COVID news 4/1/22
COVID news 4/1/22
Hi all,
BA.2 cases continue to go up in China, South Korea, the UK, France and Germany. Shanghai will be locked down for a while longer which may affect the supply chain.
So what will the BA.2 wave look like in the US? If we look to the UK and Europe, we know that they have higher vaccination and booster levels than the US, so the US may do worse. But, mathematical modeling predicts that BA.2 will probably peak in the United States around late April to mid-May when the spring weather may help to dampen an exponential surge as more people socialize outside. When the first Omicron wave (BA.1) hit, the US still had the tail end of the Delta wave going on so the Omicron cases were added to it. We are starting the BA.2 wave with case positivity numbers in the US that are some of the lowest that we've seen since June 2021.
The fourth dose (second booster) was approved this week in the US for all people over age 50 and for immunosuppressed people 12 and older. A new study in Science magazine shows that the two mRNA vaccines, Pfizer and Moderna, produce antibodies with some differences in epitope recognition and functional properties. Therefore, if you have received all Moderna vaccines so far or all Pfizer vaccines, you should consider getting the other mRNA vaccine as the fourth dose booster for broader protection. For example, I have gotten Moderna for each of the 3 doses so far and am planning on getting Pfizer for my 4th dose to hopefully broaden coverage. Unfortunately, only 29% of Americans who qualify for the 3rd dose (1st booster) have gotten them so there are many people who will be susceptible to Omicron BA.2. Of note, some people have more gastrointestinal symptoms with BA.2 but there also seems to be a GI bug going around. So if you get nausea, vomiting and diarrhea, you may want to take a COVID test to rule it out.
What you should know about the 4th dose booster:
Data from Israel shows that in people aged 60+, compared to people who had 3 doses, the 4th dose provided a 2x lower breakthrough infection rate, a 4.3x lower severe illness rate and it decreased mortality by 78%.
Omicron BA.2 has twice the viral load of BA.1 and although it causes similar disease severity, BA.2 is more contagious and can spread faster.
Case positivity numbers and hospitalizations in the US are some of the lowest that we've seen since June 2021, but they are just starting to creep up reflecting BA.2's arrival.
If you are over 50 but recently had a breakthrough COVID infection in the last 2 to 3 months, you may want to wait 1 to 2 months because having an infection can act like a booster to our immunity.
A new report shows that people who recently had an Omicron BA.1 infection should be protected against BA.2, at least for now.
Some healthy people may decide to watch wastewater virus levels closely and then get the booster when these levels go up, knowing it will take about 10 to 14 days to reap the complete benefit of the booster. Those people will need to watch things in their area very closely as waiting may be a bit of a gamble.
The New York Times came out with an article noting 7 things that you can do now to prepare for BA.2 and future COVID waves. I recommend taking a look below.
Have a good weekend,
Ruth Ann Crystal MD
Twitter: https://twitter.com/CatchTheBaby
World
US
Cases are starting to rise some
US cases:
Variant Proportions: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
Pink = BA.2
Purple = BA.1
California 1.3% positivity rate https://covid19.ca.gov/state-dashboard/
Santa Clara county 1.8% test positivity (7-day rate), 0.4% increase from 7-days prior
San Mateo county 1.9% test positivity (7-day rate), 0.4% increase from 7-days prior
UK: Please note that there is another group in the UK called the COVID-19 Actuaries Response Group that puts out a newsletter on COVID every other Friday that you can access here: https://covidactuaries.org/
4/1/22 Guardian: Covid lockdown extended in Shanghai as city struggles to control Omicron https://buff.ly/378p5Vz
4/1/22
4/1/22
4/1/22 JAMA Peds: Incidence Rates and Clinical Outcomes of SARS-CoV-2 Infection With the Omicron and Delta Variants in Children Younger Than 5 Years in the US https://buff.ly/3J1RWZ7
About 7x the number of children were infected with the Omicron variant compared to the Delta variant in children younger than 5 years, but severe clinical outcomes were less frequent than with Delta variant.
But, with such a large multiplier (7x), that does lead to many severe outcomes with the Omicron variant.
4/1/22 BioRxiV: Cross neutralization of Omicron BA.1 against BA.2 and BA.3 SARS-CoV-2 https://buff.ly/3NFGiqp
The cross-neutralization of BA.1-infected sera against BA.2 suggests the recent BA.1-infected individuals are likely to be protected against the ongoing BA.2 surge.
40% of the US was infected with BA.1.
Upcoming Webinar on the Latest on Long Covid Research with Dr. Iwasaki of Yale https://buff.ly/3uMTb9o
Mon, April 4, 2022
3:00 PM – 4:00 PM PDT (6pm to 7pm ET)
Dr. Akiko Iwasaki is the co-Lead Investigator of the Yale COVID-19 Recovery Study, which aims to determine the changes in the immune response of people with long COVID after vaccination.
