Covid19-Sources

Objectives Highly effective vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed but variants of concerns (VOCs) with mutations in the spike protein are worrisome, especially B.1.617.2 (Delta) which has rapidly spread across the world. We aim to study if vaccination alters virological and serological kinetics in breakthrough infections. Methods We conducted a multi-centre retrospective cohort study of patients in Singapore who had received a licensed mRNA vaccine and been admitted to hospital with B.1.617.2 SARS-CoV-2 infection. We compared the clinical features, virological and serological kinetics (anti-nucleocapsid, anti-spike and surrogate virus neutralization titres) between fully vaccinated and unvaccinated individuals. Results Of 218 individuals with B.1.617.2 infection, 84 had received a mRNA vaccine of which 71 were fully vaccinated, 130 were unvaccinated and 4 received a non-mRNA. Despite significantly older age in the vaccine breakthrough group, the odds of severe COVID-19 requiring oxygen supplementation was significantly lower following vaccination (adjusted odds ratio 0.07 95%CI: 0.015-0.335, p=0.001). PCR cycle threshold (Ct) values were similar between both vaccinated and unvaccinated groups at diagnosis, but viral loads decreased faster in vaccinated individuals. Early, robust boosting of anti-spike protein antibodies was observed in vaccinated patients, however, these titers were significantly lower against B.1.617.2 as compared with the wildtype vaccine strain. Conclusion The mRNA vaccines are highly effective at preventing symptomatic and severe COVID-19 associated with B.1.617.2 infection. Vaccination is associated with faster decline in viral RNA load and a robust serological response. Vaccination remains a key strategy for control of COVID-19 pandemic. ### Competing Interest Statement BEY reports personal fees from Roche and Sanofi, outside the submitted work. All other authors declare no competing interests. ### Funding Statement This study was funded by grants from the Singapore National Medical Research Council (COVID19RF-001, COVID19RF-008). The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Written informed consent was obtained from study participants of the multi-centre study approved by National Healthcare Group Domain Specific Review Board (NHG-DSRB) (Study Reference 2012/00917). Informed consent for retrospective data collection at National Centre for Infectious Diseases (NCID) was waived (NHG-DSRB reference number 2020/01122). All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

I've been talking about ivermectin a bit recently, and every time I mention it someone will link me to this odd website - ivmmeta dot comSo, a bit of a review. I think this falls pretty solidly into the category of pseudoscience 1/n pic.twitter.com/JPVUIeKOcs— Health Nerd (@GidMK) August 2, 2021

Daten der AOK und Barmer zeigen: Müssen COVID-19-Patienten beatmet werden, liegen die Fallkosten im fünfstelligen Bereich. Dabei ist noch unklar, welche gesundheitlichen Folgeschäden auftreten.

Assuming further that 30 and 50% of individuals were immune to Spanish influenza after the wave in April 1918 and the first subsequent wave, respectively, these findings imply that, in a totally susceptible population, an infectious case could have led to 2.4-4.3 and 2.6-10.6 cases in community-base …

Why children are generally less susceptible than adults to COVID-19 is unclear and has not extensively been examined longitudinally. Here the authors compare antibodies, cytokines and immune cell...

Die Uniklinik Essen forscht an einem neuen Corona-Medikament. Wenn alles glattläuft, könnte es schon bald auf den Markt kommen. Doch es stehen noch Tests an.

In December 2019, a pneumonia-like disease caused an outbreak in the city of Wuhan, China1. This disease, later named COVID-19, spread globally and was declared a pandemic in March 2020 by the World Health Organisation. By April 2021 it has already affected around 145 million people and resulted in more than three million deaths globally2. Until effective treatments are available and vaccines are extensively accessible and administered, governments rely on non-pharmaceutical interventions (NPIs) to control the epidemic.

New CDC data go against a pervasive narrative.

