COVID News 3/18/22
COVID News 3/18/22
Hi all,
Don't put away (or burn) your masks just yet. Cases are rising again in Europe and Asia with the new wave caused by the Omicron BA.2 variant. Wastewater samples show that BA.2 levels are rising in the United States now as well, so we should expect a new wave of COVID cases in the United States soon. The BA.2 spike in the Palo Alto/Mountain View watershed from last week did decrease again so I don't know exactly when cases will rise in the Bay Area.
The BA.2 variant is about 30 to 40% more transmissible than the original Omicron variant which in turn was more transmissible than previous variants. But there is good news. Infection with BA.2 is no more likely to result in hospitalization than BA.1. Plus, vaccines (specifically boosters) are just as effective against BA.2 as against the original Omicron BA.1 strain. People who are fully vaccinated and boosted may get a BA.2 infection, but they are well protected against severe disease. Also, BA.2 cases in Denmark & Netherlands are already descending from their peaks, so although cases can be expected to rise again here soon, they should go down fairly quickly as well.
A lot of people have been asking me about a 4th dose of vaccine. Pfizer and now Moderna have requested authorization for a 4th dose (booster) from the FDA. Data from a small study in an Israeli hospital showed that in younger health care workers, a 4th dose increased neutralizing antibody levels back to 3rd dose levels but did not prevent mild or asymptomatic breakthrough infections. However, a very large study from Israel with more than 1 million people age 60+ who received a 4th dose of mRNA vaccine showed that people with the 4th dose had 2x less hospitalization and 4x less deaths from COVID. The UK has started to give 4th dose boosters to people aged 75+. Here in the US, the CDC has only approved 4th doses for immunocompromised people so far, but I think that it will be important for people, especially those over age 50 or 60, to get a 4th dose soon especially since many of us had our boosters 5 months ago. UKHSA data shows that booster VE for symptomatic infections and hospitalizations decrease after 10 weeks.
This week, Congress did not approve $15 Billion in coronavirus funding from a $1.5 Trillion spending bill. The cut funding was to pay for monoclonal antibodies, to pay for testing and treatment for the uninsured, for Paxlovid antiviral pills, vaccinations, etc. Obviously, this needs to be rectified as soon as possible.
I hope that you are able to take advantage of the nicer weather to spend some time outdoors.
Have a great weekend,
Ruth Ann Crystal MD
Twitter: https://twitter.com/CatchTheBaby
Daily COVID updates: http://coronavirustechhandbook.com/doctors
World
US
US stats:
US Cases:
3/18/22 ABC: Per Dr. Fauci, COVID cases predicted to rise in coming weeks because of new BA.2 variant https://buff.ly/3JpDv26
People are no longer masking and the BA.2 variant is causing another wave of cases in Finland, France, Germany, the Netherlands and the United Kingdom. BA.2 cases are starting to rise in the US as well.
3/18/22 CDC: Effectiveness of mRNA Vaccination in Preventing COVID-19–Associated Invasive Mechanical Ventilation and Death https://buff.ly/37C4OrP
3 doses of mRNA vaccination has a 94% vaccine efficiency against being put on a ventilator (in ICU) or death.
3/18/22 TOGETHER trial of IFN-Lambda https://buff.ly/3tjo85E
In high-risk outpatients with Covid19, giving one subcutaneous dose of Peginterferon Lambda within 7 days, decreased hospitalization/ER visits by 50%.
84% of patients were vaccinated.
Variant "agnostic."
3/18/22 Cell (UCSF): Neutralizing immunity in vaccine breakthrough infections from the SARS-CoV-2 Omicron and Delta variants https://buff.ly/3qhMB9y
Omicron breakthrough infections are less immunogenic and induce a weaker neutralizing antibody response, about 1/10 that of Delta breakthrough infection and 1/3 of a booster shot, thus providing reduced protection against reinfection or infection from future variants.
Higher antibody titers are observed in severe versus mild breakthrough infections.
