Eugene Consulting Inc.
408-25 Montgomery Ave
Toronto, ON
M4R 0A1

April/May 2022 Report

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Placental Tissue Destruction and Insuf iciency From COVID-19 Causes Stillbirth andNeonatal Death From Hypoxic-Ischemic Injury: A Study of 68 Cases With SARS-CoV-2
Placentitis From 12 Countries
https://meridian.allenpress.com/aplm/article/doi/10.5858/arpa.2022-0029-SA/
477699/Placental-Tissue-Destruction-and-Insuf iciency - February 10, 2022
- The objective of the study was to evaluate the role of the placenta in causing stillbirth andneonatal death following maternal infection with COVID-19 and con irmed placental
positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)- This was a case-based retrospective clinicopathologic analysis by a multinational group of
44 perinatal specialists from 12 countries of placental and autopsy pathology indings
from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2
following delivery to mothers with COVID-19- SARS-CoV-2 placentitis, as de ined by the coexistent occurrence of 3 microscopic indings—chronic histiocytic intervillositis, increased ibrin deposition, and trophoblast necrosis—was identi ied in 65 of 68 placentas (97%) in this study- Of the 3 indings constituting SARS-CoV-2 placentitis, all 68 placentas had increased ibrin
deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis- Sixty-three placentas had massive perivillous ibrin deposition- Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue
involvement- Other indings included multiple intervillous thrombi (37%; 25 of 68) and chronic villitis(32%; 22 of 68)- The majority (19; 63%) of the 30 autopsies revealed no signi icant fetal abnormalities
except for intrauterine hypoxia and asphyxia- Four autopsied stillborns had SARS-CoV-2 identi ied in internal organs- The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread andsevere placental destruction resulting in placental malperfusion and insuf iciency and inthese cases intrauterine and perinatal death likely results directly from placental
insuf iciency and fetal hypoxic-ischemic injury- However there was no evidence that SARS-CoV-2 involvement of the fetus had a role incausing these deaths- Studies performed at the beginning phase of the current pandemic found that althoughpregnant women in China could develop infection with the newly identi ied coronavirus,
the large majority of infected mothers had either mild or nonexistent symptoms and did
not become more ill than did nonpregnant women of the same age, and that, except for areported increase in premature delivery, there was little or no excess perinatal mortality- Eventually, COVID-19 was found to be associated with adverse pregnancy outcomes
including severe maternal illness as well as neonatal complications-

Eugene Consulting Inc.
408-25 Montgomery Ave
Toronto, ON
M4R 0A1- Anecdotal experiences by pathologists and clinicians together with some publishedreports suggested that increasing numbers of pregnant women infected with SARS-CoV-2
were having stillbirths- This was supported in April 2021 when a cluster of 6 stillborn fetuses and 1 miscarriage
occurred in mothers with COVID-19 from Ireland, and then in May 2021 when apopulation-based cohort study from England demonstrated an increased risk among
pregnant women infected with SARS-CoV-2 for having a fetal death- The association of SARS-CoV-2 infection and stillbirth was con irmed on November 26,
2021, when the US Centers for Disease Control and Prevention reported a populationbased study showing that pregnant women with COVID-19 had an increased risk forstillbirth compared with uninfected women, and that the strength of this association was
highest during the period of the SARS-CoV-2 B.1.617.2 (delta) variant predominanc- Data from these 68 cases support previous case reports suggesting that placental
insuf iciency is responsible for perinatal deaths occurring with SARS-CoV-2 placentitis- SARS-CoV-2 placentitis can cause extensive placental damage as a result of destructive
lesions, and that the damage can be further exacerbated by additional pathology
abnormalities- Increased ibrin and MPFD, chronic histiocytic intervillositis, and trophoblast
necrosis result in sizable destruction of the villous capillary bed accompanied by
obstruction of the intervillous space, causing placental malperfusion andinsuf iciency that are incompatible with intrauterine survival- The fetal hypoxia that ensues can lead to a hypoxic-ischemic fetal demise orneonatal death- Fortunately this sequence of events develops in only a small percentage of pregnant
women having COVID-19

