Unsurprisingly, the Omicron BA.2 variant is now the dominant variant across the United States. The good news is that hospitalizations in the US are the lowest that they have been during the entire pandemic. Being that BA.2 is more transmissible, I will continue to mask indoors when shopping however.
The latest study from Israel on 4th dose booster given to people age 60+ shows that for the Omicron wave, the 4th dose showed 2x lower rate of breakthrough infections although this reduction waned quickly. But, more importantly, the 4th dose showed a 4x lower rate of severe disease that did not wane by 6 weeks.
This week, a meta-analysis of over 300,000 pregnant people show that the mRNA vaccines are safe in pregnancy. Giving mRNA vaccines in the first trimester is not associated with increased birth defects.
President Biden put out a Presidential Memorandum which stated that the Secretary of Health and Human Services shall coordinate federal government-wide response to the long-term effects of COVID-19 and create a national research action plan on Long COVID. Several studies on Long COVID are planned and are outlined in the articles below.
Finally, a study came out this week on Long COVID and cardiac problems other than myocarditis. The researchers found that some of the cardiac manifestations of Long COVID are not found by blood tests (Troponin), but can be picked up on cardiac MRI (CMR). Not all hospitals have access to CMR, so people with cardiac symptoms of Long COVID may need to go to centers with CMR.
In the space of a week, dozens of White House aides and federal officials have contracted the disease in an outbreak that appears to have touched all corners of the administration.
President Biden was next to Nancy Pelosi a day before she tested positive.
4/7/22 UK Office for National Statistics (ONS): Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK https://buff.ly/3xcVfdy
As of 5 March 2022, 2.7% of the UK population are experiencing Long COVID (symptoms persisting for more than four weeks after COVID-19, mostly in people age 35 to 49.
Long COVID and variant:
33% pre-Alpha SARS-CoV-2
15% from Alpha
27% from Delta
19% from Omicron
Long COVID symptoms:
51% Fatigue
34% Shortness of breath
28% loss of smell
24% muscle aches.
4/7/22 BMJ (Sweden): Risks of deep vein thrombosis, pulmonary embolism, and bleeding after COVID-19: nationwide self-controlled cases series and matched cohort study https://buff.ly/35SP3MQ
The risk of blood clots (pulmonary embolism and DVT) and bleeding events with Covid: Country-wide data from Sweden indicates the heightened risk extends out to 6 months and occurs even with mild infections in the first 30 days.
Significantly increased risk of:
DVT for 70 days after COVID infection.
PE for 110 days after COVID infection.
Bleeding for 60 days after COVID infection.
4/7/22 PNAS: COVID-19 therapeutics: Challenges and directions for the futurehttps://buff.ly/3uXdG3k
Comprehensive review on COVID therapies, unmet needs and future directions.
4/7/22 Nature: FcγR-mediatedSARS-CoV-2 infection of monocytes activates inflammation https://buff.ly/37rMOAw
About 6% of blood monocytes in COVID-19 patients are infected with SARS-CoV-2.
Monocyte infection depends on uptake of antibody-opsonized virus by Fcγ receptors.
Vaccine recipient plasma does not promote antibody-dependent monocyte infection.
Antibody-mediated SARS-CoV-2 uptake by monocytes/macrophages triggers inflammatory cell death that aborts production of infectious virus but causes systemic inflammation that contributes to COVID-19 pathogenesis and Cytokine Storm.
4/7/22 CNN: Study reveals how Covid-19 infections can set off massive inflammation in the body https://buff.ly/3NTTqs0
Certain white blood cells called monocytes/ macrophages usually chop up viruses in their endosomes.
But, when SARS-CoV-2 gets taken up, it starts to replicate in these protector cells which set off a next-level set of alarms. This sets off a cascade of crisis signals that's very difficult to stop.
Only 1% of Covid-19 cases may have been detected in Africaand about two-thirds of the continent’s inhabitants may have been infected with the disease, the WHO said.
Only 16% of people on the continent are fully vaccinated.
4/6/22 NEJM (U Penn): Pulse Oximetry for Monitoring Patients with Covid-19 at Home — A Pragmatic, Randomized Trial https://buff.ly/3DPFvP7
n = 1000 adult patients in each group
Patients with COVID-19 are enrolled in COVID Watch, a 2-week program involving twice-daily automated text messages inquiring about dyspnea and offering rapid callbacks from nurses when appropriate. This program has been associated with improved survival as compared with no remote monitoring.
Among patients with Covid-19, the addition of home pulse oximetry to remote monitoring (COVID Watch program) did not result in a greater number of days alive and out of the hospital than subjective assessments of dyspnea alone.
4/6/22 FDA Vaccines and Related Biological Products Advisory Committee Meeting, Trevor Bedford https://buff.ly/3LMkqI6
We estimate almost 50% of the US infected with Omicron, most in the span of 10 weeks
Genetic relationships of globally sampled SARS-CoV-2 to present
NEJM: Protection by a Fourth Dose of Pfizer BNT162b2 against Omicron in Israel up to 6 weeks out https://buff.ly/3jdYA3T
n = 620,000+ with 4th dose vs. n = 620,000+ with 3 doses, all age 60+
Omicron wave in Israel, 4th dose shows:
4x lower rate of severe disease and no waning at 6 weeks.
