COVID news 10/21/22
COVID news 10/21/22
Hi all,
It appears that cases in Europe and in Singapore and Taiwan are peaking and appear to be on their way down. Singapore's wave is from the XBB variant which is showing a 17% reinfection rate. Singapore started their bivalent vaccine program this week and cases are expected to decrease because of this as well. Many places in Europe have recently had a BA.5 wave, but BQ.1.1 is starting to increase in some European countries and may drive a new increase in cases.
Here in the United States, BQ.1 and BQ .1.1 rates are almost doubling every week and together account for 16.6% of reported cases this week. The good news is that the new bivalent booster should protect better against BQ.1.1 as it is a descendent of BA.5. Dr.Fauci predicts that a new wave of infection from the BQ.1(1) variant will peak in late December 2022/early January 2023 in the United States. We are starting to see an uptick in wastewater virus levels in the northeastern United States and hospitalizations are starting to increase in New York. In the United States as a whole, COVID hospitalizations have increased over the last three days.
All vaccinated people over age 5 qualify to receive the updated bivalent booster vaccine. A new report from the CDC this week shows that in immunocompetent people, vaccine efficiency against COVID hospitalization from the monovalent vaccines decreased significantly to only about 30 to 40% protection by four months post-vaccination as immunity waned. Bivalent boosters are now even more important because the new variants descend from Omicron. A report from Moderna this week, showed that the Moderna COVID vaccine for children ages six months to five years of age is safe and has similar vaccine efficiency to that seen in older children and adults.
The CDC Advisory Committee on Immunization Practices (ACIP) had a meeting in the last several days where they reviewed COVID vaccines in pregnancy. The ACIP data shows that the vaccines are vaccines and boosters are safe in pregnancy-- there is no increase risk of miscarriage or birth defects in babies born to people who had COVID vaccines in pregnancy. A COVID infection however can be extremely dangerous for both mother and baby during pregnancy. In fact, a new study showed that in 2020 to 2021, 25% of maternal deaths in pregnancy were related to COVID. In addition, 58% of pregnant people are either unvaccinated or under vaccinated making them more susceptible to COVID infections.
ACIP data also showed that maternal COVID-19 primary series vaccination protected infants ages 0-5 months from hospitalization for COVID-19. Protection was lower during Omicron than Delta predominance probably because of the mismatch of the original vaccines, but the Bivalent booster is expected to increase protection. This is important since babies ages 0 to 5 months are much more likely to be hospitalized with COVID infections than with Influenza infections.
This week, there were a lot of articles about myocarditis. CDC data showed that there is no increased risk of myocarditis in children ages six months to five years who have been vaccinated with the mRNA Covid vaccines. For teenagers, the risk of getting myocarditis from a COVID infection was shown to be 1.8 to 5.6 times higher than the risk of adverse cardiac outcomes from mRNA COVID vaccination. A new study reported from Israel this week showed that although vaccine-induced myocarditis from the Pfizer BioNTech mRNA vaccine is rare in 12 to 15 year olds, if a teen does get vaccine-related myocarditis, it is mild and has a benign course unlike myocarditis from a COVID infection. A new review of myocarditis in the New England Journal of Medicine this week showed that COVID infections cause 24 to 41 cases of myocarditis per 100,000 people, but that only 0.3 to 5 people per 100,000 will get myocarditis from vaccination in the highest risk groups. Despite all of the data from multiple sources showing that the risks of myocarditis from COVID infection are much, much greater than the risks of myocarditis from mRNA vaccination in all age groups, today the Wall Street Journal published an op-ed from the Florida surgeon general, Dr. Lapado, containing the same misinformation that he touted in a letter last week. To quote Eric Topol, "for WSJ to print this seriously flawed claim about cardiac deaths in men age 18-39 is inappropriate, to say the least."
Finally, there was an interesting article in the Financial Times about the politicization of science in the United States that you may want to read.
Have a good weekend,
Ruth Ann Crystal MD
US Cases via NY Times: https://www.nytimes.com/interactive/2021/us/covid-cases.html
https://ourworldindata.org/coronavirus
Cases in Europe and Singapore, Taiwan seem to have peaked.