Original Article from The New England Journal of Medicine — Covid-19 Breakthrough Infections in Vaccinated Health Care Workers

Places and activities during which infection prevention and control measures may be difficult to fully enforce were those with increased risk of infection. Children attending day-care, kindergarten, middle and high schools, but not primary schools, were potential sources of infection for the household.

Background There have been recent reports of myocarditis (including myocarditis, pericarditis or myopericarditis) as a side-effect of mRNA-based COVID-19 vaccines, particularly in young males. Less information is available regarding the risk of myocarditis from COVID-19 infection itself. Such data would be helpful in developing a complete risk-benefit analysis for this population. Methods A de-identified, limited data set was created from the TriNetX Research Network, aggregating electronic health records from 48 mostly large U.S. Healthcare Organizations (HCOs). Inclusion criteria were a first COVID-19 diagnosis during the April 1, 2020 - March 31, 2021 time period, with an outpatient visit 1 month to 2 years before, and another 6 months to 2 years before that. Analysis was stratified by sex and age (12-17, 12-15, 16-19). Patients were excluded for any prior cardiovascular condition. Primary outcome was an encounter diagnosis of myocarditis within 90 days following the index date. Rates of COVID-19 cases and myocarditis not identified in the system were estimated and the results adjusted accordingly. Wilson score intervals were used for 95% confidence intervals due to the very low probability outcome. Results For the 12-17-year-old male cohort, 6/6,846 (0.09%) patients developed myocarditis overall, with an adjusted rate per million of 876 cases (Wilson score interval 402 - 1,911). For the 12-15 and 16-19 male age groups, the adjusted rates per million were 601 (257 - 1,406) and 561 (240 - 1,313). For 12-17-year-old females, there were 3 (0.04%) cases of myocarditis of 7,361 patients. The adjusted rate was 213 (73 - 627) per million cases. For the 12-15- and 16-19-year-old female cohorts the adjusted rates per million cases were 235 (64 - 857) and 708 (359 - 1,397). The outcomes occurred either within 5 days (40.0%) or from 19-82 days (~60.0%). Conclusions Myocarditis (or pericarditis or myopericarditis) from primary COVID19 infection occurred at a rate as high as 450 per million in young males. Young males infected with the virus are up 6 times more likely to develop myocarditis as those who have received the vaccine. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This publication was made possible by the Clinical and Translational Science Collaborative of Cleveland, UL1TR0002548 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: TriNetX is compliant with the Health Insurance Portability and Accountability Act (HIPAA), the US federal law which protects the privacy and security of healthcare data. TriNetX is certified to the ISO 27001:2013 standard and maintains an Information Security Management System (ISMS) to ensure the protection of the healthcare data it has access to and to meet the requirements of the HIPAA Security Rule. Any data displayed on the TriNetX Platform in aggregate form, or any patient level data provided in a data set generated by the TriNetX Platform, only contains de-identified data as per the de-identification standard defined in Section 164.514(a) of the HIPAA Privacy Rule. The process by which the data is de-identified is attested to through a formal determination by a qualified expert as defined in Section 164.514(b)(1) of the HIPAA Privacy Rule (reference). This formal determination by a qualified expert, refreshed in December 2020, supersedes the need for TriNetX's previous waiver from the Western Institutional Review Board (IRB). Because we only used de-identified data, we did not seek nor did we obtain Institutional Board Approval for this research. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data set is licensed and is not publicly available.

Phosphoproteomics analysis of SARS-CoV-2-infected Vero E6 cells reveals host cellular pathways hijacked by viral infection, leading to the identification of small molecules that target dysregulated pathways and elicit potent antiviral efficacy.

