COVID news and more 5/13/23
SARS-CoV-2 virus wastewater levels are fairly low across the United States now which is good news. XBB.1.5 is slowly being pushed out of first place by several other XBB subvariants including XBB.1.16 which represents 14% of cases this week. XBB.1.16 levels are no longer doubling and are only increasing by about 2% per week, so it is not expected to cause a new wave. There are still more than 1000 people dying of COVID each week in the US, and while this is much better than most of the pandemic, we need to be vigilant.
With the end of the public health emergency this week, the CDC is changing the data that they will report regarding COVID. The CDC will no longer report cases, but they will still continue to report emergency room visits and hospitalizations, albeit on a less frequent schedule. Genomic testing will still follow which variants are causing cases, and wastewater data will still be reported. Emergency room data, one of the earliest indicators of an increase in infections, will still be reported by the CDC.
The CDC also updated their website on how to improve ventilation in buildings. They recommend 5 ACH (air changes per hour) and MERV-13 filters as the new minimum.
Yesterday was ME (Myalgic Encephalomyelitis) Awareness Day. Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) is a disabling and complex illness that can confine people to their beds. The hashtag #MillionsMissing represents ME Awareness Day because so many people with ME/CFS and Long COVID are are bed bound and can no longer go out so they are not seen and are missing. An art installation at the Washington Monument had many cots representing people who are stuck in bed with ME and Long COVID. Pillowcases were decorated by people who have ME/CFS and/or Long COVID.
Representative Anna Eshoo sent a letter to the NIH this week demanding answers regarding the slow pace of Long COVID research and the $1 billion that the NIH squandered for the RECOVER trial. Hopefully there will be more funding for research for long COVID soon. Hannah Davis wrote an article this week on 13 priorities for Long COVID research including possible treatments that should be trialed. She quoted that six percent of US adults have Long COVID and half of those have ME/CFS-type disease and dysautonomia.
Neuro Long COVID
Regarding long COVID brain fog and neurologic symptoms, Dr. Jim Jackson, a neuropsychologist, wrote that long COVID brain fog actually represents brain damage and cognitive rehabilitation can be helpful. Dr. Jackson also released a book called Clearing The Fog. In Scientific American, several people with Long COVID explained why Long COVID brain fog is a serious medical issue that needs more attention. A study from the NIH, looking at the CSF (cerebral spinal fluid) from patients with neuro-PASC showed decreased CD4+ T cells and CD8+ T cells and increased antibody-secreting B cells in their CSF. Their CSF also had increased cells expressing immune checkpoint molecules.
An interesting new study may hold clues to the cause of Long COVID pain. An article in Science magazine shows that in a hamster model, non-infectious viral RNA was found in the dorsal root ganglia (DRG) of hamsters after an intranasal infection with SARS-CoV-2. Long COVID pain may be related to viral RNA in DRGs that causes mechanical hypersensitivity and pain. Authors also found that the RNA binding protein ILF3 may be a drug target for long COVID pain.
Regarding pulmonary Long COVID symptoms, researchers compared initial CT scans in people who had COVID pneumonia requiring oxygen to dual-energy CT angiography taken 6 to 12 months later. Follow-up at 6 months to 1 year post-COVID showed CT features of acute and chronic pulmonary embolism (PE) and also two types of perfusion abnormalities suggestive of persistent hypercoagulability as well as unresolved/sequelae of microangiopathy. Of note, pulmonary function tests (PFTs) were normal in 72.6% of these patients with pulmonary Long COVID symptoms.
Another study shows that in pulmonary long COVID where people continue to have shortness of breath and abnormal chest radiology, individuals were found to have high monocyte expression of chemokine receptor CXCR6 and adhesion molecule PSGL-1, and preferential migration of monocytes towards CXCR6 ligand CXCL16 which is abundantly expressed in the lung. However, monocytes from long COVID patients with ongoing fatigue symptoms had reduced levels of the prostaglandin-generating enzyme COX-2 and CXCR2 expression. These monocyte changes were not seen after RSV or influenza infections.
