Covid updates from Israel, and lessons for the world

October 11, 2021

 

Tom Gross writes: Researchers at Tel Aviv University have said that the Covid-19 pandemic has spurred antisemitic sentiment globally. "Prejudice, superstition, primordial emotions, and bizarre theories surfaced and dominated the scene, and manifestations of antisemitism, both verbal and visual, were vicious and outrageous," a new report says.

 

Israel's advanced Covid-19 strategy is being closely watched by many experts in the rest of the world.

Several people asked me for updates so, for those interested, below are some articles from the last couple of days.

Later this month Israel will begin enforcing new rules requiring people to have had a booster (third) shot to keep their 'Green Pass' Covid passports valid.

An Israeli study found booster shots caused fewer side effects than the initial vaccinations, and studies in Israel and elsewhere have shown that initial COVID-19 immunity protection for most people diminishes after a few months.

 

CONTENTS

1. "Covid-19 Booster Shots Are Available for All in Israel. Younger People Aren't Convinced"(Wall St Journal, Oct. 10, 2021)
2. "Israelis march in Tel Aviv in protest of Covid Green Pass rules"(JNS, Oct. 10, 2021)
3. "The new frontier: Israeli hospitals contend with 'long COVID' in children"(Haaretz, Oct. 10, 2021)
4. "Moderna, Racing for Profits, Keeps Covid Vaccine Out of Reach of Some Poorer Countries"(NY Times, Oct. 9, 2021)
5. "Life-saving COVID drug comes to Israel - but most patients won't take it"(Haaretz, Oct. 11, 2021)
6. "Pfizer's COVID-19 immunity protection diminishes after 2 months, and it can reach as low as 20% after 4 months"(Insider, Oct. 8, 2021)
7. "Could playing music under 120 bpm slow spread of COVID-19?"(Jerusalem Post, Oct. 9, 2021)

 

ARTICLES

COVID-19 BOOSTER SHOTS ARE AVAILABLE FOR ALL IN ISRAEL. YOUNGER PEOPLE AREN'T CONVINCED

Covid-19 Booster Shots Are Available for All in Israel. Younger People Aren't Convinced.
Take-up rates for boosters are especially low among younger Arab and ultraorthodox Israelis
By Dov Lieber
The Wall Street Journal
Oct. 10, 2021

https://www.wsj.com/articles/covid-19-booster-shots-are-available-for-all-in-israel-younger-people-arent-convinced-11633858202

TEL AVIV?Israel is among the most aggressive countries in the world in pushing boosters for the Covid-19 vaccine. Many younger people here are asking why.

Later this month the government will begin enforcing new rules requiring people to get a booster shot of the Covid-19 vaccine or present a negative test if they want to go to restaurants, bars or other indoor entertainment spots. The boosters are needed to keep "Green Pass"Covid passports valid, which authorities view as an effective way of nudging as many people as possible to get a third shot of the vaccine to boost immunity and reduce the virus's spread through the population.

Yet while many younger Israelis were happy to get their initial doses of the Pfizer Inc. - BioNTech SE vaccine, this time they aren't so willing. Some say they feel they are being pushed toward a third shot before enforcement of the program begins on Oct. 17, and would prefer to wait, saying they believe they are still protected from severe cases of Covid despite health officials' efforts to convince them they can prevent long Covid cases.

Just over a quarter of 16-to-19-year-olds have received a booster along with 40% of 20-to-29-year-olds and 47% of 30-to-39-year-olds, according to Israel's health ministry. This is compared with older groups, such as 65% for 50-to-59-year-olds and 75% for 60-to-69-year-olds. The numbers are weighed down in part by wider hesitancy among younger Arab and ultraorthodox Israelis.

Experts say doubts by younger people over boosters could be a harbinger for what other countries might expect as they begin to roll out third shots, and raises the prospect that transmission of the virus could continue.

"Younger people are less afraid of the coronavirus,"said Tamar Hermann, who has been conducting opinion polls on vaccine policy at the Jerusalem-based Israel Democracy Institute. "Some are confused and bewildered whether they are really at such a risk or it's part of the government propaganda."

On Monday, Europe's top health regulator recommended boosters for anyone 18 and over who had received their second shot of the vaccine developed by Pfizer and BioNTech. The U.K. has begun providing boosters to anyone over 50, while the U.S. is offering them to over 65s and people in high-risk groups.

