Two years ago today on March 11, 2020, the World Health Organization declared SARS-CoV-2 a global pandemic. Science magazine has put out a special edition that reviews what we have learned about COVID over the last 2 years. It covers many topics related to the pandemic including epidemiology, immunology, wastewater tracking, vaccination technology and the road ahead.
This week, a study using data from the UK Biobank compared brain scans from before and after COVID infections. The study showed a loss of gray matter, reduced brain size, and cognitive decline even after mild COVID infections. Loss of brain gray matter was noted in parts of the brain tied to smell which may be related to decreased sensory input when people lost their sense of smell with COVID. However, the study also showed deficits on cognitive-function tests. It is not known if these changes in the brain will persist or if they are reversible.
COVID cases are starting to rise again in Europe in England, the Netherlands, Switzerland, Austria and Portugal and other countries. In England, it is thought that the increase in new cases may be related to waning vaccination protection especially in the elderly, the BA.2 Omicron variant, as well as decreases in mask use. Today, it was also reported that the level of SARS-CoV-2 is rising in wastewater from the Palo Alto and Mountain View watershed which may be related to BA.2. Therefore, we may see a rise in cases in Santa Clara county in the next 1-3 weeks. But, western San Francisco had a bump like this in their wastewater recently that decreased just as quickly so we will just have to wait and see. The BA.2 Omicron is somewhat more transmissible but not more virulent than the original (BA.1) Omicron. Vaccinations plus boosters protect against hospitalizations and severe disease with BA.2 like they did with BA.1. so it will be important for us to stay current on our COVID vaccinations.
This week, the Florida Surgeon General recommended that healthy children in Florida not be vaccinated against COVID. Immediately, the Florida Chapter of the American Association of Pediatricians responded saying that vaccination protects children against COVID, offers the best opportunity for them to remain in school for in person learning which is vital to their mental and emotional health, and will help stop the pandemic for all by reducing transmission.
Also this week, Sheila Janakos of Healthy Horizons and I answered questions on COVID-19 and Breastfeeding in a webinar. You can see the video and download the handouts here: https://www.healthyhorizons.com/pages/events
World cases are starting to increase in some countries (note: the timeline is from the June 2021 nadir)
3/11/22 China is facing its largest spike of cases now. Most vaccinations were with Chinese vaccines (Sinopharm, etc). This is also what is fueling cases in Hong Kong.
3/11/22 L.A. Times (via John Chi): 'Deltacron' is a hybrid of Delta and Omicron variants. How worried should California be? https://buff.ly/3J5gAZP
Don’t worry about Deltacron. Only a handful of cases have been documented nationwide.
Deltacron is neither a variant of interest or a variant of concern.
3/10/22 Science magazine Special Issue with reviews of the last 2 years of COVID https://buff.ly/3J8auru
Topics: COVID and wastewater, low and middle-income countries and COVID, gender-responsive social protection systems, COVID-19—lessons for zoonotic disease, epidemiology, immunology and immunopathology of COVID-19, COVID-19 vaccination and the road ahead.
Review of almost 2 years of COVID-19 immunology research and discuss definitive findings and remaining questions regarding our understanding of COVID-19 pathophysiology.
Emerging understanding of differences in immune responses seen in those with and without Long Covid (aka PASC).
3/10/22 Lancet: Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21 https://buff.ly/34By4ho
Although more than 6 million COVID-19 deaths were reported worldwide since Jan 1, 2020, the real number, as determined by excess mortality, is probably more than 18 million.
3/10/22 Nature: Misinformation: susceptibility, spread, and interventions to immunize the public https://buff.ly/3pVDYRK
3/10/22 Nature: An epidemic of uncertainty: rumors, conspiracy theories and vaccine hesitancyhttps://buff.ly/3CAqBvr
3/10/22 Cell: Broad neutralization of SARS-CoV-2 variants by an inhalable bispecific single-domain antibody https://buff.ly/3KDPVmX
An inhaled, broad neutralizing antibody effective against all variants to date.