Variant tracker in US: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
On the rise: BQ.1 and BQ.1.1 (16.6%):
BQ.1 over the last 4 weeks: 1.8% → 3.4% → 5.8% → 9.4%
BQ.1.1 over last 4 weeks: 0.9% → 1.7% → 3.6% → 7.2%
BF.7 (7%) is increasing by about 1% per week
On the decline: BA.5. Also BA.4.6 is stable and not increasing.
Wastewater Monitoring:
CDC Wastewater Monitor https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance
Biobot: https://biobot.io/data/
Wastewater rise in virus in Northeast
Bay Area: Sewer Coronavirus Alert Network (SCAN) project by Stanford University
10/21/22 Fortune: Two BQ variants are continuing to spread in the U.S. Together, they just took the Number 2 spot https://buff.ly/3ePmdS2
New bivalent booster should protect better against BQ.1 and BQ.1.1 because they are descendants of BA.5.
Dr. Fauci predicts infection wave to peak late December 2022 or early January 2023.
10/21/22 WSJ publishes Florida Surgeon General Dr. Lapado’s misinformation on vaccines and myocarditis https://buff.ly/3TGQmBv
10/20/22 NY State hospitalizations are increasing https://coronavirus.health.ny.gov/daily-hospitalization-summary
10/20/22 CDC ends daily updates. Hospitalizations increased over the last 3 days.
10/20/22 CDC MMWR: Effectiveness of Monovalent mRNA Vaccines Against COVID-19–Associated Hospitalization Among IMMUNOCOMPETENT Adults During BA.1/BA.2 and BA.4/BA.5 Predominant Periods of SARS-CoV-2 Omicron Variant in the United States https://buff.ly/3eReX86
VE against hospitalization in the first 120 days after 3rd dose monovalent mRNA vaccine:
BA.1/BA.2: 79% VE for <120 days → 41% VE after 120 days
BA.4/5: 60% VE for <120 days → 29% VE after 120 days
60% VE against hospitalization for the monovalent mRNA vaccine for the original virus is not great. It is very different from the 80 to 90% VE against hospitalization that was seen prior to Omicron.
Eligible adults aged ≥18 years should receive an updated bivalent COVID-19 mRNA vaccine to maximize protection against BA.4/BA.5 lineages and to prevent COVID-19–associated hospitalization.
10/20/22 AP: US clears Novavax COVID booster dose https://buff.ly/3Diq43u
Novavax booster is for people 18+ who cannot get mRNA boosters.
It must be used as a first time booster, 6 months after primary vaccination.
48% of Americans who received their primary vaccinations have never received that all-important first booster.
10/20/22 CNBC: Millions at risk of losing health insurance if U.S. ends Covid public health emergency in January https://buff.ly/3SkN5GU
HHS estimates up to 15 million people would be disenrolled from Medicaid and the Children’s Health Insurance Program.
The end of the public health emergency will also result in reduced food benefits for the poor and could impact vaccine access at pharmacies among many other consequences.
10/20/22 NEJM: Myocarditis, a review https://buff.ly/3F7EVyG
In patients hospitalized for Covid infection, 24 - 41 people/100,000 have probable myocarditis.
mRNA vaccines are associated with 0.3 to 5 cases/100,000.
10/20/22 NEJM: Myocarditis after Pfizer BNT162b2 Vaccination in Israeli Adolescents https://buff.ly/3EWgrZt
n = 182,605 adolescents age 12 to 15
Vaccine-induced myocarditis was rare (4.8 per 100,000) and the course was mild and benign over a 6 month follow up.
10/19/22 NEJM: Moderna mRNA-1273 Vaccine in Children 6 Months to 5 Years of Age https://buff.ly/3TzhbYy
Randomized, placebo-controlled trial of the 2-dose Moderna vaccine in children 6 months to 5 years, during Omicron.
Vaccine found to be safe in approximately 4,800 kids with a good immune response.
“In children 6 months to 5 years of age, a two-injection primary series of mRNA-1273 at a dose of 25 μg had an acceptable safety profile and elicited immune responses that were consistent with those observed in clinical trials that involved higher doses of this vaccine in older children, adolescents, and adults.”
10/20/22 USA Today: COVID-19 contributed to about 25% of maternal deaths from 2020 to 2021, government report finds https://buff.ly/3saVUsv
COVID-19 can contribute to pregnancy complications, severe illness and death.
