COVID news 4/29/23
Hi all,
XBB.1.5 is slowly being pushed out of first place by XBB1.16 and to some extent XBB1.9.1. This week, reported SARS-CoV-2 cases, wastewater SARS-CoV-2 levels, COVID hospitalizations and deaths are all very low. In the past 2 years, COVID cases tend to decrease in the spring and then increase in the summer months, especially in the south, as the weather becomes hot and people stay inside together in the air conditioning. Experts still recommend wearing masks in crowded indoor spaces like airplanes and advise testing before an important event to prevent spreading COVID to those with suppressed immune systems.
Katelyn Jetelina wrote an article this week regarding the second bivalent booster for higher risk people who are either over age 65 or are immunosuppressed and when would be the best time to get it. If someone is high-risk, and it has been at least six months since they had their last vaccine, they should get it now. If it’s been only four months, they may want to wait because cases are so low at this point and they could get their booster if numbers start to go back up. But, we know that immunity wanes about 4 to 6 months after vaccination and the best time for a second booster for one person may be different for another. Other people may choose to get the updated booster a few weeks prior to a big event such as a wedding to have the most protection at the event.
Long Covid
A recent CDC survey shows that 5.5% of California adults, or approximately 1.5 million people in California, currently have Long Covid. Of these, 82% have some limitations on their daily activities. One Covid specialist that Cal Matters interviewed said that many of the people with Long Covid have seen a significant improvement of their symptoms over time. While this can be true, I also know people on Twitter who have been suffering with Long Covid since 2020.
A new study in Neurology using BOLD-fMRI shows that people with Long COVID and neurologic symptoms use alternate brain regions and have reorganized neural networks to maintain normal performance during working memory tasks. Eric Topol reviewed in an article that there is a 20 to 40% increase in diverse autoimmune diseases after COVID infection. Another study showed that severe Covid infections can also lead to new and sometimes life-threatening heart arrhythmias within six months of infection. After severe Covid infections, participants had a 16 fold increase in ventricular tachycardia, a 13 fold increase in atrial fibrillation, 14 fold increase in other tachyarrhythmias, and a nine fold increase in bradycardia requiring a pacemaker. The authors state that since globally there have been more than 650 million reported Covid cases, hospital systems should be prepared for an increase in patients requiring management for new onset arrhythmias.
A new study showed that Molnupiravir can reduce the risk of Long Covid by 14%. This surprises me, since other studies show that Molnupiravir does not reduce severe infection if taken during an acute Covid infection. Molnupiravir is mutagenic and should be used with caution, as there are risks that Molnupiravir could cause new variants.
Regarding acute Covid infections, a study shows that oral fluvoxamine given with inhaled budesonide early in acute Covid infection can decrease the risk of emergency room care or being hospitalized for Covid. This adds another possible treatment to Paxlovid, Metformin, and Molnupiravir, to be used during acute infections to help prevent severe disease.
Pediatrics
In northern India Omicron XBB.1.16 infection affected young infants more than older children and it has been causing mild respiratory illness. Itchy, sticky conjunctivitis was noted in 43% of infants. None of the children required hospitalization.
Antibody levels in children after Omicron infections were found to be lower than with previous variants according to a new study from Germany. In Tübingen, 1850 children and adolescents have been followed since the summer of 2020. Only 18% of kids made salivary antibodies to Omicron infection versus 68% of children made salivary antibodies to prior SARS-CoV-2 variants. Of note, after vaccination, 100% of children made antibody salivary antibodies to Omicron. Regarding plasma antibodies, 70% of children made antibodies after an Omicron infection versus 100% of children made plasma antibodies against prior SARS-CoV-2 variants. The authors suggest that low antibody production against Omicron may explain why some people have repeat Covid infections with Omicron subvariants, sometimes just one month after their last infection. Also, they suggest that Omicron infections could remain undetected by seroprevalence studies.
