Impact of COVID-19: over 153 million confirmed cases and 3.2 million related deaths have been reported to WHO

COVID-19 poses major challenges to population health and well-being globally and hinders progress in meeting the SDGs and WHO’s Triple Billion targets.

The WHO Triple Billion targets are a shared vision among WHO and Member States, which help countries to accelerate the delivery of the SDGs. By 2023 they aim to achieve: one billion more people enjoying better health and well-being, one billion more people benefiting from universal health coverage (covered by health services without experiencing financial hardship) and one billion more people better protected from health emergencies.

As of 1 May 2021, over 153 million confirmed COVID-19 cases and 3.2 million related deaths have been reported to WHO. The Region of the Americas and the European Region have been the most affected, together comprising over three quarters of cases reported globally, with respective case rates per 100 000 population of 6114 and 5562 and almost half (48%) of all reported COVID-19-associated deaths occurring in the Region of the Americas, and one third (34%) in the European Region.

COVID-19 has surfaced long-standing inequalities across income groups, disrupted access to essential medicines and health services, stretched the capacity of the global health workforce and revealed significant gaps in country health information systems. 

While high-resource settings have faced challenges related to overload in the capacity of health services, the pandemic poses critical challenges to weak health systems in low-resource settings and is jeopardising hard-won health and development gains made in recent decades.

Data from 35 high-income countries shows that preventive behaviours decrease as household overcrowding (a measure of socioeconomic status) increases.

Overall, 79% (median value of 35 countries) of people living in uncrowded households reported trying to physically distance themselves from others compared to 65% in extremely overcrowded households. Regular daily handwashing practices (washing hands with soap and water or using hand sanitizers) were also more common among people who lived in uncrowded households (93%) compared to those living in extremely overcrowded households (82%). In terms of mask-wearing in public, 87% of people living in uncrowded households wore a mask all or most of the time when in public in the last seven days compared to 74% of people living in extremely overcrowded conditions.

The combination of conditions related to poverty reduce access to health services and evidence-based information while increasing risky behaviours.

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The article is published courtesy of the WHO

World Bank Support for Country Access to COVID-19 Vaccines

KATHMANDU, 3, NEPAL – 2021/01/27: A health worker holds up a vial of Covid-19 coronavirus vaccine to administer to frontlines health workers at the Armed Police Force Hospital. Nepal government is launching the Oxford-AstraZeneca vaccination campaign against coronavirus (Covid19) starting today. Nepalese Health and sanitation workers deployed in the frontlines will be the first to receive the vaccines in the first phase of the campaign. Over 400,000 such frontline workers will be included in the initial stage. (Photo by Prabin Ranabhat/SOPA Images/LightRocket via Getty Images)

With expectations to reach 50 countries amounting to $4 billion by mid-year, the World Bank Group is working with partners on the largest vaccination effort in history to stop the COVID-19 pandemic.

On April 2, 2020, at the initial COVID-19 response phase, the World Bank’s Board of Executive Directors approved a $6 billion Global COVID-19 Response Program (also called the COVID-19 Strategic Preparedness and Response Program, or SPRP).

The program has reached over 100 countries with emergency operations to prevent, detect, and respond to COVID-19 and strengthen systems for public health preparedness.

The timing of potential vaccine development was not known when the SPRP was approved, but global vaccine development efforts progressed rapidly. Recognizing the need for COVID-19 vaccines, on October 13, 2020, the World Bank Board approved an additional financing of $12 billion to the SPRP for developing countries to finance the acquisition and distribution of COVID-19vaccines, aiming to support vaccination of 1 billion people globally 

White House aims to give 70% of American adults at least one Covid-19 vaccine dose by July 4

To reach that goal, Biden’s team said he will expand walk-up vaccinations at pharmacies and vaccination sites, open additional mobile vaccination units, and accelerate a public-relations campaign aimed at boosting vaccine confidence.

The announcement comes as the pace of the U.S. vaccination effort has nosedived. As of mid-April, the country was administering just under 3.4 million vaccine doses each day. As of Tuesday, the rate had dropped to just under 2.3 million.

Still, the country is currently on track to reach President Biden’s latest goal. Over 56% of adults 18 and over have already received at least one dose of a Covid-19 vaccine, according to federal data. That number represents roughly 145 million people; to reach the 70% threshold, about 36 million additional adults would need to receive a first dose in the next two months.

The White House, additionally, set a goal of giving a full vaccine regimen — either two doses each of the Pfizer-BioNTech or Moderna vaccines, or one dose of Johnson & Johnson’s — to 160 million Americans.

That benchmark, too, appears within reach. Currently, 105 million Americans have received a full course of vaccine doses, in addition to the 40 million who’ve only received one dose. During a press briefing, a senior Biden aide said the administration estimated that reaching each goal would require administering about another 100 million doses to adults in the next two months, roughly three-quarters of the current pace.

