This week the CDC reported that by February 2022, 60% of Americans, including 75% of children, have been infected by SARS-CoV-2 with many infected during the Omicron wave. Because of Omicron's immune escape however, it is very important for people to be vaccinated to have a longer lasting immunity against COVID.
Cases:
Cases are starting to increase again in the U.S. with the Omicron BA.2, now morphing into the BA.2.12.1, wave. How it affects different parts of the country will depend on vaccination rates and prior infections. For instance, Puerto Rico, which is the hottest US hot spot now, has about 100 new cases per 100K people and New York, which is also seeing a BA.2/ BA.2.12.1 wave, only has about 33 new cases per 100K. Why the difference? Cases may be related to some protection from prior COVID infections (pre-Omicron) as Puerto Rico had about 34% prior infections while New York had 66% prior infections which may help some with better immunity now.
South Africa notes an increase in Omicron variants BA.4 and BA.5. Vaccinations and boosters help, but prior BA.1 infection does not seem to be protective against BA.4 and BA.5.
Treatments:
This week, Remdesivir was approved as the first COVID treatment for children and babies as young as 28 days old who were either hospitalized with COVID or were at high risk. There was a really great article on the latest SARS-CoV-2 issues affecting children by epidemiologist Katelyn Jetelina called "Pediatric State of Affairs: April 28" that I highly recommend you read.
Evusheld is a combination of 2 monoclonal antibodies that has been approved for prophylactic protection against symptomatic COVID infection in immunosuppressed people. A new study shows that giving Evusheld to sick COVID patients in the hospital does not decrease length of hospital stay, but does decrease risk of death in these very sick patients.
4th dose:
A third study shows again that the 4th dose booster (a.k.a. second booster) decreases hospitalizations by 64% and decreases deaths by 78% when given to people age 60+. We are fortunate that 4th dose boosters are being offered to all people over age 50 here and I would recommend getting one especially if your last booster was more than 4 months ago.
Long COVID:
A new small study showed that a subset of people with Long COVID improved when given an antibody to CCR5 called Leronlimab.
Long COVID is thought to possibly be caused by either:
1. virus reservoir in the body
2. new autoantibodies
3. immune dysregulation which can affect regulation of blood vessels in the body amongst other things.
Some of the Long COVID patients with immune dysregulation may be the ones who improve with Leronlimab.
4/28/22 Moderna files for U.S. authorization of COVID shot for kids under 6 https://buff.ly/3s0nfhh
Moderna released trial data in March showing that its vaccine was safe and generated a similar immune response in young children as for adults.
Two doses were around 37% effective in preventing infections in 2- to 5-year-olds and 51% effective for children ages 6 months to 2 years with Omicron.
Only 28% of U.S. children in the 5 to 11 age group are fully vaccinated.
4/28/22 Nature Microbiology: Daily longitudinal sampling of SARS-CoV-2 infection reveals substantial heterogeneity in infectiousness https://buff.ly/3EYUCq3
Fall of 2020 and Spring of 2021 (WT, Alpha variant)
60 people followed 14 days at the University of Illinois at Urbana-Champaign.
Viral infectiousness did not correlate with symptoms and there was extensive variability in viral shedding in different people.
Viral genome loads often peaked days earlier in saliva than in nasal swabs, suggesting that saliva may serve as a superior sampling site for early detection of infection.
Climate change causes animal habitat loss, which can force species to move and mingle more often allowing exchange of viruses. This can create a new age of infectious dangers to humans.
A new study shows that 3 of our greatest existential threats—climate change, pandemics, and the sixth mass extinction of wildlife—are really the same mega-problem. This problem is already underway to an extent that we can’t easily undo. We must prepare.
Climate and land use change will produce viral sharing among previously geographically-isolated wildlife. In some cases, this will facilitate zoonotic spillover, and will increase the risk of future pandemics.
Animals (especially bats) will bring viruses to new places.