1/ Da immer noch Rätselraten besteht warum Daten aus #Israel so stark von denen aus UK (+ Canada, Italien) abweichen, insbesondere bzgl. Schutz der m-RNA-Impfstoffe vor symptomatischer Infektion durch #Delta (ca 80% vs. 40%). 2 Faktoren könnten dies sehr plausibel erklären:

Since its emergence in Wuhan, China, covid-19 has spread and had a profound effect on the lives and health of people around the globe. As of 4 July 2021, more than 183 million confirmed cases of covid-19 had been recorded worldwide, and 3.97 million deaths. Recent evidence has shown that a range of persistent symptoms can remain long after the acute SARS-CoV-2 infection, and this condition is now coined long covid by recognized research institutes. Studies have shown that long covid can affect the whole spectrum of people with covid-19, from those with very mild acute disease to the most severe forms. Like acute covid-19, long covid can involve multiple organs and can affect many systems including, but not limited to, the respiratory, cardiovascular, neurological, gastrointestinal, and musculoskeletal systems. The symptoms of long covid include fatigue, dyspnea, cardiac abnormalities, cognitive impairment, sleep disturbances, symptoms of post-traumatic stress disorder, muscle pain, concentration problems, and headache. This review summarizes studies of the long term effects of covid-19 in hospitalized and non-hospitalized patients and describes the persistent symptoms they endure. Risk factors for acute covid-19 and long covid and possible therapeutic options are also discussed.

Introduction COVID-19 large scale immunization in the US has been associated with infrequent breakthrough positive molecular testing. Whether a positive test is associated with a high viral RNA load, specific viral variant, recovery of infectious virus, or symptomatic infection is largely not known. Methods In this study, we identified 133 SARS-CoV-2 positive patients who had received two doses of either Pfizer-BioNTech (BNT162b2) or Moderna (mRNA-1273) vaccines, the 2nd of which was received between January and April of 2021. The positive samples were collected between January and May of 2021 with a time that extended from 2 to 100 days after the second dose. Samples were sequenced to characterize the whole genome and Spike protein changes and cycle thresholds that reflect viral loads were determined using a single molecular assay. Local SARS-CoV-2 IgG antibodies were examined using ELISA and specimens were grown on cell culture to assess the recovery of infectious virus as compared to a control unvaccinated cohort from a matched time frame. Results Of 133 specimens, 24 failed sequencing and yielded a negative or very low viral load on the repeat PCR. Of 109 specimens that were used for further genome analysis, 68 (62.4%) were from symptomatic infections, 11 (10.1%) were admitted for COVID-19, and 2 (1.8%) required ICU admission with no associated mortality. The predominant virus variant was the alpha (B.1.1.7), however a significant association between lineage B.1.526 and amino acid change S: E484K with positives after vaccination was noted when genomes were compared to a large control cohort from a matched time frame. A significant reduction of the recovery of infectious virus on cell culture as well as delayed time to the first appearance of cytopathic effect was accompanied by an increase in local IgG levels in respiratory samples of vaccinated individuals but upper respiratory tract IgG levels were not different between symptomatic or asymptomatic infections. Conclusions Vaccination reduces the recovery of infectious virus in breakthrough infections accompanied by an increase in upper respiratory tract local immune responses. Funding National Institute of Health (The Johns Hopkins Center of Excellence in Influenza Research and Surveillance, HHSN272201400007C), Johns Hopkins University, Maryland Department of Health, Centers for Disease Control and Prevention. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement HHM is supported by the HIV Prevention Trials Network (HPTN) sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), National Institute on Drug Abuse, National Institute of Mental Health, and Office of AIDS Research, of the NIH, DHHS (UM1 AI068613) the NIH RADx-Tech program (3U54HL143541-02S2), National Institute of Health RADx-UP initiative (Grant R01 DA045556-04S1), National Institute of Allergy and Infectious Diseases (Johns Hopkins Center of Excellence in Influenza Research and Surveillance HHSN272201400007C), the U. S. Centers for Disease Control (75D30121C11061), Johns Hopkins University President Fund Research Response, the Johns Hopkins Department of Pathology, and the Maryland Department of Health. This research was supported in part by the intramural research program of the National Institutes of Health. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical considerations and Data availability The research Johns Hopkins Medical Institutions Institutional Review Board-X (JHM IRB-X) is constituted to meet the requirements of the Privacy Rule at section 45 CFR 164.512(i)(1)(i)(B) and is authorized and qualified to serve as the Privacy Board for human subjects research applications conducted by Johns Hopkins University faculty members. JHM IRB-3 approved IRB00221396 entitled: Genomic evolution of viral pathogens: impact on clinical severity and molecular diagnosis. IRB review included the granting of a waiver of consent based on the following criteria: 1) the research involves no more than minimal risk to subjects; 2) the waiver will not adversely affect the rights and welfare of the subjects; 3) the research could not be practicably carried out without the waiver; and 4) the IRB will advise if it is appropriate for participants to be provided with additional pertinent information after participation. This study was also approved for the inclusion of children as 'research not involving greater than minimal risk'. The permission of parents/guardians is waived. Assent is waived for all children. JHM IRB-X determined that there is no requirement for continuing review or progress report for this application. Remnant nasopharyngeal or lateral mid-turbinate nasal (NMT) clinical swab specimens from patients who tested positive for SARS-CoV-2 after the standard of care testing were used. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data are available within the manuscript and in the supplemental tables.

