The FLiRT mutations KP.2 and KP.3 now make up more than 40% of COVID cases in the United States. They are pushing JN.1 and its descendants out. Wastewater SARS-2 levels are “MINIMAL” overall for the nation, but are just starting to increase in the west. Some of this may be due to Hawaii which is at a “HIGH” or “VERY HIGH” level of SARS-CoV-2 in their wastewater. Delaware, Minnesota and Nevada have “MODERATE” levels of virus in wastewater. According to JP Weiland, nationwide 1 in every 217 people are currently infected with COVID. COVID hospitalizations are no longer being reported at the national level and Biobot has stopped reporting their wastewater data as well.
From https://iowacovid19tracker.org/
The new SARS-CoV-2 forecasting analytics website reports that as of May 21, 2024, COVID infections are growing in Hawaii, Arizona, Montana, Texas, Louisiana and Massachusetts. COVID infections are “likely growing” in Alaska, California, Oregon, Nevada, Wyoming, Virginia, New Jersey and Rhode Island. In the Bay Area, Palo Alto wastewater is now at a “HIGH” level for COVID virus although it seems to be plateauing and San Francisco Oceanside had a big uptick that quickly normalized.
Internationally, there are increases in COVID levels in Australia, New Zealand and Singapore. According to Mike Honey, a new variant descendant LB.1 is just starting to increase in Singapore, New Zealand and the United States. LB.1 is a “DeFLiRT” variant because it added a deletion mutation on the spike protein (S31Del) to the FLiRT mutation (F456L + R346T) combination which appears to increase its efficiency.
The BCG (Bacillus Calmette-Guérin) vaccine was developed against Tuberculosis over 100 years ago, but it is known to protect against other infectious diseases as well. A Phase III randomized clinical trial from Harvard shows that multiple doses of theBCG vaccine protected adults with Type I diabetes from COVID infections better than the initial mRNA COVID vaccines. It also protected this group against other infectious diseases. The BCG vaccine worked against COVID variants Delta and Omicron in this study.
Masks
A new mega-review from T. Greenhalgh and colleagues examined over 100 published reviews and primary studies on masking. It showed that masks are effective at reducing transmission of respiratory diseases if worn correctly. N95 respirator masks are more effective than surgical masks or cloth masks and there is a dose-response effect to wearing masks. The review also showed that mask mandates are effective in reducing community transmission of respiratory infections. Masks work! Fortunately, the North Carolina House of Representatives defeated the bill that had been approved by the NC Senate this week, so wearing masks in North Carolina remains legal.
Dr. Svetlana Blitshteyn is a neurologist specializing in autonomic disorders like POTS. This week, I really enjoyed listening to a discussion between Dr. Blitshteyn and Dr. Eric Topol on his podcast. She had excellent recommendations on how to approach POTS and Long COVID and gave helpful insights into workup and treatment.
A small (n=12), sham-controlled, double-blind, randomized clinical trial examined the effects of transcutaneous vagus nerve stimulation (tVNS) on Postural Tachycardia Syndrome (POTS). Participants received either active tVNS on the tragus of the ear or sham stimulation on the earlobe for one hour daily for two months. Those in the active tVNS group had a decrease in antiadrenergic autoantibodies and inflammatory cytokines, and better heart rate variability. Larger studies are needed to confirm these findings.
A group from Germany used DMI (diffusion microstructure imaging) MRI to evaluate people with cognitive impairment, olfactory dysfunction and fatigue from Long COVID (Post-COVID-condition, PCC). They found “widespread alterations in cerebral microstructure, attributed to a shift in volume from neuronal compartments to free fluid, associated with the severity of the initial infection.” Cognitive impairment, olfactory dysfunction and fatigue in Long COVID were linked to microstructural changes in specific brain networks that could be seen on DMI MRI.
Fig. 2: Spatial distribution and direction of microstructural changes after COVID-19.
The definition of Long COVID is not standardized and varies among public health agencies, such as the CDC, WHO, and UK NICE, depending on the time elapsed since the initial COVID illness. A new review from AHRQ looks at how to define Long COVID and what models of care are being used to treat Long COVID in different places. They found that “Long COVID models of care were characterized by 5 key principles: a core “lead” team, broad multidisciplinary expertise, comprehensive access to diagnostic and therapeutic services, a patient-centered approach, and providing capacity to meet demand.” As more people are infected by COVID, more people are getting Long COVID. We need excellent models of care to best treat this chronic and disabling disease.