An article this week in the New England Journal of Medicine discusses the need for comprehensive care for long COVID. They discussed that 10% or more of people will develop long COVID and that often there are multi organ systems involved. People with Long COVID have found very fragmented care that is often far from their homes. The authors recommend several things- national Long COVID Centers of Excellence to provide coordinated care and rehab, standards of care and best practices regarding long COVID and workforce training for clinicians who will be caring for patients with long COVID.
A comprehensive article in the Lancet reviewed the evidence showing that persistent virus may be causing Long COVID. This week, Yale Professor Akiko Iwasaki was awarded the Else Kroner Fresenius Prize for her research. She will receive €2.5 million and Dr. Iwasaki plans to use this for research on long COVID, ME/CFS and other post acute infection syndromes.
Vaccines
It appears that people with severe obesity have an accelerated weaning of COVID-19 vaccine induced antibody immunity. Six months after their second dose, 55% of people with severe obesity had no neutralizing antibodies detected versus 12% of people with a normal BMI. Therefore, people with severe obesity may need more frequent booster doses in order to maintain protection against COVID-19.
Regarding the future of vaccine protection against SARS-CoV-2, nasal vaccines to block infections from happening and pancoronavirus vaccines to protect against many different types of coronaviruses will be important. A new study in Science shows that an ASO3-adjuvanted COVID-19 vaccine was found to cause extremely potent neutralizing antibodies against all SARS-CoV-2 variants as well as other sarbecoviruses for at least one year in macaques monkeys. Antibody response in humans to present mRNA vaccines wanes by 6 months.
In non-COVID news, it appears that in people who have brain cancer, thinking or talking may promote tumor growth. Other tumors such as prostate, breast, and head and neck cancers can also form brain neuronal synapses. Regarding pancreatic cancer, a deep learning A.I. algorithm was able to help predict the risk of developing pancreatic cancer up to 3 years in advance in high-risk individuals. In a promising small study, personalized RNA neoantigen vaccines made from pancreatic tumor RNA were able to stimulate a person’s T cells to attack their pancreatic cancer.
The American Psychological Association issued recommendations for limiting teenagers' use of social media. This must-see commercial from Dove also sends a very powerful message about regulating social media for teens.
Florida lawmakers are considering using radioactive materials to pave roads. A custodian from Maine teaches kids chess like in The Queen’s Gambit. The first baby was born with DNA from three different people after a new IVF procedure that uses mitochondrial donation. The University of Michigan Medical School posted a photo of a US family with three generations of women doctors.
Have a good rest of your weekend,
Ruth Ann Crystal MD
Other news:
5/6/23 Eric Topol MD: When thinking or talking promotes tumor growth https://buff.ly/3LIFjFM
“When the tumor synapses with brain cells, activating the mind with cognitive tasks can promote its growth.”
New field of “cancer neuroscience”
Other tumors (prostate, breast, head and neck cancers) can also form brain neuronal synapses.
5/4/23 Science Daily: Elevated levels of toxic metals in some mixed-fruit juices and soft drinks https://buff.ly/42FgyBh
60 beverages tested:
5 had high toxic metals- 2 juices had high arsenic, other juices and an oat milk beverage had higher levels of cadmium.
Higher levels of nickel, manganese, boron, cadmium, strontium, arsenic, and selenium as well as aluminum and zinc in many fruit juices and plant milks like oat milk than for drinking water.
"People should avoid giving infants and young children mixed-fruit juices or plant-based milks at high volume," Godebo said. "Arsenic, lead, and cadmium are known carcinogens and well established to cause internal organ damage and cognitive harm in children especially during early brain development."
5/9/23 NPR: Florida lawmakers want to use radioactive material to pave roads https://buff.ly/41iYbAT
Roads in Florida could soon include phosphogypsum — a radioactive waste material from the fertilizer industry that contains Uranium and Radium-226 which can become radon gas.
Florida makes a lot of this and has lots of phosphogypsum waste lying around.
