Hospitalizations and Emergency Department visits for COVID are continuing to decrease this week. Emergency visits for RSV in babies age 0 to 1 year are starting to increase however. Fortunately, there are two new preventatives against RSV this year- an RSV vaccine that can be given in the last trimester of pregnancy and prophylactic monoclonal antibodies called Beyfortus given to babies to protect them against RSV. In school age children, Emergency Room visits for Influenza are starting to increase. We are still early in the respiratory illness season and there is still time to get the updated COVID vaccine and the flu vaccine.
As predicted, HV.1 (EG.5+L452R) has taken over as the most common variant in the U.S. right now. Of note, the 2023 XBB.1.5 vaccine should work against HV.1. Since COVID cases are no longer reported, we count on wastewater virus levels to calculate how many people have the virus now and to see which variants are circulating. The CDC had previously been using Biobot for wastewater surveillance, but they switched to Verily and this week’s CDC SARS-CoV-2 wastewater map is a bit sparse. It may take time to get the new system up and running. Biobot still is publishing their data on their website and we see that wastewater virus levels are on the decline in most places except the midwest where they have been fluctuating up and down most recently.
JN.1
The subvariant JN.1 is being watched closely as levels of JN.1 have been increasing around the world. JN.1 is BA.2.86 (Pirola) with an additional L455S mutation in the spike protein that makes it more immune evasive to neutralizing antibodies in pseudovirus studies. Pirola (BA.2.86) is very different from prior COVID variants. In fact, per Eric Topol MD, it represents an evolutionary path switch of the SARS-CoV-2 virus and is highly mutated as compared to past variants. In September, Moderna reported that their 2023 XBB.1.5 COVID vaccine neutralizes BA.2.86. But, it is unknown if the addition of the L455S mutation will allow JN.1 to escape our antibody defenses. Immune walls from prior vaccinations and prior COVID infection are complex and we do not expect to see a huge wave of infection like we did in 2022 when Omicron first came on the scene. But, JN.1 is being watched closely.
The Atlantic featured an article on the Japanese antiviral medication Xocova (Ensitrelvir) which is a SARS-CoV-2 3CL protease inhibitor drug. With Ensitrelvir, people tested negative for COVID 36 hours faster than those who took a placebo and they shed virus for a much shorter time. COVID symptoms resolved 1 day earlier with Ensitrelvir and Ensitrelvir did not show rebound like Paxlovid. It is easier to take oral Ensitrelvir because it requires fewer pills each day and it does not cause an awful taste in the mouth like Paxlovid. Data from Shionogi shows that Ensitrelvir may reduce Long COVID symptoms 26% to 45% as well. Ensitrelvir also does not interact with common medications like Paxlovid often does. Paxlovid has been proven to decrease hospitalization and death in high risk patients. Ensitrelvir was tested in high risk and low risk people. The US FDA is making Shionogi do more clinical trials before approval here.
A new study shows that the 2022 bivalent boosters worked well. By April 2023, people who did not get the bivalent booster had little protection against COVID. The Pfizer bivalent booster (OG + BA.4/5) of 2022 restored protection against hospitalization and severe COVID disease including XBB sublineages.
Katelyn Jetelina wrote a post this week about the Fall 2023 COVID vaccine and how to reach the "passive positives". Passive positives are people who are not against getting vaccines, but they may not go out of their way to get one. Using the “IIFF” (Information, Immediate and complete registration, Focused engagement and Favorable activation) model from organ donation reminders, Ms. Jetelina and her co-authors describe how to get the “passive positives” to get the COVID vaccine. Specifically, it is important to talk about the benefits of the vaccine, the fact that everyone 6 months and older is eligible for the new vaccine, remind them about the importance of the COVID vaccine when they are at the doctor’s office or the pharmacy for another issue and be ready to give the vaccine that day if they agree.
