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The booklet is a kind of monument for the relatives and caregivers

The first patient with corona in the Netherlands, three years ago this week. It marked the start of two incredible years. The corona crisis, so visible due to the mandatory mouth masks and all the other protective measures that came with it, is behind us. But she should not be forgotten, say scientists from Amsterdam UMC, among others. Together they made a booklet about it: ‘Behind a mask of sadness’.

During the first wave in 2020, scientists from Erasmus MC, Amsterdam UMC, the University of Humanistics and Rotterdam University of Applied Sciences conducted research. They tried to capture the impact of the corona measures on the family of dying patients and healthcare professionals in figures. They had hundreds of caregivers and next of kin fill out questionnaires.

The participants used those questionnaires remarkably often to express themselves, it turned out. “It soon became clear that the measures had a major impact on how people could say goodbye to loved ones during this period. And how care providers could provide good end-of-life care,” says Professor Bregje Onwuteaka-Philipsen, professor of life-end research at Amsterdam UMC. “That is why we started an investigation together in May 2020.”

Study
To the study Experiences of end-of-life care during the COVID-19-crisis more than 700 healthcare professionals participated and almost 400 surviving relatives of people who died between March and July 2020, from corona or from another cause. The experiences come from hospitals, the home situation, nursing homes, hospices and other care institutions. Initially, the research mainly yielded figures. “But with the open questions, many participants wrote down their experiences. Those were poignant stories that we didn’t want to lose,” says Onwuteaka-Philipsen.

Diffuse image
And so a copywriter interviewed a variety of experts and experience experts, and sound bites from the – anonymous – participants were put together. That resulted in Behind a mask of sadness. Anyone who reads the booklet immediately goes back to those oppressive first months of the corona pandemic, when there was great fear of infection all over the world and no one knew exactly what the disease did and what the consequences could be.
A diffuse image emerges in the booklet; an image of heartbreaking events, but also of solidarity and connection. And although everyone knows a story, the events remain impressive.

Inhuman situations
Bereaved Cora Postema talks about her elderly mother, who absolutely did not want to end up in hospital if she contracted corona, but who had to rehabilitate in a nursing home after an unfortunate ankle fracture. Where no one was allowed to visit. Mother deteriorated rapidly and died, in isolation. “That loneliness touches me the most,” says Cora in the book.

IC nurse Mechteld de Haas tells about a young father who was about to die, and that mother had to choose which of the two children could say goodbye because only two visitors were allowed. A child had to wait outside. Inhuman situations, she remembers. “Nurses and intensivists themselves have also experienced the limitations as traumatic. We are aware that you can only say goodbye once.”

Monument
The booklet is a kind of monument for the relatives and care providers, says Bregje Onwuteaka-Philipsen. “It shows many heartbreaking stories, but also shows how people continued to take care of each other as best as possible under the difficult circumstances, sometimes by interpreting the strict rules a bit more broadly. Everyone agrees that the strict visit-limiting measures that were taken in hospitals and nursing homes should never be used again. But how to do that is a tricky question. But it is a question that needs an answer, since the danger of a new pandemic is always lurking and visits in the dying phase should never be refused again.”

“If the corona crisis has shown one thing, it is that good care for people in the last phase of life and their loved ones is also crucial in times of crisis and that more psychological, social and spiritual aspects of care are important in this phase. . And that it is also important for the well-being of care providers that they can provide this care properly,” concludes Onwuteaka-Philipsen.

Advice
The researchers urge future policymakers: “Listen to the workplace. Be aware of the impact of visiting restrictions on the quality of life and death of patients, relatives and healthcare providers.” And they advise healthcare providers: “Inform openly and honestly. Make timely goodbyes possible. Pay attention to rituals surrounding death. And be rebellious if necessary.”

Read more?
The book Behind a Mask of Sadness
De studie Experiences of end-of-life care during the COVID-19-crisis

The study and book were funded by ZonMW.

Bron: Amsterdam UMC

This strategy may provide better and longer-lasting protection than the current corona vaccines

Researchers at the Leiden University Medical Center (LUMC) have made a MERS corona vaccine with the entire virus instead of just the spike protein. The candidate vaccine provides strong protection against the MERS coronavirus in a mouse model. This strategy may provide better and longer-lasting protection than the current corona vaccines.

Long before the corona crisis, virologist Marjolein Kikkert and colleagues discovered that all coronaviruses contain a protein that is essential for the virus to multiply in our body. This protein also ensures that part of our immune system is suppressed, making it easier for the virus to do its thing. In Nature Communications the researchers write that coronaviruses in which subtle changes have been made to this protein offer very good protection against infections with the normal coronavirus in a mouse model. This makes the modified virus a potential new vaccine candidate.

Fully immune after one vaccination
This concept in itself is not new. There are already several vaccines that use weakened virus particles, such as those for yellow fever, mumps and measles. “The virus particles are usually weakened by multiplying them many times in cultured cells or laboratory animals, which causes changes in the viral genome and they no longer cause disease,” says Kikkert. “In this case, we made a very specific modification in the genome. As a result, the virus was no longer pathogenic and gave the immune system the opportunity to respond more optimally and build up protection.” According to Kikkert, this is because the modified virus can continue to multiply for a while and no longer suppresses our immune system. And that worked well. “After just 1 vaccination, mice were completely immune.”