Regarding repeat Covid infections, a new article in Nature magazine states that researchers disagree over how concerning it is to be reinfected with SARS-CoV-2. A November 2022 study from Al-Aly at the Veterans Administration hospital showed that veterans with repeat infections were twice as likely to die and three times as likely to be hospitalized, and had heart problems or experienced blood clots more than people who were infected by Covid only once. Data from the UK Office of National Statistics (ONS), suggests that the risk of long Covid diminishes with subsequent infections. Adults had a 4% risk of developing long Covid after their first infection in a 2.4% risk after reinfection according to the ONS. Even if there were fewer Long Covid cases after a repeat infection, there are still increased risks of heart attacks or blood clots in the year after a Covid infection.
Using dogs to screen for Covid in California schools was found to be an easier way to test students and staff for SARS-CoV-2 and had an overall accuracy of 90%. The study supports the use of dogs for efficient and non-invasive COVID-19 screening. This week, it was discovered that Florida surgeon general Ladapo purposefully altered findings in a study on Covid vaccine safety in order to say that the vaccines were not safe. Statisticians realized that Ladapo’s analysis did not make sense and now there is proof that he altered data. In an Op Ed in the British medical journal, authors discuss that while the Covid public health emergency may be ending in the US, Covid now joins the “ordinary emergency” that is American healthcare. The article discusses our nation's mental health crisis, daily mass shootings, health inequities, the collapse of rural hospitals and other issues.
In non-Covid news, a super bloom of wildflowers is happening now in California after a very wet winter. The carpet of flowers is so grand that it can be seen from space. Kaiser Permanente will acquire Geisinger and 5 to 6 other health systems under a new company called Risant Health. Kaiser will operate these nonprofit health systems under value-based care model models. The FDA approved the first fecal transplant pill to treat repeat infections with Clostridium difficile. The Veterans Administration in Atlanta had “drive through” baby showers for pregnant veterans who may be at heightened risk for pregnancy complications, compared to their civilian counterparts. They hope to improve communication between health teams and expectant parents.
Have a good weekend,
Ruth Ann Crystal MD
Other news:
4/21/23 NPR: California's destructively wet winter has a bright side. You'll want to see it https://buff.ly/41wuZr4
A superbloom. Seas of wildflowers so vast they can be seen from space.
4/20/23 NPR: Facebook users can apply for their portion of a $725 million lawsuit settlement https://buff.ly/3URVhSa
If they had accounts from May 2007 to December 2022.
Apply by August 25
4/21/23 AP: Supreme Court preserves access to abortion pill for now https://buff.ly/3AosQBE
4/22/23 NPR: Gov. Newsom sends National Guard and CHP to tackle San Francisco's fentanyl crisis https://buff.ly/3H6qbjZ
4/24/23 JAMA Peds: Preterm Birth, Small for Gestational Age, and Large for Gestational Age and the Risk of Atrial Fibrillation (AF) Up to Middle Age https://buff.ly/3Hg7VVv
n = >8 million people from Denmark, Sweden, and Finland
Prevalence of AF in children and young adults is usually 0.12% to 0.16%.
Preterm birth and large for gestational age birth were associated with increased Afib risk (HR 1.30 and 1.55) by a median age of 29 years.
Preterm birth was more strongly associated with AF in childhood than in adulthood.
Children born SGA had an increased risk of AF in the first 18 years of life but not afterwards.
4/25/23 JAMA: Quantity of Melatonin and CBD in Melatonin Gummies Sold in the US https://buff.ly/3AykCXM
25 melatonin gummy products from different brands were analyzed. 22 contained different amounts of melatonin than what was listed on their labels: one had only 74% of the advertised melatonin, another had 347% more and one had no detectable melatonin at all.
4/25/23 NPR: Why the VA in Atlanta is throwing 'drive-through' baby showers for pregnant veterans https://buff.ly/3L7vNvz
4/2723 MedCity News: Kaiser Permanente to Acquire Geisinger, Along with 5-6 More Health Systems in the Near Future https://buff.ly/41HqlXb
Kaiser Permanente to acquire Pennsylvania-based Geisinger Health.
Geisinger will be a part of Risant Health, a new company Kaiser launched to operate nonprofit health systems under value-based care models.
Kaiser said it expects to invest $5 billion in Risant and add five or six health systems into the company over the next five years.
