COVID news 9/2/22

Hi all,

BA.5 COVID cases are continuing to decrease slowly. There is still a 14% test positivity rate in the US and we still have about 400 people dying each day of COVID. But, overall cases, hospitalizations and deaths are all slowly decreasing. In addition, new variant BA.4.6 is not spreading rapidly in the US and variant BA.2.75 has not been seen in the US.  A new study shows that the BA.2.75 variant shows cross-immunity with BA.1 and BA.2 and both Evusheld and Bebtelovimab monoclonal antibodies work against BA.2.75. This is good news.

The new bivalent boosters will be coming to a pharmacy or clinic near you starting tomorrow in some places and next week in other locations. The FDA and CDC decided to approve the BA.4/5 bivalent vaccines without human studies because they had information from the BA.1 bivalent vaccine human clinical trials and because mouse data was reassuring. Some people say that this change in vaccine components from BA.1 to BA.5 is like how we change components in the flu vaccine each year.  The mRNA vaccines have been proven safe in humans.  Other people would prefer to have human data before getting a specific BA.4/5 bivalent booster.  The problem is that by the time that clinical data would be available, the BA.5 variant wave would be long over.

Here are some facts about the BA.4/5 bivalent vaccines:

• Pfizer bivalent booster (15mcg original virus mRNA  + 15mcg BA.4/5 mRNA) will be available to everyone age 12+.

• Moderna boosters  (25mcg original virus mRNA  + 25mcg BA.4/5 mRNA) will be available to people 18 and over.  

• Some vaccine bottles and cap colors are very similar and could be confusing for healthcare workers. For instance, the Moderna monovalent vaccine for kids age 6 to 11 looks very similar to the Moderna bivalent booster for adults and both have the same blue cap.

• Where to get the bivalent booster? See

https://www.vaccines.gov/

• Recent COVID infection? Wait until you have recovered, but probably best to wait 3 months after your last COVID infection depending on your risk level for a better response.

• Recent booster of original vaccine?  Wait at least 2 months since your last COVID vaccine.

• If unvaccinated, can I get the bivalent booster? No, the new shots are only approved as a booster and not for use as a primary series.

An article this week in the Financial Times titled "Covid is leaving people sicker" reviewed studies showing that COVID can cause Long COVID, but it can also cause new chronic diseases like heart failure and diabetes in the year after an infection.  As one doctor put it “The level of damage that’s been done to population health [during Covid], it would be as if everybody suddenly decided to take up smoking in one go.” In addition, a new vital statistics report from the CDC shows that there has been a "historic" decrease in life expectancy in the US in the last two years mostly due to the SARS-CoV-2 pandemic, but also due in part to accidents and drug overdoses. The average life expectancy of Americans fell precipitously in 2020 and 2021, the sharpest two-year decline in nearly 100 years. In 2019, American life expectancy was 79 years and in 2021 it was 76 years. Native Americans and Alaska Natives lost more than 6.5 years during the pandemic bringing this group's life expectancy down to age 65.

Chengdu and Shenzhen in China were locked down this week in compliance with China's Zero-COVID policy. These cities are known for factories making electronics and automobiles. Cases in Western Europe and many places in Asia and Oceania are decreasing with the exception of Hong Kong. In the US, cases are decreasing slowly. In the Bay Area, wastewater virus levels are down significantly in the last 2 weeks. Hopefully with the new boosters and the decreasing cases of BA.5, we will have a nice fall season.

Have a good holiday weekend,

Ruth Ann Crystal MD

Twitter: https://twitter.com/CatchTheBaby

For fun:

Other infectious disease news:

FYI 9/1/22 BNO: Argentina investigates outbreak of unidentified illness https://buff.ly/3KF2qQu

• Nine cases with symptoms that include pneumonia and fever. 

• Three of those infected – a doctor, a nurse, and a patient – have died.

• Experts have so far carried out tests for more than 30 possible causes – including coronavirus, hantavirus, and multiple strains of Legionella – but all have come back negative. 

COVID news:

World

United States

US cases: https://www.nytimes.com/interactive/2021/us/covid-cases.html

CDC: US variants through August 27

Wastewater: https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance

Bay Area wastewater: https://soe-wbe-pilot.wl.r.appspot.com/charts

9/1/22 STAT news: CDC recommends use of updated Covid boosters made by Moderna & Pfizer. Bivalents targeting both the original SARS-2 strain & Omicron sub-variant BA4/BA.5. https://buff.ly/3q3pEGv 

Good news about BA.2.75

9/1/22 9/1/22 Lancet: Evasion of neutralizing antibodies by omicron sublineage BA.2.75 https://buff.ly/3BhiKUN

• BA.2.75 is not more immune evasive than BA.5, shows cross-immunity with BA.1 and BA.2, and is still sensitive to monoclonal antibodies Evusheld and Bebtelovimab. 

• Bebtelovimab neutralizes BA.2, BA.4, BA.5 and potently neutralizes BA.2.75.

• Evusheld (Tixagevimab + Cilgavimab)   

• Cilgavimab is 11x less potent against BA.2.75 compared to OG virus like BA.5.