NEW govt website https://www.covid.gov/ with links to:
Risk level for your county
Where to get vaccinated
Where to find medications like Paxlovid
Where to buy masks
3/31/22 NY Times: A New Wave of Covid-19 Is Coming. Here’s How to Prepare. https://buff.ly/386XULq
American health officials have said they are hopeful that BA.2 won’t cause another major surge, in part because so many people were infected by the original Omicron, but
<70% of age 60+ have had 1st booster (3rd dose)
Fall booster shots immunity may be waning after 5 months.
Pandemic fatigue, people don't want to wear masks.
7 things that you can do to protect yourself against BA.2 and any future waves:
Pay attention to Covid indicators in your community
CDC COVID State Risk Levels https://buff.ly/3iT2TS4
CDC Wastewater Trends https://buff.ly/3LcWoqg
Have high-quality masks on hand
CDC Free N95 Mask Locator https://buff.ly/3uMphlN
Order home Covid tests now
Get a booster
A second booster shot (4th dose) is now approved for everyone 50 and older and for people 12 and older with certain immune deficiencies.
The protective antibodies from a vaccine or an infection tend to wane in four or five months. A well-timed booster shot tells the body to bump up its antibody defenses and helps other parts of the immune system — like B cells and T cells — become better at remembering how to fight the virus
Get a pulse oximeter
You can find the devices for about $30 in pharmacies and online.
Make a plan for antiviral drug treatment for high risk people
Need to take Paxlovid or Molnupiravir within 5 days of symptoms
COVID-19 Therapeutics Locator https://buff.ly/3iHK8AT
Have backup plans for social events and travel
If traveling, take enough medicine in case you have to isolate for 10 to 14 days.
Outdoor back up plans to host weddings or grad parties if cases go up.
3/31/22 PNAS: SARS-CoV-2 infection of airway cells causes intense viral and cell shedding, two spreading mechanisms decreased by IL-13 https://buff.ly/3tTZ0Tm
For SARS-CoV-2, electron microscopy shows rapid release of virus and massive shedding of epithelial cells packed with virions.
Interleukin-13 (IL-13) protects against SARS-CoV-2 viral and cell shedding and is associated with less severe COVID-19.
People w/ allergic asthma produce IL-13 and are less susceptible to severe Covid.
IL-13 inhibits SARS-CoV-2 viral entry, replication, and cell-to-cell transmission.
3/31/22 This week's UKHSA report https://buff.ly/3qSrQS6
Boosters are very important to protect against Omicron
Risk of death from Omicron in adults age 50+:
25+ weeks after only 2 doses, VE was 59% against mortality
2 weeks after booster (3rd dose), VE was 95% against mortality
3/31/22 NEJM: BNT162b2 Vaccine Protection against the Omicron Variant in Children and Adolescents https://buff.ly/3uGFsB9
For children ages 5-11:
For Omicron:
VE 68% against hospitalizations in 5 to 11 year olds
Unfortunately, only 28% of children this age are vaccinated.
For teens, ages 12-18
For Delta: VE >90% effectiveness against hospitalization for 2 doses
For Omicron:
VE 20% for Omicron hospitalizations for 2 vaccine doses
VE 79% for Omicron ICU critical illness with 2 doses of vaccine
3/31/22 JAMA: Pushed to Their Limits, 1 in 5 Physicians Intends to Leave Practice https://buff.ly/3Dt7Vy3
Over the past 2 years, more than 36 000 survey responses from clinicians across the country have painted an alarming picture of a workforce that’s increasingly burned out, traumatized, anxious, and depressed.
Etz, who trained as a cultural anthropologist, sees a troubling pattern in the survey responses: lack of hope.
Shortage of staffing is making it worse.
3/31/22 Nature: Defining the risk of new SARS-CoV-2 variants on immune protection https://buff.ly/3JXOQGX
A template on how to comprehensively assess and respond to new variants by monitoring viral evolution in the human population to identify variants that could erode the effectiveness of countermeasures.
3/31/22 Nature Medicine: Safety, tolerability and viral kinetics during first SARS-CoV-2 human challenge in young adults https://buff.ly/3wPSr68
34 healthy volunteers aged 18–29 years in the UK were given wild type (original Wuhan) SARS-CoV-2 virus intranasally
18 (53%) became infected (PCR positive)
16 (47%) remained uninfected
Mild-to-moderate symptoms were reported by 16 (89%) infected participants, beginning 2–4 days after inoculation, whereas two (11%) were asymptomatic.
