COVID news 2/11/22

Hi all, 
Current hospitalizations have now dipped below the peak from the Delta surge and the first winter surge, but they're still higher than they have been throughout the vast majority of the pandemic. The seven-day average for U.S. new coronavirus cases is 208,086 which is the lowest level since December 26. There are currently 93,280 Americans hospitalized with COVID which is the lowest level since December 30. Hospitalizations for children still remain high because the under 5 year olds can't be vaccinated and the older kids are only 23% fully vaccinated for the 5 to 11 year olds and 56% for the 12 to 17 year olds.

This week, a very large study of 154,000 COVID patients from the Veterans Administration compared to more than 11 million control patients shows that COVID-19 infection is associated with serious long term cardiovascular disease a full year after the initial infection. COVID-19 increased the risk of all 20 cardiovascular ailments studied, including heart attacks, arrhythmias, strokes, transient ischemic attacks, heart failure, inflammatory heart disease (myocarditis, pericarditis), cardiac arrest, pulmonary embolism, and deep vein thrombosis. Risks were lower for those who were not hospitalized during the acute phase of the infection and increased in a graded fashion (non-hospitalized, hospitalized and admitted to intensive care).  

Mask mandates are being dropped in many states, but in each state there are often certain counties that are not dropping indoor mask mandates for vaccinated people until cases and hospitalizations decrease more. In California, the statewide indoor mask requirement will expire February 15th, but school children, those that are unvaccinated, and those in high risk areas such as public transit and nursing facilities, will still be required to wear masks. Dr. Bob Wachter brings up a good point that when mask mandates for vaccinated people are dropped, unvaccinated people who are at the highest risk of catching the virus will probably stop wearing masks as well. This will increase the risk for the vaccinated and even the vaccinated and boosted people because removal of masks by unvaccinated people can make an indoor space less safe for everyone. It will be a good idea to follow COVID test positivity rates in each area. Santa Clara County and Los Angeles County will continue indoor mask requirements for now. The other 8 Bay Area counties will stop indoor mask mandates February 15th.

Have a good weekend,

Ruth Ann Crystal MD

Twitter: https://twitter.com/CatchTheBaby

World

United States

United States cases:

Articles from this week:

2/11/22 USA Today: How does COVID-19 cause stillbirths in some unvaccinated pregnant people? Study identifies 'a piece of the puzzle.' https://buff.ly/3HNTTII

• COVID-19 infection destroyed the placenta, depriving the fetus of oxygen, according to the report published Thursday in Archives of Pathology & Laboratory Medicine. 

• “Among the 68 cases, an average of 77% of the placenta had been destroyed and rendered useless for supporting critical fetal needs, resulting in stillbirth or early neonatal death.”

2/11/22 JAMA: Durability of Anti-Spike Antibodies in Infants After Maternal COVID-19 Vaccination or Natural Infection https://buff.ly/368ENQg

• Babies whose moms were vaccinated during pregnancy against COVID-19 have long-lasting antibody protection at 6 months, compared with infants born to mothers with SARS-CoV-2 infection.

• #pregnancy

2/11/22 Vox (h/t Greg King): The extraordinary success of Covid-19 vaccines, in two charts https://buff.ly/3o1MHRl

2/10/22 NY Times Covid News https://buff.ly/3Ltfhp6

• Nevada abruptly drops its statewide mask mandate, “effective immediately.”

• Nearly 3,000 N.Y.C. workers will be fired on Friday if they don’t get vaccinated.

• Infections and hospitalizations are falling in the U.S., but unevenly.

  • Dr. Rochelle Walensky of the CDC, said pointedly on Wednesday that while cases were dropping, it was too soon for all Americans to take off their masks in indoor public places.

  • “Our hospitalizations are still high, our death rates are still high. So, as we work toward that and as we are encouraged by the current trends, we are not there yet.”

• Prince Charles tests positive, and had recent contact with the queen.

2/10/22 Nature: Initial analysis of viral dynamics and circulating viral variants during the Moderna mRNA-1273 Phase 3 COVE trial https://buff.ly/34vFvXj

• Pre- Delta and Omicron

• In SARS-CoV-2-infected individuals, vaccination reduced both the viral copies 100-fold on the day of diagnosis and the duration of detectable viral RNA (4 days for Moderna vaccinated vs 7 days for placebo), which may be markers for the risk of virus transmission.