Interpretation. These results accord with reports of ‘Long Covid’ cognitive symptoms that persist into the early-chronic phase. They should act as a clarion call for further research with longitudinal and neuroimaging cohorts to plot recovery trajectories and identify the biological basis of cognitive deficits in SARS-COV-2 survivors.

Interaktive Karte zeigt die aktuellen Corona-Ansteckungszahlen in Deutschland nach Landkreisen und Bundesländern.

Let's talk about breakthrough symptomatic infections in fully vaxxed adults... Today @SurvivorCorps will meet with the @CDCgov to present our data and ask for changes in policy to reflect real world evidence. @CDCgov is only tracking hospitalized cases so we did it instead. /

The SARS-CoV-2 B.1.617.2 (Delta) variant was first identified in the state of Maharashtra in late 2020 and spread throughout India, displacing the B.1.1.7 (Alpha) variant and other pre-existing lineages, including B.1.617.1 that was detected prior to B.1.617.2. Bayesian modelling indicates that the growth advantage of B.1.617.2 in Mumbai was most likely explained by increased transmissibility and immune evasion from previous infection. Indeed in vitro , we demonstrate that B.1.617.2 is approximately 6-fold less sensitive to neutralising antibodies in sera from recovered individuals, and approximately 8-fold less sensitive to vaccine-elicited antibodies as compared to wild type Wuhan-1 bearing D614G. B.1.617.2 spike pseudotyped viruses exhibited compromised sensitivity to monoclonal antibodies against the receptor binding domain (RBD) and N-terminal domain (NTD), in particular to the clinically approved bamvalinumb and imdevimab monoclonal antibodies. B.1.617.2 demonstrated higher replication efficiency in both airway organoid and human airway epithelial systems as compared to B.1.1.7, associated with B.1.617.2 spike being in a predominantly cleaved state compared to B.1.1.7. In an analysis of vaccinated healthcare workers across three centres in India during a period of mixed lineage circulation, we observed reduced ChAdOx-1 vaccine efficacy against B.1.617.2 relative to non-B.1.617.2. These combined epidemiological and in vitro data indicate that the dominance of B.1.617.2 in India has been most likely driven by a combination of evasion of neutralising antibodies in previously infected individuals and increased virus infectivity. B.1.617.2 threatens the efficacy of critically important therapeutic monoclonal antibodies for COVID-19 and compromised vaccine efficacy mandates continued infection control measures in the post-vaccination era. ### Competing Interest Statement The authors have declared no competing interest.

