L’World Health Organization (OMS) declared the health emergency linked to COVID-19 over. This announcement, widely awaited based on the trend of infections, hospitalizations and deaths around the world, represents an important step towards normality and takes place more than three years after WHO itself haddated 30 January 2020, declared a state of pandemic. This decision covers tremendous importance in terms of public health, even if it probably won’t affect the habits of individual citizens too much, who have now resumed, as has been the case for some time in Italy, an almost normal life. However, the WHO reiterated, in announcing the end of the pandemic, the need for individual states to remain vigilant against COVID-19, since occasional relapses of the disease in specific geographical areas could (and certainly will) occur, linked to the emergence of new variants. The latter aspect will be carefully monitored through specific alerts that provide for the sequencing of the virus.
Furthermore, as the WHO had always reminded on previous occasions, the fragile will be protectedby age and underlying pathologies, with a vaccination, probably on an annual basis as happens for the flu, administering updated vaccines based on the variants circulating at that time. The end of the pandemic emergency allows for a series of considerations in relation to what has been learned (at a high price) during these three years. The main lessonas repeatedly mentioned in international contexts, is represented by the need to be prepared to face future new emergenciesthrough measures that ensure prevention and care for all, together with the mandatory duty to promote scientific research, which has proven to be essential for overcoming the pandemic. With its decision the WHO hasjust saying, declassified COVID-19 from a global emergency to a disease like any other and this must now be taken into account not only as regards its management but, more generally, for the aspects of communication and information to public opinion.
A prospective observational study (Alejandro Jara and others) conducted in about 2 million children and adolescents aged between 6 and 16 years, estimated the efficacy of an inactivated virus vaccine (CoronaVac) in the prevention of symptomatic infection from SARS-CoV-2, hospitalization and ICU admission associated with COVID-19. The efficacy of the inactivated virus vaccine in this age group was 74.5% in terms of the onset of symptomatic COVID-19, 91% and 93.8%, respectively for the prevention of hospitalization and admission to therapy intensive. The results obtained indicate that primary immunization with inactivated vaccine provides children between the ages of 6 and 16 a valid protection in preventing serious illness. The efficacy of the Pfizer mRNA vaccine, administered in two doses, was evaluated against Delta and Omicron variants of SARS-CoV-2 in adolescents aged 12 to 17 years (Iulia G Ionescu and others). In this population, two doses of vaccine conferred effective and long-lasting protection against Delta, but less and shorter against Omicron. Also, the choice to make a longer interval of time between the first, the second and third dose resulted in only a marginal improvement in protection against Omicron. A systematic review and meta-analysis (Ali Rafati et al) verified the incidence of Bell’s palsy, i.e. idiopathic paralysis of the facial nerve, after anti SARS-CoV-2 vaccination.
From the 17 studies that were selected to carry out the analysis, there was a greater incidence of this morbid form among the group of vaccinated subjects, compared to those who received only the placebo. Furthermore, there was no significant difference between those vaccinated with the mRNA vaccine (Pfizer) versus the adenoviral vectored DNA vaccine (AstraZeneca). However, it should be noted that in the face of this higher incidence of Bell’s palsy in vaccinated people, SARS-CoV-2 infection still constituted a greater risk of developing Bell’s palsy than vaccination. The need for continued surveillance of possibly emerging subvariants of Omicronis underlined in a study (Julia N. Faraone et al) which evaluated the extent of immuno-evasion against neutralizing antibodies by emerging Omicron subvariants. In particular, marked immune evasion has been demonstrated against the recombinant XBB, both in individuals vaccinated with three doses of mRNA vaccine and in those recovering from a natural infection. The clinical outcomes following the treatment of COVID-19 disease with nirmatrelvir (paxlovid) and molnupinavir were the subject of a retrospective cohort study (Bosco Hon-Ming Ma and others) conducted in subjects living in assisted living facilities. This study showed that the use of oral antivirals is associated with a reduced risk of hospitalization and disease progression and for this reason, it could be extrapolated that the use of these drugs can be equally useful in elderly, frail patients who they live in community. The existence of oxidative DNA damage caused by a metabolite of molnupinavir (N4-hydroxycytidine) has been the subject of research (Hatasu Kobayashi and others) which has highlighted how this damage can result in a theoretical mutagenic mechanism, which underlines the need for some attention, at least according to this preliminary study, in the use of this drug in the course of viral diseases, including COVID-19.
The association between the amount of viral RNA in plasma (“viral storm”), host response, complications, and deaths of critically ill patients with COVID-19, have been the subject of a prospective multicenter cohort study conducted in Spain (Jesús F Bermejo-Martin et al). In particular, various clinical parameters of over 1000 patients were analysed, which highlighted how the presence of the cd “viral storm” is associated with an increased risk of death from all causes in patients admitted to intensive care for COVID-19. For this reason, it can be hypothesized that preventing the “viral storm” could help improve prognosis and this goal could be achieved through treatment with antivirals or blood purification to remove viral components from it. The use of monoclonal antibodies neutralizing agents was the subject of a study (Nalini Ambrose et al) which evaluated the safety and efficacy of four monoclonal antibodies: bamlanivimab, bamlanivimab-etesevimab, casirivimab-imdevimab and sotrovimab. The research covered more than 160,000 patients in which it was demonstrated that treatment with these monoclonal antibodies was not only safe, but was associated with a reduction in the need for medical visits, the risk of hospitalization and the event of death.
However in the course of prevalence Omicron BA.1, treatment with the above-reported monoclonals was not associated with a reduced risk of hospitalizations. The results of this extensive research underline the importance of identifying appropriate strategies to select patients who are candidates for treatment with monoclonal antibodies. THE dogs trained to recognize diseases through smellrepresent, in the course of COVID-19, an ancillary strategy for rapid, non-invasive and low-cost screening, to be implemented in a large group of people. This approach has been conducted in some schools in Californiato integrate a program of screening aimed at identifying SARS-CoV-2.