COVID news & more, 2/10/24
COVID cases have peaked and are on their way down. We are still at “HIGH” SARS-CoV-2 virus wastewater levels per the CDC and Sara Anne Willette’s analysis shows “excessive” viral wastewater levels of SARS-2 in Texas, North Carolina, Georgia, Tennessee presently. Across the U.S., there are still about 740,000 to 1,000,000 new COVID cases each day per JP Weiland. The JN.1 variant represents almost all COVID cases. Influenza is showing a small increase in cases, especially in school aged children, but overall is decreasing in the United States.
Although Biobot showed an uptick of COVID cases this week and some people feared a new wavelet, according to JP Weiland, it appears that Biobot’s report may have had an error this week. NWSS data shows a steep downward slope of SARS-CoV-2 wastewater levels and hospitalizations and Emergency Department visits for COVID infections are decreasing.
Acute COVID infections, General COVID news
Dr. Maria Van Kerkhove from the WHO was interviewed by Scientific American. She discussed that viral wastewater data is anywhere from 2 to 20-fold higher than the cases reported by many countries, so it is important to keep using this metric. Dr. Van Kerkhove also said that there are “massive mental health impacts, globally, that we’re not dealing with. We have not mourned the loss. "We understand you don’t want to hear about it [COVID]... But we need to because there’s more we can do... there’s a hell of a lot more that we can do to really keep people safe and save them from losing a loved one."
Reviewing commercial insurance data in the EPOCH-US study, immunocompromised people make up just under 3% of the population. But, because they are at high risk of severe COVID infections and prolonged hospitalizations, immunocompromised people account for 30% of total hospitalization costs for COVID-19. For many reasons, it is important to protect immunocompromised people against severe outcomes from acute COVID infection.
A preprint study from Heidelberg, Germany shows that heparan sulfates help the SARS-CoV-2 virus’ spike protein to bind to the ACE2 receptor on human cells. They said that Heparin or heparan sulfate-like drugs could potentially be used to compete with heparan sulfate to block the SARS-2 spike protein from binding.
Vaccines
There is more good news about the latest COVID vaccine. Another study confirms that the XBB.1.5 COVID vaccine, which has been available since September 2023, causes antibodies that can neutralize circulating variants including JN.1. This vaccine also increased neutralizing activity against the ancestral SARS-CoV-2 strain (WA1) and Omicron variants like HK.3 and EG.5.1. Unfortunately, only 22% of adults have received the updated COVID vaccine despite it having an unexpectedly high (54%) ability to prevent symptomatic COVID infections and an even higher vaccine efficiency (about 80%) against severe COVID infections.
Older Adults
A CNN article this week reviewed that in the three weeks around New Year’s, 4810 people aged 65+ died from COVID infections, “a group that would fill more than 10 large airliners.” This is much higher than the 1201 seniors who died of flu, and the 126 who died of RSV during the same time period. Our ambivalence towards COVID infections not only increases chances of reinfection, long term consequences like heart attacks and Long COVID, but it is causing us to lose large numbers of seniors as well. Mitigation measures, like masking during high levels of virus circulation, could help.
A review in Lancet analyzed 11 studies on new-onset dementia after COVID infection in adults over age 60. Cognitive impairment (but not dementia) was nearly twice as likely in COVID survivors as compared to uninfected people. Patients aged 60 and older who had severe COVID-19 infections had a 17-fold increased risk of new-onset dementia as compared to those with non-severe infections. This was similar to new-onset dementia after other severe respiratory infections. Fortunately, seniors with mild COVID infections did not have an increased risk for new-onset dementia.
Long COVID in children
A detailed review of PASC (Long COVID) in children was published in the journal Pediatrics this week. The study found that 10 to 20% of children had sequelae after COVID infection and that up to 5.8 million children in the United States are affected by Long COVID. In children and teens, Long COVID may not look the same as what is seen in adults. Kids might have new behavioral problems related to not feeling well and to fatigue. They might not be doing as well in school as they did before COVID. Common Long COVID symptoms in children and young people are cough, shortness of breath, headaches, fatigue, chronic pain, and loss of taste and smell. The article reviews Long COVID symptoms by organ system, Multi Inflammatory Syndrome in Children (MIS-C) and chronic conditions like Type I diabetes related to COVID infection.