The rise in maternal deaths affected Black and Hispanic mothers more during this period than White women.
In addition, preterm births and low birth weights were more prevalent.
10/19/22 CDC: COVID-19 in pregnant people and infants age 0 to 5 months and vaccination protection
(63 slide presentation)
Slide 50:
COVID-19 vaccines can be given at the same time as the Flu vaccine and Tdap (pertussis) vaccine.
Pregnancy is a risk factor for severe COVID-19 illness including ICU, ventilation, ECMO.
COVID infections can be dangerous for mother and baby.
Vaccination in pregnancy:
57% of pregnant people are unvaccinated or under-vaccinated.
Only 43% of pregnant people have received primary series plus monovalent booster.
No increase in miscarriage (spontaneous abortion) or birth defects from maternal vaccination early in pregnancy.
The Vaccine Safety Datalink shows that the vaccine is safe in pregnancy.
The CDC recommends that people who are pregnant or who may become pregnant or who are breastfeeding should get the primary vaccine series and the updated (bivalent) mRNA booster.
Infants 0 to 5 months of age:
Among infants 0-5 months of age with COVID-19-associated hospitalizations
Only 24% had an underlying health condition (prematurity was the most frequent)
18% were admitted to the intensive care unit (ICU)
265 infants died of COVID
Maternal COVID-19 primary series vaccination protected infants ages 0-5 months from hospitalization for COVID-19.
Protection was lower during Omicron than Delta predominance probably because of the mismatch of the original vaccines but the Bivalent booster is expected to increase protection.
10/21/22 Katelyn Jetelina: ACIP meeting: Updated info on COVID-19, vaccine safety for kids and pregnancy https://buff.ly/3z1pi8u
Advisory Committee on Immunization Practices (ACIP) meeting
ACIP recommended that COVID-19 vaccines be added to routine vaccine schedule for children
Children: COVID hospitalization
The hospitalization rate among children aged 6 months-4 years remains the highest compared to other pediatric age groups. This is likely due to suboptimal vaccination.
Children and Myocarditis:
No increased risk for myocarditis following mRNA vaccination in children ages 6 months–5 years
Risk of myocarditis is rare in adolescent and young adult males within the first week after receiving the mRNA vaccine.
Getting a COVID infection is worse: The risk of adverse cardiac outcomes were 1.8 – 5.6 times higher after SARS-CoV-2 infection than after mRNA COVID-19 vaccination among males ages 12 – 17 years.
Interval of 8 weeks between vaccine doses may further lower myocarditis risk
COVID vaccination in Pregnancy:
Effectiveness of the mother’s vaccination in preventing hospitalization of the child after infection was 80-90% during the Delta wave and 60% during the Omicron waves.
Good news since the rate of death from COVID infection in infants age 0 to 5 months is higher than other age groups.
This is fantastic news, especially given infection among children aged 0-5 months is leading to much higher hospitalization rates than the flu.
10/19/22 Sci Am: Which Animals Catch COVID? This Database Has Dozens of Species and Counting https://buff.ly/3s6OdDy
10/19/22 Nature: Signs of immunosenescence correlate with poor outcome of mRNA COVID-19 vaccination in older adults https://buff.ly/3s6rCXR
Pfizer vaccine
There is an age-dependent reduction of SARS-CoV-2 neutralizing antibodies, Spike-specific IgG memory B cells (MBCs) and T cells in vaccinated individuals.
(Another reason why boosters are important in older age groups.)
10/13/22 MedRxiV: Atypical B cells and impaired SARS-CoV-2 neutralization following booster vaccination in the elderly https://buff.ly/3DaRSq9
AstraZeneca vaccine
Expansion of atypical B cells and impaired T cell responses may contribute to the generation of less affinity-matured antibodies, with lower neutralizing capacity after third dose booster in the elderly.
10/18/22 JAMA: Association of mRNA Vaccination With Clinical and Virological Features of COVID-19 https://buff.ly/3MVoR5n
n = 1199
Among a cohort of US frontline and essential workers, recent vaccination with 2 or 3 mRNA vaccine doses, compared with being unvaccinated, was associated with milder COVID-19 symptoms and lower viral RNA load for Delta and Omicron breakthrough infections.