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Story credit: STAT

By Lev Facher  

Scientists find evidence that novel coronavirus infects the mouth’s cells

While it’s well known that the upper airways and lungs are primary sites of SARS-CoV-2 infection, there are clues the virus can infect cells in other parts of the body, such as the digestive system, blood vessels, kidneys and, as this new study shows, the mouth. The potential of the virus to infect multiple areas of the body might help explain the wide-ranging symptoms experienced by COVID-19 patients, including oral symptoms such as taste loss, dry mouth and blistering. Moreover, the findings point to the possibility that the mouth plays a role in transmitting SARS-CoV-2 to the lungs or digestive system via saliva laden with virus from infected oral cells. A better understanding of the mouth’s involvement could inform strategies to reduce viral transmission within and outside the body. The team was led by researchers at the National Institutes of Health and the University of North Carolina at Chapel Hill.

“Due to NIH’s all-hands-on-deck response to the pandemic, researchers at the National Institute of Dental and Craniofacial Research were able to quickly pivot and apply their expertise in oral biology and medicine to answering key questions about COVID-19,” said NIDCR Director Rena D’Souza, D.D.S., M.S., Ph.D. “The power of this approach is exemplified by the efforts of this scientific team, who identified a likely role for the mouth in SARS-CoV-2 infection and transmission, a finding that adds to knowledge critical for combatting this disease.”

The study, published online March 25, 2021 in Nature Medicine, was led by Blake M. Warner, D.D.S., Ph.D., M.P.H., assistant clinical investigator and chief of NIDCR’s Salivary Disorders Unit, and Kevin M. Byrd, D.D.S., Ph.D., at the time an assistant professor in the Adams School of Dentistry at the University of North Carolina at Chapel Hill. Byrd is now an Anthony R. Volpe Research Scholar at the American Dental Association Science and Research Institute. Ni Huang, Ph.D., of the Wellcome Sanger Institute in Cambridge, U.K., and Paola Perez, Ph.D., of NIDCR, were co-first authors.

Researchers already know that the saliva of people with COVID-19 can contain high levels of SARS-CoV-2, and studies suggest that saliva testing is nearly as reliable as deep nasal swabbing for diagnosing COVID-19. What scientists don’t entirely know, however, is where SARS-CoV-2 in the saliva comes from. In people with COVID-19 who have respiratory symptoms, virus in saliva possibly comes in part from nasal drainage or sputum coughed up from the lungs. But according to Warner, that may not explain how the virus gets into the saliva of people who lack those respiratory symptoms.

“Based on data from our laboratories, we suspected at least some of the virus in saliva could be coming from infected tissues in the mouth itself,” Warner said.

To explore this possibility, the researchers surveyed oral tissues from healthy people to identify mouth regions susceptible to SARS-CoV-2 infection. Vulnerable cells contain RNA instructions for making “entry proteins” that the virus needs to get into cells. RNA for two key entry proteins — known as the ACE2 receptor and the TMPRSS2 enzyme—was found in certain cells of the salivary glands and tissues lining the oral cavity. In a small portion of salivary gland and gingival (gum) cells, RNA for both ACE2 and TMPRSS2 was expressed in the same cells. This indicated increased vulnerability because the virus is thought to need both entry proteins to gain access to cells.

“The expression levels of the entry factors are similar to those in regions known to be susceptible to SARS-CoV-2 infection, such as the tissue lining the nasal passages of the upper airway,” Warner said.

Once the researchers had confirmed that parts of the mouth are susceptible to SARS-CoV-2, they looked for evidence of infection in oral tissue samples from people with COVID-19. In samples collected at NIH from COVID-19 patients who had died, SARS-CoV-2 RNA was present in just over half of the salivary glands examined. In salivary gland tissue from one of the people who had died, as well as from a living person with acute COVID-19, the scientists detected specific sequences of viral RNA that indicated cells were actively making new copies of the virus — further bolstering the evidence for infection.

Once the team had found evidence of oral tissue infection, they wondered whether those tissues could be a source of the virus in saliva. This appeared to be the case. In people with mild or asymptomatic COVID-19, cells shed from the mouth into saliva were found to contain SARS-CoV-2 RNA, as well as RNA for the entry proteins.   

To determine if virus in saliva is infectious, the researchers exposed saliva from eight people with asymptomatic COVID-19 to healthy cells grown in a dish. Saliva from two of the volunteers led to infection of the healthy cells, raising the possibility that even people without symptoms might transmit infectious SARS-CoV-2 to others through saliva.

Finally, to explore the relationship between oral symptoms and virus in saliva, the team collected saliva from a separate group of 35 NIH volunteers with mild or asymptomatic COVID-19. Of the 27 people who experienced symptoms, those with virus in their saliva were more likely to report loss of taste and smell, suggesting that oral infection might underlie oral symptoms of COVID-19.