Great Britain Olympic-level rower O. Cousins has Long COVID. In an interview with the BBC, she complained that the “Lightning Process”, a three-day course costing more than £1,000, had tried to teach her that she was sick because of negative thoughts. She knew that she was physically ill from Long COVID and was being gaslit. Critics have said that the Lightning Process is exploiting people with Long COVID who are desperate to feel better. We need to focus funding on finding real treatments that actually work for Long COVID.
John Hopkins Long COVID study is hoping to get people with Long COVID anywhere in the world to answer a one-time 20 minute questionnaire. The survey is available in multiple languages at https://covid-long.com/.
A few days ago, Charlie McCone posted on Twitter about Rutgers researcher Dr. William Hu who said, “The findings from our study lead us to believe that interferon — the body’s natural antiviral — and other drugs which target COVID-19 will be most beneficial in people with long COVID.” His study in Cell was on “Clinical and CSF single-cell profiling of post-COVID-19 cognitive impairment”. Medical journalist Liz Highleyman responded to Charlie’s tweet that interferon-alpha was used to treat Hepatitis C before newer Hepatitis drugs were created. But unfortunately, interferon-alpha has many side effects including very unpleasant, flu-like symptoms. A study in the NEJM in February 2023 showed that a single dose of a different interferon, Pegylated Interferon Lambda, protected people with acute COVID infection from being hospitalized or needing to go to the Emergency Department. I wonder if PEG Interferon Lambda could be used to treat Long COVID. PEG Interferon Lambda has fewer side effects than other interferons and has broad antiviral properties.
A.I.
Yesterday, the BBC reported that Google’s new AI Overview feature told users that the best way to keep cheese on pizza was to use a non-toxic glue. Google AI Overview also recommended eating at least one small rock a day for its vitamins and minerals. AI can be very helpful for certain tasks, but it is important to check its answers against reliable sources.
Wastewater testing for Avian Flu H5N1 will now be tracked by a 190-site network across 36 states run by Stanford, Emory and Verily Life Sciences at WastewaterSCAN. The tracking is funded by philanthropy. Sara Anne Willette used USDA and US WastewaterSCAN data to show H5N1 viral activity below:
Several people have asked me if they could become immunized against bird flu from drinking either pasteurized or unpasteurized milk contaminated with the H5N1 avian flu virus. Drinking unpasteurized milk could make a person extremely sick. Pasteurized milk is safe to drink. Any inactivated viral proteins would be broken down by the gastrointestinal system and would not lead to immunization however.
A new study showed that mice given raw milk from H5N1-infected cows got extremely ill with systemic avian flu infection and the H5N1 virus was found to have spread to their lungs, hearts, kidneys, spleens, livers, mammary glands, and brains. Of note, the two mice whose mammary glands were infected had not been lactating. Cats that drank raw milk infected with H5N1 showed severe neurological symptoms including blindness, and half of them died from the disease. Ingesting raw milk with H5N1 could be very dangerous.
Other news
The CDC unveiled a new Daily Heat Risk Map which allows people to type in their zip code to see what health risks there may be from heat that day. A “heat dome” this week caused power outages and led to deaths of howler monkeys in Mexico because of heat stroke. The extreme heat is expected to increase hurricanes this season as warm ocean temperatures can fuel the storms.
Male fertility has been decreasing and it appears that microplastics and pesticides are affecting sperm counts. Microplastics were found in testicles from humans and from pet dogs and are believed to cause inflammation leading to reduced sperm counts. A French fertility clinic reports that more than 55% of sperm samples tested contained high levels of glyphosate which is the pesticide in the weed killer Roundup. Not only can it affect sperm counts, but the authors found that glyphosate may also affect DNA of sperm which could have repercussions for his progeny.
Because of recent meningitis infections in visitors returning from Saudi Arabia, the CDC recommends that people traveling to the Hajj pilgrimage in Saudi Arabia or the Umrah pilgrimage be sure that they are up to date on travel vaccinations including the quadrivalent meningococcal vaccine.
As of May 21, 2024, we estimate that COVID-19 infections are growing or likely growing in 14 states and territories, declining or likely declining in 11 states and territories, and are stable or uncertain in 20 states and territories.
“Due to the sunsetting of Biobot's datavis, I recalibrated the wastewater data since Feb 2024 to 100% NWSS. It was already weighted toward NWSS prior to this update, but Biobot data was significantly higher.
5/21/24 The Straits Times: Test kits fly off the shelves as Covid-19 infection cases spike in Singaporehttps://buff.ly/3wNEo3h
Covid-19 cases in the week of May 5 to 11 rose to 25,900 cases, compared with 13,700 cases in the previous week.
