COVID & Other Viruses to Know About, 1/13/25

According to the CDC, as of January 13, 2025, the amount of acute respiratory illnesses causing people to seek healthcare is HIGH.

• COVID levels have increased across most of America and are HIGH. COVID levels are VERY HIGH in the Midwest and HIGH in the Northeast and South. Only the West is still MODERATE.

• Flu activity is HIGH everywhere in America.

• RSV is VERY HIGH in most parts of the country especially in young children.

From: https://www.cdc.gov/respiratory-viruses/data/index.html

SARS-CoV-2

Data through January 8, 2025 shows that most states are at least HIGH for COVID on Sara Anne Willette’s scale, including Arizona which has “Dizzying” levels of SARS-CoV-2

From Sara Anne Willette: https://iowacovid19tracker.org/

The good news is that it appears that emergency department visits for COVID have peaked and are starting to decline. Michigan, Maine, New Hampshire and South Dakota had slightly higher peaks for COVID emergency department visits in December as compared to their summer 2024 wave. For most other states, COVID peaks were significantly lower this winter per JP Weiland.

Vaccines

When you get a tattoo, the ink does not only stay in the skin. A new article shows that the tattoo ink also accumulates in macrophages in the lymph nodes causing systemic and local inflammation that kills some of the macrophages and makes others not work properly. The inflammation from the tattoo pigments weakens the immune response to the COVID vaccine for months leading to lower antibody production. The increased macrophage cell death can also cause the person (or mouse) to become more susceptible to infections. Effects vary by ink color and can persist for months.

Long COVID

A study of 1,300 consecutive Long COVID patients at Northwestern looked at whether vaccination prior to contracting COVID infection impacts neurological symptoms of Long COVID. They found that vaccination prior to infection did not appear to change cognitive and neurological symptoms of Long COVID, though pre-existing vulnerabilities may influence development​ of neurologic symptoms. Logically though, people can only get Long COVID if they have had a COVID infection. So, by reducing COVID infections, vaccination reduces Long COVID overall.

A case series report from Patient-Led Research Collaborative looked at 13 individuals with Long COVID who used extended courses of Paxlovid (nirmatrelvir/ritonavir), ranging from 7.5 to 30 days. Results were mixed- 5 people reported lasting improvement, 4 people with Long COVID had temporary improvement, and 4 people had no improvement. Extended antiviral therapy appears to benefit some people with Long COVID, but further research is needed to understand the optimal duration of treatment.

Long COVID Labs is crowdfunding to do clinical trials to find treatments for Long COVID by selling a crypto coin called $COVID. The auction is live through January 17, 8am PT here. The first trial planned will study combination treatment for Long COVID using an antiviral medication (Paxlovid) and monoclonal antibodies (Pemgarda) to try to get rid of SARS-CoV-2 viral reservoirs in the body. A similar combination cured founder Rohan Dixit of Long COVID, which he explains in this 2 minute video. Here is a clip of me from last week talking about my daughter who has Long COVID and the Long COVID Labs project.

H5N1 Bird Flu

The person in Louisiana who was hospitalized with H5N1 Avian Flu died this week. According to the WHO, about 50% of H5N1 human cases will die from the disease, but that is probably an overestimate since many human cases that are mild and are not factored into the calculation. Still, the mortality rate for humans who get a severe case of H5N1 is significant.

As infectious disease specialist Dr BK Titanji posted about the death of the H5N1 patient from Louisiana, “This is sad news. It is also a reminder that influenza virus infections can be severe and even lethal. The more H5N1 spreads unchecked the higher the likelihood of human infections. Some of these cases will not be mild.”

According to the CDC, more than 2,700 Americans including 11 children have died from seasonal influenza so far this year. The CDC recommends that everyone ages 6 months and older get an annual influenza (flu) vaccine. It is not too late.

The CDC randomly tests samples that are positive for Influenza A to see if they are the H5 type. A child from San Francisco tested positive for H5N1 avian flu this week. The child had symptoms of fever and conjunctivitis and has since fully recovered. The source of H5N1 for the child is unknown.

HMPV

I have seen on social media that some people are concerned about a surge of human metapneumovirus (HMPV) cases in China. Experts say that the HMPV surge can be attributed to the regular seasonal spike of this virus that affects almost all children at least once by age 5. Respiratory viruses like HMPV are known to circulate widely in the winter. Wearing a mask and washing hands can help reduce the spread of this common virus.

