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A Fulminant Reversible Cerebrovascular Disorder in Breakthrough COVID-19 Infection

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A 64-year-old lady with long standing history of migraine and recently diagnosed hypertension on amlodipine, presented with history of continuous excruciating headache and vomiting of 10 days duration. Five days after onset of headache, she developed drowsiness and difficulty in walking. She had received two doses of COVISHIELD (AstraZeneca, ChAdOx1) vaccine, 2 months back. On examination, patient had  significant vision impairment  in both eyes with normal pupillary reflexes,  quadriplegia  and recurring focal seizures involving right upper limb. She tested positive for SARS-CoV-2. Repeat  MR angiogram showed widespread vasoconstriction of intracranial blood vessels suggestive of Reversible Cerebral Vasoconstriction Syndrome (RCVS).  CSF analysis was normal. Although patient was diagnosed with COVID 19, patient did not complain of cough, breathlessness or fever. Oxygen saturation  in room air was 92% and CT chest showed mild basal ground glass opacities. Hence, no steroids were admini

A fatal case of COVID-19 breakthrough infection due to the delta variant

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A 61-year-old man with a history of arterial hypertension (PA 145/95 mmHg) and obesity with a body mass index (BMI) of 37.11 was vaccinated with a double dose of mRNA vaccine, but 4 months after the 2nd dose presented with dyspnea, cough, and fever (38°C). Four days after his nasopharyngeal/oropharyngeal (NP/OP) swabs tested positive for SARS-CoV-2 he came to the emergency room with a saturation oxygen level (SO2) at 84%. He continued to test positive for SARS-CoV-2 on NP/OP swabs with detection of the delta variant. Laboratory examination showed a high white blood count, elevated lactated dehydrogenase enzyme (LDH) (750 U/L), elevation of the C-reactive protein (CRP) (26.3 mg/dl), and a mild elevation of the liver aspartate aminotransferase (AST) (61 U/L) (normal value 0–34 U/L).  A chest CT scan showed a typical central and peripheral distribution of GGO COVID-19 pneumonia (CT-SS score of 16/20).  The other laboratory values were in the normal range.  Teh serology, performed with an

Young COVID-19 vaccine breakthrough fatalities

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The clinical course of COVID-19 depends on the complex interaction between genetic and environmental factors which might result in immune hyperactivation or dysregulation. Risk factors for severe outcomes include  cardiovascular and renal diseases, hypertension and diabetes, old age and host genetics.   Several genome-wide association studies  identified candidate genes and non-coding regions associated with the severity of COVID-19 and post-COVID sequelae.   Vaccine effectiveness may fail for individuals with particular genetics and we need more studies and more medical case reports to develop personalized preventative and curative approaches. Until then we can read the news. Valentina Boscardin , an 18 year old Brazilian model  (represented by Ford Models agency) died due to COVID complications despite being fully vaccinated against COVID. She was healthy before falling ill with the virus. Valentina Boscardin Mendes suffered a fatal thrombosis on Sunday, January 9th, 2022, after bein

Risk Factors for Severe COVID-19 Outcomes Among Vaccinated Individuals

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Why do people die from COVID-19 despite vaccination?  There is no comprehensive explanation for this yet. A new Morbidity and Mortality Weekly Report (MMWR) emphasizes the usual risk factors: 36 people that died from fatal breakthroughs were either age 65 or older or had at least one of these conditions: diabetes mellitus, immunosuppression, chronic kidney disease, chronic liver disease, chronic neurologic disease, chronic cardiac disease, or chronic pulmonary disease. Fatal breakthrough cases under 65 and even under 18 have been previously reported but no details were given yet.  Among 1,228,664 persons who completed primary vaccination during December 2020–October 2021, severe COVID-19–associated outcomes (189, 0.015%) or death (36, 0.0033%) were rare. Risk factors for severe outcomes included age ≥65 years, immunosuppressed, and six other underlying conditions. All persons with severe outcomes had at least one risk factor; 78% of persons who died had at least four. Title:  Risk Fac

Fully Vaccinated and Boosted Patients Requiring Hospitalization for COVID-19

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There were four fatalities among 65  fully vaccinated and boosted ( FV&B )  COVID-19 patients at an acute-care hospital system in Southeastern Michigan. In the FV&B cohort that required ICU-level care (n=11), 7 (63.6%) were male with a median age of 71 (66.5, 76.5). 5 (45.5%) were vaccinated with three consecutive Pfizer immunizations, 4 (36.4%) received three doses of the Moderna vaccine, and 2 (18.2%) received two Janssen vaccines. 4 (36.4%) died, 3 (27.2%) were discharged to a Skilled Nursing Facility (SNF), and 2 (18.2%) were discharged home. This data was collected b etween August 12th, 2021 and December 6th, 2021, for 4,571 patients with a primary diagnosis of COVID-19 who required inpatient treatment at an acute-care hospital system in Southeastern Michigan. Of the 4,571 encounters requiring hospitalization, 65(1.4%) were FV&B and 2,935(64%) were UV Despite older age (median 74 vs 58 years old), higher rate of pre-existing ESRD (18.5% vs 1.8%), higher proportio

Fatal breakthroughs in the alpha, delta and omicron eras

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As Coronavirus is evolving breakthrough infections are not breakthroughs anymore.  The first Israeli who died from Omicron was a fully vaccinated and boosted woman . The first Australian was a fully vaccinated man in his 80s with an underlying health condition. The first US case was a reinfection in an unvaccinated man in his 50s . The first India death  from Omicron was was a fully vaccinated 74-year-old man with diabetes. According to  today's technical briefing  from UK Health Security Agency, a total of 57 people has been reported to have died within 28 days of an Omicron COVID-19 diagnosis up to 29 December 2021. The median time from Omicron specimen date to death was 5 days (range 0 to 14). The age of those dying ranged from 41 to 99 years. 23% of Omicron cases were vaccinated with 3 doses, over 50% with two doses, while 25% where not vaccinated at all. No information about vaccination status of most Omicron deaths is available yet. No additional details on Omicron deaths ha

The risk of myocarditis in younger males is higher following COVID-19 vaccination than infection

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  Between  December  1,  2020,  to  November  15,  2021  a  total  of  42,200,614  people  were  vaccinated  with  at  least  one  dose  of  ChAdOx1  (n=20,646,456),  BNT162b2  (n=20,391,600)  or  mRNA-1273 (n=1,162,558) in England. Of these, 38,347,981 received  two  doses  of  either  ChAdOx1  (n=20,059,058),  BNT162b2  (n=17,294,004)  or  mRNA-1273  (n=1,039,919) and 10,978,507 people received a third dose of ChAdOx1 (n=35,608), BNT162b2  (n=10,599,183)  or  mRNA-1273  (n=343,716).  Amongst  people  receiving  at  least  one  vaccine  dose, 5,185,772 (12.3%) tested positive for SARS-CoV-2; 2,834,579 (54.7%) prior to vaccination,  698,993 (13.5%) after a first vaccine dose, 1,604,087 (30.9%) after a second vaccine dose and  48,113  (0.9%)  after  a  third  vaccine  dose.  Of  the  42,200,614  persons  included  in  the  study  population, 2,539 (0.006%) were hospitalized or died from myocarditis during the study period;  552  (0.001%)  of  these  events  occurred  during  1-28  days