, the WHO confirms to CheckNews "a trend of increase in BA.2 in recent weeks" and says "monitor the progression of BA.2 and its possible implications".

Effectiveness of vaccines against Omicron: what data are available?

In a new risk analysis of Covid-19 variants published on Friday 7 January, Santé Publique, France reported on the available data on the effectiveness of vaccines against the Omicron variant. 'Vaccine efficacy against infection (37 to 86%), hospitalization (70 to 88%), and severe forms (98%) appear to be maintained against Omicron after administration of a booster dose. Preliminary analyses conclude that Omicron has a reduced risk of hospitalization compared to other variants (up to 81%).' The agency recalls that these data should be interpreted with caution because cases of Omicron infection are still mostly identified in a young population, which is, therefore, less at risk. 

According to a study conducted by the Institut Pasteur and published on December 20, 2021, the Omicron variant would be resistant to the antibodies of a person who received his complete vaccination regimen five months ago with the Pfizer or AstraZeneca vaccine. Scientists find that blood from patients who have had COVID-19, collected up to 12 months after symptoms, as well as from people who have received both doses of the Pfizer vaccine or the AstraZeneca vaccine, almost no longer neutralize the Omicron variant, five months after vaccination. On the other hand, the sera of individuals who received the 3rd dose of Pfizer booster, analyzed one month after injection, remain effective against Omicron', reads the statement.

A few days later, it is Danish researchers who provide more details about the higher ability of the Omicron variant to circumvent the immunity of vaccinated people compared to the Delta variant. By surveying nearly 12,000 Danish households, the researchers found that Omicron was 2.7 to 3.7 times more infectious than the Delta variant is fully vaccinated Danes. This variant would therefore spread mainly faster because it better escapes the immunity obtained through vaccines.

In this study published in the journal "medRxiv" (a version of a scientific article that has not yet been validated by peers), and relayed by the Reuters agency, the researchers say that Omicron is not so much characterized by greater transmissibility, but by a greater ability to "escape" vaccine immunity. "Our results confirm that the rapid spread of the Omicron variant can mainly be attributed to immune evasion rather than an inherent increase in basic transmissibility," they say. Their study also shows that the effectiveness of the vaccine was reduced to about 40% against symptoms and 80% against a severe form of the disease when it came to the Omicron variant.

It also found that people who received a booster dose are less likely to transmit the virus, regardless of the variant, than people who were not vaccinated.

Finally, although more transmissible, Omicron seems to induce a less serious disease, ISS technical director Tyra Grove Krause told local media. "While Omicron will still be able to put pressure on our health care system, all indications are that it is milder than the Delta variant," she said, adding that the risk of being hospitalized with Omicron was halved compared to the Delta variant. "Maybe that's what will get us out of the pandemic so that it becomes the latest wave of COVID-19," she concludes.

Variant Omicron: are laboratories developing new vaccines?

Since the discovery, at the end of November, of the variant 'Omicron', it is the swing of combat on the side of the laboratories. Contacted by BFMTV, the Pfizer-BioNTech laboratory had explained that it was waiting for complete data from South African analysis laboratories before deciding on the possibility of developing a new vaccine.

For its part, "Moderna will rapidly develop a vaccine candidate for a booster dose specific to the Omicron variant," the U.S. company said in a statement on November 26. This announcement is part of a strategy to work on specific recall doses for variants of concern, according to the laboratory. "From the beginning, we have said that to fight the pandemic, it is imperative to be proactive in the face of the evolution of the virus," said Moderna boss Stéphane Bancel, quoted in the statement.

Oxford and AstraZeneca also say they can develop a new serum "very quickly", especially against the Omicron variant. In a statement, AstraZeneca also said it has "developed, in close collaboration with the University of Oxford, a vaccine platform that allows us to respond quickly to new variants that may appear." The British pharmaceutical company announced that it was "already conducting research in places where the variant has been identified".

Despite some claims widely relayed on social networks, variants are not created by vaccines. It is enough to take the example of the British variant that spread long before the vaccination campaign in the United Kingdom began, recalls Inserm.

Delta variant: contagion, diffusion, dangerousness?

The Delta variant was first identified in the fall of 2020, in the Nagpur region of India. To date, all the countries of Europe are confronted with it. According to the latest GISAID data, the majority of B.1.617 cases are identified in India, the United Kingdom, the United States, Germany and Singapore.