But in Israel, which began vaccinating widely before many other countries, some younger people this time say they feel they are being coerced into having the third shot.

"Everyone is saying they are just getting the third vaccine just to keep their rights,"said Dan Rushansky, 33, who owns a bar and separate cafe in the young and hip neighborhood of Florentine in Tel Aviv.

Mr. Rushansky said that he and 10 of his 20 employees haven't yet gotten a third shot, and the same is true of much of his clientele. He said he closed his cafe on Tuesday believing it would no longer be profitable under the new Covid-19 pass regime.

Aliza Petrack, 32, a philosophy student at Tel Aviv University, said she felt frustrated by the rigidity of the new regulations. Rather than rushing to get a third shot and risk the side effects, even if they are mild, she said she got an antibody test and learned she was still well protected from her previous shots.

Now Ms. Petrack said she feels she's being forced into getting a third shot earlier than she would have because otherwise she won't be able to attend classes on campus.

"It's frustrating that there's no kind of common-sense policy,"she said. When she got her first two shots, she said she felt Israel was "in line with the global medical community. Now Israel is kind of doing it's own thing."

Israel's Covid-19 passes were initially to be linked to the third shot beginning on Oct. 7, but that was pushed back because of technical problems. Meanwhile, pickup rates for the booster shots are accelerating as the enforcement date nears, but it isn't necessarily because young people want to get them or believe they will improve their protection against Covid-19. It's to keep their passes.

"Everyone wants to have a normal life, so people are getting their third shot,"said Shon Weizman, 27, who works at a wine bar in Tel Aviv.

Last week, Dr. Anthony Fauci, President Biden's chief medical adviser and director of the National Institute of Allergy and Infectious Diseases, said in an interview with Israel's Army Radio that U.S. regulators are waiting for data from Israel's military to understand the risk-benefit analysis of giving boosters for younger adults.

Dr. Fauci said the regulators were particularly interested in understanding the risk for young people developing a rare side effect of heart muscle inflammation called myocarditis after receiving a third shot of the Pfizer vaccine, and that he believed the U.S. would ultimately follow Israel's lead on boosters.

Israel's health ministry has published data indicating that the booster shots cause fewer side effects than the initial vaccinations and provide a significant increase in resistance to the virus compared with people who received their second five months or more previously. Officials and medical professionals credit the booster campaign for tamping down a wave of infections and severe illness from the contagious Delta variant.

But some suggested the government should be more flexible in enforcing the new Covid-19 pass rules, and focus more on communicating the benefits of the third shot instead.

Nadav Davidovitch, head of the Israeli Association of Public Health Physicians and director of the School of Public Health at Ben Gurion University in Be'er Sheva, thinks this is particularly true among Arab and ultraorthodox youngsters who have been slower to take up boosters, because infection rates have been higher in the latter group and many are still recovering from the virus.

"I think maybe we need to give some more time and invest more in health promotion to be targeted to specific groups,"Dr. Davidovitch said.

 

THOUSANDS OF ISRAELIS MARCH IN TEL AVIV IN PROTEST OF COVID GREEN PASS RULES

Israelis march in Tel Aviv in protest of Covid Green Pass rules
"We were thousands again tonight in the streets protesting against the Green passport ... and for our civil rights and our sovereignty,"says Israeli activist.
JNS
October 10, 2021

https://www.jns.org/israelis-march-in-tel-aviv-in-protest-of-covid-green-pass-rules/

Israelis once again took to the streets in Tel Aviv on Saturday night in protest against the government's Oct. 3 decision to restrict the country's COVID "Green Pass"to only those who have received a vaccine booster shot or those who have recently recovered from the disease.

"We were thousands again tonight in the streets protesting against the Green Pass ? and for our civil rights and our sovereignty,"tweeted Israeli activist Efrat Fenigson.

On Oct. 3, Israel became the first country in the world to require a third vaccine dose as a requirement for its vaccination passport, without which indoor venues cannot be entered and access to certain public venues is restricted. The move meant that some 2 million Israelis' Green Passes were rendered invalid.

"More than 2 million people who have already been vaccinated twice have not taken the booster [shot] ? and will be deprived of their basic human rights,"tweeted Fenigson.

Under the new criteria, those who have received two vaccine doses, and those who have recovered from coronavirus, were issued passes valid for six months from the date of their vaccination or recovery.