Southeast Asia is a hotspot, but risk is global.
The process is probably well underway in 2020 and probably won't be stopped by reducing greenhouse gas emissions now.
There is an urgent need to pair viral surveillance and species tracking, especially in tropical regions that harbor the most zoonoses and are experiencing rapid warming.
BMJ: Public health impact of covid-19 vaccines in the US: observational study https://buff.ly/3Kw3OmJ
Analysis of >30 million COVID cases from Dec 2020 to Dec 2021 in counties across 48 U.S. states.
For every 10% improvement in vaccination coverage per county, there was an 8%reduction in deaths and a 7% reduction in COVID cases.
4/27/22 JAMA: Fresh Embryo Transfer Cycle Characteristics and Outcomes Following In Vitro Fertilization via Intracytoplasmic Sperm Injection Among Patients With and Without COVID-19 Vaccination https://buff.ly/3xXBsiI
COVID-19 vaccination is safe and effective and has no impact on IVF cycle stimulation, embryological variables, or clinical outcomes.
4/27/22 NBC by Ben Ryan: Covid symptoms rebound? Rare reports of relapse after taking Paxlovid antiviral pills https://buff.ly/3kkrTT4
“These anecdotes give us reason to re-examine duration of therapy, approaches to therapy, other laboratory tests we might use to predict who could benefit from longer courses of treatment.”
People who experience such a rebound can relay their experience to Pfizer’s portal
https://paxaes.pfizersafetyreporting.com/#/en
Case report by Dr. Michael Charness of viral rebound after Paxlovid:
Rapid Relapse of Symptomatic SARS-CoV-2 Infection Following Early Suppression with Nirmatrelvir/Ritonavir https://buff.ly/3KquHbU
Genetic sequences of the patient's virus indicated it did not develop resistance to Paxlovid, nor was the patient re-infected.
4/27/22 Nature: Orally available Mpro inhibitor Y180 is effective against wild-type SARS-CoV-2 and variants including Omicron https://buff.ly/3rT3zfm
The main protease (Mpro) of SARS-CoV-2 is an attractive drug target because of its central role in viral replication and its conservation among variants.
A potent α-ketoamide-containing Mpro inhibitor called Y180 can be given orally and in mice has antiviral activity against SARS-CoV-2 variants.
4/26/22 CDC MMWR: Seroprevalence of Infection-Induced SARS-CoV-2 Antibodies — United States, September 2021–February 2022 https://buff.ly/3rQRYxm
60% of Americans, including 75% of children, had been infected with the coronavirus by February 2022 as indicated by antibody testing.
The greatest increases in seroprevalence during September 2021–February 2022, occurred in the age groups with the lowest vaccination coverage.
The proportion of the U.S. population fully vaccinated by April 2022 increased with age:
Age 5–11, 28%
Age 12–17, 59%
Age 18–49, 69%
Age 50–64, 80%
Age ≥65 years, 90%.
During the Omicron surge, infections rose most sharply among children and adolescents, according to the new research. Prior infections increased least among adults aged 65 and older, who have the highest rates of vaccination and may be most likely to take precautions.
Prior infection does not guarantee protection from future infection.Vaccination remains the safest strategy.
VP Kamala Harris is COVID positive but is asymptomatic.
4/26/22 Canadian Medical Association Journal: Impact of population mixing between vaccinated and unvaccinated subpopulations on infectious disease dynamics: implications for SARS-CoV-2 transmission https://buff.ly/3kaYJpq
Many opponents of vaccine mandates have framed vaccine adoption as a matter of individual choice.
We found that the choices made by people who forgo vaccination contribute disproportionately to risk among those who do get vaccinated.