Last week, I gave some links (here, here and here) on how to apply for disability for people with Long COVID and hobby ideas (here, here, here) to decrease boredom for people who are bedbound. This week, I found a thread on with helpful tips to help people with ME/CFS and/or Long COVID to be able to work from bed. In addition, people with Long COVID in Canada or the U.S. can call or text the Brooke Line (844-276-6530) to chat with another long hauler.
10/27/23 An update from the Physics Girl Dianna Cowern who has severe ME/CFS from Long COVID.
10/26/23
10/24/23 Cell: An atlas of continuous adaptive evolution in endemic human viruseshttps://buff.ly/46SuoTq
Comparing new mutations in SARS-CoV-2 to other viruses.
We find that SARS-CoV-2 accumulates roughly 20×10−3 amino acid substitutions per residue per year in S1.
2–2.5× faster than the accumulation of amino acid substitutions in influenza A/H3N2 HA1
7–10× faster than in the S1 subunit of seasonal coronaviruses 229E and OC43.
All SARS-CoV-2 viruses (Figure 5A) is roughly the same as
the currently predominant clade of Omicron 21L and its descendants (Figure 5B), corresponding to lineage BA.2 and derived lineages such as BQ.1 and XBB.
Convalescent plasma cuts death by 10% in COVID patients on mechanical ventilation
10/26/23 NEJM: Convalescent Plasma for Covid-19–Induced ARDS in Mechanically Ventilated Patients https://buff.ly/3FxK824
September 2020 through March 2022
In patients with acute respiratory distress syndrome (ARDS) from COVID and on a ventilator for less than 5 days, giving convalescent plasma from donors with a neutralizing antibody titer of at least 1:160 significantly reduced mortality.
10/26/23 MedRxiV (UCSF, Harvard): Plasma-based antigen persistence in the post-acute phase of SARS-CoV-2 (PACS) infection https://buff.ly/3rZcaQZ
“Although a definitive link between antigen persistence and post-acute sequelae (e.g., Long COVID symptoms, cardiovascular disease, stroke, blood clots, etc.) has yet to be confirmed, the observation that more than 10% of plasma samples for over a year following initial SARS-CoV-2 infection contain detectable viral antigens, which are potentially immunogenic, has significant implications given the sheer number of people infected with SARS-CoV-2 to date.”
These antigens (spike, nucleocapsid, S1) have been shown to induce inflammatory cytokine responses as well as dysregulation of fibrinogen, complement proteins, and endothelial cells.
10/26/23 Stem Cell Reports: Businesses marketing purported stem cell treatments and exosome therapies for COVID-19: An analysis of direct-to-consumer online advertising claims https://buff.ly/3s7rdYC
75% of these clinics are in the US or Mexico. They promote stem cell treatments and exome therapies as treatments for Long COVID and for “immune boosts” despite these therapies not having safety data, efficacy data and they are not FDA approved.
The least expensive product cost $2,950, the most expensive was $25,000, and the average listed cost for patients was $11,322.
10/25/23 The Atlantic: America May Be Missing Out on a Better COVID Treatment https://buff.ly/46NBIPU
Japanese antiviral medication Xocova (Ensitrelvir) may be approved in the US in 2024.
With Ensitrelvir, people test negative about 36 hours faster than those who take a placebo.
Symptoms go away 1 day earlier.
Ensitrelvir has fewer pills to take and it does not give the awful taste in the mouth like Paxlovid. Plus, it interacts with fewer medications than does Paxlovid.
Ensitrelvir did not show rebound in their studies.
Paxlovid, however, is proven to decrease hospitalization and death in high risk patients.
Data from Shionogi: Ensitrelvir for mild-to-moderate COVID-19, Phase 3 part of Phase 2/3 study https://buff.ly/3EAAImi
Ensitrelvir inhibits SARS-CoV-2 3CL protease and prevents viral replication by blocking polyprotein cleavage
10/25/23 Thread on things to help people with ME/CFS and Long COVID work from bed
Many people recommended mini fridge, new pjs or lounge wear, over bed desk, rolling drawers, etc.
