Frank Diamond has been with Infection Control Today since November 2019. He has more than 30 years of experience working for magazines, newspapers, and television news. 

Frank Diamond

A COVID-19 variant that proves to be resistant to vaccines keeps medical experts, public health officials, and health care professionals—including infection preventionists—on the frontlines of the COVID-19 pandemic up at nights. There’s no reason to sound the alarm yet, but there may—just may—perhaps be reason to think that there’s a chance that the alarm may have to be sounded at some point about the lambda COVID-19 mutation, or C.37.

 by investigators in Chile suggests that the mutation, which first surfaced in Peru about a year ago and is highly infectious, may also be able to evade vaccine antibodies.

“Our results indicate that mutations present in the spike protein of the lambda variant of interest confer increased infectivity and immune escape from neutralizing antibodies elicited by CoronaVac,” the study states. CoronaVac is a vaccine manufactured by a Chinese company and that’s used in Peru. The study continues: “These data reinforce the idea that massive vaccination campaigns in countries with high SARS-CoV-2 circulation must be accompanied by strict genomic surveillance allowing the identification of new isolates carrying spike mutations and immunology studies aimed to determine the impact of these mutations in immune escape and vaccines breakthrough.”

Peru has the highest COVID-19 death rate of any country in the world, according to the 

Johns Hopkins Coronavirus Resource Center

: about 600 for every 100,000 people infected with COVID-19. That’s about twice the amount of Hungary, the country with the next highest COVID-19 death rate. The World Health Organization (WHO) 

 the lambda variant has been the COVID carrier in about 81% of infections in Peru since April. The WHO declared the lambda variant a variant of interest last month. The lambda variant has spread to about 30 other countries in the world, including the United Kingdom.

The first case of lambda variant has been spotted at Houston Methodist Hospital about 2 days ago, according various news outlets, including 

. An ironic development, as Houston Methodist Hospital has sparked headlines lately by being the first hospital in the U.S. to mandate that all its employees get the COVID-19 vaccine. As 

, 153 of Houston Methodist Hospital’s employees either resigned or were fired for not getting the vaccine. KHOU 11 

 that there’s been an alarming spike in COVID-19 infections in the Houston area. Houston Methodist Hospital officials have not commented on whether the loss of those 153 employees has hindered the facility’s ability to treat the influx of patients.

The Chilean investigators give an indication of what challenges the lambda variant presents, writing that “our results indicate that the spike protein of the lambda variant confers immune escape to neutralizing antibodies elicited by the CoronaVac vaccine. Whether the lambda variant also escapes to the cellular response shown to be elicited by CoronaVac is still unknown. We also observed that the spike protein of the lambda variant presented increased infectivity when compared with the spike protein of the Alpha and Gamma variants, both of them with reported increased infectivity and transmissibility.”

’s Editorial Advisory Board, argues that the emergence of the lambda variant underscores the need to consider vaccines just 1 layer of protection against COVID-19 infection, and that they should be combined with masks and goggles.

“It needs to be remembered that a high-quality mask or respirator can decrease viral exposure up to sixfold, making them an important adjunct to vaccines with reduced efficacy,” Kavanagh tells 

. “Our goal needs to be to prevent both death and long-term disability.”

Slow the spread and the mutations of COVID-19, Kavanagh urges. And though there may be very few cases of the lambda variant in the U.S., it still “underscores the need for travel restrictions, including quarantining of returning [travelers], regardless of vaccination status,” says Kavanagh. “We also need to pivot away from our current two-tiered advisories regarding vaccinated and unvaccinated individuals. With the lambda and Delta variants we all should become vaccinated plus follow public health advice.”

Articles

Investigators in Chile conclude that the lambda COVID-19 variant is not only more infectious than standard SARS-CoV-2, but could also possibly shrug off vaccines. The first case in the United States has been spotted at Houston Methodist Hospital.