Wastewater HMPV levels in the United States now are not as high as they were last spring.

From: https://data.wastewaterscan.org/

Herpes Viruses and Dementia

Years of epidemiological data have shown that herpes infections raise the risk of Alzheimer’s disease in some people. Using a 3D human brain tissue model, researchers found that repeat mild brain injuries such as concussions can reactivate latent herpes simplex virus type 1 (HSV-1), leading to neurodegeneration and Alzeheimer’s dementia, especially in individuals carrying the APOE4 gene.

I find this fascinating given the article last week showing that incubating inactivated herpes simplex 1 virus (HSV-1) or SARS-CoV-2 virus with human cerebrospinal fluid (CSF) caused proteins in the CSF to make amyloid because of surface properties related to a process called heterogeneous nucleation (HEN). Amyloid proteins are implicated in both Alzheimer’s disease and in Parkinson’s disease.

A vaccine against another virus from the herpes family, Varicella Zoster virus (VZV), has been shown to reduce the risk of dementia. VZV causes the chicken pox and shingles which is a painful rash often seen in older adults. Getting the recombinant shingles vaccine significantly reduced the risk of dementia for at least 6 years after vaccination. As of now, there are no vaccines yet against HSV-1.

Other news:

My heart goes out to people affected by the wildfires in Southern California which have been hard to contain because of dry conditions and the Santa Ana winds. Firefighters from California, Mexico, Canada and other countries are working together to try to extinguish the blazes. If you would like to donate to help wildfire victims and firefighters, here are some links: Red Cross, World Central Kitchen, Los Angeles Fire Department Foundation and others. Also, N95 masks are available at Los Angeles public libraries.

The crazy U.S. health system

Primary care fields including Pediatrics, Family Practice and Internal Medicine are having trouble filling their residency slots. Low pay, high administrative burdens such as prior authorizations and little administrative support make these fields less desirable leaving many communities with a shortage of primary care providers.

This week, The Lown Institute's Shkreli Awards announced their annual “winners” for the most egregious US healthcare profiteering. The top 10 included Cigna refusing to pay for a baby who had to be flown to a medical center and sending the mother a $97,599 bill and United Healthcare pressuring doctors to spend less time with patients, but charge more.

Private equity firms have been buying up US hospitals over the last 10 years as investments. Not surprisingly, an article in JAMA shows that when private equity firms acquire hospitals, patient care experiences are worse.

The Consumer Financial Protection Bureau (CFPB) finalized a rule last week removing an estimated $49 billion in medical debt from credit reports. Debt due to unpaid medical bills have made it hard for many Americans to get mortgages, car loans or small business loans. The rule aims to prevent coercive debt collection practices and should raise credit scores for many Americans.

The Brain

Eric Topol MD wrote a very interesting article this week reviewing new data on how the brain gets rid of chemical waste during sleep via the glymphatic system and from brain blood vessel oscillations. He discusses, “How sleep prevents "dirty" brains that age faster.”

Other news

The world’s oldest known wild bird, Wisdom, has laid an egg at the age of 74. Typically, Laysan albatross birds live to about age 68 and lay about 1 egg per year as adults. The new egg is estimated to be Wisdom’s 60th egg laid during her lifetime.

Photo by Dan Rapp, USFWS

I’ll be taking off next week from the newsletter.

Have a great week,

Ruth Ann Crystal MD

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NOTES & CHARTS

Respiratory Illnesses Data Channel

https://www.cdc.gov/respiratory-viruses/data/index.html

• As of January 13, 2025, the amount of acute respiratory illness causing people to seek healthcare is at a high level.

• COVID-19 activity has increased in most areas of the country.

• Seasonal influenza activity remains elevated across the country.

• RSV activity is very high in many areas of the country, particularly in young children.

CDC Respiratory viruses (COVID, Flu, RSV) Hospitalizations (for those states reporting): https://www.cdc.gov/resp-net/dashboard/index.html

Benjy Renton & Jeremy Faust’s data viz: https://public.tableau.com/app/profile/benjamin.renton/viz/InsideMedicineCOVID-19MetricsDashboard/Dashboard1

National virus levels by region per WastewaterSCAN:

COVID notes:

US Variant tracker: https://covid.cdc.gov/covid-data-tracker/#variant-proportions

Will update next week. Data through 12/21/24.

