The Effectiveness of COVID-19 Vaccines in Preventing Hospitalizations During the Delta Wave: A Patient-Population Study at a Major Referral Center

Background and objective Coronavirus disease 2019 (COVID-19) has turned into a deadly global pandemic since its first discovery in Wuhan, China in December 2019. Safe and effective vaccines against COVID-19 have been introduced to the public and have been shown to reduce the severity of the disease and related mortality rates. COVID-19 vaccination was first introduced in Lebanon in mid-February 2021. In this study, we analyzed the effectiveness of vaccination against COVID-19-related hospitalization during the Delta wave at a major referral center in Lebanon. Methods This patient-population study was conducted on patients hospitalized with COVID-19 between July 1, 2021, and September 30, 2021, at the Rafik Hariri University Hospital (RHUH) in Beirut, Lebanon. Data were collected directly from the patients or from digitized records and included demographic characteristics (age, sex, and comorbidities), vaccination status, oxygen requirement, and outcomes. National vaccination data were collected from the daily bulletin provided by the Lebanese Ministry of Public Health. The data collected were analyzed using SPSS Statistics Version 19.0 (IBM Corp., Armonk, NY). Results A total of 289 patients were included in the study, of whom 90.3% were unvaccinated and 9.7% were vaccinated with at least one dose of a two-dose regimen. Only 4.5% of the 289 patients were fully vaccinated. Among those fully or partially vaccinated, the mean time from symptom onset to hospitalization was shorter but the hospital stay was longer compared to the unvaccinated group. The mortality rate was higher in the unvaccinated group (25.7%) compared to 14.3% among the vaccinated. The vaccine effectiveness compared to the national vaccination rate (22.5% in the population after the first and second dose) was 71.71% and 83.78% respectively. Conclusion The findings of this study highlight the fact that complete/partial vaccination against COVID-19 was highly protective against severe disease and hospitalization during the period with a predominance of the Delta variant in Lebanon.

Repurposed Antiviral Drugs for Covid-19 - Interim WHO Solidarity Trial Results.

BACKGROUND: World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs - remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a - in patients hospitalized with coronavirus disease 2019 (Covid-19). METHODS: We randomly assigned inpatients with Covid-19 equally between one of the trial drug regimens that was locally available and open control (up to five options, four active and the local standard of care). The intention-to-treat primary analyses examined in-hospital mortality in the four pairwise comparisons of each trial drug and its control (drug available but patient assigned to the same care without that drug). Rate ratios for death were calculated with stratification according to age and status regarding mechanical ventilation at trial entry. RESULTS: At 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750 were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir (without interferon), 2063 to interferon (including 651 to interferon plus lopinavir), and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment, with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death, day 8; interquartile range, 4 to 14). The Kaplan-Meier 28-day mortality was 11.8% (39.0% if the patient was already receiving ventilation at randomization and 9.5% otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to 1.11; P = 0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P = 0.23), in 148 of 1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio, 1.00; 95% CI, 0.79 to 1.25; P = 0.97), and in 243 of 2050 patients receiving interferon and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39; P = 0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced initiation of ventilation or hospitalization duration. CONCLUSIONS: These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay. (Funded by the World Health Organization; ISRCTN Registry number, ISRCTN83971151; ClinicalTrials.gov number, NCT04315948.).

Quality and safety measures in transfusion practice: The experience of eight southern/eastern Mediterranean countries.

BACKGROUND AND OBJECTIVES: Blood transfusion is inherently associated with risks, and little is known regarding the available quality and safety measures in developing countries. No studies or census has been carried out, and therefore, no data on this compelling issue are available. MATERIALS AND METHODS: Data emanating from eight Arabic eastern/southern Mediterranean countries who responded to five surveys were collected and tabulated. RESULTS: Asepsis during phlebotomy, screening for serological and immuno-haematological parameters and appropriate storage conditions are maintained across all countries. Variations in blood component processing exist. Universal leucoreduction is systematically applied in Lebanon. Nucleic acid testing is only performed in Egypt. Aphaeresis procedure, leucoreduction and quality control for blood components are virtually inexistent in Mauritania. Written donor questionnaire is absent in Algeria and Tunisia. Most donor deferral periods for infectious agents are inconsistent with international standards. CONCLUSION: Gaps in the processing and in the quality/safety measures applied to the manufacture of blood components are quite evident in most eastern/southern Mediterranean countries. The decision of establishing an effective collaboration network and an independent body - aside from WHO - composed of specialists that oversees all transfusion activities in these countries is certainly a crucial step towards ensuring an optimum level of blood safety.