2/10/22 BMJ: Risk of persistent and new clinical sequelae among adults aged 65 years and older during the post-acute phase of SARS-CoV-2 infection (PASC): retrospective cohort study https://buff.ly/3GBZwbz

• For people age 65+, 1 in 3 who had a COVID infection had a new medical sequelae/diagnosis, compared with 1 in 5 matched controls with other respiratory viral diseases.

• Specifically for older COVID patients, new diagnoses were respiratory failure, dementia, and post-viral fatigue.

2/10/22 Brain, Behavior and Immunity Journal: 90 minutes of exercise after influenza or COVID-19 vaccination increases serum antibody response without an increase in side effects in humans and mice https://buff.ly/3Jgpe7i

• Interferon-α may contribute to exercise-induced enhancement of vaccine response.

2/10/22 CNN: Covid-19 hospitalizations drop below 100,000 in the US, but heavy burden persists https://buff.ly/3HJAfOf

• Current hospitalizations have now dipped below the peak from the Delta surge and the first winter surge, but they're still higher than they've been throughout the vast majority of the pandemic.

• "We're going from a crisis that was almost catastrophic in certain cases to just a serious emergency." Rick Pollack

• "The work force is stretched incredibly thin, and that is taking its toll." 

• Increased Covid-19 hospitalizations for children. 

  • Children younger than 5 are not eligible to be vaccinated

  • 23% of children ages 5 to 11 are fully vaccinated

  • 56% of those ages 12 to 17 are fully vaccinated

2/10/22 NY Times: Mask Mandates and Guidance in Each State https://buff.ly/2U43YxM

• This map does not include school mask mandates.

• 

2/10/22 ABC: LA County to keep COVID-19 mask mandates in place as state prepares to lift mask requirements https://buff.ly/3LuieG2

• In California, school children, those that are unvaccinated, and those in high risk areas such as public transit and nursing facilities, will still be required to wear masks.

  • School districts are following the CDC guidelines which have not lifted mask mandates yet.

• L.A. County's health officials said they intend to keep their indoor mask mandate in place beyond the state deadline until hospitalizations have dropped below 2,500 for seven consecutive days, and case counts drop to 50 new cases per 100,000.

2/10/22 Here's Which Bay Area Counties Will Lift the Mask Mandate https://buff.ly/33bAlyY

• All Bay Area Counties will lift the mask mandate Feb 16th except for Santa Clara County.

2/8/22 AP: Governors in 4 states plan for end to school mask mandates https://buff.ly/35PbPoe

• Connecticut (Feb 28), Delaware (March 31), New Jersey (March 7) and Oregon (March 31)

• California announced plans to end its indoor masking requirement for vaccinated people next week, but masks will still be the rule for school children.

2/10/22 Santa Clara County wastewater: https://covid19.sccgov.org/dashboard-wastewater

2/10/22 Nature Review: Pathological sequelae of long COVID https://buff.ly/3AZzfmE

• Post acute COVID-19 syndrome (PASC) or Long COVID

• This Review details organ-specific sequelae of post-COVID-19 syndromes and examines the underlying pathophysiological mechanisms available so far, elaborating on persistent inflammation, induced autoimmunity and putative viral reservoirs.

2/10/22 NEJM (Qatar): Protection against the Omicron Variant from Previous SARS-CoV-2 Infection https://buff.ly/3uCiWuJ

• Effectiveness of a prior COVID infection in preventing symptomatic reinfection:

  • Alpha: 90.2% 

  • Beta: 85.7% 

  • Delta: 92.0%

  • Omicron: 56.0%

2/10/22 JAMA: Association of Primary Care Physicians (PCPs) Per Capita With COVID-19 Vaccination Rates Among US Counties  https://buff.ly/3rEz0dA

• The number of PCPs per 100 000 population was independently associated with higher COVID-19 vaccination rates in the US. 

• PCPs play a critical role in ensuring vaccine acceptance, especially in resource-limited and vaccine-hesitant regions.

2/10/22 BioRxiV: The mechanism of RNA capping by SARS-CoV-2 https://buff.ly/3gDAVIZ

• The SARS-CoV-2 RNA is capped, which contributes to its ability to evade our immune response. 

• SARS-CoV-2 caps its RNA genome by an unconventional mechanism using NiRAN, nsp 9, and methylation by nsp14 and nsp16.  This may show a new target in the drug development of antivirals to treat COVID-19.

