Коронавирус covid-19.

Обзор мировых экономических новостей

Ежегодная встреча Всемирного экономического форума

В следующей неделе в Давосе, Швейцария, состоится ежегодная встреча Всемирного экономического форума, привлекающая больше внимания благодаря названию одной из сессий: Подготовка к болезни X.

Текущее состояние коронавируса COVID-19

Будьте в курсе текущей ситуации с коронавирусом COVID-19 и его влиянием на глобальное здравоохранение, экономику и многое другое.

Основные меры защиты от нового коронавируса

Ознакомьтесь с основными рекомендациями Всемирной организации здравоохранения по защите от нового коронавируса здесь.

Здравоохранение

Опыт завершения программы COVAX – уроки, извлеченные из поставки 2 миллиардов вакцин от COVID-19 в страны с низким доходом

Шарлотта Эдмонд, 08 января 2024 года.

Что нужно знать о новом варианте COVID-19 Pirola

Новый, сильно мутировавший вариант COVID-19 находится в обращении, и ученые находятся в состоянии повышенного бдительности. Вот почему, Шарлотта Эдмонд, 11 октября 2023 года.

Долголетие и старение

Как кризис стоимости жизни влияет на молодых людей по всему миру

Когда одной работы недостаточно. Многие представители молодого поколения отказываются от надежд на приобретение собственного жилья и воспитание семьи. 08 августа 2023 года.

От оспы до COVID: медицинские изобретения, которые победили инфекционные заболевания за последний век

Инфекционные болезни влияли на историю человечества. Вот некоторые медицинские новшества, которые помогли бороться с наиболее разрушительными из них с 1920-х годов. 11 мая 2023 года.

Воздействие пандемии

COVID-19 больше не является глобальной чрезвычайной ситуацией. Вот что это означает

После того как Всемирная организация здравоохранения объявила, что COVID-19 больше не является глобальной чрезвычайной ситуацией, поведенческие ученые оценили, какие привычки, приобретенные во время пандемии, будут сохранены.

Candida auris: что нужно знать о смертельной грибковой инфекции, распространяющейся через американские больницы

Candida auris – это грибковая инфекция, впервые выявленная в 2009 году и распространенная во многих странах. Иммунолог объясняет, почему это вызывает беспокойство.

Понимание влияния нарушений в поставках COVID-19 на экспорт в глобальные цепочки добавленной стоимости

COVID-19 вызвало дебаты о том, является ли торговля в цепочке поставки преимуществом уязвимости или устойчивость. Вот последние исследования.

Воздействие загрязнения воздуха

Новое исследование показывает связь между воздействием загрязнения воздуха на молодых взрослых и симптомами долговременной COVID

Молодые взрослые, подвергшиеся высокому уровню загрязнения воздуха во время пандемии, были склонны к долговременной форме COVID более, чем те, кто проживал в низкозагрязненных районах.

Как пандемия повлияла на психическое здоровье в США

Центр исследований Pew подводит итоги основных результатов своих исследований, проведенных другими американскими организациями, по оценке влияния COVID-19 на психическое здоровье.

Лидеры мира обсуждают гипотетический вирус, болезнь X, в Давосе

The Trust Gap in Public Health Recommendations

Инфекционисты, общественные здравоохранения и широкая публика столкнулись с проблемой доверия друг к другу из-за политического вмешательства. Политики внедрили себя в этот процесс, что привело к недоверию к рекомендациям общественного здравоохранения, которые предлагаются для охраны здоровья всех.

Initiatives by WHO and Global Organizations

ВОЗ, совместно с другими международными организациями, уже запустила множество инициатив для подготовки к следующей пандемии или эпидемии. Эти усилия включают создание пандемического фонда для помощи странам с ресурсами, центра трансфера технологии вакцин мРНК для обеспечения равенства доступа к вакцинам для низкодоходных стран, а также центра разведки пандемий и эпидемий для улучшения коллаборативного наблюдения между странами.