5/9/23 NPR: Major psychologists' group warns of social media's potential harm to kids https://buff.ly/3NQPcnw
The American Psychological Association issued recommendations for guiding teenager's use of social media.
Teens are facing high rates of depression, anxiety and loneliness.
Powerful Dove Commercial on the harms of social media to kids:
(** Sensitive content: eating disorder)
5/8/23 CIDRAP: USDA green-lights Lyme disease vaccine that targets mice hosts https://buff.ly/3prAWr8
Black-legged ticks that feed on blood from infected mice can then transmit the disease to people.
The oral vaccine would be put into edible pellets for wild mice to eat.
5/9/23 AP: Start mammograms at 40, not 50, a US health panel recommends https://buff.ly/3MgMyWQ
Black women are 40% more likely to die of breast cancer than white women, making mammograms at 40 an especially important.
5/11/23 AP: A skin patch to treat peanut allergies? Study in toddlers shows promise https://buff.ly/3pnkSXh
The Viaskin patch from DBV Technologies is coated with a small amount of peanut protein that is absorbed into the skin.
5/11/23 AP: Real-life 'The Queen's Gambit': Custodian leads school chess teams in Maine https://buff.ly/44Tuolh
5/10/23 Eric Topol: A one-two punch against Pancreatic Cancer https://buff.ly/42ICWJK
Dr. Topol discusses 2 recent articles on Pancreatic Cancer:
1. Deep learning A.I. for predicting high-risk individuals for developing pancreatic cancer up to 3 years in advance of diagnosis.https://buff.ly/3LXKUbh
2. Personalized RNA neoantigen vaccines made from tumor RNA which stimulate T cells to attack Pancreatic Cancer https://buff.ly/3BhZXaP
5/11/23 Guardian: First UK baby with DNA from three people born after new IVF procedure https://buff.ly/44PUo18
Mitochondrial donation treatment aims to prevent children from inheriting incurable diseases.
COVID news:
5/11/23 CDC: COVID-19 Surveillance After Expiration of the Public Health Emergency Declaration https://buff.ly/42s2awh
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
CDC Hospital Admissions (last week): https://covid.cdc.gov/covid-data-tracker/index.html#cases_new-admissions-rate-county
https://ourworldindata.org/coronavirus
Variant tracker in US: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
Wastewater Monitoring:
CDC Wastewater Monitor https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance
Biobot: https://biobot.io/data/
Sewer Coronavirus Alert Network (SCAN) project by Stanford University:
Last 52 weeks
China:
New York City:
5/12/23 #MillionsMissing 2023 https://buff.ly/3LWV0sY
May 12th was ME Awareness Day and was commemorated with an art installation at the Washington Monument with cots representing people who have been bed bound because of ME/CFS and Long COVID.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
The pillow cases were decorated by people with ME/CFS and Long COVID.
The theme was #MillionsMissing because so many people with ME/CFS and Long COVID are isolated in their beds and cannot go out.
Indoor air quality and ventilation new guidelines:
5/12/23 CDC Updates: Improving Ventilation in Buildings https://buff.ly/3n0RvEb
CDC now recommends 5 ACH (air changes per hour) and MERV-13 filters as the new minimum.
5/11/23 CDC: How To Improve Ventilation In Buildings https://buff.ly/3BlrZCp
5/11/23 STAT news: Key House Democrat, Rep. Anna Eshoo, demands NIH answer for slow pace of long Covid research https://buff.ly/3MlRoly
Rep. Anna Eshoo sent a letter to NIH acting Director Lawrence Tabak on Tuesday highlighting the agency’s delays in enrolling clinical trials, the lack of relief for patients, and the exclusion of long Covid from the White House’s Next Gen program to accelerate development of Covid-19 vaccines and treatments.
RECOVER project
5/11/23 Nature: Accelerated waning of the humoral response to COVID-19 vaccines in obesity https://buff.ly/44QSTj3
Accelerated waning of COVID-19 vaccine-induced humoral immunity (neutralizing antibodies) seen in individuals with severe obesity (BMI > 40).