This lineage includes three sublineages, characterized by the L452R and P681R mutations: 

• B.1.617.1 (Kappa, VOI), 
• B.1.617.2 (Delta, VOC), the most frequent in France,  
• and B.1.617.3.

What are the differences between the three main Indian variants?

Each of the Indian variants involves a different risk, according to the Scientific Council (opinion of 24 May 2021):

Subline B.1.617.2 (Delta variant), which does not have the E484Q mutation (contrary to what was initially announced), is the most frequently detected lineage in France and Europe. Note that it also has additional specific mutations that can give it a superior transmissibility advantage to the other two lineages (L452R associated with T478K in the absence of E484Q mutation). It has been classified as VOC since May 12 by the WHO.

Subline B.1.617.1, (Kappa variant) which also has the combination of the two mutations, was detected in Europe and France, but at a low frequency compared to lineage B.1.617.2. Of the three viruses, it is the one that has the largest antigenic difference compared to the historical strain 'Wuhan' and therefore a risk of immune escape. It is classified as VOI. 

Subline B.1.617.3, which exhibits the combination of the L452R (which may be associated with an increase in virus transmissibility) and E484Q (responsible for post-infectious and post-vaccine partial immune escape) mutations, has spread very little in and out of India.

The Delta variant '40 to 60% more transmissible' than the Alpha variant

'This variant is characterized by increased competitiveness compared to other variants, including the Alpha variant. It is more transmissible than historical viruses (about 2 times more) and the VOC Alpha (about 40 to 60% more transmissible), Beta (about 60%) and Gamma (about 30%)', indicated Public Health France is a risk analysis published on July 28. And before adding: "Among the possible factors that may explain this increase in Delta's transmissibility, several different data sources indicate an increase in viral load in the nasopharynx in infected people compared to Alpha and other reference viral strains."

'A recent study conducted on a small number of people suggests a shortening of the Delta generational interval compared to the reference strains (4 days versus 6). Data from the UK, Canada, and Singapore indicate an increased risk of hospitalization and severe forms related to this variant compared to VOC Alpha and other reference strains," the organization said.

This variant is characterized by increased competitiveness compared to other variants, including the VOC Alpha. It is more transmissible than historical viruses (about 2 times more) and that THE VOC Alpha (about 40 to 60% more transmissible), Beta (about 60%), and Gamma (about 30%), confirms the risk analysis of Public Health France (August 25).

"The Delta variant is so contagious that it crushes the competition between variants, there is none that has managed to supplant it," explained Yannick Simonin, virologist specializing in emerging viruses, interviewed by Ouest France, October 18, 2021.

Are vaccines effective against the Delta variant?

The effectiveness of mRNA vaccines (Moderna and Pfizer/BioNTech) and Vaxzevria® vaccine (AstraZeneca) on the prevention of severe forms of Covid-19 is established. However, "vaccines save lives, but they do not completely prevent the transmission of Covid-19," said boss Tedros Adhanom Ghebreyesus on Wednesday 24 November.

Since August, the Pfizer-BioNTech laboratory has been working on an updated version of its vaccine that targets the peak protein of the Delta variant, reports BFMTV: "We took measures months ago to be able to adapt the mRNA vaccine within 6 weeks and ship the first batches within 100 days in case of the variant that escapes immunity,  says the Pfizer spokesman. To this end, the companies have begun clinical trials with alpha and Delta variant-specific vaccines to collect safety and tolerability data that can be provided to regulators as part of baseline studies if a specific vaccine is needed."

Having been infected with the coronavirus before being vaccinated would guarantee better protection against variants

Researchers at Imperial College London (study published on April 30 in the journal Science) had compared the immunity of patients who had contracted Covid-19 in the nine months before the injection, and the immunity of patients who had never contracted Covid-19, after administration of a single dose of vaccine. 

Their conclusions? Patients who have already had Covid-19 have significantly improved protection against the English and South African variants after a single dose of the mRNA vaccine. The scientists found that after the first dose of vaccine, a previous infection was associated with an enhanced response of T cells, B cells, and neutralizing antibodies, which could provide effective protection against SARS-CoV-2, as well as against the Kent and South African variants. However, since individuals contracted a moderate form of covid-19 before the first dose of vaccine, the antibody response was much less important vis-à-vis the English or South African variant.