Upcoming Webinar Topics and Speakers

Tuesday, 7 March

Clinical, Public Health, and Behavioral Aspects of COVID-19 in China and Implications for the World
Global Burden of Long COVID
Update on COVID-19 Therapeutics

Tuesday, 16 May

COVID -19 Prevention — Do We Need Subtype Specific Vaccines?
Hybrid Immunity to SARS-CoV2 – The New Normal
- Penny Moore, PhD
- University of the Witwatersrand / National Institute for Communicable Diseases, South Africa
Update on COVID-19 Therapeutics

Tuesday, 3 October

Updated Recommendations for SARS-CoV-2 Vaccination
Nirmatrelvir/ritonavir for the Treatment of Long COVID

Thursday, 14 December

COVID-19 and the Immunosuppressed Patient
The Impact of New Variants on Global Epidemiology, Disease Acquisition, and Progression

Acknowledgment and Thank You

Мы благодарим всех участников за успешные вебинары в рамках Форума по Клиническим Аспектам COVID-19 в 2023 году. Особая благодарность спикерам, модераторам и всем участникам за их вклад!

Также выражаем особую благодарность прокторам вебинара: MSD и Pfizer. Без их поддержки этот вебинар был бы невозможен.

About the COVID-19 Clinical Forum 2023

COVID-19 Clinical Forum 2023 — это серия из 4 онлайн-вебинаров (по 90 минут каждый), предоставляющих непрерывное образование широкому кругу медицинских специалистов, включая инфекционистов, пульмонологов и вирусологов.

Программа охватывает широкий спектр тем: от эпидемиологии COVID-19, лечения, пост-COVID состояний и клинических проявлений, управления клинической практикой и патофизиологии до профилактики, вакцинации, диагностики и стратегий общественного здравоохранения.

Program Directors

Тематика интересов:

Epidemiology of COVID-19
Treatments and Therapeutics
Clinical Manifestations of Post-COVID Conditions
Management of COVID-19
Pathophysiology
Prevention and Vaccination Strategies
Diagnostics
Public Health Strategies

Disclaimer: This article is a work of fiction and created for educational purposes.

Форум по клинической форме COVID-19 2023

A study in this issue of JAMA Health Forum by DeVries and colleagues directly addresses this evolving public health challenge.5 The study of US adults in a large commercial insurance database describes markedly increased risks of adverse cardiovascular events and excess all-cause mortality in the postacute phase of COVID-19. These findings, together with increasing evidence of long-term consequences of SARS-CoV-2 infections spanning a wide range of organ systems,6 call for enhanced and extended health monitoring of individuals with SARS-CoV-2 infections and raise questions about public health goals at this stage of the pandemic.

DeVries and colleagues used propensity score matching on a comprehensive set of variables in commercial insurance claims to compare a cohort of 13 435 persons who had experienced PCC symptoms with a cohort of 26 870 persons without evidence of COVID-19.5 Additional analyses were conducted among persons who had experienced PCC and been hospitalized within a month of SARS-CoV-2 infection. For both analyses, claims-based utilization tied to cardiovascular disorders, chronic respiratory disorders, and mortality over 12 months were compared between cohorts.

These studies lay a foundation for answering remaining questions about the cardiovascular consequences of PCC while also highlighting several important challenges to consider in advancing this research. First, existing studies may have been limited by selection bias, as they included only persons with access to comprehensive medical care. Attention to the experience of PCC among persons from medically underserved communities is thus warranted.

