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Viral cultures for COVID-19 infectious potential assessment – a systematic review

Authors: Jefferson T, Spencer EA, Brassey J and Heneghan C

Publication date: 03 December 2020

Journal: Clinical Infectious Disease

DOI: 10.1093/cid/ciaa1764

Objective: to review the evidence from studies relating SARS-CoV-2 culture with the results of reverse transcriptase polymerase chain reaction (RT-PCR) and other variables which may influence the interpretation of the test, such as time from symptom onset

Methods: We searched LitCovid, medRxiv, Google Scholar and the WHO Covid-19 database for Covid-19 to 10 September 2020. We included studies attempting to culture or observe SARS-CoV-2 in specimens with RT-PCR positivity. Studies were dual extracted and the data summarised narratively by specimen type. Where necessary we contacted corresponding authors of included papers for additional information. We assessed quality using a modified QUADAS 2 risk of bias tool.

Results: We included 29 studies reporting attempts at culturing, or observing tissue infection by, SARS-CoV-2 in sputum, nasopharyngeal or oropharyngeal, urine, stool, blood and environmental specimens. The quality of the studies was moderate with lack of standardised reporting. The data suggest a relationship between the time from onset of symptom to the timing of the specimen test, cycle threshold (Ct) and symptom severity. Twelve studies reported that Ct values were significantly lower and log copies higher in specimens producing live virus culture. Two studies reported the odds of live virus culture reduced by approximately 33% for every one unit increase in Ct. Six of eight studies reported detectable RNA for longer than 14 days but infectious potential declined after day 8 even among cases with ongoing high viral loads. Four studies reported viral culture from stool specimens.

Conclusion: Complete live viruses are necessary for transmission, not the fragments identified by PCR. Prospective routine testing of reference and culture specimens and their relationship to symptoms, signs and patient co-factors should be used to define the reliability of PCR for assessing infectious potential. Those with high cycle threshold are unlikely to have infectious potential.

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Covid-19 patients

UK report on 18,612 patients critically ill with COVID-19

Institution: Intensive Care National Audit & Research Centre (ICNARC)

Publication date: 18 December 2020


The Impact of COVID‐19 Stay‐At‐Home Orders on Health Behaviors in Adults

Authors: Flanagan EW et al

Publication date: 11 October 2020

Journal: Obesity

DOI: 10.1002/oby.23066

Objective: Stay‐at‐home orders in response to the coronavirus disease 2019 (COVID‐19) pandemic have forced abrupt changes to daily routines. This study assessed lifestyle changes across different BMI classifications in response to the global pandemic.

Methods: The online survey targeting adults was distributed in April 2020 and collected information on dietary behaviors, physical activity, and mental health. All questions were presented as “before” and “since” the COVID‐19 pandemic.

Results: In total, 7,753 participants were included; 32.2% of the sample were individuals with normal weight, 32.1% had overweight, and 34.0% had obesity. During the pandemic, overall scores for healthy eating increased (P < 0.001), owing to less eating out and increased cooking (P < 0.001). Sedentary leisure behaviors increased, while time spent in physical activity (absolute time and intensity adjusted) declined (P < 0.001). Anxiety scores increased 8.78 ± 0.21 during the pandemic, and the magnitude of increase was significantly greater in people with obesity (P ≤ 0.01). Weight gain was reported in 27.5% of the total sample compared with 33.4% in participants with obesity.

Conclusions: The COVID‐19 pandemic has produced significant health effects, well beyond the virus itself. Government mandates together with fear of contracting the virus have significantly impacted lifestyle behaviors alongside declines in mental health. These deleterious impacts have disproportionally affected individuals with obesity.

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Children and covid-19

Longitudinal increases in childhood depression symptoms during the COVID-19 lockdown

Authors: Bignardi G et al

Publication date: 09 December 2020

Journal: Archives of Disease in Childhood

DOI: 10.1136/archdischild-2020-320372

Objective: There has been widespread concern that so-called lockdown measures, including social distancing and school closures, could negatively impact children’s mental health. However, there has been little direct evidence of any association due to the paucity of longitudinal studies reporting mental health before and during the lockdown. This present study provides the first longitudinal examination of changes in childhood mental health, a key component of an urgently needed evidence base that can inform policy and practice surrounding the continuing response to the COVID-19 pandemic.

