Impaired humoral immunity to BQ.1.1 in convalescent and vaccinated patients.

Determining SARS-CoV-2 immunity is critical to assess COVID-19 risk and the need for prevention and mitigation strategies. We measured SARS-CoV-2 Spike/Nucleocapsid seroprevalence and serum neutralizing activity against Wu01, BA.4/5 and BQ.1.1 in a convenience sample of 1,411 patients receiving medical treatment in the emergency departments of five university hospitals in North Rhine-Westphalia, Germany, in August/September 2022. 62% reported underlying medical conditions and 67.7% were vaccinated according to German COVID-19 vaccination recommendations (13.9% fully vaccinated, 54.3% one booster, 23.4% two boosters). We detected Spike-IgG in 95.6%, Nucleocapsid-IgG in 24.0%, and neutralization against Wu01, BA.4/5 and BQ.1.1 in 94.4%, 85.0%, and 73.8% of participants, respectively. Neutralization against BA.4/5 and BQ.1.1 was 5.6- and 23.4-fold lower compared to Wu01. Accuracy of S-IgG detection for determination of neutralizing activity against BQ.1.1 was reduced substantially. We explored previous vaccinations and infections as correlates of BQ.1.1 neutralization using multivariable and Bayesian network analyses. Given a rather moderate adherence to COVID-19 vaccination recommendations, this analysis highlights the need to improve vaccine-uptake to reduce the COVID-19 risk of immune evasive variants. The study was registered as clinical trial (DRKS00029414).

The Race-Free EGFR Equation, The Kidney Failure Risk Equation and Referrals to Specialist Renal Clinics

BACKGROUND AND AIMS The new race-free estimated glomerular filtration rate (eGFR) was developed in 2021. Recently in the UK in keeping with similar initiatives elsewhere, the kidney failure risk equation (KFRE) to predict the risk of kidney failure has been incorporated into clinical guidelines. Referral from primary care to a specialist renal clinic is recommended if eGFR falls to < 30 mL/min/1.73 m2 and/or if the 5-year KFRE is greater than 5%. We investigate the impact of using the race-free eGFR equation and KFRE on CKD diagnosis in primary care and potential referrals to the renal clinic. METHOD Primary care records for 79% of the population of Wales (UK) are held in the electronic health records repository Secure Anonymised Information Linkage Databank (SAIL). We studied serum creatinine values and urine albumin-creatinine ratios (uACRs) from 1 January 2013 to 31 December 2020. We calculated eGFR values using three equations: MDRD, CKD-EPI 2009 and (race-free) CKD-EPI 2021. Using the different equations, we compared the numbers of patients with incident eGFR <60 mL/min/1.73 m2 and incident eGFR < 30 mL/min/1.73 m2 (i.e. their eGFR fell from above to below these values for more than 3 months). For each year from 2013 to 2020, we identified the patients with prevalent eGFR 30–60 mL/min/1.73 m2 those with annual uACR testing and those who met referral criteria by A) eGFR decline and B) KFRE without eGFR decline. RESULTS There were 121 471 patients with prevalent CKD between 2013 and 2020. eGFR values were lowest using the MDRD equation (median 47.1 mL/min/1.73 m2 IQI 39.7–51.9) and highest with the CKD-EPI 2021 equation (median 50.0 mL/min/1.73 m2 IQI 41.6–55.3). Changing between these two equations would have led to a 17.6% reduction in incident eGFR < 60 mL/min/1.73 m2 and a 7.5% reduction in incident eGFR < 30 between 2013 and 2020 (Figure 1). The rate of annual uACR testing fell from 46.3% in 2013 to 25.3% in 2019 (Figure 2). eGFR and uACR testing were reduced further in 2020 during the COVID-19 pandemic. Patients without diabetes and older patients were the least likely to have had uACR testing at any time: for example, amongst those aged 60–70 years, 90.0% of those with diabetes had uACR testing at any time compared to 42.7% of those without diabetes;amongst those aged over 80 years, 79.1% of those with diabetes were tested compared to 32.7% of those without diabetes. In 2019 (the last year before the COVID-19 pandemic), 787/61 721 (1.3%) patients with CKD stage 3 met referral criteria by eGFR decline and an additional 587 (1.0%) by KFRE without eGFR decline. CONCLUSION Using the race-free eGFR equation will reduce diagnoses of incident eGFR < 30 warranting referral to specialist renal clinics. KFRE can be used to identify a significant number of patients at heightened risk of kidney failure, and these numbers may be higher if more uACR testing was performed. Annual uACR testing rates are low, especially in those without diabetes and in older adults. eGFR and uACR testing were markedly reduced during the COVID-19 pandemic in 2020 as most routine disease monitoring stopped. Expanding uACR testing in primary care (particularly in those without diabetes and in older adults) and using KFRE may improve the identification of individuals at risk of progressive kidney disease, but this is challenging during the COVID-19 pandemic.FIGURE 1: Incident CKD 2013–2020.FIGURE 1: CKD stage 3 monitoring and potential renal clinic referrals by year.

National identity predicts public health support during a global pandemic (preprint)

Changing collective behaviour and supporting non-pharmaceutical interventions is an important component in mitigating virus transmission during a pandemic. In a large international collaboration (Study 1, N = 49,968 across 67 countries), we investigated self-reported factors that associated with people reported adopting public health behaviours (e.g., spatial distancing and stricter hygiene) and endorsed public policy interventions (e.g., closing bars and restaurants) during the early stage of the pandemic (April-May 2020). Respondents who reported identifying more strongly with their nation consistently reported greater engagement in public health behaviours and support for public health policies. Results were similar for representative and non-representative national samples. Study 2 (N = 42 countries) conceptually replicated the central finding using aggregate indices of national identity (obtained using the World Values Survey) and a measure of actual behaviour change during the pandemic (obtained from Google mobility reports). Higher levels of national identification prior to the pandemic predicted lower mobility during the early stage of the pandemic (r = -.40). We discuss the potential implications of links between national identity, leadership, and public health for managing COVID-19 and future pandemics.