Anosmia (loss of smell) developed more slowly in 15 (83%) participants.
Findings in the first SARS-CoV-2 human challenge study in young adults:
Viral shedding after a short incubation period peaks rapidly after human SARS-CoV-2 challenge.
Viral load is not correlated with symptoms
Viral shedding occurs at high levels irrespective of symptoms
Neutralizing antibodies are generated more rapidly than anti-spike protein IgG after human SARS-CoV-2 challenge.
Rapid antigen testing by lateral flow accurately predicts infectious virus shedding.
3/30/22 mRNA-1273 (Moderna) and BNT162b2 (Pfizer) COVID-19 vaccines elicit antibodies with differences in Fc-mediated effector functions https://buff.ly/38ckmD3
Both mRNA vaccines induced robust functional humoral immune responses, with differences in epitope recognition and antibody-mediated functional properties.
Variation in immune responses induced by the BNT162b2 and mRNA-1273 vaccines may confer differential protection so if you got Moderna vaccines, consider getting a Pfizer booster and vice versa for broader protection.
3/30/22 JAMA (Kaiser): Perinatal Complications in Individuals in California With or Without SARS-CoV-2 Infection During Pregnancy https://buff.ly/3wQnsa1
Cohort study of 43,886 pregnant individuals.
SARS-CoV-2 infection during pregnancy was associated with an increased risk of severe maternal morbidity, preterm birth, and venous thromboembolism.
Pregestational diabetes and Asian or Pacific Islander and Black race and ethnicity were associated with an increased risk of hospitalization.
3/30/22 Washington Post Opinion by Megan Ranney MD MPH:
The health-care system is as vulnerable to covid as it has ever been https://buff.ly/3K2bHkM
3/30/22 Nature NPJ: Smart toilets for monitoring COVID-19 surges: passive diagnostics and public health https://buff.ly/3JSDXpN
3/29/22
3/29/22
3/29/22
3/29/22 A new wave and a new booster? https://buff.ly/3IOvv9F
Eric Topol discusses his thoughts on the BA.2 wave in the United States and whether the 2nd booster vaccine will help.
Table comparing BA.1 to BA.2
3/29/22 Nature Biotech (Stanford, Euan Ashley): Accelerated identification of disease-causing variants with ultra-rapid nanopore genome sequencing https://buff.ly/38d0UpK
Ultra-rapid nanopore whole-genome sequencing (WGS) identified a candidate variant in <8 h from sample preparation to variant identification.
3/29/22 Nature: A TMPRSS2 inhibitor acts as a pan-SARS-CoV-2 prophylactic and therapeutic https://buff.ly/3DmlTSi
Small-molecule compound, N-0385 inhibits SARS-CoV-2 infection in human lung cells, donor-derived colonoids and in transgenic mice.
3/29/22 eLife Sciences: Post-acute sequelae of COVID-19 (PASC): A metabolic perspective https://buff.ly/3iJM4cj
Review of Long COVID (PASC) and metabolic dysfunction including the risk of diabetes.
Metabolic dysfunction (i.e. obesity, insulin resistance, and diabetes mellitus) plus a chronic inflammatory state may predispose to PASC (Long COVID.)
3/29/22 Lancet preprint (Denmark): Levels of SARS-CoV-2 Antibodies Among Fully-Vaccinated Individuals With Delta or Omicron Variant Breakthrough Infections: A Prospective Cohort Study https://buff.ly/3ILQgTy
We observed a strong association between increasing levels of anti-spike antibodies and reduced risk of breakthrough infections with the Delta but not the Omicron variant.
However, despite a high proportion of elderly participants, severe COVID-19 was rare in both Delta and Omicron infections.
3/29/22 FT: China’s patchy vaccine campaign leaves elderly at risk https://buff.ly/3NoDFsZ
Extremely low rate (20%) of vaccination and boosters among people of advanced age (age 80+).
China relied exclusively on Sinovac and Sinopharm vaccines.
1 dose and 2 doses of Sinovac did not protect as well as mRNA vaccines against Omicron deaths.
Sinovac matches Pfizer protection against death only after 3 doses.
3/29/22 Nature: Will Omicron finally overpower China’s COVID defences? https://buff.ly/3qIvf5O
In China, 52 million people aged over 60 years are yet to be fully vaccinated.
The most vulnerable — those aged over 80 years — are the least well vaccinated, with only 20% having received the primary vaccination course and booster shot.
Sinovac vaccine, one of the two main vaccines used in China, is effective at reducing severe cases and deaths, but that the third shot is necessary to confer high levels of protection in those aged over 60.