A bispecific single-domain antibody (bn03) broadly neutralizes all SARS-CoV-2 variants to date. The two arms of bn03 can bind simultaneously and synergistically to one RBD of spike trimer.
In hACE2 mice, inhalation of bn03 can effectively treat SARS-CoV-2 infection.
This study also deciphered an uncommon and highly-conserved cryptic epitope within the spike trimeric interface that may have implications for the design of broadly protective SARS-CoV-2 vaccines and therapeutics.
3/10/22 Economist: Taking stock as America moves into a new phase of the pandemic https://buff.ly/3KBKNji
Two years ago on March 11th, the World Health Organization declared COVID-19 a pandemic. Polls suggest concern about COVID is declining.
3/10/22 Reuters: Pfizer begins COVID pill study in high-risk children aged 6-17 https://buff.ly/3vRcm3Z
Antiviral COVID-19 pill to be tested in high risk non-hospitalized children aged 6-17.
So far, Pfizer's Paxlovid pill is authorized for emergency use for kids 12 years or older and high-risk adults.
3/10/22 The Hill: Pandemic babies may need to catch up on immunizations https://buff.ly/3KxFQbp
Due to lockdowns and restrictions during the pandemic, some young children may be lagging on the regular vaccine schedule.
3/10/22 Lancet preprint (Germany): Long COVID Symptoms in a Prospective Cohort of Exposed and Infected Children and Adolescents and Their Parents One Year After SARS-CoV-2 Infection https://buff.ly/35WQEke
Significantly higher moderate or severe persistent symptoms in:
Infected women (36.4% vs 14.2%),
Infected men (22.9% vs 10.3%)
Infected adolescent girls (32.1% vs 8.9%).
Moderate or severe persistent symptoms were notmore common in:
Infected adolescent boys aged 14-18 or
Children <14 years than in their exposed counterparts.
The number of persistent symptoms clustered in some households.
3/9/22 NEJM (Australia): Resistance Mutations in SARS-CoV-2 Delta Variant after Sotrovimab Use https://buff.ly/3tJCSd4
Testing 100 patients who received Sotrovimab monoclonal antibodies showed that some patients not only had persistent SARS-CoV-2 infection, but the virus had mutated its spike protein inducing resistance to Sotrovimab.
3/9/22 NEJM (Japan): Efficacy of Antiviral Agents against the SARS-CoV-2 Omicron Subvariant BA.2 https://buff.ly/3Ic9LEB
In contrast to most monoclonal antibodies, Remdesivir, molnupiravir, and nirmatrelvir (Paxlovid) retained efficacy against BA.2.
3/9/22 CDC MMWR: SARS-CoV-2 Incidence in K–12 School Districts with Mask-Required versus Mask-Optional Policies https://buff.ly/35Dswnb
In Arkansas during August–October 2021, school districts with universal mask requirements had a 23% lower incidence of COVID-19 among staff members and students compared with districts without mask requirements.
3/9/22 Fertility and Sterility: COVID-19 Vaccination and Infertility Treatment Outcomes https://buff.ly/3CC7oJR
COVID-19 mRNA vaccine did not affect the ovarian response or pregnancy rates in IVF treatment.
Women should be vaccinated for COVID-19 prior to attempting to conceive via IVF treatments, given the higher risk of severe illness in pregnant women.
3/9/22 AP: The W.H.O. now says COVID boosters are needed, reversing previous recommendations https://buff.ly/3pRr5It
Previously, the W.H.O. wanted people to wait to get boosters until more people around the world got their initial vaccines. But, with Omicron it became evident that a 3rd booster shot is needed for protection.
3/9/22 MedRxiV (Austria): The mutational steps of SARS-CoV-2 to become like Omicron within seven months: the story of immune escape in an immunocompromised patient https://buff.ly/35ZPYus
Unique case report of an immunocompromised patient (with small cell lymphocytic lymphoma cancer) who had a chronic COVID infection.