4/27/23 Menopause symptoms cost billions in medical expenses and lost days of work, study suggests | CNN https://buff.ly/3LbvdwH
4/27/23 AP: First pill for fecal transplants wins FDA approval https://buff.ly/3LgSVHQ
Four daily capsules taken for three consecutive days to treat C. Difficile.
COVID news:
World reported cases https://medriva.com/charts/world-monitor.php
US reported cases https://medriva.com/charts/usa-monitor.php
Variant tracker in US: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
The US pandemic hits new lows in hospitalizations and deaths.
XBB.1.16 (and XBB.1.9.1) are pushing out XBB.1.5.
Wastewater Monitoring:
CDC Wastewater Monitor https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance
Biobot: https://biobot.io/data/
Sewer Coronavirus Alert Network (SCAN) project by Stanford University:
4/27/23
From Mike Honey:
4/27/23 XBB.1.16 is in Los Angeles https://buff.ly/44axW2b
Pink eye or conjunctivitis can be a symptom
From https://sosophie.design/Berlin-Buyers-Club regarding Long COVID:
4/27/23 Cal Matters: Long COVID in California: ‘A pandemic of loneliness and social isolation and rejection’ https://buff.ly/449lFei
"Recent CDC surveys suggest 5.5% of California adults — roughly 1.5 million people — currently experience the ill-defined, mysterious and often debilitating collection of symptoms that make up long COVID. A majority of them, 82%, have some limits on their activity."
Long COVID specialists interviewed by CalMatters said even if patients don’t make a full recovery, most see significant improvement over time.
“You look a year or 18 months out and the majority of people have had improvement if not complete resolution,” said Dr. Caitlin McAuley, a primary care physician at the USC Keck COVID Recovery Clinic.
4/26/23 Neurology: Changes in Brain Activation Pattern During Working Memory Tasks in People With Post-COVID Condition (PCC or Long COVID) and Persistent Neuropsychiatric Symptoms https://buff.ly/3NchPex
People with Long COVID (PCC) and neurologic symptoms use alternate brain regions (greater activation in the right superior frontal gyrus) and reorganized networks to maintain normal performance during working memory tasks.
BOLD-fMRI was sensitive for detecting brain abnormalities that correlated with various quantitative neuropsychiatric symptoms.
BOLD-fMRI is blood-oxygenation-level-dependent functional MRI.
4/26/23 Nature: Are repeat COVID infections dangerous? What the science says https://buff.ly/3Lz6Iev
Researchers disagree over how bad it is to be reinfected, and whether COVID-19 can cause lasting changes to the immune system.
Al-Aly study from 11/2022 at the V.A. showed that veterans with repeat infections were twice as likely to die and three times as likely to be hospitalized, have heart problems or experience blood clots than people who were infected only once.
“If you dodged the bullet that first time and did not get long COVID, upon reinfection you could still get long COVID,” Al-Aly says.
The UK Office of National Statistics (ONS), however, suggests that the risk of long COVID diminishes with subsequent infections. Adults had a 4% risk of developing long COVID after a first infection, and 2.4% after reinfection.
For people who already have long COVID, reinfection seems to exacerbate symptoms.
Many virologists feel that SARS-CoV-2 does not affect the immune system long term.
From the Al-Aly study on veterans:
4/25/23 Katelyn Jetelina: Do I need a Spring Booster? https://buff.ly/424Ukbv
4/25/23 BMJ: Molnupiravir and risk of post-acute sequelae of covid-19: cohort study https://buff.ly/448IKha
Compared with no treatment, molnupiravir use within five days of a positive SARS-CoV-2 test result reduced the risk of PASC (Long COVID) by 14%.
4/26/23 BMJ: The Covid public health emergency is ending: it now joins the ordinary emergency that is American health https://buff.ly/3Atv82q
" It may indeed be challenging for our leaders to view covid as an emergency given that nothing currently qualifies as an emergency in the US:
not the nation’s mental health crisis,
not daily mass shootings,
not plummeting life expectancy,
not devastating health inequities,
not the collapse of rural hospitals,
not expanding maternal care deserts, and
not the fact that emergency departments—the safety net of last resort—are at a breaking point."