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Study shows persistent antibodies in infants after COVID-19 vaccination in pregnancy
https://www.sciencedaily.com/releases/2022/02/220207124816.htm - February 7, 2022
- A recent study from Massachusetts General Hospital showed vaccination during
pregnancy resulted in more lasting antibody levels in infants, when compared to babies
born to unvaccinated COVID-infected mothers- The study was published in The Journal of the American Medical Association (JAMA)- Titers were higher in vaccinated mothers and their umbilical cord blood at delivery thanin those study participants infected with COVID at 20 to 32 weeks’ gestation- After two months, 98% of the infants (48 of 49) born to vaccinated mothers had
detectable levels of the protective Immunoglobulin G (IgG), the most common antibody
found in blood- At six months, the researchers looked at 28 of the infants born to vaccinated mothers andfound 57% (16 of 28) still had detectable IgG- This was compared with just 8% (1 of 12) born to infected mothers- Limitations to the study: small study cohort, delays in follow-up with the infected group,
reporting of tigers as opposed to clinical outcomesEugene Consulting Inc.
408-25 Montgomery Ave
Toronto, ON
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Moderna aims for fall release of COVID-19 Omicron vaccine
https://globalnews.ca/news/8768889/moderna-omicron-covid-19-vaccine-fall-release/ April 19, 2022
- Moderna hopes to offer updated COVID-19 boosters in the fall that combine its original
vaccine with protection against the Omicron variant- Both Moderna and P izer are testing bivalent shots - a mix of each company’s original
vaccine and an Omicron-targeted version

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FDA authorizes irst COVID-19 breath test
https://www.nbcnews.com/health/health-news/fda-authorizes- irst-covid-19-breath-testrcna24497 - April 14, 2022
https://www.ctvnews.ca/health/ irst-covid-19-test-using-breath-samples-authorized-byu-s-fda-1.5862795 - April 14, 2022
https://globalnews.ca/news/8764652/covid-breath-test-explainer/ - April 16, 2022
- InspectIR Covid-19 Breathalyzer test is the irst COVID-10 test that uses breath samples- It needs to be done by a trained operator under the supervision of a licensed health-careprovider- To collect the sample, the person exhales through their mouth into a tube or single-use
straw connected to the testing kit- An algorithmic software analyzes the subject’s breath to look for speci ic chemistry
associated with COVID-19 and can provide a result in around 3 min.
- The InspectIR Covid-19 Breathalyzer utilizes an instrument called gas
chromatography gas mass spectrometry to separate and identify chemical mixturesand quickly detect ive Volatile Organic Compounds linked with the COVID-19
infection- According to the Centre of Public Environmental Oversight, the GC-MS is one of themost accurate tools for analyzing environmental samples- A green square on the information screen indicates a negative test result and red means
the person is COVID-positive- If this tests positive, it is recommended that one follows up with a molecular test
- With a sensitivity of 91%, the breath test is more accurate than the rapid antigen test
- The InspectIR Covid-19 Breathalyzer was tested in a study of more than 2400 individuals- The tests uses equipment about the size of a piece of carry-on luggage and can be used fortesting in places such as day-care centres, schools, long-term homes, and just outside anoperating room
- The breath test however does not provide information regarding speci ic variants- It is also unknown if it will pick up new variants- InspectIR has not yet released is proving model at his time
- The company expects to be able to produce approximately 100 instruments per week,
which can each be used to evaluate approximately 160 samples per day- The validity of the InspectIR Covid-19 Breathalyzer was tested in a study of 2409 people,
both with and without COVID-19 symptoms

Eugene Consulting Inc.
408-25 Montgomery Ave
Toronto, ON
M4R 0A1- The test was shown to have 91.2% sensitivity (per cent of positive samples
accurately recognized by the test) and 99.3% speci icity in the research (per cent ofnegative samples the test correctly identi ied)
- In a follow-up clinical research focused on the Omicron variant, it was found thatthe test had equal sensitivity- The FDA however has noted that results from InspectIR Covid-19 Breathalyzer should not
be used as the sole basis for treatment or patient management decisions