2x lower rate of infection, but VE rapidly waned.
4/6/22 NY Times: Israeli Study Says Second Booster Protects Against Omicron Infection But Wanes Fast https://buff.ly/3KAXtrn
Eric Topol MD: "Bad headline. The second booster's main effect was to reduce severe disease, which did not wane quickly, not the impact on infection. Beyond that, the study above showing survival advantage is not mentioned."
4/6/22 Nature: Studying severe long COVID to understand post-infectious disorders beyond COVID-19 https://buff.ly/3LP4pRx
Long COVID could occur by various mechanisms, including viral persistence, SARS-CoV-2 superantigen–mediated activation of the immune system, and autoimmunity.
A big plan to systematically study the extreme phenotype of Long Covid via COVID Human Genetic Effort consortium (https://www.covidhge.com/) lays out their plans for systematically studying the Long COVID (PASC) phenotype using genomics and immunology, including possible superantigen and neurotoxin motifs.
Efforts will focus on the most severe cases of long COVID available through our international network of collaborators and clinics and will be limited to patients with severe organ damage or dysfunction that can be objectively verified by imaging and physiological or biochemical–molecular tests.
Fig. 1: Common signs and symptoms and possible causes of long COVID.
4/6/22 Lancet PrePrint: Safety of COVID-19 Vaccines During Pregnancy: A Systematic Review and Meta-Analysis https://buff.ly/3x9u83i
We found no safety concerns in 309,164 pregnant persons for currently administered COVID-19 vaccines during pregnancy. Most of the vaccines studied were mRNA vaccines.
4/6/22 JAMA Pediatrics: COVID-19 Vaccination During Early Pregnancy Is Not Associated With Risk of Congenital Fetal Anomalies https://buff.ly/3x8ENet
Vaccination within the teratogenic window was not associated with presence of a congenital anomaly identified on ultrasonography.
4/3/22 DM: German man got COVID vaccine jab 87 times as part of a scheme to sell vaccination passes to anti-vaxxers. https://buff.ly/3Dzzcim
4/3/22 BioRxiV: Omicron breakthrough infection drives cross-variant neutralization and memory B cell formation https://buff.ly/3rmepKD
Omicron breakthrough infection in Pfizer vaccinated individuals results in strong neutralizing activity not only against Omicron, but also broadly against previous SARS-CoV-2 VOCs and against SARS-CoV-1.
Omicron breakthrough infection mediates a robust B cell recall response, and primarily expands preformed memory B cells that recognize epitopes shared broadly by different variants, rather than inducing new B cells against strictly Omicron-specific epitopes.
The preformed B cell memory pool has sufficient plasticity for being refocused to neutralize new variants, thus avoiding “antigenic sin” per Dr. Eric Topol.
4/2/22 Tweet thread on the different recombinant variants
Delta x BA.1 recombinants are getting outcompeted by BA.2.
BA.1 x BA.2 recombinant XE may have a 10% advantage over BA.2 per Meaghan Kall
4/1/22 Covid: Infections are sky high in the UK, so why stop testing? https://buff.ly/3LEGXGC
No more free testing in England. The rest of the UK will follow soon despite high infection numbers.
4/6/22 MedRxiV: Cardiac impairment in Long Covid 1-year post-SARS-CoV-2 infection https://buff.ly/3DKpGsQ
Prospective cohort study compared 534 individuals with Long COVID to controls.
81% had not been hospitalized with COVID (i.e. mild COVID)
Cardiac impairment such as low LVEF, other than myocarditis, is present on cardiac MRI (CMR) in 1 in 5 individuals with Long Covid at 6 months, persisting in 58% of those at 12 months.
Cardiac-related blood biomarkers (troponin I and B-type natriuretic peptide ) are unable to identify cardiac impairment in Long COVID.
4/1/22 CDC: Cardiac Complications After SARS-CoV-2 Infection and mRNA COVID-19 Vaccination, Jan 2021 to Jan 2022 https://buff.ly/3DvBGyv
Data from 40 health care systems participating in a large network found that the risk for cardiac complications was significantly higher after SARS-CoV-2 infection than after mRNA COVID-19 vaccination for both males and females in all age groups.
4/1/22 AHA: SARS-CoV-2 Infection Induces Ferroptosis of Sinoatrial Node (SAN) Pacemaker Cells in the Hearthttps://buff.ly/36MBy1y
In a hamster model, primary pacemaker cells in the heart can be infected by SARS-CoV-2.
Infection of hESC-derived functional SAN-like pacemaker cells demonstrates ferroptosis as a potential mechanism for causing cardiac arrhythmias in patients with COVID-19.
Two drug candidates, deferoxamine and imatinib, may be able to block SARS-CoV-2 infection and infection-associated ferroptosis.
4/8/22 Airlines that dropped mask requirements are now suffering staff shortages due to COVID-19 and are canceling flightshttps://buff.ly/3v6lTT3
Airline CEOs in the US are also trying to get masks dropped, but health care professionals say that this would be premature.