2/10/22 Cell: Development of a T cell-based immunodiagnostic system to effectively distinguish SARS-CoV-2 infection and COVID-19 vaccination status. https://buff.ly/3uFS5hi

2/8/22 MedRxiV: Clinical Severity and mRNA Vaccine Effectiveness for Omicron, Delta, and Alpha SARS-CoV-2 Variants in the United States: A Prospective Observational Study https://buff.ly/3HE2HRy

• A case-control study of 11,690 hospitalized adults in 21 hospitals across the United States

• mRNA VE (vaccine efficiency) against hospitalization:

  • 85% for 2 vaccine doses against Alpha

  • 85% for 2 doses against Delta

  • 94% for 3 doses against Delta

  • 65% for 2 mRNA doses against Omicron

  • 86% for 3 mRNA doses against Omicron

2/8/22 Reuters: Quarter of UK employers cite long COVID as driving absences – survey https://buff.ly/3JbxN3h

• Mild cases of COVID-19 can still lead to debilitating Long COVID and associated symptoms of fatigue, memory issues and brain fog.

• 26% of UK employers now include long COVID as a main cause of long-term sickness absence, in a survey of 804 organisations that represent more than 4.3 million employees.

• 46% of the companies had employees that had experienced long COVID.

2/8/22 Nature: Long COVID and kids: more research is urgently needed https://buff.ly/34IgJTI

• The most common symptoms are fatigue, shortness of breath, cognitive dysfunction (also called brain fog) and post-exertional malaise, in which even minor physical activity leads to lasting exhaustion.

2/8/22 Lancet Review of Long COVID in teens: Assessing the impact of the pandemic in children and adolescents: SARS-CoV-2 infection and beyond https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00035-9/fulltext#%20

2/8/22 Lancet (Denmark): Long COVID symptoms in SARS-CoV-2-positive adolescents and matched controls (LongCOVIDKidsDK): a national, cross-sectional study https://buff.ly/3BavIBH

• n =6630 teens (15 to 18 years old) with history of COVID and 21,640 controls. Median age was 17.6 years.

• Participants with SARS-CoV-2-positive tests had more long-lasting symptoms and sick leave (16 or more sick days and 16 or more days of school absence),.

• The control group had more short-lasting symptoms and worse quality of life (physical, emotional, social and school functioning scores) on the PedsQL survey.

2/8/22 Lancet (UK): Physical and mental health 3 months after SARS-CoV-2 infection (Long COVID) among adolescents in England (CLoCk): a national matched cohort study https://buff.ly/3GH9dp7

• Adolescents aged 11–17 years. 

• 3065 who tested positive and 3739 who tested negative completed the questionnaire (response rate 13.4%) between January and March 2021

• Symptoms at 3 months:

  • Test-positive group symptoms 39% tiredness, 23.2% headache and 23.4% shortness of breath.

  • Test-negative group were 24.4% tiredness, 14.2% headache, and 15.8% other (unspecified). 

• The multiple symptoms class was more frequent in girls than boys, in adolescents aged 15–17 years than those aged 11–14 years, and in those with lower pretest physical and mental health.

• Adolescents who tested positive for SARS-CoV-2 had similar symptoms to those who tested negative, but had a higher prevalence of single and, particularly, multiple symptoms (tiredness, headache, dyspnoea, and dizziness) at the time of PCR testing and 3 months later.

2/8/22 JAMA: Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications https://buff.ly/3uzXrL8

• Retrospective cohort study, n =14,104 pregnant patients

• Maternal death or serious morbidity from: 

  • hypertensive disorders of pregnancy, 

  • postpartum hemorrhage, 

  • infection other than SARS-CoV-2 

occurred significantly more frequently in individuals with SARS-CoV-2 infection compared with individuals without SARS-CoV-2 infection (13.4% vs 9.2%, respectively).

2/8/22 Dr. Bob Wachter’s thread and how he calculates if he should go to a party in Florida

2/8/22 NY Times: Why are Americans slow to get booster shots? https://buff.ly/3JuU7VV

• The unvaccinated skew heavily Republican.

• The vaccinated-but-unboosted more closely resemble the country as a whole.

• This booster shortfall is one reason the U.S. has suffered more hospitalizations and deaths over the past two months than many other countries.

• Boosters reduce hospitalization across all ages.

• Why does the U.S. lag with booster doses compared to other countries?

• Fragmented U.S. healthcare system. 

  • There is neither a centralized record system, as in Taiwan, nor a universal insurance system, as in Canada and Scandinavia, to remind people to get another shot.