Second, without a reliable mechanism to detect all SARS-CoV-2 infections, some contemporary control participants likely had undetected past infections. Accurately determining RRs attributable to prior infections depends on eliminating this source of misclassification bias, which otherwise reduces risk estimates. Future studies should consider including both historical and contemporary control groups, as done by Xie and colleagues.7

Third, the dynamic elements of PCC prevention and treatment, vaccine-induced immunity, and SARS-CoV-2 variants could alter postinfection cardiovascular sequelae of COVID-19, underscoring the need for continued epidemiologic surveillance. Fourth, as evidence illustrating sustained increased risk of adverse cardiovascular outcomes in PCC mounts, mechanistic studies are urgently needed, including those distinguishing between direct and indirect effects of COVID-19. For example, does SARS-CoV-2 infection induce irreversible damage to the cardiovascular system, predisposing individuals to myriad adverse cardiovascular outcomes? Plausible mechanisms may include prolonged postinfection hypercoagulable or proinflammatory states, electrolyte imbalances, metabolic derangements, and increased incidence of cardiovascular risk factors such as hypertension and diabetes.

Simultaneously, identifying PCC risk factors and factors associated with symptom resolution is paramount. The most immediately concerning finding is that SARS-CoV-2 reinfection is associated with substantially increased risk of PCC.11 Compared with individuals without a SARS-CoV-2 infection, the RR of incident cardiovascular disorders 6 months postinfection increased from 1.6 with 1 infection to 3.0 with 2 infections and 4.8 with 3 or more infections. Additional risk factors for PCC appear to include older age, female sex, tobacco consumption, higher body mass index, and an increased number of symptoms during the acute COVID-19 illness.12 Conversely, completion of a primary vaccination series prior to infection is protective.13

Further understanding these and additional risk factors and protective factors can inform the mechanistic understanding of PCC and public health communication moving forward. Finally, continued monitoring of the duration of PCC is imperative, as early evidence suggests substantial proportions of individuals experience the syndrome 2 years after initial SARS-CoV-2 infections.14

From a public health perspective, US institutions have largely focused on prevention and management of acute COVID-19 illness, and messaging has prioritized promotion of vaccine uptake and provided less emphasis on the importance of preventing infections. Challenges posed by PCC, specifically its incidence across the spectrum of acute COVID-19 illness and dose-response relationship with cumulative SARS-CoV-2 infections, have not been highlighted in public health communications nor guidance. We believe US public health agencies should respond to this scientific evidence and reimplement strategies aimed at reducing SARS-CoV-2 infections, especially as immune-evasive Omicron offspring combined with minimal mitigation measures point to infections rapidly affecting large portions of the population in winter 2023 and beyond.15

From a medical and health systems perspective, providing optimal care for patients with the complex constellation of symptoms in PCC is a core challenge. Health care systems should support the development of PCC clinics with multidisciplinary care teams prepared to address the physical and mental health needs of this growing patient population, recognizing that the various presentations of PCC necessitate tailored models of care.16 Moreover, given the sustained increased risk of adverse cardiovascular events5-9 and all-cause mortality,5,8,9 enhanced monitoring should be considered for conditions in which prevention, earlier detection, and effective treatment can improve outcomes.

Entering year 4 of the COVID-19 pandemic, growing evidence calls for research, public health, and medical attention to PCC in addition to acute COVID-19 illness. DeVries and colleagues5 cast light on enduring cardiovascular risks with PCC, supporting enhanced monitoring of patients after SARS-CoV-2 infections to support early detection and intervention. More broadly, rigorous programs are needed to minimize future infections, which have consequences beyond acute COVID-19 illness, and to advance scientific and medical understanding of the pathophysiology of PCC, as well as its prevention and management.

Conflict of Interest Disclosures: Dr Czeisler reported personal fees from Nychthemeron LLC, Vanda Pharmaceuticals, and With Deep; institutional grants paid to Monash University from the Centers for Disease Control and Prevention, the Centers for Disease Control and Prevention Foundation, and WHOOP Inc; and an institutional gift to Monash University from Hopelab, all outside the submitted work. No other disclosures were reported.