Methods: Mental health assessments on 168 children (aged 7.6–11.6 years) were taken before and during the UK lockdown (April–June 2020). Assessments included self-reports, caregiver reports, and teacher reports. Mean mental health scores before and during the UK lockdown were compared using mixed linear models.

Results: A significant increase in depression symptoms during the UK lockdown was observed, as measured by the Revised Child Anxiety and Depression Scale (RCADS) short form. CIs suggest a medium-to-large effect size. There were no significant changes in the RCADS anxiety subscale and Strengths and Difficulties Questionnaire emotional problems subscale.

Conclusions: During the UK lockdown, children’s depression symptoms have increased substantially, relative to before lockdown. The scale of this effect has direct relevance for the continuation of different elements of lockdown policy, such as complete or partial school closures. This early evidence for the direct impact of lockdown must now be combined with larger scale epidemiological studies that establish which children are most at risk and tracks their future recovery.

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Evidence of thrombotic microangiopathy in children with SARS-CoV-2 across the spectrum of clinical presentations

Authors: Diorio C et al

Publication date: 08 December 2020

Journal: Blood Advances

DOI: 10.1182/bloodadvances.2020003471

Most children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have mild or minimal disease, with a small proportion developing severe disease or multisystem inflammatory syndrome in children (MIS-C). Complement-mediated thrombotic microangiopathy (TMA) has been associated with SARS-CoV-2 infection in adults but has not been studied in the pediatric population. We hypothesized that complement activation plays an important role in SARS-CoV-2 infection in children and sought to understand if TMA was present in these patients. We enrolled 50 hospitalized pediatric patients with acute SARS-CoV-2 infection (n = 21, minimal coronavirus disease 2019 [COVID-19]; n = 11, severe COVID-19) or MIS-C (n = 18). As a biomarker of complement activation and TMA, soluble C5b9 (sC5b9, normal 247 ng/mL) was measured in plasma, and elevations were found in patients with minimal disease (median, 392 ng/mL; interquartile range [IQR], 244-622 ng/mL), severe disease (median, 646 ng/mL; IQR, 203-728 ng/mL), and MIS-C (median, 630 ng/mL; IQR, 359-932 ng/mL) compared with 26 healthy control subjects (median, 57 ng/mL; IQR, 9-163 ng/mL; P < .001). Higher sC5b9 levels were associated with higher serum creatinine (P = .01) but not age. Of the 19 patients for whom complete clinical criteria were available, 17 (89%) met criteria for TMA. A high proportion of tested children with SARS-CoV-2 infection had evidence of complement activation and met clinical and diagnostic criteria for TMA. Future studies are needed to determine if hospitalized children with SARS-CoV-2 should be screened for TMA, if TMA-directed management is helpful, and if there are any short- or long-term clinical consequences of complement activation and endothelial damage in children with COVID-19 or MIS-C.

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All-Cause Excess Mortality and COVID-19–Related Mortality Among US Adults Aged 25-44 Years, March-July 2020

Authors: Faust JS el al

Publication date: 16 December 2020

Journal: JAMA

DOI: 10.1001/jama.2020.24243

Coronavirus disease 2019 (COVID-19) has caused a marked increase in all-cause deaths in the US, mostly among older adults.1 Although the burden of COVID-19 among hospitalized younger adults has been described, fewer data focus on mortality in this demographic, owing to lower case-fatality rates.2

Excess mortality reflects the full burden of the pandemic that may go uncaptured due to uncoded COVID-19 and other pandemic-related deaths. Accordingly, we examined all-cause excess mortality and COVID-19–related mortality during the early pandemic period among adults aged 25 to 44 years. Because unintentional drug overdoses are the usual leading cause of death in this demographic, COVID-19 deaths were compared with unintentional opioid deaths.

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Covid-19: Mass testing is inaccurate and gives false sense of security, minister admits

Author: Elisabeth Mahase

Publication date: 18 December 2020

Journal: The BMJ

DOI: 10.1136/bmj.m4916

Mass testing of people without covid-19 symptoms is “not an accurate way of screening the general population,” a senior figure at the Department of Health and Social Care has said in a letter seen by The BMJ.

The comments were made by James Bethell, one of England’s health ministers, in response to a letter from an MP raising concerns about blanket polymerase chain reaction (PCR) testing on behalf of a constituent.