MERS and SARS: 2 different coronaviruses
In their study, the researchers used the MERS coronavirus, which has been responsible for several outbreaks in Saudi Arabia since 2012. The virus is different from the coronavirus that caused the corona crisis in 2020 (SARS-CoV-2), but they are very similar.

Superior vaccine
According to Kikkert, a vaccine with a weakened virus probably provides better and longer protection than the current corona vaccines. “The immune system gets the chance to ‘see’ all aspects of the virus. In addition, in this specific way the entire arsenal that our immune system has in house, and in particular the innate immune response, is better activated. This happens much less with all current vaccines that only contain the spike protein.”

Why was such a vaccine not used earlier? “Although this vaccine strategy is often superior, it also carries safety risks. This can cause problems, especially in people with a weakened immune system. The development of these types of vaccines therefore requires even more safety tests, and therefore takes longer,” says Kikkert.

Does it also work for SARS-CoV-2?
The now well-known SARS coronavirus contains the same protein as the MERS virus. “We are now investigating whether the same ‘trick’ also works for this virus,” says Kikkert. With this research, they also learn more about exactly how coronaviruses work. “This knowledge is essential to manage the general ‘coronavirus problem’ in a sustainable way.”

A possible new corona vaccine is therefore definitely not too late, says Kikkert. “The SARS-CoV-2 virus and other variants will continue to plague humanity for now. As with the flu virus, it is important to protect the population against serious outbreaks.” The current corona vaccines have a relatively very temporary effect and regular ‘boosting’ is required. “A vaccine with a weakened virus may work longer, so that instead of every season, you may have to get a repeat shot every 5 years.”

Bron: LUMC

These fats dampen the activity of genes that play a key role in allergies

People with relatively high levels of fats in their blood are less likely to develop allergic conditions, such as eczema and asthma. These fats ensure that genes that play a key role in allergic reactions are less active. Researchers from the Leiden University Medical Center (LUMC) have registered this Nature Communications.

“We already knew that fats in our blood, such as triglycerides and cholesterol, can influence the behavior of immune cells,” says professor of Biomedical Data Sciences Bas Heijmans. “We are now showing that these fats dampen the activity of genes that play a key role in allergies.” As a result, allergic reactions occur less quickly.

The researchers first mapped out which genes are active in immune cells in more than 3,200 people. “This turned out to be more than 17,000,” says Koen Dekkers, first author of the study. “We then investigated step by step which genes fats in the blood have an effect on, which led us to a group of genes that trigger allergic reactions.” Using an advanced analysis method in which the researchers combined blood levels of fats, gene activity and known genetic differences between people, they were able to demonstrate that this relationship is indeed causal.

Allergic reaction
An allergic reaction is characterized by an exaggerated response of your immune system to a harmless substance, such as pollen that leads to hay fever. The researchers found that fats mainly affect genes that are active in basophils. These are immune cells that, among other things, produce histamine and are crucial in triggering an allergic reaction.

More fat in our diet?
Triglycerides in particular have an effect on these basophils, the researchers discovered. The triglyceride level in the blood is partly determined by our DNA, but mainly by diet. “And that is of course very interesting,” says Heijmans. “This could mean that patients with severe allergic reactions might benefit from supplementing with extra triglycerides, or more precisely, the fatty acids that make up triglycerides.” But we are not there yet, emphasizes Heijmans. “First it must be tested whether and, if so, which fatty acids actually have these beneficial effects. Is it mainly the healthy, unsaturated fatty acids? That would be good news. Or the unhealthy, saturated fatty acids?” It is also not yet clear how fats change the behavior of immune cells in this direction.

Unexpected turn: from cardiovascular disease to allergy
Allergies were not exactly the area of ​​expertise of Heijmans and Dekkers. “We therefore totally did not expect that this study would point us in that direction,” says Dekkers. Their arrows were aimed at cardiovascular diseases, in collaboration with Professor of Cardiology Wouter Jukema. “These diseases are driven by the interaction between fats and the immune system,” says Heijmans. “We expected to discover how fats influence genes involved in cardiovascular disease. But the effect on allergic reactions was much stronger.” So their research took an unexpected turn, but that doesn’t diminish their enthusiasm. Heijmans: “Such a surprising discovery is the icing on the cake for a scientist.”

Are allergies now becoming a new focus area in their research? Dekkers, who now works at Uppsala University in Sweden, does not rule it out for the longer term: “I certainly see further research in it, and I may just pick it up again later.” Heijmans: “Wouter Jukema and I are still interested in the effect of fats on immune cells, but are now focusing again on their role in cardiovascular disease.”

This research is a result of the national atherosclerosis consortium Genius, funded by the Heart Foundation and the Dutch CardioVascular Alliance. The research data used in this study have been brought together thanks to a collaboration between the VU University and the university medical centers of Rotterdam, Groningen, Maastricht, Utrecht and Leiden within BBMRI-NL.

Bron: LUMC