After the new rules went into effect, there were protest demonstrations at several locations across the country. Opponents of the new, stricter criteria claim that they amount to a forced vaccination program.

Israel began an aggressive campaign on Aug. 29 to encourage Israelis to get a vaccine booster shot, announcing all citizens age 12 and above would be eligible. More than 3.7 million have since received the booster, according to Israel's Health Ministry.

 

THE NEW FRONTIER: ISRAELI HOSPITALS CONTEND WITH 'LONG COVID' IN CHILDREN

The new frontier: Israeli hospitals contend with 'long COVID' in children
By Ido Efrati
Haaretz
Oct. 10, 2021

https://www.haaretz.com/israel-news/the-new-frontier-israeli-hopsitals-contend-with-long-covid-in-children-1.10280661

At the "long COVID"clinic at Schneider Children's Medical Center in Petah Tikva, about 150 children are being treated, but several hundred more or on a waiting list. "Demand is high and the wait is more than half a year, because we monitor and test everything for each patient,"says Dr. Liat Ashkenazi-Hoffnung, an infectious-disease specialist.

The clinic began operating in November, several months after similar clinics were opened for adults. The symptoms the doctors see are varied, from shortness of breath (the most common complaint), muscle pain, headaches, fatigue, disordered sleep, chest pain, hair loss, and digestive disorders, to the loss of taste and smell, weight loss, difficulty concentrating, memory loss and the exacerbation of tics in children who suffered from them previously. About 60 percent report reduced daily functioning because of the symptoms.

"What's interesting, is that in some of the children, it really appears as a direct continuation of severe illness but in very many of the children, there is a severe illness, followed by a lull of several months and only then do the symptoms of long COVID begin,"says Ashkenazi-Hoffnung.

According to her, the persistence of the symptoms varies. "There are children for whom it takes half a year or more. For example, we had a boy here who was a competitive swimmer and came down with long COVID and was very anxious and in pain. After half a year he went back to swimming and even broke a personal record."

However, she also says that there are "a few children here who, a year after the illness, haven't recovered, and they have symptoms that are affecting their day-to-day functioning. There are cases in which it lasts for more than a year."

She adds that about 15 percent of the children treated at the clinic have been found to have no antibodies, even though they tested positive on a PCR test.

UNDERESTIMATED

Coronavirus infection in children has been considered to be mild since the start of the pandemic. Less than 1 percent of children who have been tested have required hospitalization, and cases of severe illness are rare and appear mainly in those with pre-existing conditions. The assumption that children are protected has been part of the medical and public discourse concerning vaccinations.

However, the illness has long-term effects, known as "long COVID,"the extent, severity and persistence of which are not yet completely clear.

A recently published Health Ministry survey of 13,000 children who contracted COVID has found that 11.2 percent of them suffered from at least one symptom after recovering and 1.85-4.6 percent still had symptoms after six months.

One of the limitations of the ministry survey is that the answers were based on asking the children's parents and their recall of how their children's symptoms were first noticed or perceived. Experts believe that there is under diagnosis of the phenomenon both on the part of parents as well as doctors.

"I think there is an underestimation,"says Ashkenazi Hoffnung, "even in the research studies, because of their methods, and the numbers are higher. That said, not all symptoms have the same significance. The essential question is whether it affects functioning. If, for example, a child loses the sense of taste and smell for eight months and that leads to picky eating, this is not necessarily clinically significant compared to symptoms that damage functioning and prevent the child from doing the things he loves."

For example, there are children for whom physical activity was an important part of their lives. "Fifteen percent of the children who come to us trained in various sports for three or four hours a day six days a week, and after the coronavirus they can't even walk for five minutes. Their parents and sometimes the doctors don't always connect this to the coronavirus."

"These children aren't spoiled or depressed - they are dealing with physical damage that is part of long COVID and they want to go back to their activities. I am sure there are other children who suffer from the same phenomenon, but it isn't noticed because it doesn't affect their routine. Some of them are sitting at home playing Fortnite and don't know they are incapable of walking for five minutes, that they have these symptoms."

NO CLINICAL DEFINITION

The process of researching and understanding the phenomena of long COVID is only in its earliest stages and even the World Health Organization does not yet have a final diagnostic definition.