In his letter Bethell stated that “swab testing people with no symptoms is not an accurate way of screening the general population, as there is a real risk of giving false reassurance.” He added, “Widespread asymptomatic testing could undermine the value of testing, as there is a risk of giving misleading results. Rather, only people with covid-19 symptoms should get tested.”

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Government and Health Authorities


Investigation of novel SARS-COV-2 variant: Variant of Concern 202012/01

Publication date: 21 December 2020

Source: UK Government

Detection of an epidemiological cluster associated with a new variant of concern

Analysis of routinely available genomic data in Kent, England was undertaken as part of an epidemiological investigation to investigate increasing incidence on 8 December 2020. Although only 4% (255/6130) of Kent cases had available genomes through COG- UK sequencing, a large phylogenetic cluster of 117 genomically similar cases over the week 10-18 November 2020 was identified.

The Kent cluster, when examined in the national phylogeny, is part of a larger cluster (962 genomes at the time of analysis on 8 December 2020). This cluster is phylogenetically very distinct from the rest of the UK dataset. These cases were concentrated in Kent and NE London, with limited spread into the rest of London, Anglia and Essex.

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Anaphylaxis Following m-RNA COVID-19 Vaccine Receipt

Publication date: 19 December 2020

Source: Centers for Disease Control (US)

  • December 8, 2020 – UK initiated vaccination with Pfizer-BioNTech COVID-19 vaccine
  • December 9 – UK authorities confirmed 2 cases of anaphylaxis after vaccination
  • Prescribing information for both Pfizer-BioNTech and Moderna COVID-19 vaccines contains information on anaphylaxis

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FDA Takes Additional Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for Second COVID-19 Vaccine

Publication date: 18 December 2020

Source: US Food & Drug Administration

Today, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the second vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The emergency use authorization allows the Moderna COVID-19 Vaccine to be distributed in the U.S. for use in individuals 18 years of age and older.

“With the availability of two vaccines now for the prevention of COVID-19, the FDA has taken another crucial step in the fight against this global pandemic that is causing vast numbers of hospitalizations and deaths in the United States each day,” said FDA Commissioner Stephen M. Hahn, M.D. “Through the FDA’s open and transparent scientific review process, two COVID-19 vaccines have been authorized in an expedited timeframe while adhering to the rigorous standards for safety, effectiveness, and manufacturing quality needed to support emergency use authorization that the American people have come to expect from the FDA. These standards and our review process, which are the same we have used in reviewing the first COVID-19 vaccine and intend to use for any other COVID-19 vaccines, included input from independent scientific and public health experts as well as a thorough analysis of the data by the agency’s career staff.”

The FDA has determined that the Moderna COVID-19 Vaccine has met the statutory criteria for issuance of an EUA. The totality of the available data provides clear evidence that the Moderna COVID-19 Vaccine may be effective in preventing COVID-19. The data also show that the known and potential benefits outweigh the known and potential risks—supporting the company’s request for the vaccine’s use in people 18 years of age and older. In making this determination, the FDA can assure the public and medical community that it has conducted a thorough evaluation of the available safety, effectiveness, and manufacturing quality information.

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Media – Science related


The PHE data that goes against the narrative - Hunting down symptomatic COVID-19

Authors: Aleks Nowak and Dr Clare Craig

Publication date: 19 December 2020

Source: Telegra.ph

Public Health England’s (PHE) notifications of infectious diseases (NOIDs) data had only 87 COVID cases listed for the week beginning 9th November compared with 145,129 cases reported on the government dashboard using another PHE data source.  This is a gargantuan discrepancy and requires further investigation.

COVID-19 became a notifiable disease in March this year. Since then there has been a statutory requirement that any Registered Medical Practitioner having “reasonable grounds for suspecting” that their patient has COVID-19, has to notify their local council or Health Protection Team. The legal requirement is to notify prior to any confirmatory analysis (e.g. PCR testing). PHE collects and aggregates this data, publishing it in the notifiable disease weekly reports.

The crucially significant aspect of the NOIDs data is that it is a measure of actual disease, which by definition requires symptoms. The bulk of data offered by the government dashboard in contrast reflects positive PCR test results with no reference to symptoms. A disease requires symptomatic diagnosis which may be confirmed by testing for causative agents. The disease here being COVID-19 and the causative agent being the virus SARS-COV-2. A positive causative agent test alone does not determine disease.

