Europe has seen a large BA.2 wave in some countries. In the UK, cases have jumped by 1 million new cases this week which translates to about 1 in every 16 people in England are infected this week. Overall, Europe has not put in new restrictions with the exception of Austria which is requiring masks again. Vaccines are not as effective in preventing breakthrough infections with Omicron but people who are triple vaccinated (2 + booster) tend to have more mild cases overall. Vaccine effectiveness (VE) against BA.1 is similar to VE against BA.2.
Experts are predicting that North America will soon have an Omicron BA.2 wave like in Europe. Overall, the US is less vaccinated and less boosted than many European countries. It’s possible BA.2 could develop into a large surge especially in areas with poor vaccination and booster rates. Potentially, in areas that are highly vaccinated and boosted, BA.2 may just result in a slower decline in cases overall.
Wastewater surveillance shows that the Omicron BA.2 strain has overtaken other variants in Santa Clara and San Mateo counties. Experts feel that we will probably have an increase in BA.2 cases in the next few weeks, but that our region is better protected against death and severe illness because of the Bay Area's high vaccination rate. The BA.2 wave here probably won't have as many cases as we saw in January.
Several studies this week show that unvaccinated people who became infected with BA.1 (with no prior vaccine and no prior COVID infection) had neutralizing antibodies (nAb) to only BA.1 and not to other variants. They will need vaccination to be protected against future variants. Vaccinated people who got breakthrough Omicron BA.1 infections however have a broad nAb response and show protection to all variants.
Regarding 4th dose boosters, there is a new study that came out from Israel today. In people age 60 and over, a 4th dose of the Pfizer vaccine provided considerable additional protection against both Omicron breakthrough infections and severe disease as compared to three doses of the vaccine. Vaccine effectiveness (VE) against breakthrough infection wanes sooner for the 4th dose than that of the 3rd dose (64% down to 29% by 10 weeks.) But, the good news is that VE against severe infection remained high (> 73%) through 10 weeks for people age 60+ who got a 4th dose. The UK, Germany, France and Sweden are among countries offering fourth doses to the elderly and vulnerable.
3/24/22 Palo Alto Online: The Omicron BA.2 strain has overtaken other variants in Santa Clara and San Mateo counties, wastewater surveillance shows. https://buff.ly/3DctzH2
The high presence of BA.2 started in the Palo Alto sewershed, which includes Palo Alto, Mountain View, East Palo Alto, Los Altos and Los Altos Hills, according to Stanford's SCAN.
In San Mateo County, the BA.2 percentage in the Silicon Valley Clean Water sewershed, which serves the cities of Belmont, San Carlos, Redwood City and the West Bay Sanitary District, was 93% on March 21.
"It is fair to expect an increase in cases in the coming weeks," said Dr. Jorge Salinas, hospital epidemiologist for Stanford Health Care.
"I believe there will be another wave. It probably won't be as high as the January wave," he said.
3/25/22 FT: European wave of Omicron sub-variant BA.2 foreshadows US surgehttps://buff.ly/3tElhEl
Experts are predicting that North America will be hit by a resurgence of the Omicron coronavirus sub-variant BA.2 like Europe.
In Europe, only Austria has opted to reimpose measures in response to the BA.2 wave, once again requiring the use of high-grade masks in indoor public settings from Wednesday.
In the U.S., people are less vaccinated and less boosted than in the UK.
3/25/22 MedRxiV: Relative Effectiveness of Four Doses Compared to Three Dose of the BNT162b2 Vaccine in Israel During Omicron https://buff.ly/3wBsBm6
Age 60+. Data through March 13, 2022.
n =27,876 received the fourth dose and n =69,623 received only three doses
Fourth dose of the BNT162b2 vaccine provided considerable additional protection against both Omicron SARS-CoV-2 breakthrough infection and severe disease relative to three doses of the vaccine.
VE against breakthrough infection wanes sooner for the 4th dose than that of the 3rd dose (64% down to 29% by 10 weeks.)
VE against severe infection remained high (> 73%) through 10 weeks.
3/25/22 JAMA: Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19 https://buff.ly/3NmESRp
Observational cohort study, n = 112 269 patients with moderate COVID-19
Those who received aspirin on the first day of hospitalization had a lower risk for 28-day mortality and pulmonary embolism than those who did not.