Social and Advocacy
Pediatrics
5/17/24 CDC: Consolidated, evidence-based guidance for preventing the spread of all infections in K-12 schools. https://buff.ly/3WRMHG6
For the 2024 – 2025 school year
Teach and reinforce proper hand washing and respiratory etiquette.
Take steps for cleaner air by improving ventilation in schools. Schools should consider ventilation enhancements and design when undergoing remodeling or when undertaking new building construction to optimize clean air.
Clean, sanitize, and disinfect, when appropriate.
Promote vaccinations for students and staff.
Vaccines
5/22/24 Science (MGH, Harvard): Late in the US pandemic, multi-dose BCG vaccines protect against COVID-19 and infectious diseases https://buff.ly/3VaLx7d
The BCG (Bacillus Calmette-Guérin) vaccine was developed against Tuberculosis over 100 years ago.
“BCG provides broad-based protection against infectious diseases from the global literature.”
A Phase III randomized clinical trial from Harvard shows that multiple doses of the BCG vaccine protected adults with Type I diabetes from COVID infections better than the initial mRNA COVID vaccines. It also protected this group against other infectious diseases.
The BCG vaccine remained effective against different COVID-19 variants like Delta and Omicron.
5/22/24 Sky News: Snakes force COVID vaccination centre in Wales to (temporarily) close https://buff.ly/3wK95Xf
The snakes have been named Cwm and Cou after the Ceredigion village where the centre is located.
Pic: Hywel Dda Health Board
Antiviral treatments
Masks
5/22/24 Clinical Microbiology Reviews (T. Greenhalgh et al.) Masks and respirators for prevention of respiratory infections: a state of the science review https://buff.ly/3V8I2hw
Massive review of over 100 published reviews and selected primary studies on masking.
“masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect.”
5/22/24 NC House votes not to concur with bill reinstating mask restrictions https://buff.ly/44TjNai
Long COVID
5/19/24 Cardiovascular Research: Persistent increase of cardiovascular and cerebrovascular events in COVID-19 patients: a 3-year population-based analysis https://buff.ly/3yuEM7y
Retrospective cohort study in Italy of 228,266 people of which 31,764 (13.9%) had positive COVID tests compared to a historical group pre-pandemic from 2017 to 2019.
Three years after COVID infection, adults had an increased risk of all major adverse cardiovascular and cerebrovascular events including heart attack, stroke, heart failure, atrial fibrillation and myocarditis or pericarditis with an odds ratio of 1.73.
Excellent podcast with recs on how to approach people with fatigue and/or POTS, treatments
5/18/24 Nature: Cerebral microstructural alterations in Post-COVID-condition are related to cognitive impairment, olfactory dysfunction and fatigue https://buff.ly/3UKYZxc
The authors used DMI (diffusion microstructure imaging) MRI to evaluate people with cognitive impairment, olfactory dysfunction and fatigue from Long COVID (Post-COVID-condition, PCC). They found “widespread alterations in cerebral microstructure, attributed to a shift in volume from neuronal compartments to free fluid, associated with the severity of the initial infection.” Cognitive impairment, olfactory dysfunction and fatigue in Long COVID were linked to microstructural changes in specific brain networks.
Fig. 2: Spatial distribution and direction of microstructural changes after COVID-19.
Peluso et al. study from UCSF showed that one-fourth of people who had prior COVID still had SARS-CoV-2 antigen proteins in their blood 14 months later.
“In a feasibility study, Putrino's lab will study two repurposed HIV antivirals, Truvada and maraviroc. "Maraviroc has had some early published evidence that it does have some antiviral action on SARS-CoV-2 in the body," he noted. "Truvada also has some weaker evidence showing it has action on SARS-CoV-2, but more importantly, it has strong evidence that it can act quite aggressively on persistent EBV," which may be a factor in a subset of long COVID patients.”
Feb 2024 JACC Clinical Electrophysiology (Stavrakis et al): Noninvasive Vagus Nerve Stimulation in Postural Tachycardia Syndrome (POTS): A Randomized Clinical Trial - PubMed https://buff.ly/4dOchBR
Sham-controlled, double-blind, randomized clinical trial to examine the effect of tVNS on POTS over a 2-month period relative to sham stimulation.
tVNS (20 Hz, 1 mA below discomfort threshold) was delivered using an ear clip attached to either the tragus (active; n = 12) or the ear lobe (sham; n = 14) for 1 hour daily over a 2-month period.
