Boosters, antithrombotic therapy, mental health effects, more COVID-19 news

An FDA advisory committee voted on Oct. 14 to authorize a 50-µg booster dose of the Moderna COVID-19 vaccine, at least six months after the second dose, for people ages 65 years and older and those ages 18 to 64 years who are at high risk either of severe disease or exposure to SARS-CoV-2 where they work or live. On Oct. 15, the committee recommended a booster dose of the Johnson & Johnson (Janssen) vaccine for all those who received it, two months after the initial immunization.

Boosters and the efficacy of vaccination in various groups were discussed during the ACP and Annals of Internal Medicine COVID-19 Forum VI on SARS-CoV-2 Immunology, held virtually on Oct. 8. Expert panelists Deborah Cotton, MD, MPH, FACP, John R. Mascola, MD, and Camille N. Kotton, MD, discussed the immunology of the virus and the available COVID-19 vaccines. The full recording of the forum is available for replay from Annals, along with a commentary coauthored by Christine Laine, MD, MPH, FACP, Editor-in-Chief and ACP Senior Vice President.

Recent research also focused on the topic of vaccine efficacy and the longevity of the humoral immune response to COVID-19 vaccination. A study published by The Lancet on Oct. 4 looked at how the effectiveness of the Pfizer-BioNTech vaccine waned over six months, while two studies analyzed breakthrough infections in health care workers—one published by Clinical Infectious Diseases on Oct. 13 and another by Annals on Oct. 19.

In other research news, antithrombotic therapy didn't provide benefit to outpatients with COVID-19, according to a study that was terminated early and published by JAMA on Oct. 11. A total of 657 symptomatic outpatients were randomized to aspirin, 81 mg/d; apixaban, 2.5 mg twice daily; apixaban, 5 mg twice daily; or placebo. They showed no significant differences on a composite outcome of all-cause mortality, symptomatic thromboembolism, myocardial infarction, stroke, or hospitalization for a cardiovascular or pulmonary cause before the study was terminated because of a primary event rate lower than anticipated. An accompanying editorial said that given the study's findings, “the use of aspirin or apixaban for symptomatic but stable ambulatory patients with COVID-19 does not seem justifiable.”

Multiple recent studies looked at the mental and behavioral health impacts of COVID-19. An international systematic review, published by The Lancet on Oct. 8, estimated that globally the pandemic was associated with an additional 53.2 million cases of major depressive disorder (an increase of 27.6%) and 76.2 million cases of anxiety disorders (an increase of 25.6%). Americans' anxiety and depression fluctuated with COVID-19 infection rates, according to a study published by MMWR on Oct. 5. It found that the average anxiety severity score increased 13% from August to December 2020 and then decreased 26.8% by early June 2021. Similarly, depression increased 14.8% and then decreased 24.8%. The authors noted that the levels in June 2021 were still elevated compared to 2019, however. The pandemic was also associated with increased cigarette sales, according to an analysis published by Annals of Internal Medicine on Oct. 19. In March 2020 to June 2021, cigarette sales were 14.1% higher than would have been expected based on prior trends.

ACP is partnering with YouTube to create new educational content to combat misinformation about the COVID-19 virus, vaccination, and treatments. ACP will provide a series of videos for clinicians in English and Spanish to help them proactively offer credible information. In addition, ACP is developing video content for the public to answer their questions about vaccines with trusted information from physicians. ACP has expressed concern about the spread of misinformation about COVID-19 and strongly supports the use of science and scientific expertise, based on the best available evidence, in the fight against COVID-19.