3/17/22 JAMA Psychiatry: Changes and Inequities in Adult Mental Health–Related Emergency Department Visits During the COVID-19 Pandemic in the US https://buff.ly/3Iju2b1
CDC study finds that mental health emergencies increase in the period immediately following a COVID surge.
The findings give an idea of when to target services, such as telehealth and emergency department resources.
3/17/22 Ed Yong in The Atlantic: America Is Zooming Through the Pandemic Panic-Neglect Cycle https://buff.ly/3CNKPBY
This week, Congress nixed $15 Billion in coronavirus funding from a $1.5 Trillion spending bill. This is catastrophic.The cut funding was for monoclonal antibodies, to pay for testing and treatment for the uninsured, for Paxlovid antiviral pills, vaccinations, etc.
Many of the measures that would make a difference against COVID—better ventilation, paid sick leave, equitable health care, a stronger public-health infrastructure—would also protect people from other diseases and health problems.
“The pandemic has gone on for two long years, turning tragedy into routine and breeding fatalism from failure. Older, disabled, poor, Black, or brown Americans, whose excess deaths were tolerated long before COVID, have borne the brunt of the pandemic, while privileged people have had the swiftest access to medical interventions—and have been quickest to declare the crisis over. A country that so readily forgets its dead is surely prone to also forgetting the lessons of the all-too-recent past, setting itself up for further failure in an all-too-imminent future.”
3/17/22 The White House: Dr. Ashish Jha to replace Jeff Zients as the new White House COVID-19 Response Coordinator. https://buff.ly/3MWuCiN
Dr. Jha is an Internal Medicine physician and is Dean of the Brown University School of Public Health.
3/17/22 NY Times: Two Years of the Pandemic in New York, Step by Awful Step https://buff.ly/369gl1l
3/17/22 The heads of top medical (AAFP, AAP, Am Nurses, AMA) groups say "We trust the COVID vaccine" in ads targeting parents https://buff.ly/3N1XtSv
3/17/22 Annals of Internal Medicine (UCSF): Comparison of SARS-CoV-2 RT-PCR Test and BinaxNOW Rapid Antigen Tests at a Community Site During an Omicron Surge https://buff.ly/3ifitqS
BinaxNOW detected persons with high SARS-CoV-2 levels during the Omicron surge, enabling rapid responses to positive test results.
Cheek or throat swabs should not replace nasal swabs.
3/17/22 NY Times: 35 companies sign on to produce generic versions of Pfizer’s Covid pill. https://buff.ly/3IlJOSP
These manufacturers will make generic Paxlovid and sell it inexpensively in 95 lower-income countries that together are home to more than half the world’s people.
3/17/22 John Burn-Murdoch tweet thread on why COVID cases are increasing again
In the UK:
Here's the same chart, but for Europe & US.
It’s the same story. What looked like mystery double-peaks are now clearly a BA.1 peak followed by BA.2.
US is just starting its BA.2 wave:
Bad news: US has lower vaccination rates and booster rates than most European countries
US is 65% vaccinated and only 29% boosted.
US boosters are only at 29% overall and only about 60% for elderly.
Good news about BA.2 from UKHSA https://buff.ly/3IjBenO
Infection with BA.2 is no more likely to result in hospitalization than BA.1.
Vaccines (specifically boosters) are just as effective against BA.2 as against the original BA.1 strain.
Denmark & Netherlands are already descending from BA.2 peaks, so we know that what goes up, comes down.
The height of BA.2 peaks varies.
Denmark’s piggy-backed on BA.1 and rose higher.
Netherlands came after and reached a similar height.
3/17/22 Cell: Imprinted SARS-CoV-2-specific memory lymphocytes define hybrid immunity https://buff.ly/3igFLwM
Vaccine-induced immunity compared to hybrid (infection plus vaccine) immunity.
We found that following vaccination, previously infected individuals generated more SARS-CoV-2 RBD-specific memory B cells and variant-neutralizing antibodies and a distinct population of IFN-γ and IL-10-expressing memory SARS-CoV-2 spike-specific CD4+ T cells than previously naive individuals.