4/26/22 Lancet: Evusheld (Tixagevimab/Cilgavimab) for Treatment of Hospitalized COVID-19 Patients: A Randomised, Double-Blind, Phase 3 Trial https://buff.ly/3EOXcyT
Among patients hospitalized with COVID-19 receiving remdesivir and other standard care, tixagevimab/cilgavimab did not improve the primary outcome of time to recovery but was safe and mortality was lower (8.6% for Evusheld vs 12.2% for placebo.)
We know from another study that Evusheld prophylaxis in high risk people
4/20/22 NEJM: Intramuscular Evusheld AZD7442 (Tixagevimab–Cilgavimab) for Prevention of Covid-19 https://buff.ly/3xIG2S0
With prophylactic Evusheld, there was a 77% reduction in symptomatic infection and 83% RR reduction at 6 month follow up.
4/25/22 Nature: Effectiveness of a second BNT162b2 booster (4th dose) vaccine against hospitalization and death from COVID-19 in adults aged over 60 years https://buff.ly/37GSp6o
560,000+ people age 60+ during the Omicron wave in Israel
Compared to 1 booster (3rd dose), the 2nd booster (4th dose):
Hospitalizations reduced 64%
Deaths reduced 78%
This study demonstrates a substantial reduction in hospitalizations and deaths due to Covid-19 conferred by a second-booster (4th dose) in Israeli adults aged 60 years and over.
4/25/22 FDA Approves First COVID-19 Treatment for Children Under Age 12 Including Babieshttps://buff.ly/3w1zhID
Remdesivir is now cleared for pediatric patients as young as 28 days of age and older weighing at least 3 kilograms who are hospitalized or at high risk for severe COVID.
4/25/22 AP: Biden admin to promote availability of COVID antiviral pill https://buff.ly/3xTYOWI
The US now has an ample supply of the life-saving COVID-19 antiviral treatment Paxlovid and that it no longer needs to be rationed.
4/25/22 AP: Beijing to mass-test most of city as COVID-19 cases mount https://buff.ly/3MrJlRF
Some residents worked from home and many stocked up on food as a safeguard against the possibility that they could be confined indoors, as has happened in multiple cities, including the financial hub of Shanghai.
4/24/22 Journal of Infectious Diseases: Global Prevalence of Post COVID-19 Condition or Long COVID: A Meta-Analysis and Systematic Review https://buff.ly/38juwBY
54% of hospitalized patients and 34% of non-hospitalized patients had Long COVID.
Fatigue was the most common symptom (23%) followed by memory problems.
IDSA: Worldwide around 200 million people currently or previously experienced long-term health-related consequences of COVID-19.
The health effects of COVID-19 appear to be prolonged and can exert stress on the healthcare system.
4/24/22 Lancet: Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalization in the UK: a prospective observational study https://buff.ly/3MpP0Yn
Only 1 in 4 patients have fully recovered 1 year after COVID hospitalization.
Risk factors include female sex, obesity and history of invasive mechanical ventilation.
Increased inflammatory mediators including IL-6 were found in very severe and moderate cognitive impairment clusters.
4/24/22 NY Times Opinion | Covid Drugs Save Lives, but Americans Can’t Get Themhttps://buff.ly/38fSDBa
The national map of participating pharmacies in test to treat shows large parts of the country with none. Even in areas where treatment is supposed to be available, it can be hard to get.
As further congressional funding has not been approved, people without insurance have to pay for the health appointment out of pocket.
Paxlovid and Evusheld were discussed.
4/24/22 Clinical Infectious Diseases: Reduced Cell Surface Levels of C-C Chemokine Receptor 5 (CCR5) and Immunosuppression in Long COVID https://buff.ly/3LpXrTe
N = 26 and 28
Treating Long COVID with the CCR5-binding antibody Leronlimab, we observed significantly increased blood cell surface CCR5 in treated symptomatic responders but not in nonresponders or placebo-treated participants.
These findings suggest an unexpected mechanism for Long COVID.
Rather than persistent immune activation, we observed abnormal immune downmodulation, which is normalized in some people by Leronlimab (a CCR5 antibody)."
