COVID news 10/28/22
COVID news 10/28/22
Hi all,
The BQ.1(1) variants now make up 27% of the SARS-CoV-2 variants in the United States this week. In US Region 2 (which includes New York), BQ.1 and BQ.1.1 make up 42.5% of cases. Over 50% of cases in France are now made up by BQ.1(1) and, in fact, it looks like case numbers there are coming down as are hospitalizations. We see cases have peaked and are going down in Singapore (XBB), France (BQ.1.1) and Germany (BQ.1.1). Of note, most children and families are on vacation in Europe for 2 weeks and this could have an effect on reported cases.
This week, there were 2 small studies from Columbia University and Harvard University showing that the bivalent COVID boosters produce similar neutralizing antibodies (nAbs) levels against BA.5 as the monovalent booster does. Some people were concerned that the new boosters will not work as well because of immune imprinting. In the two studies, researchers measured neutralizing antibody levels from vaccinated people against pseudoviruses in a petri dish. We will have to wait to see the actual vaccine efficiency data on bivalent boosters in prevention of infections, but that will take a few months.
The bivalent boosters are expected to protect against hospitalizations and deaths from Omicron BA.5 at least as well as, if not better than, the monovalent booster. To quote the Bloom lab, “Some of the discrepancy [bivalent antibody production vs monovalent vaccine antibody production to BA.5] could also be due to looking at memory B cells versus serum antibodies. Beneficial adaptations in B cells may not clearly manifest in serum antibodies until next [virus] exposure.” As our first vaccinations were against the original SARS-CoV-2 virus and not Omicron, our B cells have been primed and respond at a certain level. It may be that when a person who has had the bivalent vaccine (original virus + BA.5) has a new exposure to BA.5 either through a second dose of vaccine or exposure to the actual virus, memory B cells will then mature and make a higher dose of neutralizing antibodies to BA.5. The human immune system is complex.
Booster doses are very important because immunity from vaccines and prior COVID infections wanes overtime. Boosters increase neutralizing antibodies and broaden humoral (B cell) and cellular (T cell) immunity in addition to protecting against severe clinical disease and deaths. Monoclonal antibody treatments no longer work against the newest SARS-CoV-2 variants making a booster even more important now. Unfortunately, a recent poll by the KFF showed that 40% of older adults did not even know that they need to get the bivalent booster. It is imperative to make clear public health messaging.
President Biden announced this week that there are several new initiatives from the federal government to help fight COVID. First, Walgreens will team up with DoorDash and Uber to provide free delivery of Paxlovid directly to people in underserved communities. The government will also sponsor the "Vax Up America Vaccine Tour," with pop-up vaccination events including one at the 2022 NASCAR Cup Series Championship in Arizona next month. Medicare will be reaching out to seniors via email and telephone to provide information about the updated COVID-19 booster vaccines and how to get them. In addition, the White House will release the “Fall Playbook for Businesses” on how to manage COVID-19 with recommendations for companies to offer employees time off to get vaccinated and for colleges and schools to host onsite vaccine clinics before Thanksgiving.
This week there was good news about nasal vaccine boosters. Yale’s Dr. Iwasaki’s lab reported in Science magazine that their nasal spray booster vaccine worked in mice to protect against all sarbecoviruses including SARS-CoV-2. Using an injected primary vaccine (prime) first followed by the nasal vaccine booster (spike) containing proteins from several sarbecoviruses, the nasal vaccine protected mice against the viruses without needing to use an adjuvant or a live-attenuated virus. “Prime and Spike” induced robust resident memory B and T cell responses, IgA at the respiratory mucosa, boosted systemic immunity, and completely protected mice from SARS-CoV-2 infection. Some nasal vaccines have been through phase III human studies and are approved in other countries.
Finally, the New York Times warned about a possible “tripledemic” of COVID, Influenza and RSV (Respiratory Syncytial Virus) this winter. It will be important to get a flu vaccine this year in addition to the new COVID boosters.
Have a good weekend,
Ruth Ann Crystal MD
Twitter: https://twitter.com/CatchTheBaby
Other news:
Influenza
RSV- Respiratory Syncytial Virus (usually seen in children)
COVID news:
https://newsnodes.com/worldmonitor/
World
United States
United States cases: https://www.nytimes.com/interactive/2021/us/covid-cases.html
COVID hospitalizations are just starting to rise for people over age 70 in the US.