Conversely, in patients who have never had Covid-19, the immune response is less after the first dose of vaccine, potentially making them more at risk of being infected with a variant. The data collected indicate that 90% of vaccinated people who have not previously been infected with the coronavirus have 'not developed detectable neutralizing antibodies against the English variant B.1.1.7 (after the first vaccine injection)'. This observation underlines the importance of deploying second doses of messenger RNA vaccine.

"Our study is reassuring and a warning. We show that current vaccines offer some protection against variants of concern. However, people who have only received the first cycle of a double-dose vaccine have a more attenuated immune response," warns Professor Áine McKnight, of the Queen Mary University of London.

Delta variant has reduced the effectiveness of vaccines against disease transmission to 40%, warns WHO

The Highly Contagious Delta variant has reduced the effectiveness of vaccines against the transmission of Covid-19 to 40%, the head of the World Health Organization (WHO) announced on Wednesday (November 24th). At a press briefing, Tedros Adhanom Ghebreyesus called on people to continue wearing masks and other barrier measures. 

"There is evidence to suggest that before the arrival of the Delta variant, vaccines reduced transmission by about 60%. With the Delta, it dropped to 40 percent," he said. "In many countries and communities, we are concerned that there is this misconception that vaccines have ended the pandemic and that people who are vaccinated no longer need to take further precautions."

What protective measures against omicron and Delta variants?

In order to protect against the Delta variant and other variants of the coronavirus, it is important to maintain barrier gestures and respect the protocol if you are considered a contact case.

What to do when you are a contact case, but already vaccinated?

If a person has a complete vaccination schedule and is not considered immunocompromised, there is no obligation to self-isolate. On the other hand, the contact case person must respect certain health rules to break the chains of transmission of Covid-19:

• immediately perform a screening test (RT-PCR or antigen test);
• inform the people we have met within 48 hours after meeting the sick person and recommend that they limit their social and family contacts;
• respect barrier gestures for 1 week after the last contact with the patient and in particular:
• limit social interactions, especially in establishments open to the public were wearing a mask is not possible;
• avoid contact with people at risk of severe illness, even if they are vaccinated;
• wear a category 1 mask in public spaces;
• if you live with a person who tests positive: wear a mask at home;
• carry out self-monitoring of temperature and the possible onset of symptoms, with immediate screening in case of symptoms, regardless of age;
• Perform a second self-test on Day 2 and Day 4 after the last contact with the positive person.

What to do when you are a contact case and you are not vaccinated?

At a press conference held on Tuesday, December 14, 2021, the Director-General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus warned about the progression of the Omicron variant that is spreading "at a rate we have never seen".

77 countries have reported cases of Omicron

The World Health Organization yesterday expressed its concern about the progression of the Omicron variant. According to her, this new strain of Covid-19 is spreading "at a rate that we have never seen with any other variant". In detail, the Director-General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus announced that 77 countries have now reported cases of omicron variant contamination in their territories, even if "the reality is that Omicron is probably in most countries even if it has not yet been detected".

Faced with this observation, the UN institution calls for the use of all tools to prevent health systems from being overwhelmed as the end of the year holidays approach. "We are concerned that people consider Omicron to be benign," warned Tedros Adhanom Ghebreyesus. To which he added, "Even if Omicron causes less serious illnesses, the number of cases could once again overwhelm unprepared health systems."

WHO warns of vaccine inequity

With 41 countries still failing to vaccinate 10% of their population and 98 countries still failing to reach the 40% vaccination rate mark, the WHO chief is calling on the international community to respond to vaccine inequity. "If we end inequity, we end the pandemic. If we allow inequity to continue, we are allowing the pandemic to move forward," he warned.

Indeed, while some countries are now offering booster doses, Dr. Tedros is concerned that this could contribute to the accumulation of Covid-19 vaccines by rich countries, as has been the case so far. He said that the WHO is not against booster doses but against vaccine inequity. For him, "it's a question of prioritization. [...] Giving booster doses to groups at low risk of serious illness or death simply endangers the lives of high-risk groups who are still waiting for their first doses."