Bull-Otterson L , Baca S , Saydah S , et al. Post-COVID conditions among adult COVID-19 survivors aged 18-64 and ≥65 years—United States, March 2020-November 2021. MMWR Morb Mortal Wkly Rep. 2022;71(21):713-717. doi:10.15585/mmwr.mm7121e1Google ScholarCrossref

DeVries A , Shambhu S , Sloop S , Overhage JM . One-year adverse outcomes among US adults with post–COVID-19 condition vs those without COVID-19 in a large commercial insurance database. JAMA Health Forum. 2023;4(3):e230010. doi:10.1001/jamahealthforum.2023.0010Google Scholar

Wang W , Wang CY , Wang SI , Wei JCC . Long-term cardiovascular outcomes in COVID-19 survivors among non-vaccinated population: a retrospective cohort study from the TriNetX US collaborative networks. EClinicalMedicine. 2022;53:101619. doi:10.1016/j.eclinm.2022.101619 PubMedGoogle ScholarCrossref

Robineau O , Zins M , Touvier M , et al; Santé, Pratiques, Relations et Inégalités Sociales en Population Générale Pendant la Crise COVID-19–Sérologie (SAPRIS-SERO) Study Group. Long-lasting symptoms after an acute COVID-19 infection and factors associated with their resolution. JAMA Netw Open. 2022;5(11):e2240985. doi:10.1001/jamanetworkopen.2022.40985 PubMedGoogle ScholarCrossref

One-Year Adverse Outcomes Among US Adults With Post-COVID-19 Condition vs Those Without COVID-19 in a Large Commercial Insurance Database

Free PMC article

Erratum in

Objective: To quantify 1-year outcomes among individuals meeting a PCC definition compared with a control group of individuals without COVID-19.

Exposures: Individuals experiencing postacute sequelae of SARS-CoV-2 using a Centers for Disease Control and Prevention-based definition.

Main outcomes and measures: Adverse outcomes, including cardiovascular and respiratory outcomes and mortality, for individuals with PCC and controls assessed over a 12-month period.

Conclusions and relevance: This case-control study leveraged a large commercial insurance database and found increased rates of adverse outcomes over a 1-year period for a PCC cohort surviving the acute phase of illness. The results indicate a need for continued monitoring for at-risk individuals, particularly in the area of cardiovascular and pulmonary management.

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.. Sample Construction

The sample construction diagram shows inclusion and exclusion criteria for assembly of the sample of individuals with post–COVID-19 condition (PCC) and matched controls without COVID-19. BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared); ER, emergency room.

Figure 2.. Twelve-Month Mortality Among Individuals With Post–COVID-19 Condition vs Those Without COVID-19

The 12-month mortality for individuals with post–COVID-19 condition was substantially higher than in matched controls without COVID-19.

Comment in

“Disease X,” according to the World Health Organization, “represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease.”

Indeed, the organization’s head, Director General Tedros Adhanom Ghebreyesus, will speak at the event, in addition to Michel Demaré, chair of the board of AstraZeneca, Brazil Minister of Health Nisia Trindade Lima, and Jamil Edmond Anderlini, editor in chief of Politico Europe, among others.

On Thursday night, former Trump-era Assistant Secretary for Public Affairs for the U.S. Treasury Department and Fox News analyst Monica Crowley tweeted a baseless warning that “unelected globalists at the World Elected Forum will hold a panel on a future pandemic 20x deadlier than COVID.”

“Just in time for the election, a new contagion to allow them to implement a new WHO treaty, lock down again, restrict free speech and destroy more freedoms,” she wrote. “Sound far-fetched? So did what happened in 2020.”

Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, tells Fortune that those in the medical and public health professions “have always conducted thought experiments and tabletop exercises to prepare for pandemics.”

“These exercises serve the vital function of identifying strengths and weaknesses, as well as highlighting important aspects of response that merit further refinement,” he says.