According to Ashkenazi-Hoffnung, the lack of recognition and awareness of the syndrome among doctors in the community is leading to two phenomena.

On one hand, "doctors are telling parents it's psychological, or the child is spoiled, or they should wait and it will pass and they aren't diagnosing the symptoms,"she notes. But on the other hand "it is leading to children being tested extensively and unnecessarily. For example, a child who was experiencing dizziness came to us after a series of tests and was diagnosed as suffering from vertigo and was sent to an ear, nose and throat doctor. The doctors aren't managing to put their finger on the correct diagnosis and the parents tend to interpret it as being spoiled or something psychological. I have children coming in with chest pains and shortness of breath and their mother is whispering 'I think it's psychological, he's having a panic attack.'"

Because of lack of familiarity with the symptoms, children often come to the clinic due to one of the symptoms, but then it turns out they are suffering from additional ones. "A teenager comes in and says he is suffering from shortness of breath and pains in his chest. And only after I ask,"she says, "it turns out he has difficulty falling asleep and has tingling in his extremities."

Another phenomenon, which was first reported in April of 2020 is multisystem inflammatory syndrome in children, of which about 100 cases have been reported in Israel. The syndrome usually appears eight to ten weeks after the illness, even among children who had light cases. It starts out as stomach aches, a rash and a fever and can develop into life-threatening damage to the heart. It requires hospitalization, and in most cases cardiac damage remains after recovery.

There is also treatment for long COVID in children available at Ichilov Hospital in Tel Aviv (Sourasky Medical Center) and at Shaare Zedek Medical Center in Jerusalem, where Prof. Yechiel Schlesinger is head of pediatrics.

"A year ago we opened a clinic that treated the continuing symptoms in children. With the waning of the third wave, it hardly operated at all, but in the fourth wave with the extensive infection rate among children, it is back in action,"he says.

While all of the cases "ended well,"Prof. Schlesinger says that they now have cases of children coming "long after they had fallen ill, with the most prevalent symptom being severe difficulty in breathing, damage to the nervous system and the brain, very severe pains and neurological phenomena, alongside dermatological problems like rashes and problems with the digestive system."

IRON, PHYSIOTHERAPY AND AN INHALER

"We are seeing children coming in with very significant nutritional deficits because of the loss of the sense of taste or its incomplete return,"says Ashkenazi-Hoffnung at Schneider. "There are children who smell the smell of burning or for whom the tastes of foods that had been familiar to them have completely changed. This is a common phenomenon, and it leads to very picky eating and weight loss. In the wake of that, we are seeing, among other things, iron deficiency, which exacerbates exhaustion and hair loss."

"We have found that many of the children, at least a third of them, suffer from shortness of breath and giving them an inhaler, even if they don't have asthma, helps some of them."

The clinics also provide physiotherapy for pain and for improving breathing techniques, as well as psychological support for children with post-trauma and anxiety and medicinal treatments for damage to the peripheral nervous system, along with therapies for sleep disturbances by means of medications or at sleep clinics if needed.

 

MODERNA, RACING FOR PROFITS, KEEPS COVID VACCINE OUT OF REACH OF POOR

Moderna, Racing for Profits, Keeps Covid Vaccine Out of Reach of Poor
Some poorer countries are paying more and waiting longer for the company's vaccine than the wealthy ? if they have access at all.
The New York Times
Oct. 9, 2021

https://www.nytimes.com/2021/10/09/business/moderna-covid-vaccine.html

Moderna, whose coronavirus vaccine appears to be the world's best defense against Covid-19, has been supplying its shots almost exclusively to wealthy nations, keeping poorer countries waiting and earning billions in profit.

After developing a breakthrough vaccine with the financial and scientific support of the U.S. government, Moderna has shipped a greater share of its doses to wealthy countries than any other vaccine manufacturer, according to Airfinity, a data firm that tracks vaccine shipments.

About one million doses of Moderna's vaccine have gone to countries that the World Bank classifies as low income. By contrast, 8.4 million Pfizer doses and about 25 million single-shot Johnson & Johnson doses have gone to those countries.

Of the handful of middle-income countries that have reached deals to buy Moderna's shots, most have not yet received any doses, and at least three have had to pay more than the United States or European Union did, according to government officials in those countries.

Thailand and Colombia are paying a premium. Botswana's doses are late. Tunisia couldn't get in touch with Moderna.