The patient was followed over 7 months with sampling and gene sequencing of the SARS-CoV-2 virus which over that time evolved to have many of the mutations seen in the Omicron variant.
In a trial in 73 workplaces, the tests detected hundreds of people with asymptomatic COVID-19 and generated very few false positives.
3/8/22 England hospital cases are starting to increase again:
3/11/22 The Guardian: One-third of all US child Covid deaths occurred during Omicron surge https://buff.ly/3tLtLZk
Since the beginning of 2022, 550 children have died from Covid-19 in the US, compared with 1,017 children in the preceding 22 months, according to the CDC.
The children who are too young to wear masks and too young to be vaccinated need other people to reduce transmission around them by getting vaccinated and wearing masks when appropriate.
3/7/22 CNN: The Florida Department of Health will recommend against Covid-19 vaccinations for healthy children https://buff.ly/3IRol5u
Children vaccinated against Covid-19 are less likely to be hospitalized.
Vaccinated grade schoolers are nearly half as likely to need to go to urgent care or the emergency room.
3/7/22 Florida Chapter of the American Academy of Pediatrics (FCAAP) Statement Regarding the COVID-19 Vaccine and Florida’s Children https://buff.ly/3pMVYxM
Following a COVID-19 roundtable convened by Florida Governor Ron DeSantis where Surgeon General Joseph Ladapo recommended against the COVID-19 vaccine for “healthy children,” the Florida Chapter of the American Academy of Pediatrics (FCAAP), which represents more than 2,500 pediatricians across the state, spoke out in support of the COVID-19 vaccine for all eligible children ages 5 and older in Florida.
Vaccination protects the children against COVID, offers the best opportunity to remain in school for in person learning which is vital to their mental and emotional health, and will help stop the pandemic for all.
3/7/22 Nature: SARS-CoV-2 is associated with changes in brain structure in UK Biobankhttps://buff.ly/3sP9zqj
Longitudinal imaging study with brain scans pre & post COVID diagnosis compared to controls.
Findings: Reduction of gray matter in areas related to smell, brain size, and cognitive decline all noted even after mild COVID infection.
Only 15 COVID cases were hospitalized and results did not change when they were deleted from analysis.
Changes in the brain areas tied to smell may be from having no sensory input when people lost their sense of smell with COVID. This may be reversible.
3/8/22 The Guardian, Eric Topol MD: What do we know about Covid’s impact on the brain? https://buff.ly/3sXpNxq
Eric Topol discusses the findings in the UK Biobank study that showed loss of gray matter, reduced brain size, and cognitive decline even after mild COVID infection and what this may mean in the future.
3/7/22 NBC: Even mild Covid is linked to brain damage months after illness, scans show https://buff.ly/3vTsuls
The UK study participants tested positive for Covid through April 2021, before widespread vaccinations in the UK. It is unknown if vaccination might mitigate the risk of the coronavirus-linked damage to the brain that this study identified.
Covid-19 is linked to damage in parts of the brain tied to smell, but also showed cognitive-function deficits.
On cognitive-function tests, those who had Covid in this brain-scan study had a slower ability to process information and had lower executive function, which is an umbrella measure of the brain’s ability to manage complex tasks.
It's unclear whether the losses in various regions of the brain related to smell, as well as the overall brain-volume loss observed among people with Covid in this brain-scan study will persist. The study author noted that the brain can indeed heal itself.
“It is brain damage, but it is possible that it is reversible,” the author said. “But it is still relatively scary because it was in mildly infected people.”
3/7/22 SF Chronicle: For people who never got COVID, what are the odds they never will? Here’s what experts say https://buff.ly/3CmReE7
When case rates are low, like they are now, people are unlikely to be infected with COVID. But if case counts go back up again, then we will need to be more vigilant.
Vaccinations and boosters, Improved ventilation in buildings, especially places like schools, is important.
For people who are risk averse or immunocompromised, a high-quality N95 mask allows you to do things like go to the gym or shop and be relatively well protected.
Delaying infections now allows us to understand more about the virus and to make better treatments that are more available like Paxlovid.