 The Ministry of Health published this Monday, December 13, the opinion of the Scientific Council to deal with Covid-19 during the holiday season. Among its recommendations, the body gave a series of individual and collective measures to be implemented before Christmas. Here's what to remember.

 Limit the number of guests, perform self-tests and ventilate the rooms well

In general, the Scientific Council recommends during family gatherings such as Christmas meals to 'limit the number of participants, to ensure that vulnerable people have received their booster dose, to ventilate the premises regularly, and to perform a self-test the same day or an antigen test the day before or the same day of the event ”.

Regarding screening, the Scientific Council recommends that all participants be tested, "either by a self-test on the same day or by an antigen test, the day before or the same day of the event". Recalling that a self-test costs 5 euros, the body suggests that "the organizers of these festivities could thus very usefully organize the self-test, by buying them and making them available as soon as the participants arrive".

Regarding the ventilation of rooms, the Scientific Council advises to "keep a window or door open for at least 10 minutes per hour or permanently if possible during the event" to reduce the risk of contamination. In addition, the authority encourages the use of a CO2 sensor.

Giving up mass gatherings and canceling corporate events

Faced with the progression of the 5th wave linked to the Delta variant and the emergence of the Omicron variant, the Scientific Council recommends "giving up as much as possible, and at least until the end of the year holidays, to participate, without permanent wearing of a mask, in collective gatherings, parties, receptions, lunches, dinners or evenings". In this sense, the body recommends that "major events that can lead to giant clusters must be avoided".

Regarding administrations, companies, associations, and organizations, the Scientific Council asks to cancel "immediately all events scheduled for December", and to favor teleworking for employees who can. "It would also be important that any employee with symptoms of COVID-19 does not go to work, in doubt," adds the Scientific Council.

 After the Moderna laboratory had already announced less than a week ago, its intention to develop a booster dose of vaccine-specific to the Omicron variant, the Pfizer and Johnson * Johnson laboratories announced in turn, this Monday, November 29, to have begun work on a new version of their respective vaccines.

Laboratories are ready in case current vaccines are not effective enough against Omicron

In an interview with the American channel CNBC, the boss of Pfizer Albert Bourla, announced that the Pfizer laboratory has already made its first DNA model, which is the first step in the development of a new vaccine. While the laboratory had already created two new versions of its vaccine in less than a hundred days, against the Delta and Beta variants (which were ultimately not used), the leader explained that in "95 days, we will have the new vaccine" against Omicron. He also said the group has the capacity to produce four billion doses next year.

Laboratories remain "confident" in the face of current solutions

Although the laboratories are ready to launch a new version of the Covid-19 vaccine, they are still confident about current solutions. Mathai Mammen said Johnson, "remains confident" in the immune response to his current single-dose vaccine in the face of various variants.

On the side of Pfizer, Albert Bourla also assured to be "quite confident" in the vaccine currently distributed indicating on this subject that "we have reached the right dosage from the beginning". The CEO of Pfizer also recalls that beyond the vaccine, the anti-Covid pill developed by Pfizer (allowing to reduce from ten to one the number of people going to the hospital), was "developed with the idea" that mutation of the virus would appear. "I'm very, very confident in the ability (of the pill) to work with all mutations, including Omicron," he explained.

 The Pfizer laboratory has designed an antiviral drug that would be able to reduce the risk of hospitalization and death after Covid infection by 89%. This is an orally administered pill called Paxlovid. What is its mode of action? Its side effects? Discovery.

Pfizer has designed an oral treatment specifically designed to be administered orally at the first signs of Covid infection. This pill is called Paxlovid. On November 16, 2021, the U.S. pharmaceutical company applied for emergency use authorization from the U.S. Food and Drug Administration (FDA). How does this pill work? Its effectiveness against Covid? Its side effects? Knowledge to date.

What is Paxlovid?

The American pharmaceutical company Pfizer has developed an antiviral treatment, marketed under the name Paxlovid. If granted marketing authorizations, this pill, administered orally, could be taken at home in the first days after the onset of symptoms in case of Covid-19 infection. Paxlovid is a treatment similar to Molnupiravir, an antiviral drug developed by the American pharmaceutical company Merck. Already authorized since the beginning of November in the United Kingdom, this antiviral has been the subject of an application for emergency authorization in the United States, which must be examined on November 30 by the FDA. The French government would have ordered 50,000 doses, said Health Minister Olivier Véran at the end of October, pending validation by the European Medicines Agency.