• Poor U.S. government communication 

  • Across Europe, Canada and Australia, health officials are urging adults of all ages to receive booster shots.

2/7/22 Nature: Long-term cardiovascular outcomes of COVID-19 (Long COVID, PASC) https://buff.ly/3srGNdK

• Significant cardiovascular complications of Long COVID (PASC) at 1 year at the Veterans Administration: 

  • 153,760 people with COVID-19

  • 5,637,647 contemporary controls

  • 5,859,411 historical controls

• Beyond the first 30 days of infection, people with COVID-19 exhibited substantial increased risks and 12-month burdens of incident cardiovascular diseases including:

  • Cerebrovascular disorders (stroke, TIA)

  • Dysrhythmias (atrial fibrillation, sinus tachycardia, sinus bradycardia, ventricular arrhythmias and atrial flutter)

  • Inflammatory heart disease (myocarditis, pericarditis)

  • Ischemic heart disease (acute coronary disease, myocardial infarction, ischemic cardiomyopathy and angina)

  • Heart failure

  • Thromboembolic disease (pulmonary embolism, deep vein thrombosis and superficial vein thrombosis)

  • Other cardiac disorders ( non-ischemic cardiomyopathy, cardiac arrest and cardiogenic shock)

• The risks were evident regardless of age, race, sex and other cardiovascular risk factors, including obesity, hypertension, diabetes, chronic kidney disease and hyperlipidemia; they were also evident in people without any cardiovascular disease before exposure to COVID-19.

• These risks and burdens were evident even among individuals who were not hospitalized during the acute phase of the infection and increased in a graded fashion (non-hospitalized, hospitalized and admitted to intensive care).

2/10/22 Commentary on the Nature COVID CV study: 

Science: COVID-19 takes serious toll on heart health—a full year after recovery https://buff.ly/339kilc

• "This is clearly evidence of long-term heart and vascular damage. Similar things could be happening in the brain and other organs resulting in symptoms characteristic of Long Covid, including brain fog."

• COVID-19 increased the risk of all 20 cardiovascular ailments studied, including heart attacks, arrhythmias, strokes, transient ischemic attacks, heart failure, inflammatory heart disease, cardiac arrest, pulmonary embolism, and deep vein thrombosis.

• Millions of COVID-19 survivors could suffer long-term consequences, straining health systems for years to come.

2/7/22 AP: 32 Olympic athletes in isolation for COVID https://buff.ly/3uuLK8t

• The disclosure that 32 athletes are in isolation facilities came after complaints by athletes and teams about inedible food, dirty rooms and a lack of training equipment and internet access.

• People in the "Olympic bubble" are tested daily with PCR and must be negative on PCR before they are released from isolation, which is 7 days on average.

  • So far, there have been 393 positive cases inside the Olympic bubble. 

  • In addition to athletes, the figure includes news media, team officials and others inside the bubble. 

  • More than 12,800 people have arrived from outside China for the Olympics.

2/7/22 MedRxiV (Seattle): Pediatric Croup during the COVID-19 Omicron Variant Surge https://buff.ly/35Y79ww

• Croup is a common upper respiratory disease usually associated with parainfluenza virus, resulting in stridor, hoarse voice, barky cough, and variable respiratory distress.

• During the Omicron surge, the incidence of croup nearly doubled compared to the rate in prior months, while at the same time the number of cases of parainfluenza virus identified decreased.

2/7/22 MedRxiV: Protection by 4th dose of Pfizer BNT162b2 against Omicron in Israel https://buff.ly/3Lbz7oJ

• 4th dose was given at least 4 months after the 3rd dose to those over 60 years and at-risk populations.

• By 12 days after the 4th dose, the rate of confirmed Omicron infection was:

  • 2.0x lower than in those who received only 3 doses

  • 1.9x lower than those who were only 3 to 7 days after vaccination.

• The rate of severe illness was lower by factors of: 

  • 4.3x lower than those who received only 3 doses

  • 4.0x lower than 3 to 7 days after vaccination

2/7/22 BioRxiV (NIAID): mRNA-1273 or specific mRNA-Omicron boost in vaccinated macaques elicits comparable B cell expansion, neutralizing antibodies and protection against Omicron https://buff.ly/333Ss9Y

• An Omicron specific booster may not provide greater immunity or protection compared to a boost with the current mRNA-1273 vaccine.