PASC in Children
The New York Times looked at the above review article on Long COVID in children. "Fatigue, brain fog and headaches are among the most frequently reported symptoms of long Covid in children. While these issues are sometimes on the mild end of the spectrum, they can prevent kids from participating fully in school or recreational activities. Young children may also act out, frustrated that they can’t easily do what they used to. Most symptoms improve within a year, experts said, but for some children they can persist for longer."
Long COVID in adults
A pilot study run by company AgelessRx tested low-dose naltrexone (LDN, 4.5 mg/day) and NAD + supplementation via patches in 36 patients with persistent moderate/severe fatigue after COVID-19. Half (52%) of patients responded to LDN and NAD+ after 12 weeks of treatment. There was significant improvement in quality of life seen on the SF-36 survey and a significant decrease in fatigue on the Chalder fatigue scale after 12 weeks of treatment in those patients. Further studies are needed to see which subset of people with Long COVID and persistent fatigue could benefit from this therapy.
Some people on social media are posting about individuals who got sick with COVID over the holidays and now are showing signs of Long COVID. Others, like Dave Christopher, note that they are seeing increases in people with cardiac problems, strokes, blood clots and diabetes after this wave of COVID infections as well. In addition, Bloomberg reporter Lisa Pham discusses her experience with Long COVID and how some women are mistakenly being told that their symptoms are from perimenopause when they really have Long COVID, and vice versa.
An article this week in Medscape reviewed evidence showing that Long COVID can cause brain injury, including pronounced brain aging after severe COVID infections and milder cognitive dysfunction after other COVID infections. “What's more," said [Dr] Al-Aly, “it's unclear whether the impacts of the brain damage are permanent or how to stop them from worsening.”
The UK Office of National Statistics (ONS) released updated figures showing that the UK employment rate has decreased because of 2.8 million people who have new-onset chronic illness. “Spiraling waiting lists for NHS treatment, the rise of Long Covid and an increase in mental illness have been driving the UK’s falling labor force participation rate, which dropped by more than in the US and Europe.” Lord Jim Bethell tweeted about ONS’ upward revision of long term sickness numbers: “Britain is too sick to work productively. The economic hit will be HARD.”
Regarding ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome), undergraduate researcher Molly Drosen working with Dr. Avik Roy showed that ATG13 gene inactivity may be a factor in ME/CFS. Drosen tested mice with inactive ATG13 genes. The mice had fatigue after treadmill exercise and anxiety from open field tests which reflects similar findings in people with ME/CFS. The ATG13 gene is involved in several metabolic pathways in the body, and these may have a role in Chronic Fatigue Syndrome.
In non-COVID news, Dysautonomia International tweeted about positive results from Johnson & Johnson on Nipocalimab, an anti-FcRn drug that helps reduce autoantibody levels in Sjogren’s syndrome and in Myasthenia Gravis. Looking at a nationwide health database in Taiwan, investigators found that women diagnosed with Polycystic Ovary Syndrome (PCOS) had an 8.5-fold increase in risk for suicide attempt compared with the control group. The authors recommend referrals for a psychological evaluation in people with a new diagnosis of PCOS.
Progesterone injections had been used to stop preterm birth. Then, a study found that Makena progesterone injections did not work and it was pulled from the market by the FDA in 2023. A new study from Stanford shows that some people will benefit from progesterone supplementation in pregnancy to prevent preterm labor, depending on noncoding mutations in genes related to uterine contraction. "Progesterone has effects during pregnancy on the contraction of the uterus and on inflammation. We found that genes related to inflammation were not the problem; it was mutations in the genes related to uterine contractions.” Testing genetic mutations in people who had prior preterm deliveries could allow doctors to know which patients would benefit from progesterone supplementation for the prevention of preterm deliveries in future pregnancies.
Measles, measles, measles. We are seeing articles on measles outbreaks in many places around the world. Measles is one of the most contagious infectious diseases and about 95% of the population needs to be vaccinated against measles in order to prevent the disease from spreading. BBC news had some great infographics on signs and symptoms of measles here.