How effective is it against Covid?

Paxlovid would be able to reduce the risk of hospitalization or death by 89%

In an interim phase 2/3 randomized, double-blind analysis conducted on more than 1,800 out-of-hospital patients in July 2021, all with at least one risk factor for developing a severe form of the disease, Pfizer showed that Paxlovid was able to reduce the risk of hospitalization or death by 89% compared to the placebo group,  reports the laboratory in a press release of November 5, 2021. Each patient received oral treatment or placebo every 12 hours for 5 days. 

For patients who received Paxlovid or placebo within 3 days of the onset of symptoms: 

• Hospitalizations: 0.8% (3 of 389) of patients who received Paxlovid were hospitalized up to day 28 compared to 7% of patients (27 of 385) who received placebo.
• Death: No deaths were reported in patients who received Paxlovid versus 7 in patients who received placebo.

For patients who received Paxlovid or placebo within 5 days of the onset of symptoms: 

• Hospitalizations: 1% (6 of 607) of patients who received Paxlovid were hospitalized up to day 28 compared to 6.7% of patients (41 of 612) who received placebo.
• Deaths: No deaths were reported in patients who received Paxlovid versus 10 in patients who received placebo.

"This data suggests that our oral antiviral candidate if approved or authorized by regulatory authorities, has the potential to save patients' lives, reduce the severity of COVID-19 infections and eliminate up to 9 out of 10 hospitalizations," said Albert Bourla, Pfizer's Chairman and Chief Executive Officer. Subject to approval or authorization, it could be prescribed more widely as a home treatment to help reduce the severity of the disease, hospitalizations, and deaths, as well as the likelihood of infection. After exposure, in adults.'

What is the composition of Paxlovid?

Paxlovid is composed of two molecules. The first PF-07321332 is the active agent that prevents the virus protein from replicating. The second is ritonavir, a protease inhibitor normally used for the treatment of HIV infections. "HIV is not related to coronaviruses and the replication of its genetic material is done through a different mechanism. But it also produces a poly-protein that must be cut 9 times by a protease to form the new viral particles," explains an article published in the scientific journal Médecine Science in June 2020.

Mode of action: how does Paxlovid work?

Paxlovid would prevent the coronavirus protease from replicating.

A protease is a virus-specific enzyme that acts on viral proteins to promote virus replication. To stop the replication of a virus, it is therefore necessary to reduce or prevent the protease from acting. Coronaviruses have two proteases, one of which is called SARS-CoV-2, 3CL. It is on this protease that paxlovid oral treatment acts. 

When will it be available?

The company says it has entered into advance purchase agreements with several countries and is in negotiations with several others.

At the moment, Paxlovid is not marketed. But faced with the "overwhelming efficacy" highlighted in its clinical trials, Pfizer decided to stop the trial earlier than planned and submitted an authorization dossier to the U.S. Food and Drug Administration (FDA) for an application for emergency use authorization (EUA) as soon as possible, the laboratory said in its statement of November 5, 2021. If the request is accepted, this pill could be administered in the United States and doses could be ordered by countries that wish to do so, such as France. The company says it has entered into advance purchase agreements with several countries and is in negotiations with several others. According to the Washington Post, the U.S. government plans to buy 10 million doses and invest up to $1 billion in the manufacture and distribution of Paxlovid. In addition, a voluntary licensing agreement, announced on 16 November, with the Medicines Patent Pool (MPP), has reportedly been voted. This patent sharing would allow generic manufacturers to produce the drug to supply to 95 middle- and lower-income countries.

What are the side effects?

Of the patients who participated in the study and received Paxlovid, 1.7% experienced serious adverse events and had to stop treatment. The active substance contained in this medicine, ritonavir, can cause side effects such as: 

• diarrhoea,
• nausea and vomiting
• abdominal pain
• throat irritation or cough
• headache and dizziness
• rash and itching

disturbances in sugar and fat metabolism with abnormal fat redistribution observed after several months of treatment (called lipodystrophy)

toxicity to the liver (increased transaminases) and pancreas. 

What is the price?