“To arbitrarily suggest these exercises and meetings are part of some kind of conspiracy evades the actual purpose they serve and the problems on which they are trying to gain traction, all for the nihilistic purpose of compromising pandemic preparedness and brazen pandering,” he added.

Dr. Stuart Ray, vice chair of medicine for data integrity and analytics at Johns Hopkins’ Department of Medicine, told Fortune that it would be “irresponsible” for world leaders not to meet at the forum.

“There have been multiple such events in recorded history, and the recent coronavirus pandemic taught us that rapid response can save millions of lives,” he said. “Coordination of public health response is not conspiracy, it’s simply responsible planning.”

Such meetings should be publicized because “such planning requires oversight, appreciation for personal impact on personal and economic freedom, and impact on special populations,” he added. “It makes good sense for a global public health organization, scientific leaders, and interested private individuals to be involved.”

COVID (SARS-CoV-2)

As Dr. Maria Van Kerkhove, head of WHO’s emerging diseases and zoonoses unit, said at a January presser, the world is still in a COVID pandemic, whether or not it wants to recognize it. So far, the official COVID death toll sits at 7 million, though it’s thought to be at least three times higher.

While the public health emergency of international concern (PHEIC) status ended in May 2023, a WHO committee could always choose to reinstate it, especially if the virus evolved into a more severe form, according to Van Kerkhove. And that’s entirely possible.

“We are concerned—deeply concerned—that this virus is circulating unchecked around the world, and that we could have a variant at any time that would increase severity,” she said Friday. “This is not meant to be a scare tactic. This is a scenario we plan for.”

Lassa fever

Like Ebola, Marburg, and Crimean-Congo hemorrhagic fever, Lassa fever is an acute viral hemorrhagic illness. But with a case fatality rate of 1%, it’s far less deadly. The vast majority of those infected with Lassa fever—80%—have no symptoms.

For the other 20%, disease is severe. Symptoms usually start with non-specific ailments not unlike COVID or the flu—fever, weakness, and malaise—and then progress to headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhea, cough, and stomach pain. Facial swelling, collection of fluid in the lung cavity, and low blood pressure may develop, in addition to shock, seizures, tremor, disorientation, and coma. Multiple organ systems are often damaged. Those who survive may suffer from temporary or permanent deafness, in addition to transient hair loss and gait disturbance.

Those who die of the virus usually do so within two weeks of onset, according to the WHO. Eighty percent of pregnant women in their third trimester who are infected die, in addition to their fetus. Rodents carry the virus and also shed it in their urine and feces.

Ebola & Marburg virus diseases

Viruses in this family cause hemorrhagic, or bloody, fevers, which are typically accompanied by bleeding from bodily orifices and/or internal organs. The family consists of five strains of Ebola in addition to Marburg—an extremely similar virus that made headlines during an outbreak in Equatorial Guinea earlier this year.

On average, Ebola kills about 50% of those it sickens, though case fatality rates have ranged from 25%-90%, according to the WHO. Marburg also kills around 50% of those it infects, though case fatality rates range from around 24% to 88%, experts say. While there are two licensed vaccines for the deadliest strain of Ebola, Zaire, there aren’t any for the four other strains. Nor is there an approved vaccine for Marburg, though some are in development.

Middle East respiratory syndrome coronavirus (MERS)

SARS was the world’s first identified killer coronavirus, and MERS was the second. Discovered in 2012 in Saudi Arabia, it caused about 2,500 cases and 800 deaths. SARS has not been detected since 2004, but MERS continues to be reported sporadically, with the latest report—of three infections and two deaths—occurring in Saudi Arabia in August 2023.

Zika virus

Like COVID, Zika virus-related microcephaly (a brain-related birth defect) was once declared a PHEIC by the WHO, from February through November of 2016. Most who are infected with the virus—transmitted primarily by Aedes mosquitoes—don’t develop symptoms. Those who do usually experience rash, fever, conjunctivitis, muscle and joint pain, malaise, and headache for two to seven days.