Cohen et al. evaluate immune responses longitudinally in 254 COVID-19 patients over 8 months. SARS-CoV-2-specific binding and neutralizing antibodies exhibit biphasic decay, suggesting long-lived plasma cell generation. Memory B cells remain stable; CD4 and CD8 memory T cells are polyfunctional. Thus, broad and effective immunity may persist long-term following COVID-19.

Countries have adopted several measures to control the spread of Covid-19. However, substantial differences remain in terms of performance in controlling the virus, potentially due to heterogeneity in citizen engagement with government measures. Drawing on this observation, this paper seeks to analyze the effect of pre-crisis ties, particularly trust in government, on crisis management, proxied by the number of Covid-19 cases and deaths per million population. We examine this question based on a sample of 41 countries for which data are available. Results reveal that a high level of trust in government predicts better crisis management in terms of relatively low levels of cases and deaths. These results, which successfully pass a series of robustness tests, may vary according to level of contamination and increase with time. JEL Classification E71, H12, I12, I18, I38, Z18 ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: UCA All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data are available on request

O bjec tiv e T o cha ra ct erize the cli nica l f eatu re s o f c hildre n a nd ad ole sc en t s ho spi tali ze d w ith SARS -C oV - 2 i nfecti on s and to explore pre dict or s fo r d ise a se sev eri ty . D esign Natio nw ide pro sp ectiv e ob se rvation a l coh ort study . Setting Dat a c ollec te d from 169 out of 351 c hildren’ s ho spi ta l s in Germany betwe en Ma rc h 1 8, 2020 and April 30, 202 1 and c ompari son w ith th e S tatu tory No ti ficatio n Syst em. Participants 1 ,501 c hildren and adol e scen ts up to 19 y ear s o f a g e w ith labo rat ory c on firm ed SARS - Co V- 2 i nfecti on s w ho wer e admit ted to c hild r en’ s ho spi tal s a nd sub s equen tly rep ort ed to the COVI D -19 reg istry of the Ge rma n Pedi a tric Inf ectio u s Di s ea se So ci ety (DG PI ). M ain outcome measures Admi ssion to int en siv e ca re , in-h os pital .

Correspondence from The New England Journal of Medicine — Household Transmission of SARS-CoV-2 from Children and Adolescents

My colleagues @hillaalroy and @Meir_Marciano have tonight published the data leading the Israeli MoH to suspect that @pfizer vaccine's immunity is waning. In this graph, you can see infections and hospitalizations in the last 3 weeks, normalized. Chances of a January vaccinnated https://t.co/qFNjeGqNXu

Extracorporeal membrane-oxygenation (ECMO) is an established treatment option for severe acute respiratory failure (1). In the context of the SARS-CoV-2 pandemic with the occurrence of many severe ARDS cases, ECMO is increasingly being used worldwide depending on the available resources. Data from high-volume centers show that ECMO therapy may reduce in- hospital mortality rate of ventilated patients that would otherwise reach more than 50-80% (2, 3). Analyzing 10,021 hospitalized patients being treated in 920 different Germany hospitals during the first wave of the pandemic, ECMO was reportedly used in 119 patients (1.2%) with a mortality rate of 71% (4). In contrast, a recent worldwide meta-analysis revealed a lower in- hospital mortality of 37% in 1896 patients (5). The recent data of the EURO-ELSO point into the same direction (6). The aim of the current research letter was to determine the in-hospital mortality during the first and second COVID-19 wave in Germany, a country having always quantitively sufficient health care resources during the pandemic without major restrictions.