Antiadrenergic autoantibodies and inflammatory cytokines were lower in the active arm compared with the sham arm at 2 months (P < 0.05).
Heart rate variability was better in the active arm.
Our results support the emerging paradigm of noninvasive neuromodulation to treat POTS. Mechanistically, this effect appears to be related to reduction of antiautonomic autoantibodies and inflammatory cytokines, and improvement in autonomic tone.
5/20/24 BBC: Long Covid course, Lightning Process, is ‘exploiting people’, says ex-GB rower https://buff.ly/3wWiquZ
The Lightning Process claims it can help people quickly improve or stop Long Covid symptoms by changing their thoughts and actions. It offers a three-day course, usually costing £1,000.
"I had a very clearly physical illness. And I felt that they were blaming my negative thought processes for why I was ill."
“In secret recordings by the BBC, [Lightning Process] coaches can be heard telling patients that almost anyone can recover from long Covid by changing their thoughts, language and actions… Long Covid support groups told the BBC's File on 4 programme that a lack of consistent services for patients is leaving people with nowhere to go.”
John Hopkins Long COVID survey https://covid-long.com/
20 minute questionnaire, available in multiple languages
RTHM Direct: https://direct.rthm.com/
“Starting at $49 per online consultation, getting started is easy. Submit a condition assessment, then a clinician will review it within 24 business hours and prescribe medication if appropriate for you.”
RTHM treats Long COVID, ME/CFS, MCAS, Dysautonomia, POTS, EDS, Sjogren’s, Fibromyalgia, etc.
5/13/24 Cell (William Hu et al., Rutgers): Clinical and CSF single-cell profiling of post-COVID-19 cognitive impairment https://buff.ly/4dSKVuh
“What we learned was that Long COVID was really very similar to acute infection” “The findings from our study lead us to believe that interferon — the body’s natural antiviral — & other drugs which target COVID-19 will be most beneficial in people with LC”
5/22/24 NJ Spotlight News: What causes long COVID’s ‘brain fog’? Rutgers researchers zero in on answer https://buff.ly/44SaY0F
“The findings from our study lead us to believe that interferon — the body’s natural antiviral — and other drugs which target COVID-19 will be most beneficial in people with long COVID,” Hu said.
Interferon-alpha was standard treatment for hepatitis C before modern antivirals were developed 10 years ago. It causes of lot of side effects, including flu-like symptoms & depression. Might be worth it, especially if it leads to cure in the short term, but not a panacea.
Do you know what the success rate was with hep c? So I’m guessing you think antivirals are significantly superior to these kind of immune stimulating drugs?
Interferon cured about half of people with 6-12 months of treatment. Modern antivirals cure >90%, regardless of genotype, in 8-12 weeks. For hep C, antivirals are unquestionably more effective. Since we aren't sure about the underlying mechanism(s) of long COVID yet, it's impossible to say what will be most effective.
We don't know as much about interferon lambda, which seems to be better tolerated. Interferon-alpha was used for hepatitis C treatment. Lambda was being tested for hep C, but once the new antivirals came along, it became moot.
AI:
5/24/24 BBC: Google AI search tells users to glue pizza and eat rockshttps://buff.ly/3KhNt7Q
5/22/24 Modern Healthcare: Epic launches AI validation tool for health systems https://buff.ly/44XrBb2
From the AMA news: “Electronic health record company Epic launched an open-source tool on Wednesday that will allow health care [professionals] to test and validate artificial intelligence models.” The AI Trust and Assurance Suite “is free and available through the public coding website GitHub where health systems can add it to their electronic health record systems, said Corey Miller, vice president of research and development at Epic.” It “will allow health systems to evaluate the performance of any AI model that integrates with any EHR, whether it’s from Epic or not, Miller said.”
H5N1
5/22/24 Wastewater testing specifically for bird flu virus will scale up nationally in coming weeks https://buff.ly/3wDmEYy
Wastewater testing for Avian Flu H5N1 will be tracked by a 190-site network across 36 states run by Stanford, Emory and Verily Life Sciences at WastewaterSCAN.
5/21/24 STAT News: Move over, wastewater. Store-bought milk could be another way to track the bird flu outbreak in cows https://buff.ly/44R9tQ9
5/22/24 CDC Reports Second Human Case of H5 Bird Flu Tied to Dairy Cow Outbreak https://buff.ly/4bsioKB
The second dairy worker also had conjunctivitis.