Patients who received early aspirin did not have higher rates of gastrointestinal hemorrhage, cerebral hemorrhage, or blood transfusion.
3/24/22 Per New York Times reporter Paul Mozur, fake news in China reports that Moderna created the COVID virus.
3/24/22 Lancet preprint (Hong Kong): Intrinsic Severity of SARS-CoV-2 Omicron BA.2 in Previously Uninfected, Unvaccinated Children: A Population-Based, Case-Control Study on Hospital Complications https://buff.ly/3tBKkrK
The intrinsic severity of Omicron BA.2 in children who had no past COVID-19 or vaccination is not mild, and in fact, they had higher odds of PICU admissions, mechanical ventilation and oxygen use.
Compared to prior SARS-CoV-2 variants and influenza infections, Omicron had a higher death rate, PICU (pediatric ICU) admissions, neurological complications such as seizures (14.9%), and croup.
3/24/22 UKHSA: Effectiveness of COVID-19 vaccines against Omicron and Delta
Excluding incidental COVID positive patients admitted for other reasons,
Booster VE against Omicron hospitalizations for 18 to 64 year olds:
Admissions for 2+ days with a respiratory code in the primary diagnostic field VE went from 91% down to 67% at 15+ weeks after the booster.
Booster VE against Omicron for 65+ year olds:
Admissions for 2+ days with a respiratory code in the primary diagnostic field, booster VE remained high at 85.3% at 15 weeks.
For 65+ year olds who required oxygen/ventilation/ICU, Booster VE was 86.8% at 15+ weeks.
3/24/22 NEJM: Neutralization Profile after Recovery from SARS-CoV-2 Omicron Infection https://buff.ly/3IF3rFM
People infected with BA.1, with no prior vaccine and no prior COVID infection, had neutralizing antibodies (nAb) to only BA.1 and not to other variants.
They will need vaccination to be protected against future variants.
Vaccinated people who got breakthrough Omicron BA.1 infections had a good nAb response to all variants.
3/23/22 Los Angeles Times: Proportion of Omicron BA.2 cases rising rapidly. Is a surge coming or just a ripple? https://buff.ly/3D3QUuh
It’s possible BA.2 could develop into a full-blown surge especially in areas with poor vaccination and booster rates. But BA.2 could also plausibly just result in simply a slower decline in cases.
The BA.2 wave in Europe is now starting to turn around three weeks into it.
Britain has rising cases and hospitalizations but has not seen an increase in COVID ICU demand.
Austria is reporting a record number of new cases and restrictions are being put in place.
3/23/22 Healio: Antiplatelet agents (aspirin and P2Y12 inhibitors) fail to benefit critically ill adults with COVID-19 https://buff.ly/3qvFj2d
Adding aspirin or a P2Y12 inhibitor on top of anticoagulation thromboprophylaxis was not beneficial and did not reduce days on ventilator.
3/23/22 FT: Scientists debate fourth dose of Covid vaccine as Omicron cases rise https://buff.ly/3NhY3vC
The UK, Germany, France and Sweden are among countries offering fourth doses to the elderly and vulnerable.
3/23/22 MedRxiV (Qatar): Effect of prior infection, vaccination (with mRNA vaccines), and hybrid immunity against symptomatic BA.1 and BA.2 Omicron infections and severe COVID-19 in Qatar https://buff.ly/37WVPBR
Prior infection, BNT162b2 vaccination, and hybrid immunity all showed strong effectiveness >70% against any severe, critical, or fatal COVID-19 due to BA.2 infection.
There are no discernable differences in the effects of prior infection, vaccination, and hybrid immunity against BA.1 versus BA.2.
Hybrid immunity resulting from prior infection and recent booster vaccination (infection + 3 doses of mRNA vaccine) confers the strongest protection.
Vaccination enhances protection of those with a prior infection against either subvariant.