The majority of vaccinated people who were admitted to hospital for covid-19 were probably infected shortly before or around the time of their vaccination, highlighting the importance of maintaining social distancing and understanding that immunity develops over time, researchers have said.1 The International Severe Acute Respiratory Infection Consortium Clinical Characterisation Protocol (ISARIC4C), which is funded by UK Research and Innovation and the National Institute for Health Research, analysed UK hospital admissions after the start of the covid-19 vaccination rollout. As of 10 April 2021, 3842 of the 99 445 inpatients enrolled in the study had been vaccinated. Looking at symptomatic patients (1823), the researchers found that 40% (729) developed covid-19 symptoms 0-7 days post-vaccination. A …

The emergence of SARS-CoV-2 variants with mutations in major neutralizing antibody-binding sites can affect humoral immunity induced by infection or vaccination[1][1]–[6][2]. We analysed the development of anti-SARS-CoV-2 antibody and T cell responses in previously infected (recovered) or uninfected (naive) individuals that received mRNA vaccines to SARS-CoV-2. While previously infected individuals sustained higher antibody titers than uninfected individuals post-vaccination, the latter reached comparable levels of neutralization responses to the ancestral strain than previously infected individuals 7 days after the second vaccine dose. T cell activation markers measured upon spike or nucleocapsid peptide in vitro stimulation showed a progressive increase after vaccination in the time-points analysed. Comprehensive analysis of plasma neutralization using 16 authentic isolates of distinct locally circulating SARS-CoV-2 variants revealed a range of reduction in the neutralization capacity associated with specific mutations in the spike gene: lineages with E484K and N501Y/T (e.g., B.1.351 and P.1) had the greatest reduction, followed by lineages with L452R (e.g., B.1.617.2) or with E484K (without N501Y/T). While both groups retained neutralization capacity against all variants, plasma from previously infected vaccinated individuals displayed overall better neutralization capacity when compared to plasma from uninfected individuals that also received two vaccine doses, pointing to vaccine boosters as a relevant future strategy to alleviate the impact of emerging variants on antibody neutralizing activity. ### Competing Interest Statement AI served as a consultant for Spring Discovery, Boehringer Ingelheim and Adaptive Biotechnologies. IY reported being a member of the mRNA-1273 Study Group and has received funding to her institution to conduct clinical research from BioFire, MedImmune, Regeneron, PaxVax, Pfizer, GSK, Merck, Novavax, Sanofi-Pasteur, and Micron. NDG is a consultant for Tempus Labs to develop infectious disease diagnostic assays. All other authors declare no competing interests. ### Funding Statement We thank M. Linehan for technical and logistical assistance, D. Mucida for discussions, and M. Suchard and W. Hanage for statistics advice. This work was supported by the Women s Health Research at Yale Pilot Project Program (A.I.), Fast Grant from Emergent Ventures at the Mercatus Center (A.I. and N.D.G.), Mathers Foundation, and the Ludwig Family Foundation, the Department of Internal Medicine at the Yale School of Medicine, Yale School of Public Health and the Beatrice Kleinberg Neuwirth Fund. A.I. is an Investigator of the Howard Hughes Medical Institute. C.L. is a Pew Latin American Fellow. C.B.F.V. is supported by NWO Rubicon 019.181EN.004. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by Yale Human Research Protection Program Institutional Review Board (IRB Protocol ID 2000028924). Informed consent was obtained from all enrolled vaccinated HCWs. The Institutional Review Board from the Yale University Human Research Protection Program determined that the RT-qPCR testing and sequencing of de-identified remnant COVID-19 clinical samples conducted in this study is not research involving human subjects (IRB Protocol ID: 2000028599). All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All the background information for HCWs participants in this study are included in Source Data Figure 1. All the genome information for SARS-CoV-2 variants used in this study are available in Source Data Figure 2, and the aligned consensus genomes are available on GitHub ([https://github.com/grubaughlab/paper\_2021\_Nab-variants][3]). Additional correspondence and requests for materials should be addressed to the corresponding author (A.I). [https://github.com/grubaughlab/paper\_2021\_Nab-variants][3] [1]: #ref-1 [2]: #ref-6 [3]: https://github.com/grubaughlab/paper_2021_Nab-variants

Background The COVID-19 pandemic is pushing healthcare systems to their limits. Dramatic reductions in the adult elective surgery are ubiquitous, but corresponding changes in pediatric services are ...