Unlike Pfizer, Johnson & Johnson and AstraZeneca, which have diverse rosters of drugs and other products, Moderna sells only the Covid vaccine. The Massachusetts company's future hinges on the commercial success of its vaccine.

"They are behaving as if they have absolutely no responsibility beyond maximizing the return on investment,"said Dr. Tom Frieden, a former head of the Centers for Disease Control and Prevention.

Moderna executives have said that they are doing all they can to make as many doses as possible as quickly as possible but that their production capacity remains limited. All of the doses they produce this year are filling existing orders from governments like the European Union.

Even so, the Biden administration has grown increasingly frustrated with Moderna for not making its vaccine more available to poorer countries, two senior administration officials said. The administration has been pressing Moderna executives to increase production at U.S. plants and to license the company's technology to overseas manufacturers that could make doses for foreign markets.

Moderna is now scrambling to defend itself against accusations that it is putting a priority on the rich.

On Friday, after The New York Times sent detailed questions about how few poor countries had been given access to Moderna's vaccine, the company announced that it was "currently investing"to increase its output so it could deliver one billion doses to poorer countries in 2022. The company also said this past week that it would open a factory in Africa, without specifying when.

Moderna executives have been talking with the Biden administration about selling low-cost doses to the federal government, which would donate them to poorer countries, as Pfizer has agreed to do, the two senior officials said. The negotiations are continuing.

In an interview on Friday, Moderna's chief executive, St?phane Bancel, said "it is sad"that his company's vaccine had not reached more people in poorer countries but that the situation was out of his control.

He said that Moderna tried and failed last year to get governments to kick in money to expand the company's scant production capacity and that the company decides how much to charge based on factors including how many doses are ordered and how wealthy a country is. (A Moderna spokeswoman disputed Airfinity's calculation that the company had provided 900,000 doses to low-income countries, but she didn't provide an alternate figure.)

Nearly a year after Western countries began sprinting to vaccinate their populations, the focus in recent months has shifted to the severe vaccine shortages in many parts of the world. Dozens of poorer countries, mostly in Africa and the Middle East, had vaccinated less than 10 percent of their populations as of Sept. 30.

In August, for example, Johnson & Johnson faced rebukes from the director general of the World Health Organization and public health activists after The Times reported that doses of that shot produced in South Africa were being exported to wealthier countries.

Biden administration officials are especially frustrated with what they see as Moderna's lack of cooperation, because the U.S. government has provided the company with critical assistance.

Scientists at the National Institutes of Health worked with the company to develop the vaccine. The United States kicked in $1.3 billion for clinical trials and other research. And in August 2020, the government agreed to preorder $1.5 billion of the vaccine, guaranteeing that Moderna would have a market for what was an unproven product.

While clinical trials last year found that the Moderna and Pfizer vaccines were similarly effective, more recent studies suggest that Moderna's shot is superior. It offers longer-lasting protection and is easier to transport and store.

Moderna's shot is "essentially the premium vaccine,"said Karen Andersen, an industry analyst at Morningstar. "They're in a position where they probably don't need to sacrifice too much on pricing in a lot of these deals."

There is limited public information about the deals that Moderna has struck with individual governments. Of the 22 countries, plus the European Union, to which Moderna and its distributors have reported selling the shots, none are low income, and only the Philippines is classified as lower middle income. (Six are upper middle income.)

Pfizer, by comparison, said it had agreed to sell its vaccine at discounted prices to 12 upper-middle-income countries, five lower-middle-income governments and one poor country, Rwanda. (Tunisia, for example, is paying about $7 per dose.)

Only a handful of governments have disclosed how much they're paying for Moderna doses. The United States paid $15 to $16.50 for each shot, on top of the $1.3 billion the government gave Moderna to develop its vaccine. The European Union has paid $22.60 to $25.50 for its Moderna doses.

Botswana, Thailand and Colombia, which the World Bank classifies as upper-middle-income countries, have said they are paying $27 to $30 per Moderna dose.

The lack of transparency about how much other governments are paying has put relatively poor countries in a weak bargaining position. They are "negotiating totally in the dark,"said Kate Elder, who advises Doctors Without Borders on vaccine policy.

In some cases, Moderna has offered to provide poorer countries the vaccine at relatively low prices, but only after it has fulfilled other countries' orders.