Lambda Variant of COVID-19 Might Be Resistant to Vaccines

Comes a point in a health care provider’s work life when she or he might be tempted to throw up their hands. It can happen when they’re dealing with the person with diabetes who won’t stay away from sweets, or the person with a substance abuse problem who refuses to seek counseling, or the person with heart problems who won’t take their medications. Compassion fatigue has been around a long time and providers should always be on guard against it says the 

Centers for Disease Control and Prevention

 (CDC). Perhaps especially these days when it comes to infection preventionists and other health care professionals who have to treat people who refuse to get vaccinated for COVID-19. The CDC says that as of yesterday, only 49.1% of Americans have been vaccinated, nowhere near the number needed to fend off variants such as the rapidly spreading 

. The ability of variants to circulate among the unvaccinated increases the possibility that COVID-19 might mutate into a strain that can neutralize the vaccines, a possibility some experts have detected in the 

Heather Saunders, MPH, RN, CIC, the director of infection control at the Johns Hopkins Office of Population Health, and a member of 

’s Editorial Advisory Board (EAB), says that it’s impossible to generalize about compassion fatigue though “I do think that for some individuals, providing care to unvaccinated patients could trigger compassion fatigue. Health care workers are experiencing various degrees of psychological trauma, including [post-traumatic stress disorder], as a result of their experiences during the pandemic. This trauma could lead some individuals to feel a sort of indifference or irritability toward unvaccinated individuals who they believe are perpetuating the pandemic.”

EAB member Linda Spaulding, RN, BC, CIC, says that while she hasn’t seen compassion fatigue affect patient care “it is depressing staff because we know the patients could avoid getting COVID and decided not to get the vaccine. Patients ask for it [pre-admission] but that’s too late and they can’t get vaccinated while sick with COVID. It’s just very sad.”

EAB member Kevin Kavanagh, MD, has written extensively for 

. Kavanagh points out that compassion fatigue can always pounce because poor decisions made by patients necessitates much of health care treatment.

“Vaccination rates are not only low with the public but also with health care workers,” Kavanagh points out. “All need to realize that the public looks up to health care workers for guidance and many have cited the example of unvaccinated workers as influencing their decision.”

Kavanagh also points out that many health care workers suffer from PTSD, as 

“Ideally, counseling and time off of work is desperately needed,” says Kavanagh. “Unfortunately, this is not possible and we will be soon facing a health care worker shortage. The solution is for everyone who can, to become vaccinated and we all need to adopt strict public health strategies. And for all to support, however possible, our frontline workers.”

Robbie Hilliard, MSN, RN, CIC, the infection control coordinator for Carl Vinson VAMC in Dublin, Georgia, recently wrote an 

 about how Veterans Affairs nurses tackle infections. Hilliard says that there’s a danger that compassion fatigue could set in when it comes to treating unvaccinated COVID-19 patients, but tries not to simply dismiss the concerns of the unvaccinated.

“As a nurse, I am vaccinated for COVID-19, but I still have co-workers who are not, which just emphasizes the importance of understanding and accepting people’s personal choices,” Hilliard tells 

. “Most of these providers are very educated individuals, who are compassionate, but continue to feel that not enough research on side effects, etc., was done for a vaccine released on an emergency basis.”

Hilliard agrees that compassion fatigue comes with a provider’s job “and I am sure, at times, compassion fatigue creeps in with COVID patients, but most of us understand the fear associated with the unknown/new pharmaceutical treatments that have long-term unknown effects.”

The attitude that both Kavanagh and Hilliard encourage—patience in the face of vaccine hesitancy—might be easier said than done. For instance, CNN 

 a nurse identified as “Sunny,” who works in Western Arkansas. Sunny says that it’s difficult to watch people die and then “so many people on Facebook or in a Walmart tell you you’re a liar…. Nurses have really been the symbol of the pandemic and all of the hate has been centralized around us…. We heard it more than once that we were killing people on purpose to make it look like it [the COVID-19 pandemic] was worse than it was.”

 states that the tools used before COVID-19 to alleviate compassion fatigue among physicians might not suffice now. “The pandemic has only increased the need for physicians to receive social/emotional support from their institution and to feel their workplace contributions are valued,” the study states. “Successful pre-pandemic workplace interventions may not adequately support physicians during the pandemic.”

The study, by investigators with the Icahn School of Medicine at Mount Sinai, states that “the personal and professional aftershocks of the current SARS-CoV-2 pandemic for physicians will likely persist well into the foreseeable future. Our results suggest that institutions may be able to mitigate these effects using targeted interventions aimed at conveying to physicians that they are valued.”

Not nearly enough Americans are vaccinated to prevent COVID-19 from doing further damage. For some providers, dealing with patients who refuse to do what’s best for them can trigger compassion fatigue.