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Asymptomatic Spread Revisited

Author: Jeffrey Tucker

Publication date: 21 December 2020

Source: American Institute for Economic Research

The phrase “fog of war” is attributed to Carl von Clausewitz. It has come to refer to the confusion and uncertainty felt by everyone in the midst of conflict. It is often unclear who is making decisions and why, and what the relationships are between the strategies and the goals. Even the rationale can become elusive as frustration and disorientation displace clarity and rationality.

In 2020, we’ve experienced the fog of disease mitigation.

The initial round of lockdowns was not about suppressing the virus but slowing it for one reason: to preserve hospital capacity. Whether and to what extent the “curve” was actually flattened will probably be debated for years but back then there was no question of extinguishing the virus. The volume of the curves, tall and quick or short and long, was the same either way. People were going to get the bug until the bug burns out (herd immunity).

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Has the Evidence of Asymptomatic Spread of COVID-19 been Significantly Overstated?

Authors: Dr Clare Craig and Jonathan Engler

Publication date: 19 December 2020

Source: Lockdown Sceptics

Evidence of transmission of SARS-CoV-2 from patients who remain asymptomatic (as opposed to pre-symptomatic) is found in a body of numerous meta-analyses. Evidence of asymptomatic transmission has been based on only a handful of instances which themselves are questionable. The existence of transmission of SARS-CoV-2 from asymptomatic individuals has become an accepted truth but the evidence for this phenomenon being anything other than mistaken interpretation of false positive test results is weak. Examination of the underlying data from the most frequently-cited such meta-analyses reveals that the conclusions are based on a surprisingly small number of cases (six in total globally) and, moreover, the possibility that they are all coincidental contacts with false positive results cannot be ruled out. Transmission which is pre-symptomatic is rare and represents a negligible risk to the population. It is questionable therefore whether any of the extensive testing, tracing, isolation and lockdown policies have delivered any worthwhile benefit over and above strategies which seek to advise symptomatic individuals to self-isolate.

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Lockdowns Do Not Control the Coronavirus: The Evidence

Publication date: 19 December 2020

Source: American Institute for Economic Research

The use of universal lockdowns in the event of the appearance of a new pathogen has no precedent. It has been a science experiment in real time, with most of the human population used as lab rats. The costs are legion.

The question is whether lockdowns worked to control the virus in a way that is scientifically verifiable. Based on the following studies, the answer is no and for a variety of reasons: bad data, no correlations, no causal demonstration, anomalous exceptions, and so on. There is no relationship between lockdowns (or whatever else people want to call them to mask their true nature) and virus control.

Perhaps this is a shocking revelation, given that universal social and economic controls are becoming the new orthodoxy. In a saner world, the burden of proof really should belong to the lockdowners, since it is they who overthrew 100 years of public-health wisdom and replaced it with an untested, top-down imposition on freedom and human rights. They never accepted that burden. They took it as axiomatic that a virus could be intimidated and frightened by credentials, edicts, speeches, and masked gendarmes.

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Covid-19 patients

Men significantly more likely to need intensive care treatment for COVID-19

Publication date: 10 December 2020

Source: University College London

Men have almost three times the odds of needing admission to intensive care and 40% higher odds of dying from COVID-19 than women, according to a new study led by researchers at UCL, Great Ormond Street Hospital (GOSH) and the University of Cape Town.

The study, published in Nature Communications and the largest review of its kind, looked at publicly available data from 92 reports across 47 countries to investigate why COVID-19 may affect genders differently.

Researchers found that in more than three million cases of COVID-19 there were equal proportions of men and women infected. However, of those infected, the odds (likelihood) of adult males needing admission to intensive care were 2.84 times higher and 1.39 times higher of dying from COVID-19 than adult females.

The research team, led by the Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH (hereafter called the Adolescent Centre), usually focuses on understanding why young female children and adolescents are more like to develop diseases like juvenile idiopathic arthritis and lupus, than boys and young men. They used this knowledge to shed light on the susceptibility of adult males to severe COVID-19.

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Media – Reporting


Lockdowns may actually prevent a natural weakening of this disease

Author: Matt Ridley

Publication date: 22 December 2020

Source: The Telegraph

rescue is risky: ask General Custer. With the vaccine cavalry in sight, and just when we thought we had earned a Christmas break, the virus has ambushed us with a strain that seems more contagious, and which is rapidly coming to dominate the epidemic in south-east England.