5/24/24 Ars Technica: After mice drink raw H5N1 milk, bird flu virus riddles their organs https://buff.ly/3UW2Es3
In a new NEJM article below, mice who drank raw milk from H5N1 cows became very sick with virus in their lungs and also their hearts, kidneys, spleens, livers, mammary glands, and brains.
Cats who drank raw milk "displayed distressing neurological symptoms, and studies found the virus had invaded their lungs, brains, hearts, and eyes" and half of them died from the disease.
Pasteurized milk is safe for consumption.
5/24/24 NEJM: Cow’s Milk Containing Avian Influenza A(H5N1) Virus — Heat Inactivation and Infectivity in Mice https://buff.ly/3yCcBUg
In mice, giving H5N1 by mouth caused systemic Avian Flu infection with high virus levels in the lungs and moderate levels in other organs including the mammary glands of two non-lactating mice. If raw milk has H5N1, it could be very dangerous.
5/23/24 CIDRAP: H5N1 avian flu viruses can persist on milking equipment surfaces https://buff.ly/4btdqxa
5/23/24 AP: 'Heat dome' leads to sweltering temperatures in Mexico, Central America and US South https://buff.ly/4btrKpt
In Mexico, howler monkeys were dropping dead from trees because of heat stroke.
"the extreme heat adds another ingredient to the risk of tropical cyclone activity this season, since these storms are fueled by warm ocean temperatures."
Male fertility
5/20/24 The Guardian: Microplastics found in every human testicle in study https://buff.ly/3K7wcOs
A recent study looked at microplastics and they found it in all 23 human testes and all 47 testes from pet dogs. Microplastics cause inflammation and PVC in dog testes was found to reduce sperm counts.
Original study: 5/15/24 Toxicological Studies: Microplastic presence in dog and human testis and its potential association with sperm count and weights of testis and epididymis https://buff.ly/3ylVQfF
5/17/24 The Guardian: High levels of Roundup weed killer found in more than half of sperm samples, study finds https://buff.ly/4bFqwa8
"More than 55% of sperm samples from a French infertility clinic contained high levels of glyphosate...The new research also found evidence of impacts on DNA and a correlation between glyphosate levels and oxidative stress on seminal plasma, suggesting significant impacts on fertility and reproductive health.
glyphosate-based product is Monsanto’s Roundup weedkiller, an association between it and cancer.
Original study: 6/15/24 Preprint Ecotoxicology and Environmental Safety: Glyphosate presence in human sperm: First report and positive correlation with oxidative stress in an infertile French population https://buff.ly/3QVLHNh
a negative impact of GLY on the human reproductive health and possibly on his progeny.
5/20/24 CIDRAP: CDC urges travelers to Saudi Arabia to be current with meningococcal vaccines https://buff.ly/3wKUFWU
Because of recent meningitis infections in visitors returning from Saudi Arabia, the CDC recommends that people traveling to the Hajj pilgrimage in Saudi Arabia or the Umrah pilgrimage be sure that they are up to date on travel vaccinations including meningococcal disease.
55 year old fetal cardiology nurse Amy Appelhans Gubser successfully swam 30 miles from the Golden Gate Bridge to the Farallon Islands. It took her 17 hours.
5/16/24 The Guardian: Scientists find buried branch of the Nile that may have carried pyramids’ stones https://buff.ly/3ypYOzN
5/16/24 Nature Communications Earth & Environment: The Egyptian pyramid chain was built along the now abandoned Ahramat Nile Branch https://buff.ly/4bxA1IL
5/23/24 AP: Massive cradle of baby stars revealed in new space telescope images https://buff.ly/3KjZsBu
European space telescope Euclid sent back pictures of Messier 78 which is an "enormous cradle of baby stars" some 1,300 light-years away. A light-year is 5.8 trillion miles.
Non-toxic glue, pffft. Everyone knows double-sided tape is the best way to keep cheese on pizza! (Thanks for this wide-ranging and always helpful post.)
Thank you, Dr. Ruth. This is what I have read from many sources however, the anti-vaxers I have encountered are often well educated, otherwise reasonable people and are adamant that they "know the truth". So much misinformation out there...
Non-toxic glue, pffft. Everyone knows double-sided tape is the best way to keep cheese on pizza! (Thanks for this wide-ranging and always helpful post.)
Thank you, Dr. Ruth. This is what I have read from many sources however, the anti-vaxers I have encountered are often well educated, otherwise reasonable people and are adamant that they "know the truth". So much misinformation out there...