Can Providers be Blamed for Losing Patience with Vaccine Hesitant?

strikes again, but this time the deadly Superbug’s super toxic powers seem to have been enhanced. The Centers for Disease Control and Prevention (CDC) reports that 

uris outbreaks have occurred in two hospitals in the Dallas-area, and a nursing home in Washington, D.C. What makes this a particularly troublesome development is that the Superbugs appear to be pan-resistant—that is resistant to all antibiotics available—and that includes echinocandins, a class of anti-fungal drugs that have proven to be the most effective against 

“These two simultaneous, independent clusters of pan- or echinocandin-resistant 

 cases in patients with overlapping inpatient health care exposures and without previous echinocandin use provide the first evidence suggesting that pan- or echinocandin-resistant 

 strains might have been transmitted in U.S. health care settings,” CDC researchers 

). “Surveillance, public health reporting, and infection control measures are critical to containing further spread. Clinicians should consider early antifungal susceptibility testing in patients with 

 infection, especially in those with treatment failure.”

Also worrying, the clusters in the 3 health care facilities seem to have been created as a result of 

Meghan Lyman, MD, medical officer in the CDC’s Mycotic Diseases Branch

“Among 22 clinical and screening cases of 

 in Texas during the same period, two were pan-resistant and five were resistant to both echinocandins and fluconazole,” the 

 report states. “These seven cases were identified in patients who were cared for at two facilities that share patients in the same city; two patients were at a long-term acute care hospital, three at a short-term acute care hospital, and two at both facilities.”

Meghan Lyman, MD, a medical officer in the CDC’s Mycotic Diseases Branch and the report’s corresponding author, said that “this is really the first time we’ve started seeing clustering of resistance” in which patients seemed to be getting the infections from each other.

 report states that “data are lacking about the most appropriate therapy for pan-resistant infections. Combination and investigational antifungal treatments can be considered, but evidence in clinical settings is limited. More information is needed to evaluate patient outcomes and identify proper treatment for 

 cases with pan-resistance or echinocandin resistance.”

 has been diagnosed in 40 countries since the first report about it in 2009, when clinicians found a single isolate from the discharge of the external ear canal of a 70-year-old inpatient at Tokyo Metropolitan Geriatric Hospital. By 2016, 13 cases had been identified in the United States, leading the CDC to issue interim recommendations, as well as a clinical alert, requesting laboratories to report cases and send samples to state and local health departments and the CDC.

 is difficult to identify with standard laboratory methods. It can be misidentified in labs without specific technology, which can lead to mismanagement.

Elizabeth Jefferson, PhD, CIC, an infection preventionist in the infection prevention and clinical epidemiology department at Scripps Memorial Hospital La Jolla, explained at the annual conference of the Association for Professionals in Infection Control and Epidemiology in June how quick action at her facility stopped 

 that “it’s really important to know that it just takes like one single case. You have to really pay attention and make sure that it stays contained so that you don’t have an outbreak. It just takes one case.”

 of pathogenic threats. The other list categories are “serious” and “watch.” The CDC also encourages quick action when faced with 

 on antibiotic resistant threats, the agency cites a case of a patient in a long-term care facility who tested positive for the disease. “An extensive, aggressive containment response followed that involved screening hundreds of patients. When a new patient was identified as carrying or infected with 

they were immediately put under special precautions to prevent spread. This vigilant action by public health officials and health care facilities helped control the spread of 

in Orange County, protecting hundreds of vulnerable patients.”

 report states: “Approximately 85% of 

 isolates in the United States are resistant to azoles, 33% to amphotericin B, and 1% to echinocandins, based on tentative susceptibility breakpoints…. Echinocandins are thus critical for treatment of 

 infections and are recommended as first-line therapy for most invasive 

 infections…. Echinocandin resistance is a concerning clinical and public health threat, particularly when coupled with resistance to azole and amphotericin B (pan-resistance).”

For the first time, according to the CDC, health care institutions in the United States have to grapple with a form of C. auris that’s resistant to all antibiotic and antifungal treatments.

Deadliest Form of Candida Auris Spotted in the United States

Bug of the Month helps educate readers about existing and emerging pathogens of clinical importance in healthcare facilities today. Each column explores the Bug of the Month's etiology, the infections it can cause, the modes of transmission, and ways to fight its spread. The pathogen profiles will span bacterial, viral, fungal and parasitic species. We encourage you to use Bug of the Month as a teaching tool to help educate healthcare personnel and start a dialogue about microbiology-related imperatives.

Bug of the Month helps educate readers about existing and emerging pathogens of clinical importance in healthcare facilities today. 

Frank Diamond

Articles

Lambda Variant of COVID-19 Might Be Resistant to Vaccines

Can Providers be Blamed for Losing Patience with Vaccine Hesitant?

Deadliest Form of Candida Auris Spotted in the United States

Bug of the Month: I’m Easy to Treat but Difficult to Spot