It is now a race between the virus and the vaccine as to which can get into your bloodstream first.

Lockdown sceptics are suspicious. Nervtag, the sinister-sounding "new and emerging respiratory virus threats advisory group", is dominated by people on public salaries holding the extreme view that all Covid risks must be considered and most economic, social, mental and physical effects of lockdown pretty well ignored, and they have clearly been itching to call off Christmas.

But that does not mean the new B117 strain is a myth or its danger is exaggerated. Britain does 50 times more genome sequencing of viruses than most other countries which means that we are cursed with knowing more about these mutations but not necessarily being able to do anything about them. Most mutations, thankfully, make little difference.

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Top German Covid expert pours scorn on Boris Johnson's ‘mutant strain’ claims, saying ‘politicians simply called it 70% more infectious’

Author: Tim Stickings

Publication date: 21 December 2020

Source: Mail Online

A top German virologist heavily played down fears about Britain's mutant virus strain today, saying he was 'not so worried' and questioning Boris Johnson's claim that it is 70 per cent more infectious.

Christian Drosten said the 70 per cent figure was 'simply called that', suggesting that preliminary scientific estimates might have been overblown by politicians. 

'I wonder whether a scientist gave an estimate, perhaps asked what he would say if he had to give a figure, and then it takes on a life of its own. Then it enters politics and politicians use this figure and the media takes it up,' Drosten said.

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Prof Hugh Pennington: We have not seen evidence to support claim new Covid variant is more transmissible

Author: Kathryn Wylie

Publication date: 21 December 2020

Source: The Press and Journal

A leading north-east microbiologist has called into question the reason behind the cancellation of eased coronavirus restrictions during the festive period.

Professor Hugh Pennington says the scrapping of the four nations-agreed five-day Christmas bubble is a necessary move, but suggests claims the new variant is pushing the virus out of control to be questionable.

The Aberdeen University professor said: “The big issue with the variant is that it’s no nastier than the first one that came in March.

“It doesn’t kill people more readily or make them any more unwell but it’s said to be more transmissible. However, that’s what we’re being told. We have not seen any evidence to back that claim up.

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It is inhumane for ministers to tell us who we can hug at Christmas... these restrictions massively infringe on our civil liberties, writes Dr JOHN LEE

Author: Dr John Lee

Publication date: 20 December 2020

Source: Mail Online

As I watch Boris Johnson and Health Secretary Matt Hancock's hapless handling of the Covid-19 pandemic, and listen to their parroting of 'the science' as if it is some sort of religious text, I can't help but think of the Spanish Inquisition.

Now, as then, public policy hangs on central dogmatic beliefs that are being used to control a population – all in the name of the 'greater good'.

In our case, that means somehow snuffing out a respiratory virus using a combination of ill-judged military rhetoric and restrictions that massively infringe on our civil liberties.

All the evidence suggests that this approach is not working, and that implementing increasingly draconian tier systems and lockdowns will do little or nothing to hasten a return to normality, while causing massive collateral damage along the way.

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Publication date: 19 December 2020

Source: Recovery Campaign

Recovery today challenged Health Secretary Matt Hancock to reveal the details of the strain of SARS COV-19 that he announced on Monday as a new and more infectious mutation, as evidence emerged that those claims may have been seriously misleading.

On Tuesday 15 December, Professor Nick Loman of the Covid-19 Genomics UK (COG UK) consortium, identified the new set of mutations as VUI – 202012/0. He confirmed that it is not new, as COG UK identified it in September, and there is no proof that it is more infectious. As Professor Sharon Peacock, COG Director, pointed out: “We are still dealing with very thin evidence at the moment about this variant.”

Dr Maria van Kerkhove, the technical lead of COVID-19 response and the head of emerging diseases and zoonosis unit at WHO, has also confirmed that the strain involved has been circulating for many months, though she referred to it as N501Y.

Recovery is challenging Matt Hancock to answer these key questions:

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2,000 patients received Ayurvedic treatment for Covid-19 in Delhi govt hospital

Authors: Antonna Dutt

Publication date: 12 December 2020

Source: Hinudstan Times

A day after doctors from across the country protested the Centre’s decision to allow Ayurveda practitioners to perform certain surgeries, the Delhi health minister congratulated one of the hospitals under it for providing “pure Ayurvedic treatment” to 2,000 coronavirus disease (Covid-19) patients.