Have a great rest of your weekend,
Ruth Ann Crystal MD
COVID news links:
US Variant tracker: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
JN.1 is 93% of variants now
Variants in locations around the globe: https://outbreak.info/
CDC COVID data tracker: https://covid.cdc.gov/covid-data-tracker/index.html#datatracker-home
CDC COVID Hospitalizations (blue) and Emergency Room (orange) visits tracker: https://covid.cdc.gov/covid-data-tracker/index.html#trends_weeklyhospitaladmissions_7dayeddiagnosed_00
Weekly ED visits for respiratory illnesses, by age and disease: https://www.cdc.gov/ncird/surveillance/respiratory-illnesses/index.htmlCOVID news:
Weekly ED visits for respiratory illnesses, by age and disease: https://www.cdc.gov/ncird/surveillance/respiratory-illnesses/index.html
US Wastewater Monitoring:
CDC wastewater reporting: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html
CDC wastewater map: https://www.cdc.gov/nwss/rv/COVID19-currentlevels.html
Biobot: https://biobot.io/data/
National SARS-CoV-2 data from Sarah Anne Willette: https://iowacovid19tracker.org/
Excessive viral wastewater levels of SARS-2 in Texas, North Carolina, Georgia, Tennessee
Wastewater SCAN: https://data.wastewaterscan.org/
California statewide view https://buff.ly/3YObiul
Sewer Coronavirus Alert Network (SCAN) project by Stanford University:
Santa Clara County wastewahttps://covid19.sccgov.org/dashboard-wastewater
CDC Respiratory vaccination trends: https://www.cdc.gov/respiratory-viruses/data-research/dashboard/vaccination-trends-adults.html
JP Weiland: https://twitter.com/JPWeiland
2/5/24 https://twitter.com/JPWeiland/status/1754677549081260131
https://twitter.com/JPWeiland/status/17560986527359
2/9/24 JP Weiland update:
Lucky Tran
https://twitter.com/luckytran/status/1754635623573385242
Comparing SARS-CoV-2 virus levels in wastewater for different years
Michael Hoerger modeling: http://pmc19.com/data/
https://twitter.com/michael_hoerger/status/1754620629398020217
Estimated real world COVID risk from Biobot wastewater data:
Variants
JN.1 93% of variants in the U.S.
Acute COVID infections, General COVID news
2/6/24 Scientific American: Rampant COVID Poses New Challenges in the Fifth Year of the Pandemic. https://buff.ly/4bvMa1w
Interview with Dr. Maria Van Kerkhove ot the WHO
"If we look at wastewater estimates, the actual circulation [of SARS-CoV-2] is somewhere between two and 20 times higher than what’s actually being reported by countries. The virus is rampant. We’re still in a pandemic. There’s a lot of complacency at the individual level, and more concerning to me is that at the government level."
“massive mental health impacts, globally, that we’re not dealing with. We have not mourned the loss.
"We understand you don’t want to hear about it... But we need to because there’s more we can do... there’s a hell of a lot more that we can do to really keep people safe and save them from losing a loved one." - Maria Van Kerkhove, WHO
Reviewing commercial insurance data in the EPOCH-US study, immunocompromised people make up just under 3% of the population, but they are at high risk for severe COVID outcomes from all SARS-CoV-2 variants. Prolonged hospitalizations for immunocompromised individuals increases health care costs as well.
For many reasons, it is important to protect immunocompromised people against severe outcomes from acute COVID infection.
1/13/24 Advances in Therapy: Assessing the Burden and Cost of COVID-19 Across Variants in Commercially Insured Immunocompromised Populations in the United States: Updated Results and Trends from the Ongoing EPOCH-US Study https://buff.ly/3w2a1W9
immunocompromised [IC] individuals
immunosuppressive [IS] treatment
Despite reduced burden in the general population, immunocompromised populations continue to have a higher risk for severe COVID-19 outcomes, including prolonged hospitalization and death.
"Conclusion:
"While only 2.9% of the population, IC individuals had a higher risk of COVID-19 hospitalization and incurred higher healthcare costs across variants. They also disproportionately accounted for over 30% of total costs for first COVID-19 hospitalization in 2022, amounting to ~ $310 million. These data highlight the need for additional preventive measures to decrease the risk of developing severe COVID-19 outcomes in vulnerable IC populations."
2/5/24 BioRxiV (Heidelberg): The accomplices: Heparan sulfates and N-glycans foster SARS-CoV-2 spike:ACE2 receptor binding and virus priming https://buff.ly/4bpXbBh
Heparan sulfate (HS) has a multifaceted role in facilitating SARS- CoV-2 infection.
Heparin was used as a model for HS.
New insights into the modulatory effects of N-glycans and heparin/HS on the spike protein-ACE2 receptor interaction and gave new insights into the mechanism of SARS-CoV-2 viral infection.
Heparin/HS mimetic drugs with enhanced specificity could be used to compete with HS for binding of the SARS-2 spike protein.