Cases: South Korea, Vietnam, UK going up. Hong Kong is going down.
South Korea is one of the best vaccinated (87%) and boosted (63%) countries in the world.
Nearly 90% of South Korea elderly are boosted compared with ~60% in the USA.
3/17/22 NY Times: As Virus Data Mounts, the J.&J. Vaccine Holds Its Own https://buff.ly/3MZM4CL
Once dismissed as less effective, the vaccine now seems to be preventing infections and illness about as well as the two mRNA options.
As compared to unvaccinated people, the 1 dose of Johnson & Johnson vaccine (3.2x) appeared to be somewhat more protective against infection than 2 doses of Pfizer (2.8x) or Moderna (2.4x).
But, among Americans who got booster doses, all the vaccines appeared to have roughly the same effectiveness against infection.
J&J may only appear to be effective now because many recipients got breakthrough infections early on, gaining additional immunity, said Dr. Natalie Dean, a biostatistician at Emory University. “They may have a different immunity profile.”
3/17/22 NEJM: Neutralization of the SARS-CoV-2 Omicron BA.1 and BA.2 Variants https://buff.ly/3IpHKJO
Neutralizing antibody titers against BA.2 were similar to those against BA.1, with titers against BA.2 lower by a factor of 1.3 to 1.4.
A third dose of the BNT162b2 vaccine was needed for induction of consistent neutralizing antibody titers against either BA.1 or BA.2.
In vaccinated persons infected with BA.1, robust neutralizing antibody titers against BA.2 developed, which shows cross-reactive natural immunity.
BA.2 outcompeting BA.1 is probably related to increased transmissibility rather than to enhanced immune evasion.
3/17/22 Diabetologia: Incidence of newly diagnosed diabetes after Covid-19 https://buff.ly/3qbnh4Q
Matched pair analysis of 35,865 people with mostly mild COVID to 35,865 controls with acute URI and similar comorbidities shows a 28% increase of Type 2 diabetes after COVID infection.
3/16/22 Financial Times: Britons less cautious over Covid than at any point during pandemic https://buff.ly/3wkvJ5M
UK pandemic precautions are at all time lows
No longer avoiding public transport, working remotely, avoiding large gatherings and public events like sports or indoor dining or mixing with other households
Mixing more with others and not wearing masks anymore
3/16/22 Eric Topol MD in the Guardian: Once again, America is in denial about signs of a fresh Covid wave https://buff.ly/3JzxJuZ
"If you haven't gotten a booster or any shot, now would be a very good time."
New wave starting:
During the 2 years of the pandemic, every time there is a new wave in the UK and the US should get ready because cases are going up in UK and Europe.
Boosters:
In the US, only 64% have had two shots, and 29% three shots.
For people over age 65, only 65% are boosted unlike the UK and many European and Asian countries which exceed a 90% booster rate for people 65 and over.
4th dose:
The Israeli study of over 1 million people aged 60 and over showed a 4.3x enhanced protection versus severe illness from Omicron compared with those receiving three shots.
Congress:
We have a gaping hole in our immunity wall because of lower vaccination rates than other countries, but the $58bn budget for the American Pandemic Prepared Plan (AP3), advanced by the White House to comprehensively address the deficiencies, was gutted by the Senate and reduced to just $2bn.
Zero COVID countries:
China has relied on a Zero-Covid policy, resulting in very little natural immunity. China's vaccines have much lower efficacy against Omicron. There are new major outbreaks in two of its most populous cities, Shanghai and Shenzhen.
3/16/22 Reuters: BA.2 Omicron sub-variant makes up 23% of COVID variants in U.S. - CDC https://buff.ly/36oKJEO
BA.2 is now 39% of total cases in New Jersey, New York, Puerto Rico and Virgin Islands, Connecticut, Maine, Massachusetts, New Hampshire, Vermont and Rhode Island.
There is no significant difference in disease severity with BA.1 and BA.2.