“Congratulations to Chaudhary Brahm Prakash Ayurved Charak Sansthan for successfully catering to 2000 covid patients with pure Ayurvedic treatment. It is the 1st Indian Ayurvedic hospital which has treated covid patients from ages 1month-106years. I applaud the team and staff,” said the health minister Satyendar Jain in a tweet.

The hospital was one of the three designated as Covid Health Centre that admitted mild to moderate Covid-19 patients who did not need much medical intervention.

The hospital has been treating its patients with a concoction called Nagaradhi Kwath that contains three herbs, haldi milk, and Amla Churan for Vitamin C. This protocol was followed for a case control study of 1,000 patients where half received the ingredients and the other half didn’t. Another trial of 1,000 patients was conducted to test sitopaladi churna which is given to patients for common cold.

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How Belarus Exposes the Lockdown Lie

Author: Rachel Allen

Publication date: 19 December 2020

Source: Off Guardian

Most European governments instituted the shutdown of economies, restrictions on freedom of movement and other policies known as lockdown. This was allegedly in response to the spread of Sars-Cov-2, a dangerous respiratory virus that originated in Wuhan, China.

Few countries rejected this approach; Sweden is the most well known of these. However, a more interesting case of dissent from the official narrative is Belarus and its leader Aleksandr Lukashenka.

This article will outline Lukashenka’s approach to the alleged pandemic, followed by an analysis of death figures and how the Belarussian case exposes the lies of lockdown advocates.

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French government delays bill branded as ‘vaccine blackmail’

Author: Jules Damanin

Publication date: 23 December 2020

Source: Politico

The French government has been forced to postpone plans that could see unvaccinated people banned from public places during health crises, following vocal opposition.

The text was proposed Monday to create a framework for future health emergencies. It would give the prime minister exceptional powers to restrict access to public transport and other public spaces for people who cannot present a negative test result, or proof of vaccination or treatment, for an infectious disease.

But after a day of controversy around the plans, French Health Minister Olivier Véran went on the evening news Tuesday to defuse the controversy and postpone the bill.


Peruvian Man Suffers Guillain-Barré-like Symptoms After Receiving Sinopharm COVID-19 Vaccine

Author: Marco Cáceres

Publication date: 21 December 2020

Source: the Vaccine Reaction

On Dec. 11, 2020, Peru’s National Institute of Health (INS) said it was temporarily suspending the Phase 1 clinical trial of an experimental COVID-19 vaccine developed by Sinopharm Group Co. Ltd. of Shanghai, China after one of the participants in the trial who got the vaccine showed difficulty in moving his arms and legs—symptoms of Guillain-Barré syndrome (GBS).1 2 3 4 5

Peru’s Health Service Suspends Clinical Trial of Sinopharm COVID-19 Vaccine

In a public statement, the INS said that the “adverse event” was “under investigation to determine if it is related to the vaccine or if there is another explanation.”4 5

“Several days ago we signaled, as we are required, to the regulatory authorities that one of our participants (in trials) presented neurological symptoms which could correspond to a condition called Guillain-Barre syndrome,” said German Malaga, MD, chief researcher at Cayetano Heredia University in Lima, Peru, where the vaccine trial is being conducted. “We are concerned about the situation, and we are providing all of our help and support to ensure that it is cleared up,” he said.

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Brazil's Bolsonaro warns virus vaccine can turn people into 'crocodiles'

Publication date: 18 December 2020

Source: CTV News

Brazilian President Jair Bolsonaro has launched an attack on coronavirus vaccines, even suggesting that the one developed by Pfizer-BioNTech could turn people into crocodiles or bearded ladies.

The far-right leader has been sceptical of the coronavirus since it first emerged late last year, branding it "a little flu." This week he insisted he would not be vaccinated, even while launching the country's mass innoculation program.

"In the Pfizer contract it's very clear: 'we're not responsible for any side effects.' If you turn into a crocodile, it's your problem," Bolsonaro said on Thursday.

That vaccine has been undergoing tests in Brazil for weeks and is already being used in the United States and Britain.

"If you become superhuman, if a woman starts to grow a beard or if a man starts to speak with an effeminate voice, they will not have anything to do with it," he said, referring to the drug manufacturers.

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