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Biden Administration expands availability of COVID antiviral pill Paxlovid
https://www.ctvnews.ca/health/coronavirus/biden-administration-expands-availabilityof-covid-antiviral-pill-1.5876305- April 26, 2022
https://theconversation.com/what-is-paxlovid-and-how-will-it-help-the- ight-againstcoronavirus-an-infectious-diseases-physician-answers-questions-on-the-covid-19pill-181998 - April 28, 2022
- The Biden Administration is not taking steps to raise awareness of Paxlovid and making iteasier to access- As part of this initiative, they announced that the drug will now be distributed directly topharmacies, in addition to existing distribution channels run by states- Paxlovid has been proven to bring about a 90% reduction in hospitalization and deaths
among high risk patients when taken within 5 days of symptoms appearing- Paxlovid is made up of 2 protease inhibitors, including one used in treating HIV as abooster medicine- These protease inhibitors block enzymes that viruses need to replicate- Therefore, the combination in Paxlovid prevents the coronavirus from completingits like cycle- It is currently authorized for adults and children age 12 or older with a positive COVID-19
test and early symptoms who face the highest risk of severe outcomes - including thosewith conditions like obesity and heart disease- However, the drug is not recommended for patients with severe kidney or liver
problems- The U.S. has ordered enough supply of the pills for 20 million people - it is estimated that
this will last for several months- The administration is also working to expand the number of tets-to-treat sites thatprovide a one-stop shop for those with COVID-19 to get tested, consult wit ha medical
professional, and ill a prescription for Paxlovid on site
- There are currently 2200 locations nationwide- Some caveats to Paxlovid:- It was studied only in unvaccinated patients so it is unclear how well it works in a
vaccinated population - unsure how much additional bene it it gives on top of
vaccination- Some who could most bene it from Paxlovid are also at highest risk for druginteraction with PaxlovidEugene Consulting Inc.
408-25 Montgomery Ave
Toronto, ON
M4R 0A1

Covid symptoms returning for some after taking Paxlovid
https://www.nbcnews.com/health/health-news/covid-symptoms-may-return-takingpaxlovid-antiviral-pills-rare-cases-rcna25581- April 27, 2022
https://www.aarp.org/health/conditions-treatments/info-2022/paxlovid-covidrebound.html- The FDA is evaluating rare reports that patients treated for COVID-19 with Paxlovid
experience a second round of the disease shortly after recovering- Infectious disease experts stress that such cases of apparent viral rebound are not cause
for alarm as patient who report a return of symptoms are not experiencing severe
symptoms- So far, there are only anecdotal reports- Scienti ic documentation about post-Paxlovid relapse has actually been available sincelast fall- In the placebo-controlled clinical trial, which included 2,246 participants, they
noted that several subjects appeared to have a rebound in SARS-CoV-2 RNA levels
around Day 10 or Day 14 after beginning treatment- People who experience such a rebound can relay their experience to P izer’s portal forreporting Paxlovid-related adverse events- One theory is that a 5-day course of Paxlovid lows the amount of virus in the body, butdoes not remove it all and in the meantime, the immune system takes a back seat while
the antiviral treatment leads the charge- However, when the Paxlovid stops, the virus has a chance to resurrect itself- Researchers are looking into whether extending the course of the drug might solve theissue- They are also exploring whether variants play a role in the newly reported rebound cases,
since Paxlovid was tested when the delta strain was dominant- There is currently no evidence that additional treatment with Paxlovid or other antiSARD-CoV-2 therapies is needed in cases where COVID-19 rebound is suspected

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Early pandemic survivors still report symptoms 2 years later
https://www.medicalnewstoday.com/articles/long-covid-half-of-patients-still-report-atleast-1-symptom-2-years-on - May 25, 2022
- Since the irst cases of COVID-19 were reported in December 2019, many COVID-19
survivors have reported lingering health issues or symptoms that suddenly appear
months and even a year after the initial infection- These are mainly in people who experienced COVID-19 before vaccines weredeveloped- A recent study looked into the current conditions of COVID-19 patients from Wuhan 2
years later- The 2.469 participants in the study had all been discharged from Jin Yin-tan
Hospital between January 7 and May 29, 2020

Eugene Consulting Inc.
408-25 Montgomery Ave
Toronto, ON
M4R 0A1- At 6 months after acute infection, 68% of participants reported symptoms of long
COVID and by 2 years, that number dropped to 55%- Long COVID symptoms at 2 years were related to decreased quality of life, lower
exercise capacity, abnormal mental health, and increased use of healthcare after
discharge- The most common long COVID symptoms after 2 years were muscle weakness or
fatigue and sleep dif iculties - reported by 31% of participants- After 2 years, 89% of participants had returned to their original work
- Long-term sequelae of COVID-19 may be dependent on a number of factors: treatmentsthat patients got when they were acutely ill, number and type of vaccinations theyreceived prior to contracting COVID-19, dose of the virus, host response, as well as thevariant, so it is dif icult to predict the medical future of COVID-19 survivors

