COVID news 7/22/22
COVID news 7/22/22
Hi all,
BA.5 now makes up 78% of COVID cases in the United States. It has spread very quickly and hospitalizations have been increasing as well although less than with previous variants. A new early study from Denmark shows that people may be 65% more likely to be hospitalized with BA.5, but we will need other studies to confirm this.
President Biden is now COVID positive and he has started a course of Paxlovid as a precaution. He is having mild symptoms.
We are seeing via wastewater studies that some counties in the US are showing their highest level of virus- more than what has been seen previously during the entire pandemic in places like Los Angeles County, CA, Monterey County, CA and Clark County, NV. Ninety-nine percent of California's population is in a "high risk" transmission area, as is 98% of Florida’s population, 95% of Hawaii’s population, 91% of New Jersey’s population and 88% of Illinois’ population according to Jason Salemi, epidemiologist who has based these numbers on CDC reports. Avoiding indoor restaurants and wearing a mask indoors can help to reduce transmission. Some places around the world including Greece, New Zealand, Australia, Costa Rica and Japan have very high cases of BA.5.
Drs. Eric Topol and Akiko Iwasaki wrote an op-ed yesterday in Science magazine, recommending that the government spend time and money on getting SARS-CoV-2 nasal vaccines to the market as soon as possible. Intramuscular vaccines alone cannot provide tissue level mucosal immunity in the nose and mouth. For that, we need nasal vaccines which can be used to boost protective IgA in the nasal and oral mucosa which will help prevent entry of the virus into our bodies.
If you are over age 50, it is recommended that you get a shingles vaccine like Shingrix to help prevent painful shingles which is also known as herpes zoster (HZ). It appears to be even more important now to protect yourself against shingles because of COVID. Reports show people who get a COVID infection are at a higher risk for reactivation of infections like shingles (from chickenpox), herpes, and possibly CMV and EBV (the virus that causes mononucleosis). While you are at the pharmacy or doctor's office getting your shingles vaccine, remember to get a COVID vaccine booster if you are over age 50 and haven't had your 4th dose yet. Unfortunately, in the US only 9% of people age 50 to 64, and only 23% of people age 65+ have gotten their 4th dose booster. The fourth dose booster has been proven in multiple studies to protect against severe disease and death in those over age 50.
Novavax has been approved by the FDA as a new COVID vaccine. Novavax is a protein nanoparticle vaccine, which is a type of vaccine that has been used for decades to protect against other viruses like Human Papillomavirus and Hepatitis B. It contains a synthetic SARS-CoV-2 spike protein and Matrix-M adjuvant, which is used to create a stronger immune response in the vaccinated person. Unlike other COVID-19 vaccines, Novavax can be stored in standard refrigeration, enhancing access. According to Katelyn Jetelina, Novavax may not be the silver bullet that we need however. Although a new study in Science shows that getting 2 doses of Novavax and then a mRNA booster may produce slightly more neutralizing antibodies to BA.5 than 3 doses of mRNA vaccine, the people in the Novavax group in this study were younger than other groups tested. This study showed that all types of original (ancestral strain) vaccines given as a booster were able to help protect against the Omicron variants including BA.5.
In other news, scientists in the British Medical Journal ask for Eli Lilly to expand availability of the only monoclonal antibody that can fight off BA.5, Bebtelovimab, to be made available to places outside the United States. And finally, there is good news about the variant BA.2.75 which appears only to be spreading in 2 states in India and not spreading elsewhere in the world.
Have a good weekend,
Ruth Ann Crystal MD
Twitter: https://twitter.com/CatchTheBaby
Monkeypox news:
7/21/22 Reuters: WHO reports 14,000 cases of monkeypox globally, five deaths in Africa https://buff.ly/3PsSWJS
Most cases reported are in Europe, particularly among men who have sex with men.
COVID news:
World
United States
US positivity rate:
Reported cases (likely under represents by at least 5x)
California reported case positivity: 16%
7/19/22 CDC: BA.5 is 78% of COVID infections this week
Bay Area Wastewater (last 52 weeks): https://soe-wbe-pilot.wl.r.appspot.com/charts
Wastewater SARS-CoV-2 virus levels in US Counties as of 7/14/22: https://biobot.io/data/
New peaks of virus with BA.5 in many counties
7/21/22 High Risk SARS-CoV-2 Transmission areas
99% of California’s population is in high risk transmission area
98% of Florida’s population
95% of Hawaii’s population
91% of New Jersey’s population
88% of Illinois’ population
Cases since Nov 15 2021 to present:
Greece (!), New Zealand, Costa Rica, Germany, Japan
Japan cases: BA.5 causes more cases than ever
7/21/22 CNN: President Biden tests positive for Covid-19 and is experiencing mild symptoms https://buff.ly/3B7sK2T
Direct oral anticoagulants (DOACs)—dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Savaysa), and betrixaban (Bevyxxa).