In May, Moderna offered the African Union doses for about $10 each, according to a bloc official involved in the discussions. But the doses wouldn't be available until next year, causing the talks to fall apart, according to two African Union officials.

Dr. Ayoade Alakija, who helps run the African Union's vaccine delivery program but was not involved in the procurement discussions, said Moderna's attitude amounted to: "We're here to make money. We've stumbled upon a good thing, and we're not even trying to pretend that we're trying to save the world."

Moderna's Covid vaccine has been transformative for the company and its leaders. The company has said it expects its vaccine to generate at least $20 billion in revenue this year, which would make it one of the most lucrative medical products in history. Ms. Andersen, the Morningstar analyst, projected that the company's profits on the vaccine could be as high as $14 billion. In 2019, Moderna reported total revenue of $60 million.

Moderna's market value has nearly tripled this year to more than $120 billion. Two of its founders, as well as an early investor, this month made Forbes magazine's list of the 400 richest people in the United States.

As the coronavirus spread in early 2020, Moderna raced to design its vaccine ? which uses a new technology known as messenger RNA ? and to plan a safety study. To manufacture the doses for that trial, the company received $900,000 from the nonprofit Coalition for Epidemic Preparedness Innovations.

The nonprofit group said Moderna had agreed to its "equitable access principles."That meant, according to the coalition, that the vaccine would be "first available to populations when and where they are needed and at prices that are affordable to the populations at risk, especially low- and middle-income countries or to public sector entities that procure on their behalf."

Moderna agreed in May to provide up to 34 million vaccine doses this year, plus up to 466 million doses in 2022, to Covax, the struggling United Nations-backed program to vaccinate the world's poor. The company has not yet shipped any of those doses, according to a Covax spokesman, although Covax has distributed tens of millions of Moderna doses donated by the United States.

Mr. Bancel said that many more doses would have gone to Covax this year had the two parties reached a supply deal in 2020. Aur?lia Nguyen, a Covax official, denied that, saying, "It became clear early on that the best we could expect was minimal doses in 2021."

Late last year, the Tunisian government was hoping to order Moderna doses. Dr. Hechmi Louzir, who led Tunisia's vaccine procurement efforts, didn't know how to contact Moderna to begin talks and asked the U.S. Embassy in Tunisia for help, he said. Officials there contacted Moderna, he said, but nothing came of it.

"We were very interested in Moderna,"Dr. Louzir said. "We tried."

In Thailand, where about 32 percent of people are fully vaccinated, a government spokeswoman said the government was paying Moderna about $28 per dose for one million shots that are designated for vulnerable people. Deliveries from that order will start next year.

In Botswana, the health minister told Parliament in July that the government had ordered 500,000 shots from Moderna, at nearly $29 per dose ? enough to fully vaccinate about 10 percent of the population. (That would roughly double the number of Botswanans who are fully vaccinated.) A spokesman for the Health Ministry said that the doses were expected to start arriving in August, but that none had yet arrived.

Colombia ordered 10 million shots from Moderna. The government budgeted about $30 per dose, a price that may include the cost of transportation and other logistics, according to Finance Ministry documents. The country's health minister, Dr. Fernando Ruiz, said Moderna's vaccine was the most expensive among the Covid shots that Colombia had ordered.

There were some initial delays, Dr. Ruiz said: The first deliveries, expected in early June, came in August. About 2.3 million had arrived as of Friday.

 

LIFE-SAVING COVID DRUG COMES TO ISRAEL - BUT MOST PATIENTS WON'T TAKE IT

Life-saving COVID drug comes to Israel - but most patients won't take it
By Ido Efrati
Haaretz
Oct. 11, 2021

https://www.haaretz.com/israel-news/life-saving-covid-wonder-drug-comes-to-israel-but-most-patients-won-t-take-it-1.10282942

Nobody in Israel's healthcare system anticipated this scenario: Many at-risk COVID patients who are candidates to receive the drug Regeneron have refused to take it since the health maintenance organizations began offering it on September 23. It's been administered to only 256 patients so far, with 291 declining it.

The medication, which costs $1,500 dollars per patient, is given intravenously, and according to studies it reduces the risk of severe illness substantially if it's given within 72 hours of infection. The drug made headlines last year when it was given to former U.S. President Donald Trump, who was diagnosed with COVID-19. About a month later it was

Until recently the drug was administered in Israel mainly to inpatients at hospitals and geriatric facilities. But since September 23 its use was expanded through the HMOs.