Taken together, the researchers said, the study’s findings suggest that the mouth, via infected oral cells, plays a bigger role in SARS-CoV-2 infection than previously thought.

“When infected saliva is swallowed or tiny particles of it are inhaled, we think it can potentially transmit SARS-CoV-2 further into our throats, our lungs, or even our guts,” said Byrd.

More research will be needed to confirm the findings in a larger group of people and to determine the exact nature of the mouth’s involvement in SARS-CoV-2 infection and transmission within and outside the body.

“By revealing a potentially underappreciated role for the oral cavity in SARS-CoV-2 infection, our study could open up new investigative avenues leading to a better understanding of the course of infection and disease. Such information could also inform interventions to combat the virus and alleviate oral symptoms of COVID-19,” Warner said.

This research was supported by the NIDCR Division of Intramural Research. Support also came from the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) grant DK034987 and the intramural programs of NIDDK, the National Cancer Institute, NIH Clinical Center, and the National Institute of Allergy and Infectious Diseases. Additional support came from the American Academy of Periodontology/Sunstar Foundation, American Lung Association, and the Cystic Fibrosis Foundation.

WHO says more research needed into the symptoms among people who’ve recovered from COVID-19.

© UNICEF/Evgeniy Maloletka
A mother and a doctor tend a girl with COVID-19 at an intensive care ward, in Chernivtsi, Ukraine.

The World Health Organization (WHO) said on Friday that far more research is needed into the “constellation” of sometimes debilitating symptoms among people who’ve recovered from COVID-19. 

“We know that this post-COVID-19 condition – or as some patients also call it ‘long COVID’ and some clinicians call it ‘long COVID’ – is a heterogenous group of symptoms that occur after the acute illness”, said Dr. Janet Diaz, Team Lead, Health Care Readiness at WHO.

“So, these are symptoms or complications that can happen potentially a month after, three months after, or even six months after, and as we are learning more, we are trying to understand the real duration of this condition.” 

Citing reported symptoms such as neurological and physical illness, Dr. Diaz noted that an unspecified number of sufferers had been unable to return to work, once they had recovered from the acute sickness caused by the new coronavirus. 

“We are concerned obviously with the numbers of patients infected with SARS-CoV-2 virus that the numbers…just by the magnitude of the pandemic, will impact health systems.” 

Although comprehensive data on the condition is not yet available, the WHO official insisted that “these (symptoms) were real”.  

“Some of the “more common” ailments were “fatigue, exhaustion and post-exertional malaise, cognitive disfunction”, along with what some patients called “brain fog”, Dr Diaz said, describing a “constellation of symptoms”.  

“What we know this far is that patients experiencing (a) post-COVID-19 condition could have been hospitalized patients, those in the ICU. So, we do know that has happened in patients who are very sick, but also in patients who were not managed inside the hospital…they have had complications and they have had persistent symptoms or new symptoms…or symptoms that waxed and waned, that came and went after their acute illness.” 

To promote a better understanding of post-COVID sickness and support patient care and public health interventions, the WHO has called on clinicians and patients to report data on symptoms to the Organization’s Clinical Platform.  

The case report form – which is available in multiple languages – has been designed to report standardized clinical data from individuals after they have left hospital or after recovering from acute illness. 

“What we don’t know is why it’s happening, so what is the pathophysiology … of this condition…the researchers are really working hard to get to the answers of these questions,” Dr. Diaz said. 

NIH calls for greater inclusion of pregnant and lactating people in COVID-19 vaccine research

Longstanding obstacles to include pregnant and lactating people in clinical research have led to this population now deciding whether or not to receive a SARS-CoV-2 vaccine without the benefit of scientific evidence, writes Diana W. Bianchi, M.D., director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health, and colleagues. Their viewpoint article appears online in JAMA(link is external).

The manufacturers of currently available vaccines excluded pregnant and lactating people from the clinical trials needed to obtain Emergency Use Authorizations from the U.S. Food and Drug Administration. Now that the vaccines have been distributed, the U.S. Centers for Disease Control and Prevention and the FDA will obtain information from those who receive them on their potential impact during pregnancy, as well as information on infant outcomes. While these data will prove useful, pregnant people and their clinicians must make real-time decisions now about the vaccine based on little or no scientific evidence that applies specifically to them.

In 2016, the 21^st Century Cures Act established the Task Force on Research Specific to Pregnant Women and Lactating Women, representing multiple federal agencies, academia, industry and non-profit organizations. The Task Force developed recommendations on how to safely and ethically include pregnant and lactating people in clinical research. These recommendations must now be implemented to ensure pregnant people receive the same evidence that non-pregnant adults receive to make informed decisions about their medical care.

Recent findings from a National Institutes of Health study suggest COVID-19 during pregnancy can carry a higher risk for complications. Pregnant people need to be protected through research rather than from research, the authors contend.