3/16/22 JAMA: Comparing Human Milk Antibody Response After 4 Different Vaccines for COVID-19 https://buff.ly/3u70acP
SARS-CoV-2 IgA antibodies in human milk were found more frequently w/mRNA-based (Pfizer, Moderna) vaccines than w/vector-based (AZ, J&J) vaccines, thus mRNA vaccines provide better viral protection to babies.
Human milk IgA is the first line of defense for babies against invading viruses.
3/16/22 Lancet: Evaluating COVID-19 vaccines in the real world
The definition of fully vaccinated now is reasonably three doses.
3/16/22 CDC MMWR: COVID Hospitalization of Infants and Children Aged 0–4 Years https://buff.ly/3w5yFmO
Hospitalizations during the Omicron wave for kids under age 5 were 5x higher than with Delta or any other time in the US pandemic.
Infants aged <6 months had the highest rates of hospitalization during Omicron.
Why are cases going up in Europe?
Waning vaccine effectiveness.
Restrictions such as masking and vaccine passes were recently dropped.
BA.2 is 30% more transmissible than BA.1.
3/15/22 Reuters: China's COVID outbreak in Shenzhen hit Toyota, Volkswagen and Apple supplier Foxconn https://buff.ly/3wbM8cL
China's efforts to curb its largest COVID-19 outbreak in two years has forced companies from Apple supplier Foxconn to automakers Toyota and Volkswagen to suspend some operations, raising concerns over supply chain disruptions.
3/15/22 STAT news: ‘Haven’t we learned anything?’: Experts warn of disastrous consequences if pandemic funding dries up https://buff.ly/3igzIIc
Congress did not approve additional pandemic response funding this week leaving the federal government unable to invest in more therapeutics, vaccines, testing, and other initiatives.
Without additional funds, testing capacity could decrease in March; a program that pays for free testing and treatments for people without insurance could expire in April; supplies of monoclonal antibody treatments will dry up in May; and supplies of oral antivirals will run out in September.
3/15/22 MedRxiV: High vaccine effectiveness against severe Covid-19 in the elderly in Finland before and after the emergence of Omicron https://buff.ly/34LlEDI
Boosters achieved 95% VE against hospitalization both before and after Omicron became dominant in almost 900,000 people aged 70+ in Finland.
For hospitalization, 2 dose Pfizer vaccine VE was 93% at 2wks to 3 months and 87% 3 to 6 months after 2nd dose.
VE increased to 96% against hospitalization after 3rd booster dose.
For Omicron, Pfizer 2 dose VE against hospitalization was 91% at 2 wks to 3 months, 76% VE from 3 to 6 months and 95% VE 14- 60 days after the 3rd booster dose.
Protection against severe Covid-19 requiring ICU treatment was even better.
3/14/22
Wastewater through March 10th: https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance
Feb 26 to March 12 shows fewer sites in the 1000% increase but Ohio, North Carolina, Florida still show quite a bit of red.
Palo Alto wastewater shows that virus levels have decreased since last week:
3/14/22 FT: Hong Kong Omicron deaths expose limits of fraying zero-Covid policy https://buff.ly/3MW5IQ4
Since the article is behind a paywall, here is FT’s John Burn-Murdoch’s tweet thread explaining Hong Kong’s very high death rate
“Zero COVID” policy countries have not had COVID outbreaks yet in the pandemic. But then Omicron came and it is much more transmissible. Countries like New Zealand which have high vaccination and high booster numbers are less affected.
When Omicron hit, more than two-thirds of people aged 80+ in Hong Kong were still unvaccinated, compared to a couple of percent in New Zealand and Singapore.
This was a year after vaccines became available.
Exacerbating this is that most of Hong Kong’s elderly vaccinees had China’s non-mRNA Sinovac shot, which is less effective than Pfizer etc at blocking infection although it does fare better against severe disease.