• Tixagevimab does not neutralize BA.2 but showed partially restored activity against BA.2.75.

9/1/22 CDC: Updates on COVID-19 Vaccine Effectiveness during Omicron  https://buff.ly/3KEcysO

• Less protection for both 3rd and 4th dose vaccines against BA.5 hospitalizations compared with the prior wave (BA.2, BA.2.12)

9/1/22 CDC ACIP meeting. Moderna presentation: COVID-19 Vaccine, Bivalent (Original And Omicron BA.4/BA.5) Booster https://buff.ly/3ALwjdg

• Slide 21: Neutralizing antibody response similar to BA.1 bivalent vaccine in mice.

• Slide 22: Mice challenged with BA.5 virus, there was similar impact for the 2 Moderna bivalent vaccines (BA.1 + original vs. BA.5 + original), better than the original (ancestral) vaccine.

9/1/22 MedRxiV (NIH study): Recent SARS-CoV-2 infection abrogates antibody and B-cell responses to booster vaccination https://buff.ly/3RrmLLu

• Over a two-month period, we evaluated antibody and B-cell responses to a third dose mRNA vaccine in 66 individuals with different infection histories. 

• Spike-specific B-cell responses from recent infection were elevated at pre-boost but comparatively less so at 60 days post-boost compared to uninfected individuals 

• B-cell responses to booster vaccines are impeded by recent infection. 

Reminder that the air filtration doesn’t start on airplanes until you are in the air.

8/31/22 Bloomberg: China Locks Down Western Megacity Chengdu as Covid Zero Rolls On https://buff.ly/3AF1Cqn

• Chengdu, a city of 21 million, is the biggest to be locked down since Shanghai.

• Electronics, automaker supply chains at risk of disruption.

8/30/22 CNN: China shuts world's largest electronics market as Shenzhen imposes lockdown https://buff.ly/3pZA6yR

8/31/22 Science: Omicron booster shots are coming—with lots of questions https://buff.ly/3AuXedq

• FAQs about the new bivalent BA.5 + original virus boosters that were just approved.

• An additional dose of a vaccine coding for the ancestral virus resulted in an 11-fold increase in neutralizing antibodies against all variants. 

• Strain-specific vaccines improved antibody levels 1.5x higher than those who received an ancestral strain vaccine.

8/31/22 Washington Post: What you need to know about fall booster shots of coronavirus vaccine https://buff.ly/3R7Gccf

• When will the shots be available?

• Where can I get one and how much will it cost?

• If I just got a booster of the original vaccine, should I get the new one right away?

  • It’s best to wait at least 2 months after your last vaccination.

• Will the new boosters be more effective against the omicron variant?

• Who are the boosters for?

  • Anyone 12 and older for the new booster from Pfizer/ BioNTech, and 18 and older for the Moderna booster.

• What are the side effects of the boosters?

8/31/22 NY Times: California Approves Bill to Punish Doctors Who Spread False Information https://buff.ly/3B4g2BU

• Trying to strike a balance between free speech and public health, California’s Legislature on Monday approved a bill that would allow regulators to punish doctors for spreading false information about Covid-19 vaccinations and treatments. 

• Spreading false or misleading medical information to patients as “unprofessional conduct” subject to punishment (suspension or revoking a physician’s license) by the Medical Board of California. 

8/31/22 NEJM Review: Covid-19 Vaccines — Immunity, Variants, Boosters https://buff.ly/3AFGtMA

• Current Covid-19 vaccines are less effective at blocking infection with the Omicron variant than prior variants, but protection against severe disease remains largely preserved.

8/31/22 Contact Dermatitis: Facial Dermatoses Induced by Face Masks: A Systematic Review and Meta‐Analysis of Observational Studies https://buff.ly/3KP0J3j

• Around half the people who wear face masks may develop acne, facial dermatitis, itch, or pressure injuries, and the risk increases with the length of time the mask is worn,” investigators concluded in a 37-study systematic review and meta-analysis 

8/31/22 Bloomberg: Americans Could Have to Pay for Covid Shots Starting Next Year https://buff.ly/3KHkbik

• The U.S. government anticipates that it will stop purchasing and providing COVID-19 shots as soon as January due to a lack of funds, leaving Americans to obtain vaccines through insurers or pay for them out-of-pocket. 

8/30/22 FT: The growing evidence that Covid-19 is leaving people sicker  https://buff.ly/3cwi2sU

• Long COVID but also new chronic diseases seen even after a mild COVID infection.

• Great graphic of the Veterans Administration study showing that: 

  • Growing evidence that Covid-19 is shifting the global burden of disease.

  • Even people who had mild Covid may have higher risk of heart and brain disease, diabetes and other new chronic medical issues.

• UK NHS data set shows 15% increase in heart attack deaths in people age 40-64 in 2021.

• “The level of damage that’s been done to population health [during Covid], it would be as if everybody suddenly decided to take up smoking in one go,” Strain says. 

8/30/22 Annals of Internal Medicine: The Association of Baseline Plasma SARS-CoV-2 Nucleocapsid Antigen Level and Outcomes in Patients Hospitalized With COVID-19   https://buff.ly/3RrHXkx

• Elevated plasma nucleocapsid antigen is highly associated with both severity of pulmonary illness and clinically important patient outcomes in hospitalized patients.