Vaccines
More good news about the latest COVID vaccine:
2/5/24 BioRxiV (Emory): XBB.1.5 monovalent booster improves antibody binding and neutralization against emerging SARS-CoV-2 Omicron variants https://buff.ly/4935gtT
The XBB.1.5 booster improved both neutralizing activity against the ancestral SARS-CoV-2 strain (WA1) and the circulating Omicron variants, including EG.5.1, HK.3, HV.1, XBB.1.5 and JN.1.
Older Adults
https://twitter.com/tmprowell/status/1755821753438253529
2/8/24 CNN: Thousands of seniors are still dying of Covid-19. Do we not care anymore? https://buff.ly/3SPWMAK
“In the last week of 2023 and the first two weeks of 2024 alone, 4,810 people 65 and older lost their lives to Covid — a group that would fill more than 10 large airliners — according to data provided by the CDC. But the alarm that would attend plane crashes is notably absent. (During the same period, the flu killed an additional 1,201 seniors, and RSV killed 126.)”
2/6/24 Lancet preprint: Temporal Association between COVID-19 Infection and Subsequent New-Onset Dementia in Older Adults: A Systematic Review and Meta-Analysis https://buff.ly/3usAVWO
Review of 11 studies on new-onset dementia (NOD) after COVID infection in adults age 60+.
Cognitive impairment was nearly twice as likely in COVID-19 survivors compared to those uninfected.
Patients with severe COVID-19, had a 17-fold increased risk of new-onset dementia (NOD) as compared to those with non-severe infections.
Those with mild COVID infections did not have the same increase in risk for dementia.
The risk of new-onset dementia was similar to NOD after other respiratory infections.
Long COVID in children
2/7/24 Pediatrics: Postacute Sequelae of SARS-CoV-2 (Long COVID) in Children https://buff.ly/3uqiAtr
Detailed, excellent review of PASC (Long COVID) in children including demographics, symptoms, organ systems affected and post acute de novo conditions like type 1 diabetes.
Current pediatric PASC prevalence estimates are 10% to 20%, PASC is estimated to affect up to 5.8 million children, representing a significant community impact.
Common symptoms are cough, shortness of breath, headaches, fatigue, chronic pain, and loss of taste and smell.
MIS-C discussed as well.
PASC in Children
2/7/24 NY Times: New Report (from Pediatrics, above) Raises Concerns About Long Covid in Children https://buff.ly/3OF98Jt
"Fatigue, brain fog and headaches are among the most frequently reported symptoms of long Covid in children. While these issues are sometimes on the mild end of the spectrum, they can prevent kids from participating fully in school or recreational activities. Young children may also act out, frustrated that they can’t easily do what they used to. Most symptoms improve within a year, experts said, but for some children they can persist for longer."
https://twitter.com/Dakota_150/status/1755236355297198116
12/19/23 Pediatrics: Bilateral Vocal Cord Paralysis Requiring Long-term Tracheostomy After SARS-CoV-2 Infection https://buff.ly/48aL9ce
15 year old. Her vocal cord function remains impaired, and the patient continues to be tracheostomy-dependent 13 months after the initial presentation.
Vocal cord paralysis may be an additional neuropathic sequela of COVID.
Vocal cord pathology should be an important consideration when constructing a differential for children presenting with voice, swallowing, or breathing complaints after SARS-CoV-2 infection.
Long COVID in adults
https://twitter.com/MLS_Dave/status/1756026004869452247
2/9/24 Bloomberg: Untangling the Links Between Sex Hormones and Long Covid https://buff.ly/3SSb2sF
Reporter Lisa Pham discusses her experience with Long COVID and how hormones affect her symptoms.
Some women who have Long COVID are mistakenly being told that their symptoms are from perimenopause.
Dr. Newson thinks women who have been diagnosed with Long Covid should also be evaluated for perimenopause and menopause too, regardless of their age.
2/8/24 Brain, Behavior & Immunity, March 2024 issue:
Low-dose naltrexone and NAD+ for the treatment of patients with persistent fatigue symptoms after COVID-19 https://buff.ly/48aLrjh
Pilot study (by AgelessRx) tested low-dose naltrexone (LDN, 4.5 mg/day) and NAD + supplements in 36 patients with persistent moderate/severe fatigue after COVID-19.
52 % of patients responded to LDN and NAD+ after 12 weeks of treatment.
Significant improvement in quality of life seen on SF-36 survey.
Significant decrease in fatigue on the Chalder fatigue scale after 12 weeks of treatment.
Further studies are needed to see which subset of people with Long COVID and persistent fatigue could benefit from this therapy.