Overbed Table with Wheels for Full/Queen Beds | Height Adjustable Rolling Bed Desk https://buff.ly/3rZx7v4
10/25/23 Salon: The doctors with long COVID who have been left behind https://buff.ly/3FAiEsG
“Those [doctors] who are not absent with Long COVID are burnt out and leaving in droves.”
Brookings Institution indicates 15% of the nation’s 10.6 million unfilled jobs could be attributable to long COVID, altogether costing the country at least $170 billion in lost wages.
“It's a devastating healthcare and humanitarian crisis,” Heeger said. “It's [also] an economic crisis.”
10/25/23 Lancet Resp: Effectiveness of BNT162b2 BA.4/5 bivalent mRNA vaccine against a range of COVID-19 outcomes in a large health system in the USA: a test-negative case–control study https://buff.ly/40gDoPI
"By mid-April, 2023, individuals previously vaccinated only with wild-type vaccines had little protection against COVID-19—including hospital admission.
A BNT162b2 BA.4/5 bivalent booster restored protection against a range of COVID-19 outcomes, including against XBB-related sublineages, with the most substantial protection observed against hospital admission and critical illness."
10/25/23 Eric Topol MD: The Virus Takes a Detour in its Evolutionary Arc https://buff.ly/478Xm0Z
JN.1 = Highly-mutated BA.2.86 (Pirola) has added a L455S mutation.
BA.2.86 has 34 additional spike protein mutations compared to BA.2.
We are seeing an evolutionary path switch from Omicron to XBB and now to BA.2.86.
10/26/23 Forbes by William A. Haseltine: JN.1: The Odd Man Out Among Omicron Sublineages https://buff.ly/3FwCsgo
The different mutations of JN.1 vs. HV.1 as compared to XBB.1.5 which is the target of the 2023 fall booster
The mutations of JN.1 in blue are all different from XBB.1.5. in the diagram below.
9/8/23 MedRxiV (Moderna): Safety and Immunogenicity of XBB.1.5-Containing mRNA Vaccines https://buff.ly/462bqZt
Moderna XBB.1.5-containing vaccines elicited potent neutralizing responses against variants of the omicron XBB-lineage (XBB.1.5, XBB.1.6, XBB.2.3.2, EG.5.1, and FL.1.5.1) as well as the recently emerged BA.2.86 variant.
More COVID-19 studies suggest BA.2.86 is less immune-evasive than feared.
10/24/23 Nature: Anti-COVID drug Molnupiravir accelerates viral evolution https://buff.ly/49jWE2X
"Continued widespread administration of molnupiravir seems inadvisable."
9/18/23 The Atlantic: The Pandemic Had a Silver Lining for Cypriot Catshttps://buff.ly/46Qmmds
COVID Drug (Molnupiravir) is a Miracle Cure for Cats
Leftover medications are going to save the animals from a deadly feline coronavirus.
10/23/23 Nature (David Ho): Antigenicity and receptor affinity of SARS-CoV-2 BA.2.86 spikehttps://buff.ly/3QcwiHb
XBB.1.5 vaccine should work against the BA.2.86 variant.
BA.2.86 has an extremely high affinity towards the ACE2 receptor which could lead to high transmissibility.
Brooke Line for people with Long COVID to talk with another long hauler:
10/24/23 Katelyn Jetelina: Fall 2023 vaccine coverage and reaching "passive positives" https://buff.ly/3Sk7gZc
Covid-19 is more transmissible, more severe, has more long-term implications, and is more unpredictable than the flu. So, why is coverage so much lower than flu?
COVID circulates year round, age eligibility debate, poor access, pandemic fatigue, low resources.
“Increasing trust, access, and coverage of vaccines will take an all-hands-on-deck approach. We are exhausted, but it’s worth the push—fewer lives will be lost, fewer work and school days will be missed, and our quality of life will improve.”
See the Sci Am article she wrote with 2 psychologists:
Passive positives are people who agree with the idea of vaccination and have gotten COVID vaccines in the past, but just haven't signed up for the new vaccine yet.