3/23/22 Reuters: Italian study shows ventilation can cut school COVID cases by 82%https://buff.ly/37LsASh
Replacing air in classrooms:
2.4x per hour reduced infections by 40%
4x per hour reduced infections by 66.8%
6x per hour reduced infections by 82.5%
3/22/22 Searchable government website shows where to get available doses of COVID treatment drugs (Evusheld, Paxlovid, Molnupirvir, Bebtelovimab, Sotrovimab)
3/22/22 WP Opinion by Dr. Leana Wen: In this next phase of the pandemic, beware of the extremes https://buff.ly/3NbAftj
3/22/22 Leana Wen MD tweet about going back to pre-pandemic normal now. Twitterstorm responses from doctors and others about protecting the immunosuppressed and kids under age 5 who can’t be vaccinated, waning immunity, etc.
3/22/22 The Hill: Black Americans hospitalized at pandemic high during Omicron wave: CDC https://buff.ly/3wiLwSN
Black adults were hospitalized at nearly 4x the rate of white adults during the Omicron wave.
Black adults were hospitalized at a rate of 94.7 per 100,000 people compared to 24.8 per 100,000 for white adults.
"Removing barriers to vaccination access among persons with disproportionately higher hospitalizations rates from COVID-19, including Black adults, is an urgent public health priority," the CDC noted.
3/18/22 CDC MMWR: COVID-19 Hospitalizations Among Adults During Delta and Omicron Variant Predominance, by Race/Ethnicity and Vaccination Status https://buff.ly/3tvBc7W
3/21/22 Lancet: Risks and burdens of incident Diabetes in Long COVID: a cohort study https://buff.ly/3qqe5Ka
In the US Veterans Administration, 40% increased risk of Type 2 Diabetes, in people with COVID infection, not present at 1 month, but manifest at 1-year follow-up as compared to controls.
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.
Neutralizing antibody response against Omicron declined 6.3x over the 6-months after the 3rd dose.
2/18/22 CDC report on waning of 3rd dose VE against emergency department and urgent care encounters (ED/UC) visits for adults went from 87% VE at < 2 months down to only 31% VE at > 5 months after 3rd dose.https://buff.ly/3BdAn6d
He also talks about how we do less testing in the U.S. and that the home antigen tests that people are doing are not being recorded in official numbers.
3/20/22 Cell: Getting to the (germinal) center of humoral immune responses to SARS-CoV-2 https://buff.ly/3ikYyqL
Lymph Nodes (LN):
After vaccination, there is an increase in total and antigen-specific LN germinal center (GC) B cells, which correlates with T follicular helper (Tfh), Memory B and Plasmablasts (PBs), as well as neutralizing antibodies (Abs).
Severe COVID-19 disrupts GC architecture.
LN memory B cells and PBs were also increased following vaccination in healthy people.
Serum Antibodies and vaccination:
Vaccination causes antibody levels equivalent to severe COVID-19 infection.
Vaccination induced a greater breadth of binding than natural infection.
3/20/22 3/20/22 NPR: Lifesaving COVID drugs are sitting unused on pharmacy shelves, HHS data shows https://buff.ly/36glGnA
Less than half of the supply of treatments ordered since October 2021 have been used.
These drugs are currently prioritized for people at high risk of COVID-19 (though sites and providers have discretion on who qualifies), but it may be time to expand availability to people at lower risk.
Lifesaving COVID vaccines are also expiring on pharmacy shelves and getting tossed every day.
3/20/22 NY Times: Another Covid Surge May Be Coming. Are We Ready for It? https://buff.ly/3N3e88u
BA.2 infections are doubling every seven or eight days in Western Europe (Britain, France, Germany) — half the rate of Omicron’s growth this winter, but faster than the Delta variant’s 11-day doubling time.
In the U.S., the new wave could come as soon as April, or perhaps later in the spring.
About 1 in 30 people 70 and older in England have been infected the week prior to March 12th. Waning vaccine immunity may be to blame and 4th doses are planned for later this month in Britain.
3/18/22 NPR: People with 'medium COVID' are caught in a gray area of recovery with little support https://buff.ly/37xzH0x
Some people feel bad with extreme fatigue for six to eight weeks after their mild initial infection. Serious rest is needed for this more gradual recovery.
Recent research from the Brookings Institution estimated that lasting COVID-19 symptoms could be responsible for up to 15% of the unfilled jobs in America's labor market.