COVID-19 was milder and potentially less transmissible among people who got infected with a Delta or Omicron variant within about 5 months after their second or third dose of an mRNA vaccine.
10/18/22 Nature (Acta Pharmacologica Sinica): Endothelial dysfunction in COVID-19: an overview of evidence, biomarkers, mechanisms and potential therapies https://buff.ly/3VDbKJF
Endothelial cells line blood vessels throughout the body. COVID-19 is a (micro)vascular and endothelial disease.
Review of biomarkers associated with endothelial cell activation in COVID-19, molecular basis of endothelial activation/dysfunction in macro- and micro-vasculature of COVID-19 patients.
10/17/22 SF Chronicle: A long-hidden disease is pulled from the shadows by its cousin, long COVID https://buff.ly/3yMqkVq
ME/CFS
Stanford ME/CFS Collaborative Research Center started by Dr. Ron Davis, father of Whitney Dafoe https://buff.ly/3yZ35rC
What Is ME/CFS? - Open Medicine Foundation https://buff.ly/3F6QyGe
AXA1125 | Axcella Health Inc. https://buff.ly/3F2Nkn7
Center for Complex Diseases, Mtn View,CA https://www.centerforcomplexdiseases.com/
10/17/22 Mike Honey
10/17/22 Belgium is serious about the bivalent boosters. The U.S., not so much.
10/16/22 FT: Tragic Fallout from the Politicization of Science in the US https://buff.ly/3eBTbFj
Over the past 18 months, the politicization of attitudes to science may have directly cost as many as 60,000 American lives.
Since vaccines became available, Covid death rates are now almost 3x higher in Republican areas than Democrat-dominated ones
Depth of politicization and polarization in the US far outstrip what we see anywhere else in the developed world.
By May 2021, with all US adults eligible for vaccination, less than half of Republicans had taken up the offer, compared to 82% of Democrats.
In Britain, Labour and Conservative voters alike turned up in droves, with 90% of eligible adults inoculated.
Even among backers of the populist, anti-establishment Reform party in the UK, 70% were vaccinated.
@CorneliusRoemer’s venn diagram showing that BQ.1.1 and XBB contain many of the same mutations. Eric Topol highlights non-shared mutations that are located at the same position on the spike protein.
10/17/22 Human induced pluripotent stem cell-derived salivary gland organoids model SARS-CoV-2 infection and replication - Nature Cell Biology https://buff.ly/3TaeHQu
SARS-CoV-2 derived from saliva in asymptomatic individuals may participate in the spread of the virus.
Human induced salivary glands (hiSGs), generated from human induced pluripotent stem cells, may be a promising model for investigating the role of salivary glands as a virus reservoir.
10/17/22 Nature Reviews Nephrology: Therapeutic advances in COVID-19 https://buff.ly/3eEZB6A
Review of clinical evidence for these therapies through a kidney medicine lens.
10/17/22 eLife Sciences (UC, Stanford): Early immune markers of clinical, virological, and immunological outcomes in patients with COVID-19: a multi-omics study https://buff.ly/3eB4nlq
n = 108
Variations in early immune responses are associated with disease severity in COVID-19 patients.
RIG-I levels, early IFN signaling, and related cytokines (CXCL10, MCP1, MCP-2, and MCP-3) associated with subsequent disease progression, control of viral shedding, and the SARS-CoV-2-specific T cell and antibody response measured up to 7 months after enrollment.
10/15/22 Singapore Minister of Health (MOH) on the latest XBB wave https://buff.ly/3D1XhQr
XBB peak in Singapore is expected to be higher than the BA.5 wave.
High percent of reinfections, especially if the last COVID infection was more than 4 to 6 months ago. (17% reinfections means that this is a more immune evasive variant.)
Bivalent booster vaccines just started to be rolled out 10/14/22. MOH recommends it especially for people over age 50.
10/16/22 Nature: Human leukocyte antigen (HLA) alleles associate with COVID-19 vaccine immunogenicity and risk of breakthrough infection https://buff.ly/3eyVLfj
People with HLA-DQB1*06 alleles who were vaccinated with AstraZeneca vaccine made more RBD antibodies, had longer B cell responses and were less likely to experience PCR-confirmed breakthrough COVID infection.
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