7/21/22 Texas Biomed working to accelerate COVID-19 drug development https://buff.ly/3zqW9DW
Professor Luis Martinez-Sobrido from Texas Biomed and his team developed a weakened, or attenuated, version of SARS-CoV-2 that does not cause illness nor death.
The NIH said that this attenuated SARS-CoV-2 virus can be used in biosafety level (BSL-2) laboratories.
Previously, SARS-CoV-2 could only be safely studied in a biosafety level 3 (BSL-3) laboratory, which is much more restrictive, requires more personal protective equipment, and extensive training.
7/21/22 Lancet: Risk of Reinfection, Vaccine Protection, and Severity of Infection with the BA.5 Omicron Subvariant https://buff.ly/3zqDkAM
Observational cohort study in Denmark.
High protection (94% VE) against BA.5 from prior Omicron infection in triple-vaccinated individuals.
Triple vacinees had similar VE against BA.5 or BA.2 infections.
BA.5 infection was associated with a 65% increased risk of hospitalization in this study which needs confirmation and continued surveillance.
7/21/22 Science: Operation Nasal Vaccine—Lightning speed to counter COVID-19 https://buff.ly/3aVJ4t9
Eric Topol and Akiko Iwasaki call for Operation Nasal Vaccine, the urgent need for a lightning speed initiative, to help block Covid infections and transmission with nasal vaccines.
Even BA.5 specific vaccines that may be available by the end of 2022 will likely be obsolete by that time, outcompeted by new variants.
Intramuscular shots alone do not provide tissue-level mucosal immunity. The only path to achieve this will be via nasal or orally administered vaccines.
“The prospect of achieving [containment of SARS-CoV-2] with nasal vaccines is high, but will only be possible with dedicated funding, priority, and breaking down of any regulatory hurdles.”
6/13/22 The Scientist: 12 Nasal Vaccines in clinical trials: https://buff.ly/3zoWFm9
7/21/22 Second boosters in the United States:
9% of people age 50 to 64
23% of people age 65+
7/21/22 CDC: Rates of COVID-19 Cases and Deaths by Vaccination Status https://buff.ly/3p5JqCa
Second booster protection in people age 50+:
29x reduction of death: with 2 doses + 2 boosters, vs. unvaccinated
4x reduction of death: with 2nd booster vs 1 booster
7/20/22 Reactivation of dormant viruses (HSV, CMV, VZV, EBV) with COVID infections.
Lymphocytopenia noted with SARS-CoV-2 infections.
7/20/22 Oxford Press (OFID)from May 2022: Increased Risk of Herpes Zoster (Shingles) in Adults ≥50 Years Old Diagnosed With COVID-19 in the United States https://buff.ly/3aQPc5M
394,677 individuals ≥50 years old with COVID-19 were matched with 1,577,346 individuals without COVID-19.
Individuals diagnosed with COVID-19 had a 15% higher Herpes Zoster (HZ) risk than those without COVID-19 (P < .001).
The increased HZ risk was more pronounced (21%) following COVID-19 hospitalization.
7/20/22 NEJM (Singapore): Effectiveness of BNT162b2 Vaccine against Omicron in Children 5 to 11 Years of Age https://buff.ly/3B4Palv
During the Omicron (BA.1) wave, Pfizer 2 dose vaccination reduced the risks of infection by 65% and hospitalization by 83% among children 5 to 11 years of age.
7/20/22 Science: Tunneling nanotubes provide a route for SARS-CoV-2 spreading https://buff.ly/3zlKx5h
SARS-CoV-2 induces the formation of tunneling nanotubes (TNTs) to get into human neuronal cells and uses this route to spread to uninfected cells.
Human neuronal cells, non-permissive to infection through the endocytic pathway, can be infected when co-cultured with permissive infected epithelial cells.
7/20/22 PLOS: Cardiometabolic outcomes up to 12 months after COVID-19 infection. A matched cohort study in the UK https://buff.ly/3zh1a24
Electronic records for 428,650 COVID-19 patients
Diabetes: 81% increase during acute COVID-19 infection and remained elevated by 27% from 4 to 12 weeks after the infection.
Cardiovascular: Acute COVID-19 was associated with:
6x cardiovascular diagnoses overall, including an 11x increase in pulmonary embolism, 6x increase in atrial arrhythmias, 5x increase in venous thrombosis
CVD diagnoses declined from 4 to 12 weeks after COVID-19 and returned to baseline levels or below from 12 weeks to 1 year after the infection.