Use the “IIFF” model (Information, Immediate and complete registration, Focused engagement and Favorable activation) from organ donation. COVID vaccination, is rife with passive positives: people who approve of donation but have not signed up to be donors.
How to reach “passive positives” to get the COVID vaccine:
Remind them about the BENEFITS of the vaccine.
Every one 6 months and over is ELIGIBLE.
Doctors and pharmacists should REMIND people even if they are seeing them for another reason.
BE READY. Have a vaccine dose available that day if the person agrees.
10/23/23 JAMA Pediatrics: SARS-CoV-2 Culturable Virus Shedding in Childrenhttps://buff.ly/40bntSr
n = 76 children, 68.4% were vaccinated and 55.4% were aged between 7 and 12 years.
Children were found to be infectious with culturable virus until:
Day 3 in 78% of kids
Day 5 in 18% of kids
Day 10 in 4% of kids
“Current policies requiring isolation for 5 days after a positive test might be appropriate, as the majority of children were not infectious by day 5.”
Children with COVID infectivity:
Candida Albicans and COVID
“In people with severe [acute] Covid, fungus in the gut (such as Candida albicans) can induce pathologic, chronic inflammation consistent with #LongCovid” -Eric Topol MD
The fungus Candida Albicans is just making the inflammation worse.
10/23/23 Nature Immunology (Cornell): Fungal microbiota sustains lasting immune activation of neutrophils and their progenitors in severe COVID-19 https://buff.ly/3S7O1lL
In COVID-19 infections with lung dysfunction, secondary fungal infections with fungus (mycobiota) of the GI tract might be a contributing factor to the immunopathology.
Antibodies to common intestinal fungi are elevated in patients with COVID-19 and neutrophil progenitor cells show altered function in patients recovering from sCOVID-19.
Mice colonized with C. albicans strains from patients with COVID-19 experienced increased IgG antibody titers to C. albicans (ACAL) as well as lung neutrophilia and pulmonary NETosis during infection with SARS-CoV-2, which were partially resolved by antifungal treatment and by the blockade of IL-6.
10/23/23 Nature Immunology: Candida makes a lasting impression in COVID-19 https://buff.ly/3SaLNly
Severe COVID-19 is marked by excessive inflammation that can persist after infection.
The commensal yeast Candida albicans is now implicated in the acute and chronic immunopathology of COVID-19.
Fungal dysbiosis occurs during COVID-19 and could be long-lasting throughout convalescence.
C. albicans antibodies =ACAL IgG
10/23/23 Cell: Population immunity predicts evolutionary trajectories of SARS-CoV-2 https://buff.ly/46Ew8zx
Population "immune pressure, including contributions of vaccinations and previous infections, has become the dominant force driving the recent evolution of SARS-CoV-2."
A fitness model can predict how our immune wall will put pressure on SARS-CoV-2 to mutate to be more competitive.
10/20/23 eBioMedicine: Selective adaptation of SARS-CoV-2 Omicron under booster vaccine pressure: a multicentre observational study https://buff.ly/3sbu42G
Boosters against SARS-2 and their immune pressure on 5400+ SARS-CoV-2 virus sequences in NYC from July 2021 to August 2022 (evolutionary transition from Delta to Omicron BA.1-BA.5 variants.)
Looking at the SARS-CoV-2 genomic fingerprints of increasing booster vaccine pressure.
Convergent evolution has become common in Omicron, engaging spike positions crucial for immune escape, receptor binding, or cleavage.
Omicron adapted to booster immune pressure differently than prior variants like Delta.
Reviews recent articles on Long COVID and low cortisol, persistent virus and newer study on low serotonin and what that may mean.
Hannah Davis reminds us that supplementing Tryptophan can be dangerous for some and that SSRI studies did not show that it helped with ME/CFS.
10/20/23 BioRxiV (Harvard): Neuroinflammation in post-acute sequelae of COVID-19 (PASC) as assessed by [11C]PBR28 PET correlates with vascular disease measures https://buff.ly/46EzsKZ
Diffuse brain neuroinflammation in people with PASC (Long COVID) seen on PET scan as compared to matched controls.