4/24/23 NY Times: What’s Going On With Covid Right Now? https://buff.ly/3VbubFR
Lower cases and hospitalizations. But, it is still important to mask indoors if there are a lot of people present.
4/24/23 JAMA Peds: Lessons Learned From a COVID-19 Dog Screening Pilot in California K-12 Schools https://buff.ly/3Nceg8e
The trained dogs, led by handlers, sniffed the ankles and feet of children and staff.
The dogs had an overall accuracy of 90% with a sensitivity of 83% and specificity of 90%.
"This study supports use of dogs for efficient and noninvasive COVID-19 screening"
4/24/23 Politico: Florida surgeon general Ladapo altered key findings in study on Covid-19 vaccine safety https://buff.ly/3V4IjjP
4/24/23 Sydney Herald: ‘It can’t be ignored’: Long COVID is costing Australia $5.7b a year https://buff.ly/3H9DJuU
There are economic costs of lost wages and increased medical costs, but there is also lost quality of life with Long COVID.
“Because long COVID can affect relatively young people, and potentially keep them out of the labour force for an extended period during prime working years, it has the potential to affect the long-term earning capacity of many sufferers.”
4/23/23 Eric Topol: The heightened risk of autoimmune diseases after Covid https://buff.ly/44dE7mn
Three large cohort studies support a “substantially increased risk of developing a diverse spectrum of new-onset autoimmune diseases.”
20% to 40% increased risk of new autoimmune disease after COVID infection.
4/17/23 European Society of Cardiology: Severe COVID-19 linked with 16-fold risk of life-threatening heart rhythm Ventricular Tachycardia within 6 months https://buff.ly/3LrXsss
Compared to the control group, patients who had severe COVID-19 requiring mechanical ventilation had:
16x ventricular tachycardia,
13x atrial fibrillation,
14x other tachyarrhythmias, and
9x bradycardia/pacemaker implantation.
“An increased risk of arrhythmias following COVID-19 has also been reported previously in the bulk of COVID-19 patients not requiring ICU treatment. Together with our new data and taking into the account that we globally have 650 million reported COVID-19 cases, hospital systems should prepare for an increase in patients requiring management for new onset arrhythmias.”
4/17/23 JAMA Peds: Antibody Levels After Primary Infection With Omicron Variants of SARS-CoV-2 Infection in Germany https://buff.ly/3LmG74c
N = 1850 children and adolescents followed since summer 2020 in Tübingen, Germany.
Saliva antibodies: 18% of kids made salivary Ab to Omicron infection vs. 68% of kids for prior variant infections. 100% of kids made salivary Ab after vaccination.
Plasma antibodies: 70% made plasma antibodies to Omicron vs 100% to prior variants.
Low antibody production may explain why some people have a repeat COVID infection just 1 month after their last.
Omicron infections may remain also largely undetected by seroprevalence studies.
4/20/23 MedRxiV: Preliminary clinical characteristics of Pediatric Covid-19 cases during the ongoing Omicron XBB.1.16 driven surge in a north Indian city https://buff.ly/43S6Sot
Higher involvement of young infants than older children with mostly a mild respiratory illness.
Itchy, non-purulent conjunctivitis with mucoid discharge and stickiness of eyelids in 42.8% of positive infants.
None of the children required hospitalization. All recovered with symptomatic treatment.
4/23/23 NY Times: Chinese Censorship Is Quietly Rewriting the Covid-19 Story https://buff.ly/40NIrG1
Censorship of Chinese scientists studying COVID by the Chinese government.
4/18/23 Annals of Internal Medicine (Brazil): Oral Fluvoxamine With Inhaled Budesonide for Treatment of Early-Onset COVID-19: A Randomized Platform Trial https://buff.ly/3A51BvN
Fluvoxamine (100 mg twice daily for 10 days) plus inhaled budesonide (800 mcg twice daily for 10 days)
n = 738 treated and 738 controls
1.8% of treated people vs 3.7% of controls were either observed in an emergency setting for COVID-19 for more than 6 hours or hospitalized due to COVID-19.