The price of the Paxlovid pill is not yet known. Nevertheless, Pfizer announced, in its statement, tiered pricing based on each country's income level to ensure equitable access for all and an affordable price. In other words, high- and upper-middle-income countries will pay more than low-income countries.

Sources

- PFIZER'S NOVEL COVID-19 ORAL ANTIVIRAL TREATMENT CANDIDATE REDUCED RISK OF HOSPITALIZATION OR DEATH BY 89% IN INTERIM ANALYSIS OF PHASE 2/3 EPIC-HR STUDY, November 5, 2021.

- Targeting the major protease of SARS-CoV-2 to manufacture an effective drug against this coronavirus, Medicine Science, June 2020.

 According to the High Council of Public Health (HCSP) and the High Authority of Health (HAS), women who are pregnant or have a desire for a child should receive a third dose of the SARS-CoV2 vaccine when they were vaccinated more than 6 months ago. We take stock of the latest recommendations of the health authorities.

Pregnant, should I do the 3rd dose of vaccine?

 Since 1 September 2021, a booster of the Covid-19 vaccine is recommended for people at very high risk of severe form and for people with comorbidities that increase the risk of severe forms of Covid-19. In an opinion issued on November 17, the French National College of Gynecologists and Obstetricians (CNGOF) and the Research Group on Infections during Pregnancy (GRIG) explain that due to the decline in immunity over time and the particular vulnerability of pregnant women to COVID, especially if there is comorbidity,  'a third dose of SARS-CoV2 vaccine should be offered to women with a desire to become pregnant or pregnant, regardless of the term of pregnancy, when the initial scheme is more than 6 months old. The CNGOF and the GRIG also recall that pregnant women are recognized as a risk group for severe forms by the High Council of Public Health (HCSP) and the High Authority of Health (HAS), especially if there is comorbidity. "Compared to an uninfected pregnant woman, there is an 18-fold increased risk of admission to intensive care, 2.8-fold fetal loss, 5-fold risk of newborn admission to intensive care and more if comorbidity," they insist. These two reference bodies also specify that studies have shown that vaccinated pregnant women are less often infected and that vaccines against Covid-19 are safe and effective and recommended by many independent learned societies.

Pregnant, should I get vaccinated against Covid-19?

In a statement published on July 12, 2021, the National College of French Gynecologists and Obstetricians (GNGOF) and the Research Group on Infections during Pregnancy (GRIG) already insisted on the importance of getting vaccinated as soon as possible when you are pregnant. Ditto for couples in desire of the child. And for good reason, 'Covid is a potentially very serious disease during pregnancy. 

Vaccination of pregnant women: at what month of pregnancy?

On July 20, 2021, health minister Olivier Véran said that pregnant women could be vaccinated against Covid-19 from the first trimester of pregnancy.

Vaccination of pregnant women: what recommendations?

In its press release of July 12, 2021, the National College of French Gynecologists and Obstetricians (GNGOF) and the Research Group on Infections during Pregnancy (GRIG) recalled that "vaccination is possible and even recommended during pregnancy". 

Does the health pass apply to pregnant women?

To allow the proper continuity of the care of pregnancies, the health pass does not apply to patients. They can therefore continue to come to consult at any time without having to have a health pass. The need for vaccination should not be an obstacle to pregnancy follow-up.

Vaccination of pregnant women: what contraindications?

According to the Minister of Health, only three situations on the advice of the National Agency for the Safety of Medicines (ANSM), Alain Fischer's committee on vaccine strategy and the scientific council "which potentially concern a few hundred French people", can give rise to a contraindication to the vaccine. Thus, only the 'PIMS syndrome', or pediatric multi-systemic inflammatory syndrome or "reactions such as myocarditis, pericarditis and severe hepatitis that required hospitalization and following the first injection of mRNA vaccine", are concerned, he said on July 20. As well as people allergic to one of the components of the vaccine, this "which must concern about ten cases in our country", reassures Olivier Véran. In these three cases, only 'proper medical certificates can be recognized as contraindications'. The Minister of Health adds that there are "no contraindications to the messenger RNA vaccine, including pregnancy in the first trimester".

What vaccines for pregnant women?