3/29/22 NY Times Opinion | We Study Virus Evolution. Here’s Where We Think the Coronavirus Is Going. https://buff.ly/3iFAuyZ
SARS-CoV-2 will probably continue to mutate to avoid our immune system. In the future, it may be like seasonal flu requiring annual vaccination.
3/29/22 MedRxiV: Monitoring of the SARS-CoV-2 Omicron BA.1/BA.2 variant transition in the Swedish population reveals higher viral quantity in BA.2 cases https://buff.ly/382HLqh
175,000 nasopharyngeal samples show that BA.2 viral load is 2x higher than BA.1, thus increasing BA.2's transmissibility.
3/29/22 FDA Coronavirus (COVID-19) Update: FDA Authorizes Second Booster Dose of Two COVID-19 Vaccines for Age 50+ and Immunocompromised Individuals https://buff.ly/3Nv1cbH
h/t @kavitapmd
50+ may get 2nd booster FOUR MONTHS after 1st (4th shot)
Immunocompromised 12+ can get a 2nd (or 5th shot) after their 4th mRNA
J and J no changes
Still nothing re boosters for 5-11
And no vaccine yet for under 5
4th dose:
3/28/22 Bob Wachter talks about what immunocompromised people should do to protect themselves
3/28/22 AP: Shanghai starts China's biggest COVID-19 lockdown in 2 years https://buff.ly/3IQSyRc
Another 3,500 cases in Shanghai on Sunday, though only 50 people had symptoms of COVID-19.
While people who are asymptomatic can still infect others, China categorizes such cases separately from “confirmed cases” — those in people who are sick — leading to much lower totals in daily reports.
Although China’s vaccination rate is around 87%, it is considerably lower among older people who are more likely to become seriously ill if they contract the virus.
3/28/22 NBC: Flu cases tick upward as Covid restrictions ease https://buff.ly/3uBh9nT
The number of weekly flu-related hospitalizations has been ticking up for nearly two months.
Flu season typically peaks by February.
"We're taking off masks, we're getting together more."
3/28/22 Helio: At-home testing tripled during Omicron, but data show disparities in use https://buff.ly/3qIC7jK
Home testing was less common among people who were older, Black, had a lower income and a high school education level or less.
3/28/22 Reuters: FDA pauses Sotrovimab authorization for COVID-19 in U.S. regions with high BA.2 activity https://buff.ly/3IKnClt
BA.2 variant is now circulating with a frequency exceeding 50% in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, New York, Puerto Rico, and the Virgin Islands.
Sotrovimab is authorized and available in all other U.S. regions until further FDA notice.
3/27/22 MedRxiV: Protection by Fourth dose of BNT162b2 against Omicron in Israel https://buff.ly/3Lbz7oJ
In age 60+ who received a 4th dose (as compared to 3 doses at > 4 months out):
2x lower breakthrough infection rate
4.3x lower severe illness rate
3/27/22 Nature preprint: Second Booster (Fourth Dose) Vaccine and Covid-19 Mortality in Adults 60 to 100 Years Old in Israel https://buff.ly/3iDNmWa
Compared to people who had 3 doses, people over age 60 had a 78% reduction of mortality with 4 doses of mRNA vaccine (2 + 2 boosters).
3/26/22 NY Times: Biden Administration Plans to Offer (Fourth dose) Second Booster Shots to Those 50 and Up https://buff.ly/3INEQhU
The suggested plan is to give everyone age 50 and up the option of an additional shot, in case infections surge again before the fall.
In the fall, officials say, Americans of all ages, including anyone who gets a booster this spring, should get another shot.
The C.D.C., Britain and Israel have put out data on the waning effectiveness of booster shots. The latest report by Britain’s health security agency (UKHSA) states that effectiveness against symptomatic infection drops to between 25% and 40% 15 weeks or longer after a booster dose of either Pfizer or Moderna.
3/26/22 Regarding last week’s charts with BA.2 increasing in San Mateo and Santa Clara counties. If you look at the last 12 weeks instead of the last few weeks, you can see that the rise in virus in wastewater is not that great yet.
Low risk people:
COVID infection + 3 doses:
Over 65 year olds:
Ontario, Canada:
New York City:
3/25/22 In the UK:
3/25/22 Washington Post: Moderna says its coronavirus vaccine for young children is safe, but efficacy is a more complicated picture https://buff.ly/3tAT7u4
Children received two shots of a 25-microgram dose, a quarter of the adult dose.
Two doses have turned out to be far less effective against the highly transmissible Omicron variant in adults, and that also held true for children.
40% VE against infection in young children
Moderna plans to test a booster dose in children.
Moderna is authorized only for people 18 and older in the US, while Pfizer’s shot is authorized for children as young as 5 years old.