8/30/22 Lancet: Constructing custom-made radiotranscriptomic signatures of vascular inflammation from routine CT angiograms: a prospective outcomes validation study in COVID-19 https://buff.ly/3Rj9G6L

• Patients with COVID-19 had higher C19-RS than those without.

• A new radiotranscriptomic marker called C19-RS used during CT angiogram showed vascular inflammation and had prognostic value for in-hospital mortality. Patients with higher C19-RS who were then given dexamethasone had a much lower mortality rate.

8/29/22 Becker's Hospital Review: California hospital reports spike in staff COVID-19 infections https://buff.ly/3AWLlhR

• Sonoma Valley Hospital reported that 80% of its staff members exposed or showing COVID-19 symptoms tested positive for the virus in the last two weeks of July.

8/29/22 KHF: Unraveling the Interplay of Omicron, Reinfections, and Long Covid https://buff.ly/3cnH8KH

• The latest Omicron wave is waning, but the effects continue with Long COVID.

• Estimates of the proportion of patients affected by Long Covid also vary, from 4% to 5% in triple-vaccinated adults to as many as 50% among the unvaccinated.

• Even if Omicron causes Long Covid less often than other variants like Delta, the large number of people infected with Omicron will mean that many people may get Long Covid.

• VA studies show that reinfections dramatically increased the risk of serious health issues like a heart attack or stroke up to a year later. Each additional reinfection with Covid may increase risk to heart, lungs, kidneys, etc.

• Vaccination reduces the risk of long covid 15% to 50% depending on the study.

8/28/22 MedRxiV (Australia): Predicting the efficacy of variant-modified COVID-19 vaccine boosters https://buff.ly/3ehFydD

• Mathematical modeling (not a clinical trial) predicts that variant-modified booster vaccination can provide 1.5x neutralization antibody titers to a diversity of current and historic SARS-CoV-2 variants compared to ancestral-based boosters, with a maximum of 9.7% increase in protection (VE).

8/27/22 JAMA: Analysis of COVID-19 Incidence and Severity Among Adults Vaccinated With 2-Dose mRNA COVID-19 or Inactivated SARS-CoV-2 Vaccines With and Without Boosters in Singapore https://buff.ly/3cvxghO

• Two or 3 doses of Pfizer-BioNTech BNT162b2, Moderna mRNA-1273, Sinovac CoronaVac, or Sinopharm BIBP-CorV. 

• Vaccines and boosters during the Omicron wave in Singapore, among 2.4 million people, age 30+

• 3 shot mRNA, vaccine effectiveness:

  • 32 - 41% VE against Confirmed Omicron Infection to 2 months with rapid waning after that.

  • 87% VE against Severe Disease 87%, 5-6 months

• 3 dose inactivated virus vaccine (Sinovac or Sinopharm):

  • 70% VE against Severe Disease 

8/27/22 Lancet: Wearable technology and COVID-19 https://buff.ly/3AwBzBE

• Smartwatches and wrist sensors can help in early diagnosis of Covid and other viral illnesses. It may also be useful in managing Long Covid.

8/25/22 Washington Post by Dr. Wes Ely:

How long Covid reshapes the brain — and how we might treat it https://buff.ly/3pVS9Ws

• Dr. Ely did a long tweet thread with all of what he discussed in the Washington Post article because there is a paywall with WashPo.

• Excerpts from the Tweet thread by Wes Ely summarizing Long COVID and the Brain:

Mild Covid is biologically dangerous long after initial viral infection.

81 mild COVID pts bit.ly/3pcqbFV

Study revealed:

✔️Astrocytes (🧠 support cells for neurons) get infected

✔️Neurotransmitters are altered

✔️Neurons die indirectly

✔️Then we lose brain power

 CoronaVirus Ghosts: 👻

Antibody patterns over time indicate prolonged antigenic stimulation long after COVID infection.

We find virus in the GI system of some patients months later. go.nature.com/3w1jnhZ

One theory about #LongCOVID is that COVID has figured out how to rent space in our gut mucosa wreaking havoc on some people’s immune system. bit.ly/3BYVThj

Ongoing Antigen stimulation of our immune systems by “COVID ghosts” in the GI tract may be a source of Long COVID. go.nature.com/3bQgHNo

Three different profiles of #LongCOVID were found in N=1,500 patients: bit.ly/3QjM5mq

• brain predominant

• heart/lung predominant

• multi-system (including joints & GI).

Other neuroimaging, PET & cognitive testing data support abnormalities in the hippocampus & frontal cortex. bit.ly/3axWlaN

• PET studies showing metabolic slowing help explain profound anxiety, loss of memory & neurocognitive deficits in long COVID pts.

Thread goes on to explain brain fog in Long COVID, astrocytes, glia. 

 In 20 years of studying long-term ICU outcomes, we’ve learned that acquired dementia is often partially correctable. bit.ly/3vCMTtc

• #PICS patients can benefit from brain exercises even years after ICU care.

• There will be overlap w #LongCOVID & we must study this.