The Directorate-General for Health already recommended the Pfizer-BioNTech vaccines or the Moderna vaccine for future mothers. In a previous opinion, the High Authority for Health also recommended RNA vaccines such as the Pfizer and Moderna vaccines rather than the AstraZeneca vaccine, which is likely to cause more high fevers after vaccination. 

On March 8, the French National College of Gynecologists and Obstetricians (CNGOF) and the Research Group on Infections during Pregnancy (GRIG), which requested vaccination of all pregnant women, also made recommendations regarding the type of vaccine to be used. "mRNA vaccines (Comirnaty® or Moderna®) should be preferred. The DNA vaccine (VaccineAstraZeneca®) is not contraindicated but it is more frequently the cause of a reaction, fever without the specific risk that can be treated with paracetamol. There is? To date, no argument to think that the vaccines mentioned can induce a deleterious fetal effect? But an injection during the first trimester of pregnancy is to be avoided in principle, "said the experts.

Covid vaccine and pregnancy: what are the risks for pregnant women?

The various studies conducted on pregnant women have shown that messenger RNA vaccines against Covid-19 are not dangerous for pregnant women and their fetuses and that it is also safe to be vaccinated during breastfeeding. The Reference Centre on Teratogenic Agents (Crat) therefore advises to 'start the protocol between 10 and 20 weeks of amenorrhea [no rule], i.e. After the end of organogenesis and early enough for the pregnant woman to be protected in the third trimester'. However, there is currently little data on vaccination before 12 weeks of pregnancy, even though it is practiced in other countries. And among women who were vaccinated in early pregnancy, especially those who did not yet know they were expecting a baby, no risk was observed.

Covid and risks of premature births?

At a press briefing by the Belgian vaccination task force, Dr. Frédéric Debiève, head of the obstetrics department at the Cliniques Universitaires Saint-Luc, said that 'pregnancy increases the possibility of being treated in intensive care for Sars-CoV-2. Due to the physiology of a pregnant woman, mechanical and invasive ventilation is often necessary." Studies conducted in the United Kingdom and the United States with 4,000 pregnant women who have been affected by the Covid-19 show that they have a "60% additional risk of giving birth prematurely," said the doctor. Vaccination prevents severe forms of Covid-19, premature deliveries as well as maternal and perinatal mortality. In addition, antibodies are transmitted during pregnancy and lactation, which protects the baby."

Can I get vaccinated while breastfeeding?

Regarding breastfeeding young mothers, the CNGOF and GRIG assure it: "vaccination does not disrupt breastfeeding and breastfeeding does not prevent vaccination in any way". A breastfeeding mother can therefore be vaccinated during breastfeeding without risk to herself or her baby.

 All COVID-19 vaccines authorized in Canada are safe, effective, and of high quality.

Name: Spikevax® Vaccine from Moderna against COVID-19

Manufacturer ModernaTX, Inc.

Type: mRNA

Status: Approved by Health Canada

Approved for: people 12 years of age and older

Method of administration: Injection into a muscle (usually the upper arm)

Number of doses: 2 doses

People for whom the vaccine is approved

The vaccine is approved for people 12 years of age and older. Its safety and efficacy in young people under 12 years of age have not yet been demonstrated.

Efficiency

Clinical trials showed that from two weeks after the second dose, Moderna's Spikevax® COVID-19 vaccine was 94.1% effective in protecting clinical trial participants from COVID-19.

Dosage

Two doses are required for maximum protection.

The dosage schedule approved by Health Canada calls for 2 doses at one-month intervals, based on evidence from clinical trials.

A booster dose of the Moderna COVID-19 Spikevax® vaccine may be given to people 18 years of age and older at least six months after completing their primary vaccine series.

Your province or territory decides when doses are administered.

These decisions are based on public health recommendations and the most recent data.

Mixed dose schedules

A different vaccine may be offered for your second dose. For example, you may have received the Comirnaty® vaccine from Pfizer-BioNTech as the first dose and you may have been offered the Spikevax® vaccine from Moderna as the second dose. This is called a series of mixed vaccines.

The National Advisory Committee on Immunization (NACI) recommends getting an mRNA vaccine (Comirnaty® from Pfizer-BioNTech or Spikevax® from Moderna) for your second dose. Find out more about mRNA vaccines

For more information:

1. mRNA vaccines
2. Viral vector vaccines

Vaccine ingredients