Significantly increased neuroinflammation in PASC versus controls across a wide swath of brain regions including midcingulate and anterior cingulate cortex, corpus callosum, thalamus, basal ganglia, and at the boundaries of ventricles.
Neuroinflammation in PASC correlates with blood inflammatory markers related to vascular dysfunction which may contribute to PASC symptoms.
Live Tweeting by @patientled of the PolyBio Symposium on Long COVID on 10/20/23
10/20/23 New Scientist: Schools cut covid-19 sick days by 20% using HEPA air filtershttps://buff.ly/3Mek6o2
Placing HEPA air filters into classrooms in the Bradford area of the UK reduced the number of covid-19-related absences among students by more than 20%.
FYI: For Long COVID or ME/CFS researchers:
Ontario, Canada:
10/2023 Biochimie (Iran): Possible cancer-causing capacity of COVID-19: Is SARS-CoV-2 an oncogenic agent? https://buff.ly/45I7WuO
SARS-CoV-2 infects several organs which may enable cancer stem cells to develop in multiple organs.
Cancer-related effects of SARS-CoV-2 may take several years to manifest themselves.
Other news:
10/20/23 npj Digital Medicine (R. Daneshjou): Large language models propagate race-based medicine https://buff.ly/45Kd2q8
"LLMs [ChatGPT, GPT-4, Google Bards, and Claude were tested] are being proposed for use in the healthcare setting, with some models already connecting to electronic health record systems. However, this study shows that based on our findings, these LLMs could potentially cause harm by perpetuating debunked, racist ideas."
10/20/23 AP: Health providers say AI chatbots could improve care. But research says some are perpetuating racism https://buff.ly/3QqqdXZ
10/20/23 Reuters: US FDA approves Pfizer's vaccine for meningococcal disease https://buff.ly/3MdcAde
The FDA approved Pfizer’s vaccine Penbraya, making it the first shot to protect against five meningococcal bacteria groups - A, B, C, W and Y.
Meningococcal diseases are rare bacterial infections that commonly affect the brain, spinal cord and bloodstream, and can be deadly in a matter of hours.
Vaccine for 10 to 25 year olds.
10/25/23 NBC: Exposure to chemicals in the womb may be linked to childhood weight gain https://buff.ly/3s9QFNb
Abnormal weight gain in childhood is linked to being exposed to endocrine-disrupting chemicals in utero.
PFAS or “forever chemicals” degrade slowly and are found in nonstick cookware, cosmetics and plastic food containers. These endocrine-disruptors mimic natural hormones in the human endocrine systems.
10/24/23 JAMA: Traditional Chinese Medicine Compound (Tongxinluo) and Clinical Outcomes of Patients With Acute Myocardial Infarctionhttps://buff.ly/45K6zLX
Randomized, double-blind, placebo-controlled clinical trial of 3777 patients with STEMI, who took Tongxinluo or placebo orally for 12 months.
Tongxinluo reduced 30-day major adverse cardiac and cerebrovascular events (rate of MACCEs, 3.4% vs 5.2%), with a significant reduction in cardiac death (3.0% vs 4.2%).
Benefits persisted within 1 year (MACCEs: 5.3% vs 8.3%; cardiac death: 4.5% vs 6.1%), with no significant difference in major bleeding."
10/26/23 USA Today: Prescription for disaster: America's broken pharmacy system in revolt over burnout and errors https://buff.ly/479Euih
Pharmacists and techs are understaffed and are forced to fill more Rx than before, educate regarding vaccines and give vaccines and are told to up sell products in large corporate pharmacies.
10/28/23 WP: Firefighters made kids breakfast after mother rushed to hospital https://buff.ly/3QBLUFK
‘It really does take a village. We all have to look out for one another,’ said firefighter Brian Thompson.
Thank you for your work. It’s such a help!