More troubling, infection during pregnancy can result in infants with congenital malformations, in addition to early birth and miscarriage. It can also result in Guillain-Barré syndrome, neuropathy, and myelitis in adults and children, according to the WHO.

Nipah and other henipaviral diseases

Nipah is a henipavirus, the most lethal of paramyxoviruses. It was first identified in pigs in Malaysia and Singapore in the late 1980s, though its natural reservoir is fruit bats. The other henipavirus known to infect people, Hendra, was first noted in racehorses and humans in Australia in 1994. Both feature respiratory illness and severe flu-like symptoms, and may progress to encephalitis—inflammation of the brain—along with other neurologic symptoms and death.

Nipah kills between 45% and 75% of the people it infects. No licensed vaccines exist, though a vaccine by Moderna, in coordination with the U.S. National Institute of Allergy and Infectious Diseases Vaccine Research Center, is being evaluated.

The WHO’s ‘priority pathogens,’ aside from ‘Disease X’

The WHO maintains a list of “priority pathogens” that “pose the greatest public health risk due to their epidemic potential and/or whether there are no, or insufficient, countermeasures” available.

While the list is far from exhaustive and doesn’t necessarily indicate the most likely cause of the next epidemic or pandemic, here are the known pathogens global public health officials are keeping an eye on, in addition to “Disease X.”

Crimean-Congo hemorrhagic fever

Two to four days later, agitation may turn into sleepiness, depression, and lassitude; abdominal pain may concentrate in the upper right quadrant; and the liver might become enlarged, according to the WHO.

Other symptoms may include fast heart rate, enlarged lymph nodes, and a petechial rash (caused by bleeding into the skin) on internal mucosal surfaces like the mouth and throat, and on the skin. The rash may grow. Hepatitis is usually present. After the fifth day of illnesses, patients may suffer the failure of organs like the kidneys, liver, or lungs.

The case fatality rate for this illness—spread by ticks and the tissue of infected animals during and after slaughter—is around 30%. Most patients who die do so in the second week of illness. Those who recover generally begin to improve after the ninth or tenth day of illness.

Severe Acute Respiratory Syndrome (SARS-CoV-1)

The world’s first known coronavirus pandemic occurred in 2002, when SARS-CoV-1 was reported in China. It spread to more than two dozen countries in North and South America and Europe before being contained seven months later. SARS is thought to have originated in an animal population, perhaps bats, before being passed to civet cats—a tropical animal that looks like a mix of a dog and an ocelot—and then to people. A spillover could happen again, experts say.

Symptoms include headache, body aches, mild respiratory symptoms, possible diarrhea, an eventual dry cough, and pneumonia in most. SARS sickened nearly 8,100 people and killed just under 10% of them from 2002 to 2003. There is no licensed vaccine for SARS, though researchers are working on universal coronavirus vaccines that could target both SARS and COVID, among other coronaviruses.

Rift Valley fever

This virus is known for causing massive devastation among livestock. While it can be transmitted from animals to other animals and to humans as well, it’s not yet known to transmit from humans to other humans. But with viral evolution, that could change.

Human infections occur through inoculation—for instance, via a wound through an infected knife, or through broken skin. Humans can also be infected via aerosols produced during the slaughter of infected animals. Human infection may also be possible through drinking unpasteurized or uncooked milk of infected animals, according to the WHO. Additionally, human infection could occur through the bites of infected mosquitoes or blood-feeding flies.

Most infected humans don’t develop symptoms; if they do, cases are mild. Symptoms include the sudden onset of a flu-like fever, muscle pain, joint pain, and headache. Neck stiffness, light sensitivity, appetite loss, and vomiting are also possible. Such cases may be mistaken for meningitis.

Around 3% of cases will develop severe disease, and less than 1% will die. Severe disease usually takes one of three forms: ocular, meningoencephalitis, or hemorrhagic.