The Health Ministry designated the expensive medication as a limited national asset and feared excessive demand by patients, particularly ones who don't meet the criteria. A letter by ministry director general Nachman Ash to the HMOs requested that clearly defined criteria be drawn up as to who is eligible for the drug, and that professional committees be formed in each fund to consider exceptional requests by patients who do not meet all the clinical criteria. Noting the shortage of the drug which he called "a national asset,"Ash wrote that "all steps must be taken to prevent waste and destruction of doses or administering doses to those who do not meet the criteria."

Accordingly, the HMOs set criteria based on the patient's age, number of hospitalizations in the past three years, vaccination status, and whether they had chronic conditions such as kidney disease, diabetes and coronary disease, among others, or were heavy smokers or suffering from immunosuppression. Each criterion is worth so many points, and if the patients "scores"seven points - they are eligible for the drug. Non-vaccination is worth five points and is the heaviest-weighted criterion. The HMOs prepared for rapid deployment of the drug. In addition, IDF Medical Corps teams were called up to help the HMOs deliver the drugs to home-bound patients, and the very day the Health Ministry announced expansion of the drug's use, the HMOs began approaching prospective patients.

But it turns out that demand is very low and the HMOs find themselves urging patients to take a drug meant to protect them from severe illness.

"We've administered the drug to over 140 patients so far, mostly in patients' homes all over the country, with Medical Corps aid,"says Dr. Doron Netzer, head of medicine in the community division of Clalit Health Services. Netzer tells Haaretz that the entire process at the patient's home, including the infusion (which takes about 20 minutes) and observation afterwards, lasts 90 minutes to two hours. Netzer's teams contact COVID-19 patients who have risk factors for serious disease and explain the importance of taking the medication. But to his surprise, a substantial number refuse. This includes many who are not vaccinated and are therefore at greater risk for serious illness and are also eligible for the costly drug.

"Another group of 'Regeneron refusers' are those whose condition is mild and who feel well and do not sense the danger. It's human and understandable, but they have a 20-25 percent risk of developing severe illness, and we can't persuade them [to take the drug],"he says. Others express willingness, make an appointment, and then renege at the last moment - often due to consultation with friends and family. "It's their right. It's a novel treatment that is undoubtedly the best available right now, but there's still distrust among some patients,"says Netzer.

CRITERIA BEING EASED

A senior figure at another HMO tells Haaretz, "We're investing a lot in Regeneron, but we have four times as many refusals as takers. On one hand we were surprised. On the other - why would someone who declined the vaccination take a drug? If at first we thought we'd have to ration it, now we're easing criteria and giving it to willing patients even if they don't fully meet criteria."

The drug is manufactured by U.S. firm Regeneron under the trademark REGEN-COV. It made headlines last year, when it was given to former U.S. President Donald Trump, who was diagnosed with COVID-19. About a month later it was FDA-approved for emergency use.

Since approval, a study published in The New England Journal of Medicine showed efficacy of 81 percent in preventing symptomatic illness, and 66 percent in preventing contagion among those living with confirmed patients. In addition, duration of symptoms among those who were infected was shorter by half compared to those who did not receive the drug.

Regeneron contains two antibodies - Casirivimab and Imdevimab - which adhere to the viral envelope of the coronavirus and disrupt its ability to penetrate the cell and replicate itself.

Company studies showed it to be 70 percent effective in preventing severe illness among non-admitted patients when given within 72 hours of infection - as long as it is given close to the appearance of symptoms, and not after deterioration has begun. Studies have found next to no side effects except for an allergic reaction or local bleeding and swelling related to the injection itself.

 

PFIZER'S COVID-19 IMMUNITY PROTECTION DIMINISHES AFTER 2 MONTHS, AND IT CAN REACH AS LOW AS 20% AFTER 4 MONTHS: STUDIES

Pfizer's COVID-19 immunity protection diminishes after 2 months, and it can reach as low as 20% after 4 months: studies
By Matthew Loh
Insider news
October 8, 2021

https://news.yahoo.com/pfizers-covid-19-immunity-protection-032404881.html

Two recent studies found that Pfizer's immunity protection diminishes rapidly a few months after a person has their second dose.

However, one study noted that the vaccine's protection against death and hospitalization still remained as high as 96%.

The studies affirm Pfizer's earlier comments that its vaccines may not defend against COVID-19 infection as effectively over time.

COVID-19 immunity protection from two doses of the Pfizer vaccine starts dwindling after about two month, still, the shots remain effective in guarding against hospitalization and death, according to a pair of studies published in the New England Journal of Medicine on Wednesday.

The new findings affirm what Pfizer, Moderna, and the Centers for Disease Control and Prevention have indicated in recent weeks - that the vaccines' ability to protect the body from coronavirus infection may wane over time. Last month, the Food and Drug Administration authorized Pfizer booster shots for older or more vulnerable people.

In the first study, researchers from Qatar found that Pfizer's immunity protection drops to as low as 20% just four months after a person receives their second dose. They based their report on observations of infections among Qatar's over 900,000 vaccinated people.

The researchers found that Pfizer's protection against infection was "negligible"shortly after the first dose, but jumps to 36.8% three weeks later. When people receive their second dose, immunity protection increases to 77.5% after about a month.

But once that month is over, Pfizer's immunity effectiveness declines steadily, hovering at around 20% after the four-month mark, per the researchers.

"These findings suggest that a large proportion of the vaccinated population could lose its protection against infection in the coming months, perhaps increasing the potential for new epidemic waves,"wrote the report.

Still, Pfizer's protection against hospitalization and death remained "robust"at 90% or higher for six months after the second dose, it said. The report also noted that its findings may not apply well to countries with older populations, since Qatar's population is relatively young with only 9% of its people being 50 or older.

The other study, conducted in Israel, looked at 4,868 healthcare workers. It reported that people have substantially decreased COVID-19 antibodies just six months after receiving their second dose of Pfizer's vaccine.

The drop is especially prominent among men, the elderly above 65, and those with weakened immune systems.

In comparison, vaccines for other conditions such as mumps, measles, and rubella only show small decreases of about 5% to 10% each year in neutralizing antibody levels, wrote the researchers.

They also noted that they observed higher antibody counts in obese participants who have a body mass index of 30 or above.

"Yet, it is still unclear whether vaccinated obese persons are at higher or lower risk for breakthrough infection and whether the relatively high humoral response to the vaccine is protective,"the report stated.

 

COULD PLAYING MUSIC UNDER 120 BPM SLOW SPREAD OF COVID-19?

Could playing music under 120 bpm slow spread of COVID-19?
South Korea has decided to restrict gyms from playing music at over 120 beats per minute (bpm) during group activities like aerobics and spinning.
Jerusalem Post
October 9, 2021

https://www.jpost.com/health-and-wellness/exercise/could-playing-music-under-120-bpm-slow-spread-of-covid-19-681489

In South Korea, they're struggling with another coronavirus wave. Instead of closing the gyms the government stated that it's forbidden to play rhythmic music at over 120 beats per minute. The speed of the treadmills will be limited and other restrictions implemented. These laws caused a great deal of opposition and many questions: "How can one control the music that people hear?"

The vast majority of people who regularly work out in gyms probably love music that puts them into a rhythm and motivates them during exercise. But, South Korea has decided to significantly reduce this musical option under the new coronavirus restrictions.

In addition to social distancing and various similar rules, this Asian country has also decided to restrict gyms from playing music at over 120 beats per minute (bpm) during group activities like aerobics and spinning.

The state health authorities explained that the purpose of these guidelines is to prevent exercisers from breathing too fast or sweating near other people, in order to reduce their chances of getting infected, which could lead to the business closures that happened in previous corona waves.

But this law, as you must have guessed, has caused a great deal of opposition on the part of exercisers and also lawmakers who have called it "nonsensical,"along with gym owners who oppose this law and claim that it's ineffective and impossible to implement.

Hang Yun-Koo, owner of a gym in north Seoul, commented on this restriction, by asking if playing classical music or quiet songs has been proven to prevent the virus spreading? He added that many people use headphones to listen to music they choose, so you can't control what they hear.

South Korea, which is dealing with a big corona wave, added additional restrictions and even decided to limit the speed of treadmills to only 6 km/h and a ban on using showers in gyms. The government also decreed that no more than two people would participate in table tennis games at once, among another rules.

Will it help them? It remains to be seen.

 

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