CDC COVID data tracker: https://covid.cdc.gov/covid-data-tracker/index.html#datatracker-home

COVID Emergency Dept visits: https://covid.cdc.gov/covid-data-tracker/#ed-visits_all_ages_combined

Walgreens positivity rate: https://www.walgreens.com/businesssolutions/covid-19-index.jsp

US Wastewater Monitoring:

CDC wastewater reporting: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html

Data through 1/4/25.

CDC wastewater map: https://www.cdc.gov/nwss/rv/COVID19-currentlevels.html

National SARS-CoV-2 data from Sara Anne Willette: https://iowacovid19tracker.org/

Data through January 8, 2025 shows that most states are at least HIGH or VERY HIGH on her scale, including Arizona which is Dizzying,

Wastewater SCAN: https://data.wastewaterscan.org/

California statewide view https://buff.ly/3YObiul

California SARS-CoV-2 in Wastewater from CDPH: https://skylab.cdph.ca.gov/calwws/

Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater

Marin county: https://coronavirus.marinhhs.org/surveillance

COVID deaths per week: https://covid.cdc.gov/covid-data-tracker/#trends_weeklydeaths_weeklypctdeaths_00

JP Weiland: https://twitter.com/JPWeiland

1/10/25 JP Weiland:

https://x.com/JPWeiland/status/1876421949452337202

Michael Hoerger modeling: http://pmc19.com/data/, https://twitter.com/michael_hoerger

CDC Forecasting of expected EPIDEMIC GROWTH of SARS-CoV-2: https://www.cdc.gov/forecast-outbreak-analytics/about/rt-estimates.html

Tara Moriarty Canadian COVID data: https://x.com/MoriartyLab

Canada wastewater https://health-infobase.canada.ca/wastewater/

UK:

UKHSA Dashboard: https://ukhsa-dashboard.data.gov.uk/

1/9/25 Prof Christina Pagel:

UK COVID PCR Test Positivity Map: https://jamestindall.info/skeuomorphology/ladb_covid/index.html

International@nichtGenes61287

Acute COVID infections, General COVID info

1/6/25 Nature Communications Biology: The identification of a SARS-CoV2 S2 protein derived peptide with super-antigen-like stimulatory properties on T-cells https://buff.ly/3DYrcf2

Preprint discussed last month here:

11/27/24 BioRxiV (U Montreal): The identification of a SARs-CoV2 S1 protein derived peptide with super-antigen-like stimulatory properties on T-cells https://buff.ly/4fMsic4

A small peptide called P3 in the SARS-CoV-2 spike protein acts like bacterial superantigens Staphylococcal Enterotoxin B (SEB) and Staphylococcal Enterotoxin H (SEH). “Like SEB and SEH peptides, P3 stimulated 25-40% of human CD4+ and CD8+ T cells, increasing IFN-γ and granzyme B production.”

Vaccines

1/3/25 BioRxiV: Tattoo ink induces inflammation in the draining lymph node and impairs the immune response against a COVID-19 vaccine https://buff.ly/421u8BU

Long COVID

1/7/25 Brain Communications: Vaccination prior to SARS-CoV-2 infection does not affect the neurologic manifestations of long COVID https://buff.ly/3Wd04j0

A study of 1,300 consecutive Long COVID patients at Northwestern.

Vaccination prior to infection did not appear to alter cognitive and neurological symptoms of Long COVID, though pre-existing vulnerabilities may influence its development​.

1/7/25 Northwestern: New research finds COVID-19 vaccination prior to infection does not affect the neurological symptoms of long COVID https://buff.ly/4aapiEv

@m-cost.bsky.social‬

“Working backwards: if you don’t get Covid you can’t get long covid, so the fewer people that get it or are less likely to spread it the better. So public vaccination is currently the only way to prevent the neurological complications of long covid.

Get vaccinated, stay vaccinated.”

1/6/25 Nature Communications Medicine: Impact of extended-course oral nirmatrelvir/ritonavir in established Long COVID: a case series https://buff.ly/3DMLvfH

1/6/25 NY Times: Paxlovid Improved Long Covid Symptoms in Some Patients, Researchers Report https://buff.ly/4gWYhqa

Patient Led: 13 case studies of using extended Paxlovid (7-30 days) for Long Covid.

Results were mixed: 5 reported lasting improvement, 4 temporary improvement, and 4 no improvement.