Long COVID and the Brain
2/8/24 Medscape: New Evidence Suggests Long COVID Could Be a Brain Injury https://t.co/6ZR75dZfAx
SARS-CoV-2 viral-borne brain injury that may cause cognitive and mental health issues that persist for years.
Recent study showed that Brain Deficits Equal to 20 Years of Brain Aging
351 patients hospitalized with severe COVID-19 had evidence of a long-term brain injury a year after contracting the SARS-CoV-2 virus. The findings were based on a series of cognitive tests, self-reported symptoms, brain scans, and biomarkers.
“For Ziyad Al-Aly, MD, chief of research and development at the Veterans Affairs St. Louis Health Care System, the concern is that some long-COVID patients may be suffering from cognitive deficits that are more subtle but still impacting their daily lives, and that they're not getting the help they need.
“What's more, said Al-Aly, it's unclear whether the impacts of the brain damage are permanent or how to stop them from worsening.”
https://twitter.com/FvRhijn/status/1755278498900349036
2/2/24 U of Wisconsin, Milwaukee: Undergraduate researcher Molly Drosen works to pinpoint the cause of chronic fatigue syndrome (CFS) https://buff.ly/3UomsFY
ATG13 gene inactivity is suspected to be a factor in the cause of ME/CFS.
Molly Drosen worked with Dr. Avik Roy of the Simmaron Research Institute (SRI) and tested mice with inactive ATG13 genes. The mice had fatigue after treadmill exercise, and anxiety from open field tests similar to people with ME/CFS.
The ATG13 gene is involved in several metabolic pathways in the body, and any of these could play a role in chronic fatigue syndrome.
2/5/24 Times: UK Employment rate slumps as 2.8 million people suffer long-term illness https://buff.ly/3w9dRgk
"The updated figures [from ONS] lay bare the extent of the UK’s long-term sickness problem... Spiraling waiting lists for NHS treatment, the rise of Long Covid and an increase in mental illness have been driving the UK’s falling labor force participation rate, which dropped by more than in the US and Europe.”
2/5/24 UK ONS (Office of National Statistics)
2/5/24 https://twitter.com/Dysautonomia/status/1754629499474313556
2/5/24 Press Release: Johnson & Johnson reports positive topline results for nipocalimab from a Phase 3 pivotal study in generalized Myasthenia Gravis (gMG) and a Phase 2 study in Sjögren's Disease (SjD) https://buff.ly/49mnQwR
Dec 2022: Long covid and medical gaslighting: Dismissal, delayed diagnosis, and deferred treatment https://buff.ly/49b7hEK
79% of study respondents reported negative interactions with their healthcare providers when they sought treatment for their long-COVID symptoms.
AI:
2/5/24 Nature: Closing the accessibility gap to mental health treatment with a personalized self-referral chatbot https://buff.ly/49mkxpC
“Using natural language processing to analyze qualitative feedback from 42,332 individuals, we found that the chatbot’s human-free nature and the patients’ self-realization of their need for treatment were potential drivers for the observed improvement in the diversity of access.”
Other news:
2/6/24 Stanford SCOPE Blog: Why precision medicine's targeted interventions may help prevent dangerously early births https://buff.ly/4buojiz
Some people benefit from progesterone supplementation in pregnancy to prevent preterm labor, but others do not.
"Progesterone has effects during pregnancy on the contraction of the uterus and on inflammation. We found that genes related to inflammation were not the problem; it was mutations in the genes related to uterine contractions.
Pregnant women who had those mutations were not able to respond in the normal way to progesterone. Apparently, it did not keep their uterine contractions quiet during pregnancy. " - Dr. Stevenson
Original article: 1/19/24 Science: Integrative analysis of noncoding mutations identifies the druggable genome in preterm birth https://buff.ly/3HTaxIz
2/6/24 Annals of Internal Medicine: Suicide Attempts After a Diagnosis of Polycystic Ovary Syndrome (PCOS): A Cohort Study https://buff.ly/3uuJU9O
Taiwanese nationwide database from 1997 to 2012
Participants with PCOS had a notable 8.47-fold increase in risk for suicide attempt compared with the control group, after adjustment for demographic characteristics, psychiatric comorbid conditions.
“Referral to a psychologist, psychiatrist or social worker for medical assistance or case management is recommended for patients at high risk for suicide.”
2/4/24 BBC: Measles: Urgent Wales call on MMR vaccine for children https://buff.ly/3UAAxQR