3/14/22 Nature Immunology (Stanford, Pulendran Lab):
Mechanisms of innate and adaptive immunity to the Pfizer-BioNTech mRNA vaccine https://buff.ly/3Ih6B2a
Fig. 8: Depicting the mode of action of BNT162b2 in vivo.
a. At 6 h to 7 d after BNT162b2 prime, DCs and macrophages in dLNs take up the vaccine and express spike proteins. These innate cells are highly activated and produce cytokines, including IL-6, IFN-α, IFN-γ, MCP1 and MIP1b. In this process, the MDA5–IFNAR1 signaling pathway is essential for IFN-α production and innate cell activation.
b. At days 7 to 21, strong GC B and TFH cell responses are induced in B cell follicles. The CD8+ T cell response is increased mildly in both spleen and lung tissue.
c. At days 1 to 3 after boost, much more IFN-γ is produced by NK, CD4+ and CD8+ T cells, contributing to the enhanced innate cell activation after boost.
d. At 21 d after boost, the antibody response, CD4+ and CD8+ T cell responses increase significantly. The MDA5–IFNAR1 signaling pathway is essential for CD8+ T cell responses in both spleen and lung tissue.
3/14/22 JAMA: The Growing Influence of State Governments on Population Health in the United States https://buff.ly/3KLVXCp
Life expectancy in some states is plummeting as state leaders adopt positions that are bad for health.
Florida's excess death rate was 4x higher than Massachusetts and 3x higher than New York from Aug-Dec 2021.
3/13/22 The Guardian: The Covid cloud is starting to lift – but two years on, its legacy of grief lingers https://buff.ly/3CFuCi4
1 million lives lost affects 8.5 million bereaved family members
>200,000 kids under age 18 have lost a parent.
“Children who lose a parent have a greater likelihood of dropping out of school, not attending college, criminal justice involvement, lower earnings and higher mortality in later life.”
Long Covid
So far, >10 Million Americans will have Long COVID and long term issues.
Boosters:
Only about 42% of Americans have received a booster.
The US now ranks 67th in the world for 2 dose vaccinations and 54th for boosters.
Healthcare Workforce:
>500K experienced nurses plan to retire this year.
Inequity: Hispanic, Black, and Native American and Alaska Native people are twice as likely to die from Covid as their white counterparts.
3/13/22 UKHSA: UK COVID-19 vaccine surveillance report, Week 10 (10 March 2022) https://buff.ly/3pYQv7e
From Eric Topol MD:
1. Booster shots have prevented about 160,000 hospitalizations in England during the Omicron wave.
2. The falloff of effectiveness against Omicron over time is striking.
Here VE for age 50+ against mortality.
3. VE also seen against hospitalizations by 10+ weeks
Comparing:
2 doses of Pfizer
2 doses Pfizer + Pfizer booster
2 doses Pfizer + Moderna booster
4. No difference in vaccine effectiveness between Omicron lineages BA.1 and BA.2 for symptomatic disease, but steady decline at 10+ weeks after booster
5. The UK has done an exceptional job in getting >90% people of advanced age boosted. The US stands at only 65% boosted for older adults.
6. Unlike the UK, which has laid out its plan for a 4th dose, the US has no plan. Just like what happened for the 3rd dose.
3/13/22 Nature (Signal Transduction and Targeted Therapy): ACE2-independent infection of T lymphocytes by SARS-CoV-2 https://buff.ly/3MMRVeI
SARS-CoV-2 can infect T cells via the LFA-1 receptor found on lymphocytes in a spike-ACE2/TMPRSS2-independent manner.
The virus causes T cell apoptosis and may lead to SARS-CoV-2-induced lymphopenia in COVID-19 patients.
Presently, vaccines target receptors in the spike protein and not the LFA1 receptor.
3/13/22 The Standard Hong Kong: China places 17 million residents of Shenzhen under Covid lockdown https://buff.ly/3vZSBHG
Hong Kong's neighboring city and home to tech giants including Huawei and Tencent, Shenzhen will be put under a citywide lockdown Monday for an Omicron outbreak.
The Chinese vaccines (Sinopharm, Sinovac) are less effective against Omicron.
Tongue-in-cheek tweet:
