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[Viewpoint] COVID-19 vaccine strategies must focus on severe disease and global equity

Ve, 17/12/2021 - 00:30
In September, 2020, the WHO Prioritisation Roadmap for COVID-19 vaccines gave priority to prevention of severe disease and the highest risk groups. In July, 2021, the revised Roadmap noted that despite the progressive emergence of SARS-CoV-2 variants of concern, defined as mutations conferring increased infectivity, virulence, or relative capacity for immunological escape, vaccine effectiveness against severe disease had been retained.1 At the end of 2021, global differences in the inter-related variables of population seropositivity2 and vaccine coverage3 have widened, and omicron has been declared the fifth variant of concern.

[Correspondence] Projecting COVID-19 disruption to elective surgery

Ve, 17/12/2021 - 00:30
Millions of elective surgical procedures were cancelled worldwide during the first wave of the COVID-19 pandemic.1 This enabled redistribution of staff and resources to provide care for patients with COVID-19 and addressed evidence that perioperative SARS-CoV-2 infection increases postoperative mortality.2 Although some hospitals established COVID-19-free surgical pathways to create safe elective surgery capacity,3 the National Health Service (NHS) in England has not returned to pre-pandemic elective surgery activity levels.

[Comment] Anticoagulation in COVID-19

Gi, 16/12/2021 - 00:30
Thrombotic complications (arterial and venous) are common in patients admitted to hospital with COVID-19 and are an independent predictor of poor outcome.1 Microvascular thrombi also contribute to organ dysfunction, including acute respiratory distress syndrome. The pathogenesis of thrombosis in COVID-19 is intimately linked with the inflammatory response to the virus, endothelial infection, activation, and injury as well as hypercoagulability.2 Recognition that thrombosis is a key contributor to clinical deterioration and death has led to global interest in whether escalated anticoagulation dose or extended duration improves patient outcomes.

[Articles] Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial

Gi, 16/12/2021 - 00:30
In patients at high risk discharged after hospitalisation due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days improved clinical outcomes compared with no extended thromboprophylaxis.

[Editorial] Preventing violence against women: beyond 16 days

Sa, 11/12/2021 - 00:00
16 Days of Activism against Gender-Based Violence, an annual, global civil society campaign calling for the prevention and elimination of violence against women and girls, ended on Dec 10. This year, the 30th anniversary of the event, carries particular poignancy. Violence against women and girls, already at high levels before COVID-19, has risen markedly during the pandemic and increased in severity, according to Oxfam. Government responses to the pandemic included lockdowns, suspension of social services, and economic hardship, many of which had the consequences of placing women at increased risk of violence, while in many countries, financial and logistical support for violence response services was withdrawn.

[Comment] Offline: The origin story

Sa, 11/12/2021 - 00:00
The relationship between humans and animals is deep and ancient. The spread of our Early Bronze Age (3300–2500 BCE) ancestors from central Eurasia westwards into Europe and eastwards towards Mongolia depended on the domestication of horses, sheep, goats, and cattle. Migration is a defining characteristic of who we are as a species. But the extent of our migration has long been entwined with the fate of animals. These relationships are only growing more complex over time. One aspect of our association with animals has recently provoked a controversy of momentous geopolitical importance—the origin of SARS-CoV-2 and the COVID-19 pandemic that it has caused.

[World Report] US Supreme Court expected to weaken abortion rights

Sa, 11/12/2021 - 00:00
A majority of Supreme Court justices may be inclined to overturn Roe v Wade. Susan Jaffe reports from Washington, DC.

[World Report] What next for the Philippines’ war on drugs?

Sa, 11/12/2021 - 00:00
With President Duterte's term in office ending, an investigation by the International Criminal Court into the killing of drug users has been suspended. Talha Burki reports.

[Perspectives] The healer as the enemy: attacking health care in war

Sa, 11/12/2021 - 00:00
Violence against health care in war has shocked the global public conscience over the past decade. Images of attacks on hospitals from my home country, Syria, have been especially disturbing. Documentaries such as The New Barbarianism, For Sama, and The Cave, the latter two from Syria, provide gripping accounts of the plight of hospitals and health workers under attack. Scholarship on health-care attacks has not been extensive. For instance, three fairly recent authoritative edited volumes on conflict and health—Ilkka Taipale's 2001 War or Health: A Reader, Barry Levy and Victor Sidel's 2007 War and Public Health, and Natasha Howard, Egbert Sondorp, and Annemarie Ter Veen's 2012 Conflict and Health—did not dedicate a chapter to the topic.

[Perspectives] Zarlasht Halaimzai: striving to provide a better future for refugees

Sa, 11/12/2021 - 00:00
When Zarlasht Halaimzai was 11 years old, she and her family were forcibly displaced from Kabul, Afghanistan, as the civil war in the early 1990s escalated. “When we left it was very sudden, done in a moment when everything was very insecure and hopeless. In Kabul, food was difficult, it was difficult to get water, there were militias everywhere. Normal life had completely collapsed”, she recalls. Their displacement continued for 4 years, during which time the family became separated and Halaimzai missed out on much education.

[Perspectives] Clay

Sa, 11/12/2021 - 00:00
The light fills a hospital space, swells through old windows and blinds, and throws you, breathless, into relief—the ridges and folds of you now textured, grained like a field, ruffled water, clay. But this is more than a display of likeness—it is the sudden exposure, as Tim Dee writes, that “our bodies are grass”, that we are the stuff of the world, “a pucker”, in Annie Dillard's words, “of the earth's skin”. And if self-evident, it's still unsettling, even for doctors, supposed familiars of the body.

[Perspectives] Something in the water

Sa, 11/12/2021 - 00:00
Rare Earth Mettle at London's Royal Court Theatre concerns rival missions to extract lithium from the Bolivian salt flats. Henry Finn (Arthur Darvill), billionaire founder of Edison Motors, needs copious quantities for the batteries of the electric vehicles he's developing. They’ll help save the climate and sales will enrich him—not inconsiderably—in the process. But lithium has other uses too. In the play, Anna Carter (Genevieve O’Reilly), a British doctor, argues that communities who drink naturally lithium-rich water have improved mental health.

[Correspondence] Prioritising immunisation across the life course

Sa, 11/12/2021 - 00:00
We read with interest the paper by Kate Causey and colleagues,1 the first detailed quantification of the substantial disruptions to routine childhood immunisations throughout the COVID-19 pandemic. Their findings corroborate the comprehensive report published by WHO and UNICEF of official vaccination figures globally: primary infant diphtheria, tetanus, and pertussis vaccine coverage declined to 83% in 2020, the lowest rate of the decade, resulting in 3·7 million more children under-vaccinated compared with 2019; and up to 17 million children, mainly living in settings that are affected by conflicts, under-served, deprived, or remote, probably did not receive even a single dose of this vaccine, exacerbating existing inequities in vaccine access.

[Correspondence] Prioritising immunisation across the life course – Authors' reply

Sa, 11/12/2021 - 00:00
Anja Saso and colleagues rightly emphasise the importance of quantifying pandemic-related effects on maternal immunisation, with the IMmunising PRegnant women and INfants neTwork highlighting the multifaceted disruptions in 2020 and incomplete recovery to date among 18 countries.1 Our study, which modelled the effects of COVID-19 on routine childhood immunisation in 2020,2 focused on one part of the life course where vaccination can improve health and wellbeing. But the ambition of the Immunization Agenda 20303 is broader: a world where everyone benefits from vaccines at every age.

[Correspondence] High-dose budesonide for early COVID-19

Sa, 11/12/2021 - 00:00
The importance of effective community-based treatments for COVID-19 cannot be overstated. We applaud Ly-Mee Yu and colleagues1 for addressing this issue in the PRINCIPLE trial and would like to share some comments.

[Correspondence] High-dose budesonide for early COVID-19

Sa, 11/12/2021 - 00:00
We were encouraged by the results of the PRINCIPLE trial,1 which in vulnerable individuals showed inhaled budesonide to confer a non-significant –25% (95% CI –45 to 3) relative reduction in the composite coprimary endpoint of hospital admission or death, with the number needed to treat being 50.1 Notably, the study had 90% power to detect a 50% reduction in the composite endpoint. The investigators appear to have attributed any protective effects of budesonide to its local glucocorticoid activity in the lung.

[Correspondence] High-dose budesonide for early COVID-19 – Authors' reply

Sa, 11/12/2021 - 00:00
We thank Ivan Berezowski and colleagues for highlighting the importance of the PRINCIPLE trial finding a safe, effective, and inexpensive community repurposed medication that shortens COVID-19 illness and reduces the need for hospitalisation and use of oxygen.1 Most participants (85%) had up to 10 days’ illness duration (63% fewer than 7 days in the concurrent population). Inclusion of those almost recovered would reduce rather than increase the chance of showing an effect. In addition, if people without obesity incorrectly reported as people with obesity (32% self-reported a body-mass index >35, but only 27·4% of those were eligible on this criterion alone), this would also probably bias the results towards the null because obesity can be associated with worse outcomes.

[Department of Error] Department of Error

Sa, 11/12/2021 - 00:00
Romanello M, McGushin A, Di Napoli C, et al. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. Lancet 2021; 398: 1619–62—In this Review, species names in the seventh paragraph of the Executive Summary should have been Aedes aegypti and Aedes albopictus; data in indicator 4.2.2 for direct employment in fossil fuel extraction should have been 11·6 million employees in 2019 and 9·9 million employees in 2020; and the third sentence of the second paragraph of indicator 4.2.2 should have read “Fossil fuel extraction industries employed more people globally than all renewable energy industries combined in 2019, although the number of jobs in 2020 was slightly lower than in 2019, at 9·9 million compared with 11·6 million.” These corrections have been made to the online version as of Dec 9, 2021.

[Department of Error] Department of Error

Sa, 11/12/2021 - 00:00
Jaffe S. Legal challenges threaten Biden's COVID-19 vaccine rule. Lancet 2021; 398: 1863–64—In this World Report, Michael Felsen's name was misspelled. This correction has been made to the online version as of Dec 9, 2021.

[Clinical Picture] Oncogenic NTRK fusion in congenital spinal cord glioblastoma: sequencing directs treatment

Sa, 11/12/2021 - 00:00
A baby girl delivered vaginally at full-term at a local hospital was found to have a global decrease in tone which was predominately in her arms. She had been born after an induction of labour because of decreased movements and oligohydramnios seen at 39 weeks of gestation on ultrasound.