Six months after their 2nd dose, 55% of people with severe obesity vs. 12% of people with normal BMI had no neutralizing antibodies detected.
Neutralizing capacity was restored by a third dose of vaccine but again declined more rapidly in people with severe obesity.
As obesity is associated with increased hospitalization and mortality from breakthrough infections, findings have implications for vaccine prioritization policies.
5/12/23 Sci Am (Op Ed): The ‘Brain Fog’ of Long COVID Is a Serious Medical Issue That Needs More Attention https://buff.ly/42O3Ik6
5/11/23 PBS News hour: 'Why aren't you taking care of us?' Why long COVID patients struggle for solutions https://buff.ly/3pun8w1
5/10/23 Lancet: Association of SARS-CoV-2 infection and persistence with long COVID https://buff.ly/3LZMCZX
Ebola and West Nile virus can remain dormant and persistent in the body and SARS-CoV-2 appears to too.
A review of evidence supporting a pathophysiological model of Long COVID based on the persistence of SARS-CoV-2 virus that triggers a dysregulation of the immune system, followed by increased release of inflammatory cytokines and abnormal endothelial damage, ultimately leading to the development of chronic inflammation, vascular damage, hypercoagulability, microthrombosis, and multiorgan symptoms.
5/10/23 NPR: Millions of people have long COVID brain fog — and there's a shortage of answers https://buff.ly/42NHw9G
Neuropsychologist James C. Jackson of Vanderbilt University discusses Long COVID brain fog. He also has a new book coming out called, Clearing the Fog, which is “a practical guide for long COVID patients and their families, with advice on how to find help, and information on treatments and strategies for dealing with symptoms.”
When people with Long COVID say that they have "memory problems", they often have issues with executive function of their brain.
"People with executive dysfunction ... they have problems driving. They can't manage their money. They have a hard time managing their medication. They can't plan for the future. So executive dysfunction, processing, speed, inattention and some deficits with memory."
Mental health issues often accompany long COVID and need to be treated.
Long COVID can cause brain injury and cognitive rehabilitation may be helpful.
Social isolation- Others may not understand how impaired people with Long COVID actually are because they don't look impaired.
Teaching people with Long COVID the right and the wrong ways to ask for help.
5/10/23 Katelyn Jetelina: End of Public Health Emergency (PHE) for COVID: A shift in data https://buff.ly/41sKGia
“What is changing?
No change:
Wastewater and genomic surveillance, which will allow us to track variants and transmission.
Emergency room data, which is one of the best early indicators of state-level transmission.
Changing a little:
Hospitalization data will remain through April 2024, but frequency of reporting will change. This will help us track severe disease.
Death data will remain, but the data source is changing.
Changing a lot:
Test positivity rates —one of our earliest metrics of transmission—will no longer be national, state, or county-wide. Negative tests no longer have to be reported. But, some pharmacies will still report.
Cases will be dropped. This makes sense given at-home antigen tests.
Vaccination coverage will be spotty. The frequency of updates will also change.
5/10/23 Science: Broadly neutralizing antibodies against sarbecoviruses generated by immunization of macaques with an AS03-adjuvanted COVID-19 vaccine https://buff.ly/42oooj1
An AS03-adjuvanted COVID-19 vaccine was found to cause extremely potent neutralizing antibodies against SARS-CoV-2 variants and other sarbecoviruses for at least 1 year in macaques monkeys.
The neutralizing antibodies gained greater potency and breadth over time.
______
5/9/23 Medscape (Hannah Davis): Clinical Trials: Top Priority for Long COVID https://buff.ly/42QHIFp
6.1% of US adults have Long COVID and half of those have ME/CFS-type disease and dysautonomia.
13 priorities for LC research are discussed including possible drugs that should be trialed including:
JAK-STAT inhibitors, SARS-CoV-2 antivirals and antivirals against reactivated herpesviruses (Valcyte, Valacyclovir, EBV vaccine),
mast cell stabilizers (ketotifen, cromolyn sodium),
microglial activation regulators (low-dose naltrexone, low-dose aripiprazole), anti-CGRP medications, beta-blockers, and intravenous immunoglobulin.