Cases are decreasing in Singapore, Germany and France:
https://ourworldindata.org/coronavirus
Variant tracker in US: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
On the rise: BQ.1 and BQ.1.1 are 27.1% of US cases. (and higher in Region 2).
BQ.1 over the last 5 weeks: 1.8% → 3.4% → 5.8% → 9.4% → 14%
BQ.1.1 over last 5 weeks: 0.9% → 1.7% → 3.6% → 7.2% → 13.1%
BF.7 (7.5%) increased only 0.5% this week
On the decline: BA.5. and BA.4.6.
United States:
Region 2 (including NY) has 42.5% BQ.1 and BQ.1.1 and so far hospitalizations are not up much.
France (>50% BQ.1.(1) and hospitalizations are decreasing now.)
Wastewater Monitoring:
CDC Wastewater Monitor https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance
Ohio, Wisconsin are high
Biobot: https://biobot.io/data/
It looks like wastewater viral levels are more accurate than daily clinical cases reported.
Sewer Coronavirus Alert Network (SCAN) project by Stanford University:
Health Equity:
10/28/22 CDC: People of color less likely to receive COVID-19 treatments including Paxlovid https://buff.ly/3SOCIvx
Black patients with COVID-19 were 36% less likely than White patients to be treated with Paxlovid, and Hispanic patients were 30% less likely than non-Hispanic patients to receive the antiviral pill.
Racial and ethnic disparities persisted within the group of immunocompromised patients and across all age groups.
10/27/22 Science (Iwasaki lab): Unadjuvanted intranasal spike vaccine elicits protective mucosal immunity against sarbecoviruses https://buff.ly/3NcaPfJ
Prime and Spike: Give primary vaccination injection(s), and then give nasal vaccine booster.
No adjuvants, no live attenuated virus (like FluMist)
Broad immunity
“Prime and Spike” induces robust resident memory B and T cell responses, IgA at the respiratory mucosa, boosts systemic immunity, and completely protects mice with partial immunity from lethal SARS-CoV-2 infection.
Using divergent spike proteins, prime and spike enables induction of cross-reactive immunity against all sarbecoviruses used.
10/27/22
Mortiz Gerstung thread on BQ.1.1 in Europe.
BQ.1.1 looks to be declining in Germany.
Watching France (BQ.1.1 share 50%) in the next weeks should provide further clues how BQ.1.1 affects the infection dynamics in Europe.
People responded about how there is a 2 week school break in many European countries now.
Bivalent boosters:
2 small studies indicate that the bivalent vaccines are generally at least as good or better as the original vaccines in generating neutralizing antibodies (nAbs), particularly to BA.4/BA.5 and other newer variants.
But both boosters (WT or bivalent) will help preserve a high level of protection against severe Covid.
Lack of big increase in nAbs to BA.5 might be related to imprinting.
10/26/22 BioRxiV (Barouch lab): Immunogenicity of the BA.5 Bivalent mRNA Vaccine Boosters https://buff.ly/3N85ohQ
Our data show that BA.5 NAb titers were comparable following monovalent and bivalent mRNA boosters. Bivalent BA.5 nAb titers were 1.3x the monovalent nAbs, but this was nonsignificant.
Our findings suggest that immune imprinting by prior antigenic exposure may pose a greater challenge than currently appreciated for inducing robust immunity to SARS-CoV-2 variants.
10/25/22 BioRxiV (Columbia U, Ho lab): Antibody responses to Omicron BA.4/BA.5 bivalent mRNA vaccine booster shot https://buff.ly/3U4pzzz
Pseudovirus used to test serum 3 to 5 weeks after vaccination from:
n = 14 people with 3 WT doses
n = 20 people with BA.5 infection
n = 19 people with 4 WT doses
n = 21 people with 3 WT doses + BA.5 Bivalent booster
When given as a fourth dose, a bivalent mRNA vaccine targeting Omicron BA.4/BA.5 and an ancestral SARS-CoV-2 strain did not induce superior neutralizing antibody responses compared to the original monovalent vaccine formulation.
Both the monovalent and the bivalent vaccine do cause neutralizing antibodies, it just appears that the bivalent may not be superior to the monovalent booster.
Not real world data.
10/26/22 NEJM: Protection against Omicron from Vaccination and Previous Infection in a Prison System https://buff.ly/3gAZ2v0
Two high-risk populations (inmates and prison staff) suggest that mRNA vaccination and previous infection were effective against omicron infection, with lower estimates among those infected before the period of delta predominance.
Three vaccine doses offered significantly more protection than two doses, including among previously infected persons.