7/20/22 Katelyn Jetelina: Novavax is here! Just not the silver bullet we need https://buff.ly/3yWaLKf
Novavax is a great vaccine for the unvaccinated, and it will save millions of lives.
It can eventually be used as a booster, but the effect will not be as impactful as I would have hoped. For now, I don’t recommend using Novavax off-label as a booster or, worse, waiting for a booster because Novavax is coming.
1/2022 Lancet: Study comparing mRNA, viral-vector, and protein-adjuvant vaccines in the UK (Com-COV2) https://buff.ly/3PrsoIM
Antibody levels after 1st dose Pfizer and 2nd dose Novavax were not as high as giving two doses of mRNA vaccine. The same was found for T-cell protection.
7/19/22 Science: Omicron spike function and neutralizing activity elicited by a comprehensive panel of vaccines https://t.co/8WCzGWB5S4
Although primary vaccine series (first 2 doses) do not protect as well against getting Omicron subvariant infections, booster doses of the original Wuhan strain vaccines provide protection against severe disease from BA.1, BA.2, BA.2.12.1, and BA.4/5.
The original (ancestral strain) booster helps against BA.5.
Of note, 2 Novavax shots with a mRNA booster may have made more neutralizing antibodies to BA.5 than 3 doses of mRNA vaccine. However, people in the Novavax group were also younger.
7/18/22 The pandemic and the boiling frog story by Eric Topol MD https://buff.ly/3INrMuu
If a frog is put suddenly into boiling water, it will jump out, but if the frog is put in tepid water which is then brought to a boil slowly, it will not perceive the danger and will be cooked to death. (P.S. We are the frog.)
The perception is that the pandemic is going away because ICU admissions and hospitalizations with BA.5 are lower than BA.1. But, the virus is still out there and is more fit and more contagious (see diagram below). We now have more of an “immunity wall” from vaccines and antiviral drugs like Paxlovid than in the beginning of the pandemic, but BA.5 is a mighty foe and can still cause Long COVID, hospitalizations and deaths despite our defenses.
The Gradual Attrition of Protection (and boosters are not helping as much):
“When BA.1 was the predominant variant, vaccine effectiveness (VE) was 61% for two doses against COVID-19-associated hospitalizations; VE increased to between 85%-92% after a receipt of a third/booster dose.
When BA.2.12.1 became predominant, vaccine effectiveness with two doses was 24% against COVID-19 -associated hospitalizations and increased to 52%-69% after a third/booster dose.”
7/18/22 Nature (Austria): Viral variant-resolved wastewater surveillance of SARS-CoV-2 at national scale https://buff.ly/3zgzQB5
Studying wastewater is a powerful way to follow emerging variants of concern (VOC) and their reproductive numbers in wastewater before they show up clinically.
Particularly valuable for countries without extensive individual monitoring.
7/18/22 Office for National Statistics (ONS) Self-reported Long COVID after infection with the Omicron variant in the UK https://buff.ly/3OjN7ge
Triple-vaccinated adults, self-reported Long COVID 12 - 16 weeks after first a COVID-19 infection was:
4.5% for infections compatible with Omicron BA.1 (1 in 22 people)
4.2% for infections compatible with Omicron BA.2 (1 in 24 people)
5.0% for infections compatible with Delta (1 in 20 people)
Double-vaccinated adults:
4.0% Long COVID 12 to 16 weeks after a first infection with BA.1 variant
9.2% Long COVID with the Delta variant
3 reasons why some people were already immune to SARS-CoV-2 before the pandemic:
Common Cold Coronavirus memory T cells
T cells that cross react to microbiome of skin and GI tract bacteria and viruses
Higher OAS1 expression
7/20/22 Cell: Immunological memory to Common Cold Coronaviruses assessed longitudinally over a three-year period pre-COVID19 pandemic https://buff.ly/3ofYETx
Pre-pandemic, some people already had high Common Cold Coronaviruses (CCC) memory T cells that protected them against SARS-CoV-2 infection.
7/18/22 Science: SARS-CoV-2-specific T cells in unexposed adults display broad trafficking potential and cross-react with commensal antigens https://buff.ly/3IKBpdD
In pre-pandemic blood samples, the researchers found SARS-CoV-2-specific CD4+ T cells that appear to cross-react to commensal bacteria from the skin and gastrointestinal tract microbiome and from endemic coronaviruses.
This may be why some people are intrinsically protected from COVID infections.