Others medications that target mitochondrial dysfunction, ivabradine, Mestinon, DRP-1 inhibitors, supplements showing success in patient communities including lactoferrin, ubiquinone, and nattokinase, therapies targeting glymphatic/lymphatic dysfunction, microbiome therapies, and therapeutic peptides.
Post Exertional Malaise (PEM) can be measured by DSQ-PEM and autonomic symptoms with COMPASS-31.
Cognitive dysfunction trials should use tools that measure specific deficits such as processing speed.
5/9/23 Science: SARS-CoV-2 airway infection results in the development of somatosensory abnormalities in a hamster model https://buff.ly/3MemD27
Long COVID neurological issues can include generalized pain, neuropathy, and myalgia.
In a hamster model, non-infectious viral RNA was found in the dorsal root ganglia (DRG) of hamsters after intranasal infection with SARS-CoV-2.
The SARS-CoV-2 RNA in the DRG was associated with gene expression in sensory neurons that partly resembled those of mouse models of inflammatory and injury-induced neuropathic pain.
The RNA binding protein ILF3 may be a drug target for Long COVID pain.
Transcriptomic signatures in the DRGs triggered by SARS-CoV-2 may underlie both short- and long-term sensory abnormalities and pain.
Long COVID pain may be related to viral RNA in DRGs that cause mechanical hypersensitivity.
9/2022 StatPearls - NCBI Bookshelf: Neuroanatomy, Dorsal Root Ganglion https://buff.ly/3Mo3Ilq.
“Dorsal nerve roots carry sensory neural signals to the central nervous system (CNS) from the peripheral nervous system (PNS). Anatomically, a dorsal root ganglion (DRG) emerges from the dorsal root of the spinal nerves. They carry sensory messages from various receptors (i.e., pain and temperature) at the periphery towards the central nervous system for a response. The role of DRG in chronic pain has been well established.”
Anatomy of the spine, spinal cord and dorsal root ganglions:
5/9/23 NEJM: Toward Comprehensive Care for Long Covid https://buff.ly/3LMIhJk
10% or more of people develop Long COVID.
Long COVID or PASC is difficult to define and the absence of evidence-based treatments is frustrating.
Multiple signs and symptoms and multiple organ systems are involved.
Fragmented care, often far from people's homes, needs to be improved.
Disability claims and employers need to understand LC.
RECOVER trial will follow people longitudinally.
Authors recommend:
1. National Long Covid Centers of Excellence to provide coordinated care and rehab.
2. Define and disseminate standards of care and best practices.
3. Use innovative methods for disseminating information and providing support in order to educate clinicians, patients, and communities; broaden access to high-quality care; and further reduce disparities.
4. Workforce training programs for clinicians caring for patients with Long Covid.
5/9/23 BBC: US FDA recalls over 500,000 Covid tests over bacteria risk https://buff.ly/44KusDT
Pilot COVID-19 At-Home Tests were found to have contaminated solution.
4/25/23 European Radiology: Pulmonary circulation abnormalities in post-acute COVID-19 syndrome (PASC): dual-energy CT angiographic findings in 79 patients https://buff.ly/3HT5sk7
79 patients with symptoms more than 6 months after hospitalization for SARS-CoV-2 pneumonia who had been evaluated with dual-energy CT angiography.
Follow-up at 6 months to 1 year post-COVID showed CT features of acute and chronic pulmonary embolism (PE) but also two types of perfusion abnormalities suggestive of persistent hypercoagulability as well as unresolved/sequelae of microangiopathy.
PFTs were normal in 72.6% of the study population.
Key Points
This study demonstrates newly developed proximal acute PE/thrombosis in the year following SARS-CoV-2 pneumonia.
Dual-energy CT lung perfusion identified perfusion defects and areas of increased iodine uptake abnormalities, suggestive of unresolved damage to lung microcirculation.
In conclusion, this study shows a striking difference between the limited extent of CT features of COVID-19 pneumonia and the presence of numerous abnormalities at the level of lung microcirculation in the year following hospitalization.
