COVID-19 assessment: chemo patients and post-COVID depression

In this week’s summary, the latest scientific research on the coronavirus and efforts to find treatments and vaccines suggest that the response of chemo patients to the COVID-19 vaccine improves with booster shots, and those vaccinated should continue to wear masks in public.

Dangerous blood clots can occur in moderate COVID-19

A European study found a high risk of a life-threatening blood clot called venous thromboembolism (VTE) in COVID-19 patients who were not critically ill. The risk of a blood clot had previously been linked to severe COVID-19. Researchers followed 2,292 patients who presented to hospital emergency rooms with mild or moderate COVID-19 but without VTE. Four weeks later, VTE had developed in about one in 200 mildly ill patients who had not been hospitalized and nearly five out of 200 moderately ill patients in total, researchers reported in Thrombosis Research on Friday. They conclude that physicians caring for mildly and moderately ill COVID-19 patients should be aware of these risks, “especially in patients with moderate COVID-19 requiring hospitalization.”

High-dose blood thinners prevent clots in moderate COVID-19

In hospitalized and moderately ill COVID-19 patients who have high levels of D-dimer protein in the blood – indicating a higher than average risk of dangerous blood clots – treatment with high doses of low molecular weight heparin ( LMWH) anticoagulant) significantly reduced the risk of blood clots and death, according to clinical trial data. The incidence of venous thromboembolism (VTE) or death was 28.7% in the high dose group compared to 41.9% in the standard dose patients. After accounting for various patient risk factors, this was a 32% reduction in risk with high-dose heparin, the researchers said Monday in a report published in JAMA Internal Medicine. The researchers said they started the trial “because we have seen patients get blood clots and die in front of us while receiving standard doses of preventative heparin,” said study director Dr Alex Spyropoulos of the Feinstein Institutes for Medical Research in New York. “We were able to prove (…) that d-dimer levels more than four times above the upper limit of normal are able to predict a very high risk group of hospitalized COVID-19 patients – and the administration of therapeutic doses of heparin in these patients works, ”Spyropoulos said. “This is the practice that is changing now.”

The response of chemo patients to the vaccine improves with the booster

A new study quantifies the improvement in protection against COVID-19 obtained with a third booster dose of the vaccine from Pfizer Inc. and BioNTech SE in cancer patients undergoing chemotherapy. “Chemotherapy can weaken the ability of cancer patients to fight infection and respond appropriately to vaccines,” said Deepta Bhattacharya of the University of Arizona College of Medicine, co-author of the study published in Nature Medicine. His team studied 53 patients receiving chemotherapy for solid tumor cancers who received two injections of the vaccine. Almost all of the subjects had an immune response after vaccination. But “the magnitude of those responses was worse than in people without cancer in almost every measure we measured,” Bhattacharya said. “In all likelihood, this leaves cancer patients more susceptible to infection and COVID-19 than healthy vaccinated people. The researchers were able to bring 20 of the study participants back for a third dose of the vaccine, to see if immune responses would improve. “Antibody levels have improved in about 80% of cancer patients,” Bhattacharya said. “Our data on cancer patients support the CDC’s broad guidelines that immunocompromised people should receive a third dose of Pfizer vaccine.”

Post-COVID depression responds well to treatment

Persistent depression in COVID-19 survivors can be highly treatable, suggests a small Italian study. Doctors treated 58 patients who had developed post-COVID-19 depression with a widely used class of antidepressants known as selective serotonin reuptake inhibitors, or SSRIs. These include sertraline, sold by Pfizer under the brand name Zoloft, Paxil (paroxetine) from GlaxoSmithKline, Prozac (fluoxetine) from Eli Lilly and Co and Celexa (citalopram) from AbbVie’s Allergan unit. . Usually around 66% of patients see improvement with SSRIs, but among those with post-COVID-19 depression, 91% responded to treatment within four weeks, researchers reported this week at the European College meeting. of neuropsychopharmacology in Lisbon. They speculate that depression after COVID-19 is linked to inflammation caused by the coronavirus, and note that SSRIs have anti-inflammatory and antiviral properties. Dr Livia De Picker of the University of Antwerp in Belgium, who was not involved in the study, said in a statement that the results are particularly important for survivors with the persistent symptom syndrome known as of COVID-19 long, which often includes depression. A separate study presented at the meeting found that while SSRIs relieved depression in COVID-19 survivors, the drugs had less of an effect on their anxiety levels.

Similar viral loads in vaccinated and unvaccinated patients

Vaccinated people should continue to wear masks in public because they can still carry – and possibly spread – as much virus as unvaccinated people and not realize it, data from a new study confirms. The researchers studied the viral levels at the time of diagnosis in 869 patients, including 632 who were asymptomatic. Most infections have been caused by the highly contagious delta variant of the coronavirus. They found no statistically significant difference in mean viral loads between vaccinated and unvaccinated individuals, or between those with or without symptoms, or between different age groups, sexes or vaccine types, according to a report published on medRxiv. Tuesday before the peer review. “Our study does not provide information on infectivity,” said Richard Michelmore of the University of California at Davis, noting that the transmission of the virus is influenced by several factors, not just vaccination status and viral load. “It is not acceptable to assume that because you are vaccinated you cannot be infected and cannot infect someone else, even if they are asymptomatic,” he said. COVID-19 vaccines decrease the risk of infection and reduce the severity of infection. However, people vaccinated against COVID-19 should always wear masks in public as they could infect others if they themselves were infected, the researchers advised.

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