7/18/22 Nature: Genetic regulation of OAS1 nonsense-mediated decay underlies association with COVID-19 hospitalization in patients of European and African ancestries https://buff.ly/3objiUu
Analysis of patients of European (n = 2,249) and African (n = 835) ancestries.
Decreased OAS1 expression due to a common OAS1 haplotype increases hospitalization risk.
7/18/22 Lancet: A monoclonal antibody stands out against Omicron subvariants: a call to action for a wider access to Bebtelovimab https://buff.ly/3B4fE6C
Bebtelovimab works against BA.1 and BA.4/5.
We advocate that bebtelovimab should be made available outside the USA for patients worldwide, especially because Paxlovid has many drug-drug interactions but Bebtelovimab doesn't.
7/19/22 Good news: BA.2.75 (Centaurus) does not appear to be spreading more outside of 2 states in India. Early studies show that it is not as immune evasive as BA.4/5.
7/16/22 BioRxiV (Kei Sato lab): Neutralization sensitivity of Omicron BA.2.75 pseudovirus to therapeutic monoclonal antibodies https://buff.ly/3OcxabH
Bebtelovimab exhibited robust antiviral effect against BA.2 & BA.4/5, but BA.2.75 was more resistant to this antibody than BA.2 (21-fold) and BA.4/5 (26-fold), suggesting that Bebtelovimab may not be a good choice to combat BA.2.75.
Similar to BA.4/5, BA.2.75 was more resistant to Cilgavimab than BA.2.
Sotrovimab, Tixagevimab & Regdanvimab were not efficiently antiviral against BA.2 and BA.4/5 but,
Sotrovimab, Tixagevimab and Regdanvimab work against BA.2.75.
CDC MMWR: Effectiveness of 2, 3, and 4 doses of COVID-19 mRNA Vaccine When SARS-CoV-2 Omicron BA.1 and BA.2/BA.2.12.1 Sub Lineages Predominated — VISION Network, 10 States, December 2021–June 2022 https://buff.ly/3OhJpnm
Table 2:
for 18 to 49 years old
BA.1
2 doses--> 3 doses (in 1st 119 days) --> 3 doses (after 120 days)
24%--> 76%--> 29%
BA.2 or 2.12.1
2 doses--> 3 doses (in 1st 119 days) --> 3 doses (after 120 days)
7%--> 55%--> 17%
For age 50+
BA.1
2 doses--> 3 doses (in 1st 119 days) --> 3 doses (after 120 days)
52%--> 87%--> 81%
BA.2 and BA.2.12.1. Adding 4th dose.
2 doses--> 3 doses (in 1st 119 d) --> 3 doses (after 120 d)--> 4 doses
18%--> 58%--> 32%--> 66%
Importance of boosters to restore vaccine effectiveness improved after significant drop-off, BA.2/BA.2.12.1 variants showed worsening decline.
7/18/22 BioRxiV: Novavax NVX-COV2373 triggers potent neutralization of Omicron sub-lineages https://buff.ly/3aLH46u
The NVX-CoV2373 vaccine, a protein nanoparticle vaccine, has value in countries with constrained cold-chain requirements.
3 doses of Novovax induced neutralizing antibodies against BA.1 and BA.4/5 as well as 3 mRNA jabs.
7/18/22 PNAS: In SARS-CoV-2, brain astrocytes are in it for the long haul https://buff.ly/3uXmsiF
7% to 34% of COVID-19 survivors experience Long COVID, with diverse neurological and neuropsychiatric complications such as headaches, fatigue, anosmia, cognitive impairment, and depression.
Loss of gray matter in several regions of cortex have been identified in COVID-19 survivors.
SARS-CoV-2 preferentially infects astrocytes in the brain through noncanonical mechanisms.
Neurological symptoms associated with Long COVID arise indirectly from increased neuroinflammation.
7/15/22 7/18/22 BMJ: The NHS is not living with COVID, it’s dying from it https://buff.ly/3zgfW9f
How is the UK government responding to this crisis? Largely by pretending it is not happening or implying it is all under control.
Existing public health advice to wear masks in crowded places, ensure good ventilation, and test regularly need to be communicated much more powerfully and widely.
This should include a return to mask wearing in healthcare settings and on public transport, as well as re-introduction of free tests for the public.
Vaccination is the fourth pillar of action.
7/15/22 FT: UK Covid-19 vaccine boosters to be expanded to all over-50s https://buff.ly/3IUDALF
"People aged above 50, along with residents & staff in care homes, frontline health & social care workers, unpaid carers,.. aged 5-49 in clinical-risk groups and household contacts of those immunosuppressed."
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