Our results suggest the complementarity between High-resolution CT (HRCT) and spectral imaging for proper understanding of post COVID-19 lung sequelae.
2023: European Respiratory Journal: Monocyte migration profiles define disease severity in acute COVID-19 and unique features of long COVID https://buff.ly/41eyYaJ
n=142
People with pulmonary Long COVID symptoms (continued shortness of breath and abnormal chest radiology) had high monocyte expression of chemokine receptor CXCR6 and adhesion molecule PSGL-1, and preferential migration of monocytes towards CXCR6 ligand CXCL16 which is abundantly expressed in the lung.
Conversely, monocytes from long COVID patients with ongoing fatigue exhibited reduction of the prostaglandin-generating enzyme COX-2 and CXCR2 expression.
These monocyte changes were not present in RSV or flu convalescence.
5/8/23 MedPage Today: Neurologic Long COVID Patients Show Immune Dysregulation https://buff.ly/451M4LM
CSF from people with neuro PASC (Long COVID) had:
Lower levels of CD4+ and CD8+ T cells compared with healthy controls
Increased B cells and other types of immune cells, suggesting immune dysregulation may play a role in mediating long COVID.
7/2023 issue of Neuroimmunology & Neuroinflammation (A.Nath, NIH):
Deep Phenotyping of Neurologic Post Acute Sequelae of SARS-CoV-2 Infection https://buff.ly/44OIrse
n = 12 from Oct 2020 to April 2021 with neuro PASC (Long COVID)
Most common neuro-PASC symptoms were cognitive difficulties and fatigue.The majority (83%) had a very disabling disease.
Immunophenotyping of CSF showed that patients with neuro-PASC had:
low effector memory phenotype for CD4+ T cells and CD8+ T cells in CSF.
increased antibody-secreting B cells in CSF.
increased cells expressing immune checkpoint molecules in CSF.
On autonomic testing, there was evidence for decreased baroreflex-cardiovagal gain and an increased peripheral resistance during tilt-table testing.
5/8/23 NPR: The COVID public health emergency ends this week. Here's what's changing https://buff.ly/3nA1lmd
Vaccines and tests no longer free – now covered by health insurance
The White House says people without insurance will still be able to get free COVID-19 vaccines – and treatments like Paxlovid – through 2024.
COVID data tracking gets scaled back.
The CDC will stop tracking and reporting new infections.
The CDC will continue to track COVID-19 hospitalizations and deaths, do genetic analysis to identify worrisome variants, and monitor spread through wastewater surveillance.
Telemedicine access to remain in place.
Vaccines, tests and treatments FDA emergency use approval will continue.
Concerns that extra federal funding for Medicaid may end and people could lose their health insurance.
5/8/23 Slate: Where Are the Treatments for Long COVID? Long COVID Treatment Research Is Stuck in a Frustrating Catch-22 https://buff.ly/42EXy5N
People with Long COVID, researchers and physicians discuss needed research.
5/7/23 Clin Infectious Diseases: Real-World Effectiveness of Nirmatrelvir/Ritonavir (Paxlovid) on Covid-19-Associated Hospitalization Prevention: A Population-Based Cohort Study in the Province of Québec, Canada https://buff.ly/3BebEQ3
Previous studies of Paxlovid were done before Omicron.
Nirmatrelvir/ritonavir treatment reduced hospitalizations by:
96% in outpatients with incomplete primary vaccination course
44% in severely immunocompromised outpatients
50% in high-risk outpatients aged 70 years and older when the last dose of the vaccine was received at least six months ago.
5/5/23 Science: Cytokinopathy with aberrant cytotoxic lymphocytes and profibrotic myeloid response in SARS-CoV-2 mRNA vaccine–associated myocarditis https://buff.ly/3HIt0rI
Vaccination-related myocarditis, especially in young males, is from elevated systemic levels of cytokines, an increased frequency of activated T and NK cells, and induction of inflammatory monocytes with profibrotic features. Cytokines are driving inflammation.