10/25/22 ABC: Biden gets new bivalent COVID vaccine and announces new COVID initiatives https://buff.ly/3SBR5TN
Walgreens will team up with DoorDash and Uber to provide free delivery of Paxlovid directly to people in underserved communities.
"#VaxUpAmerica Family Vaccine Tour," with pop-up events -- including at the 2022 NASCAR Cup Series Championship in Arizona next month.
CMS/Medicare will try to reach seniors via email and telephone to provide information about the updated COVID-19 vaccines and how to get them.
White House will release the Fall Playbook for Businesses to manage COVID-19.
Biden called on companies to offer employees time off to get vaccinated and called on colleges and schools to host onsite vaccine clinics before Thanksgiving.
10/25/22 JAMA: Association of COVID-19 Vaccination Symptoms With Anti–SARS-CoV-2 Antibody Response https://buff.ly/3W5vW7h
People who had more symptoms (fever, chills, muscle pain, nausea, headache, and/or moderate to severe fatigue) from the COVID vaccine were found to make more antibodies than those with local reaction (pain or rash at injection site) or no symptoms.
10/25/22 JAMA: Racial and Ethnic Disparities in Severe Maternal Morbidity (SMM) Before and During COVID-19 https://buff.ly/3TGRFRt
In pregnancy, racial segregation perpetuated disparities in maternal mortality even before the pandemic for Black people as compared to Whites.
During the pandemic, Black vs White disparities were similar, but Hispanic vs White disparities increased.
10/24/22 Eric Topol MD: A booster is your best shot now https://buff.ly/3CUWBuS
A summary of the data for why now is a good time to get a booster especially for the 110 million Americans who have been vaccinated but never got a booster.
“Yunlong Cao’s lab posted results for lack of neutralizing antibodies to BQ.1.1 and XBB (and BA.2.75.2) after 3 shots (Coronavac) and 7 months after a BA.1 infection. If anything should be considered as a red flag about immune evasion, this would be it.”
Hybrid immunity is insufficient. Now we have no monoclonals.
Addendum from Dr. Eric Topol regarding the Ho lab study from Columbia showing antibody levels were similar after the monovalent and the bivalent booster.
“This does not detract from getting a booster, as equivalent induction of neutralizing antibodies (nAbs)—at least as good—will undoubtedly help augment the level of nAbs and broaden both humoral and cellular immunity, and improve clinical outcomes, as has been consistently seen for boosters for each of the previous major variants (Delta, Omicron BA.1, BA.2, BA.5).”
A reminder that boosters work to prevent death from COVID:
10/24/22 Our World in Data
United States: COVID weekly death rate by vaccination status, age 50+
Eric Topol MD on the importance of boosters
10/23/22 NY Times: A ‘Tripledemic’? Flu and Other Infections Return as Covid Cases Rise https://buff.ly/3sndwRQ
COVID + Influenza + RSV
With few to no restrictions in place and travel and socializing back in full swing, an expected winter rise in COVID cases appears poised to collide with an influenza surge.With RSV (respiratory syncytial virus) also in the mix, a ‘tripledemic,’ may be seen this winter.
Increasing cases of flu have begun earlier than usual, while children with RSV, rhinoviruses and enteroviruses are already straining pediatric hospitals in several states.
Most cases of the respiratory illnesses “are likely to be mild, but together they may sicken millions of Americans and swamp hospitals, public health experts warned.”
10/23/22 NY Times: Among Seniors, a Declining Interest in Boosters https://buff.ly/3gxXKRn
Americans over 65 remain the demographic most likely to have received the original series of vaccinations. But fewer are getting the follow-up shots.
8% of seniors have received the updated bivalent booster
37% said they intended to “as soon as possible.”
According to KFF, almost 40% of older adults said they had heard little or nothing about the updated bivalent vaccine, and many were unsure whether the C.D.C. had recommended it for them.
10/20/22 Maggie Fox and Eric Topol MD: Should People Be More Worried About Long COVID? https://buff.ly/3TQeOk3
Gerstung-lab on GitHub re: International SARS-CoV-2 surveillance https://buff.ly/3FbG3Bz
Variant rates based on cov-spectrum.org, GISAID, and https://ourworldindata.org/coronavirus
Daily Growth Rates compared to BA.5
The BQ.1.x wave projection for the US, and calculations for many other countries based on growth advantage vs BA.5, by @MoritzGerstung
Variant Share By Country: https://github.com/gerstung-lab/SARS-CoV-2-International#variant-share-by-country