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https://globalnews.ca/news/8869117/long-covid-vaccination-older-people/ - May 25,
2022- New U.S research on long COVID-19 provides evidence that it can happen even after
breakthrough infections in vaccinated people and that older adults face higher risks forthe long-term effects- In a study of 13 million veterans published in Nature Medicine (aged 60 on average), 1%
experienced breakthrough infections and of that, 32% showed signs of long COVID- This is compared with 36% of unvaccinated veterans who had been infected anddevelop long COVID- Of the 13 million, 3 million had been vaccinated- The study was done before the highly contagious omicron variant appeared andthus, researchers presume that the number of breakthrough infections have likely
increased- Breakthrough infections and long COVID symptoms were more common among
those who have received Johnson & Johnson’s single-dose shot compared with 2
doses of either Moderna of P izer vaccines- Whether any had recovered booster shots is not known- A separate reports from the Centers for Disease Control and Prevention found that up to ayear after an initial coronavirus infection, 1 in 4 adults aged 65 and older had at least one
potential long COVID health problem, compared with 1 in 5 younger adults- Long COVID refers to any of more than 2 dozens symptoms that linger, recur or appear atleast one month after a coronavirus infection- Vaccinated reduced the chances for any long COVID symptoms by about 15%, although it
cut the risk in half for lingering respiratory or clotting problems- An infectious disease expert who runs a centre for long COVID patients at the Cleveland
Clinic said that the Nature Medicine study mirror what she sees at her clinic- A CDC reported that was recently released used medical records for almost 2 million U.S.
adults form the start of the pandemic in March 2020 to November 2021
- The included 353,000 who had COVID-10

Eugene Consulting Inc.
408-25 Montgomery Ave
Toronto, ON
M4R 0A1- Patients were tracked for up to a year to determine if they developed any of 26
health conditions that have been attributed to long COVID- Those who had COVID were much more likely than other adults without COVID todevelop at least one of these conditions and risks were greatest for those aged 65
and older- Breathing problems and muscle aches were among the most common conditions- Older adults’ risks were higher for certain conditions, including strokes, brain fog,
kidney failure and mental health problems- Information on vaccination, sex and race was not included

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A study deliberately infected healthy volunteers with the SARS-CoV-2 virus was
published in journal Nature Medicine
https://www.ctvnews.ca/health/coronavirus/ irst-covid-19-human-challenge-studyyields-valuable-insights-1.5843948 - April 1, 2022
- Findings from a research study that deliberately infected healthy volunteers with the
SARS-CoV-2 virus was published in journal Nature Medicine- The study began in March 2021 and included 36 volunteers between the ages of 18 and30- All participants were screened for any risk factors for severe COVID-19- The irst 10 infected volunteers got the antiviral drug remdesivir to reduce their chancesof progressing to severe disease- Researchers also had monoclonal antibodies at the ready in case anyone took a turn for
the worse but ultimately, the remdesivir proved unnecessary, and researchers never had
to give anyone antibodies- The volunteers got a tiny drop of luid containing the originally detected strain of thevirus through a long, thin tube inserted into their nose
- They were medically monitored 24 hours a day and stayed for two weeks in rooms at
London's Royal Free Hospital that had special air low to keep the virus from escaping- A total of 18 participants became infected, 2 of whom never developed symptoms- Among those who got sick, their illnesses were mild - stuffy nose, congestion, sneezing
and sore throats- Most of the study participants -83% - lost their sense of smell to some degree- 9 could not smell at all- This got better for most people, but six months after the study ended, there's one
person whose sense of smell isn't back to normal but is improving- Researcher have given this participants cognitive tests to check their short-term
memory and reaction time and believe these tests will be quite informative- None of the volunteers develop lung involvement in their infections- Findings from the study:- Just a tiny virus-laden droplet, about the width of a human blood cell, was enoughto infect someone with COVID-19

Eugene Consulting Inc.
408-25 Montgomery Ave
Toronto, ON
M4R 0A1

f- COVID-19 has a very short incubation period -it takes about two days after infection
for a person to start shedding virus- People shed high amounts of virus before they show symptoms- On average, the young, healthy study volunteers shed virus for 6½ days, butsome shed virus for 12 days
- Infected people can shed high levels of virus without any symptoms- About 40 hours after the virus was introduced, it could be detected in the back of
the throat- It took about 58 hours for virus to show up on swabs from the nose, where it
eventually grew to much higher levels- Lateral low tests, the rapid at-home kind, work really well for detecting when aperson is contagious- The study found that these kinds of tests could diagnose infection before 70
per cent to 80 per cent of viable virus had been generated- Everyone was screened for antibodies to closely related viruses, like the original SARS
virus, meaning it wasn't cross-protection that kept them safe; it was something else
- Blood and tissue samples collected for the study will continue to be analyzed for years tocom- Researchers who conducted this challenge study plan to do another one with vaccinatedpeople infected with the Delta variant to study their immune response