H5N1

1/10/25 San Francisco: Presumptive Bird Flu Case Identified In San Francisco Resident https://buff.ly/3PyPWgB

A child from San Francisco has tested positive for H5N1 avian flu. The child had symptoms of fever and conjunctivitis and has since fully recovered. The source of H5N1 is unknown.

1/6/25 CNN: America’s first bird flu death reported in Louisiana https://buff.ly/4h8xoPY

BK. Titanji‬ ‪@boghuma.bsky.social‬

This is sad news. It is also a reminder that influenza virus infections can be severe and even lethal. The more #H5N1 spreads unchecked the higher the likelihood of human infections. Some of these cases will not be mild.

https://www.cdc.gov/fluview/surveillance/2024-week-52.html

• Two pediatric deaths associated with seasonal influenza virus infection were reported this week, bringing the 2024-2025 season total to 11 pediatric deaths.

• CDC estimates that there have been at least 5.3 million illnesses, 63,000 hospitalizations, and 2,700 deaths from flu so far this season.

• CDC recommends that everyone ages 6 months and older get an annual influenza (flu) vaccine.

• There are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for patients at higher risk for severe illness.2

1/6/25 BioRxiV: Polymerase mutations underlie adaptation of H5N1 influenza virus to dairy cattle and other mammals. https://buff.ly/40qKW47

HMPV

1/7/25 BBC| HMPV: What to know about China's human metapneumovirus cases https://buff.ly/40oL1Fd

"Almost every child will have at least one infection with HMPV by their fifth birthday and we can expect to go on to have multiple reinfections throughout life," says Paul Hunter, a medical professor at University of East Anglia in England.

"So overall, I don't think there is currently any signs of a more serious global issue."

Other news:

Southern California Wildfires

1/8/25 CBS: Shortage of primary care doctors in U.S. comes down to money — and respect https://buff.ly/4fQsFS9

1/7/25 The Guardian: Annual ‘winners’ for most egregious US healthcare profiteering announced https://buff.ly/4fUlWqe

1/925 JAMA: Changes in Patient Care Experience After Private Equity Acquisition of US Hospitals https://buff.ly/40r8oxR

1/7/25 Consumer Financial Protection Bureau: CFPB Finalizes Rule to Remove Medical Bills from Credit Reports https://buff.ly/407vLez

1/12/25 Eric Topol: Our Sleep, Brain Aging, and Waste Clearance https://buff.ly/4gQwcku

“It’s [Sleep] like turning on the dishwasher before you go to bed and waking up with a clean brain” — Maiken Nedergaard

Herpes Viruses and Dementia

1/7/25 Science: Repetitive injury induces phenotypes associated with Alzheimer’s disease by reactivating HSV-1 in a human brain tissue model https://buff.ly/401xmCG

1/7/25 STAT News: Using lab-grown human mini-brains, scientists find links between head trauma, herpes, and Alzheimer’s https://buff.ly/4hoaNPR

Research suggests concussions could awaken latent infections in the brain and lead to dementia

Decades of epidemiological data have shown that infections with herpes simplex virus type 1, or HSV-1 can raise the risk of Alzheimer’s disease in certain people. So can a history of head injury. The new research, published Tuesday in Science Signaling, is the first to connect the dots between them, and adds to mounting evidence that this most common form of dementia can be caused by an everyday microbe.

Last week’s article on HSV-1 and SARS-CoV-2 and Amyloid

11/7/24 ACS Chemical Neuroscience (Sweden): SARS-CoV-2 and HSV-1 Induce Amyloid Aggregation in Human CSF Resulting in Drastic Soluble Protein Depletion https://buff.ly/408YBMQ

“Importantly, UV-inactivation of SARS-CoV-2 does not affect its ability to induce amyloid aggregation, as amyloid formation is dependent on viral surface catalysis via HEN and not its ability to replicate.”

7/25/24 Nature: The recombinant shingles (varicella zoster) vaccine is associated with lower risk of dementia https://buff.ly/40taEVz

https://www.nature.com/articles/s41591-024-03201-5

12/6/24 AP: World's oldest-known wild bird lays an egg in Hawaii at age 74 https://buff.ly/41sSW5c

A 74 year old albatross bird has laid her 60th egg. Typically, Laysan albatross birds live to age 60 and lay about 1 egg per year as adults.