COVID news & more, 6/22/24

KP.3 and its subvariant KP.3.1.1 are causing increases in COVID in the western American states, as they also are causing waves in Spain, Portugal, Australia and other countries.

Portugal

From Pedro Lerias

In France, “figures from health authority Santé publique France show a 52% increase week-on-week in hospital emergency visits for Covid-related issues, and 51% more consultations with SOS Médecins (1,507 between June 3 and 10) - although numbers remain very low compared to during the pandemic.” The Paris Olympics will start on July 26th.

Across the United States, KP.3 cases increased from 16.9% to 25.9% to 33.1% over the last 3 weeks reported, while LB.1 went from 8.8% to 13.5% to 17.5%. According to JP Weiland, there are about 250,000 new COVID infections daily in the entire U.S. and approximately 1 in every 134 people is currently infected overall. But, there are large differences in different U.S. regions:

From https://x.com/JPWeiland/status/1804269671593411001

Hawaii is at its highest COVID case load since the Summer 2022 (BA.5 variant) as seen by emergency department visits and from SARS-CoV-2 wastewater levels. Hawaii had a smaller JN.1 wave last December and January. As of June 1, 2024, Hawaii wastewater levels of SARS-CoV-2 are still very high, followed by Florida, California and Vermont.

From: https://public.tableau.com/app/profile/sara.anne.willette/viz/USCompositeWastewaterData/NWSSData

Nationally, highest SARS-CoV-2 in wastewater in PMMoV is Ithaca NY (3455)!!!, followed by Honolulu (1741-2349), Harrison, AR (1257), South Parker, CO (1137), Sausalito (1076), New Orleans, LA (1048), Concord NH (1009), Orange County, FL (956), Key Biscayne FL (851), Oceanside San Francisco, CA (830.6), Bridgewater NJ (755), and Novato CA (653). I have never seen as high a wastewater virus level as Ithaca has now according to Wastewater SCAN.

In California, the top-third highest SARS-CoV-2 virus levels in PMMoV are in Sausalito (1076 PMMoV), Oceanside San Francisco (830), San Rafael (784), Novato (653), Half Moon Bay (639), Southeast San Francisco (592), Santa Cruz (561), Union City (556), Laguna Niguel (507), San Mateo (499), Redwood City (387). San Jose (336) and Palo Alto (264) are considered high for Santa Clara county, but they are in the middle-third of SARS-CoV-2 wastewater levels in the state. Marin county reports medium levels, but the wastewater is trending up in almost all places. Los Angeles County is at a very low level of SARS-CoV-2 in wastewater between only 43 to 64 PMMoV, but cases and COVID positive hospitalizations are just starting to trend up according to the Los Angeles Times.

Variants 

This week, Ben Murrell posted a graph of variants that have a growth advantage over others. The subvariant with the highest growth advantage is KP.3.1.1 which has an added S31 deletion to KP.3. According to Ryan Hisner, adding the S31 deletion adds a glycan to the spike protein which confers it its growth advantage. All of the latest variants include the F456L mutation, so it is good that the FDA approved KP.2 [JN.1 + F456L] for the fall 2024 vaccine. 

Graph from Ben Murrell, annotated by Ryan Hisner showing key mutations

Pediatrics

A review came out in Nature this week on the relationship between Type 1 diabetes mellitus (T1DM) and SARS-CoV-2 infection. Sweden reported a 62% increase in type 1 diabetes in 2022 as compared to 2018 before the COVID pandemic. Viral infections often precede a new diagnosis of type 1 diabetes which is an autoimmune disease that attacks the pancreas. Sweden did not enforce lockdowns early in the pandemic which allowed many people, including children, to be infected by COVID. Now, they will study if giving young children and babies COVID vaccinations can reduce the amount of Type I diabetes in children.

Two different articles in the lay press this week looked at children with Long COVID discussing the myth that a COVID infection is “harmless” for kids. They showed how families are being gaslit by the medical profession and how parents are sometimes blamed for their child’s Long COVID symptoms. The Guardian article looked at a 12 year old boy named Toby. For him, Long COVID brings pain, exhaustion and sadness as well as months away from school because he is so ill. Dr. Putrino from Mount Sinai in New York was interviewed. He said, "We looked at the acute phase and said, 'This doesn't seem so bad for kids', and we forgot about the cumulative risks over time." It doesn't matter how mild your acute COVID infection is, he says: "You have the same risk of developing long COVID. And I say 'cumulative' because the latest data shows us that with every reinfection, your risk of long COVID increases." 

Long COVID

Someone with the handle of Antiviral Mktng on Twitter made a chart of different studies that all show an increased cumulative risk of Long COVID from COVID reinfections: 

Autoantibodies in Long COVID

This week, a study from Dr. Putrino of Mount Sinai and Dr. Iwasaki of Yale showed that the passive transfer of autoantibodies from people with Long COVID into mice causes the mice to get the same symptoms as the Long COVID patients. This study confirms findings from the den Durren lab a few weeks ago that also showed that injecting mice with IgG antibodies from people with Long COVID caused them to get the same symptoms. 

In the Mount Sinai-Yale study, they used a 21,000 protein array to identify which autoantibodies in people with Long COVID were related to their symptoms. Long COVID patients with cognitive impairment and neurologic symptoms were found to have autoantibodies to proteins in the nervous system including human pons tissue and to murine sciatic nerves, meninges and cerebellum. The pons is part of the brainstem that is important for balance and equilibrium, sleep, respiration, swallowing and facial sensation and movement. Patients with headache and disorientation were found to have autoantibodies to the sciatic nerves and to the meninges. The meninges are a triple layer of membranes that cushion and protect the brain and spinal cord.

Several Long COVID patients in this study were found to have autoantibodies that affected multiple areas throughout the central nervous system including the brain. Some Long COVID patients also had autoantibodies consistent with known autoimmune diseases.

From https://www.medrxiv.org/content/10.1101/2024.06.18.24309100v1

IgG antibodies from people with Long COVID associated with new pain syndromes (pins and needles, burning pain, and weakness) caused the mice to become very sensitive to pain as well. The mice showed a rapid reduction of intraepidermal nerve fibers (IENF) which is a marker for Small Fiber Neuropathy. Small Fiber Neuropathy (SFN) is a condition that affects the small sensory nerves in the skin and can cause “pins and needles” sensations and a burning type of pain that often starts in the feet. SFN may affect both sensory and autonomic fibers, leading to sensory changes, autonomic dysfunction, or a combination of symptoms. General symptoms of SFN include fatigue, cognitive disturbances, headache, and widespread musculoskeletal pain.

Tatiana Prowell brought up a good point about the findings in these studies. Medications used to treat autoimmunity often suppress the entire immune system. If Long COVID patients also have virus persisting somewhere in their bodies, it will be important to treat the persistent virus with antiviral medications and possibly monoclonal antibodies against SARS-CoV-2 before starting them on immunosuppressant medication for autoantibodies.

In a multisite prospective cohort study of 4708 people followed from April 2020 to February 2023, the median recovery time from a SARS-CoV-2 infection was 20 days, with more than 1 in 5 of adults not recovering by 90 days. With reinfections, median recovery time was longer at 27 days. “Recovery within 3 months was less likely in women and those with preexisting cardiovascular disease and more likely in those with COVID-19 vaccination or infection during the Omicron variant wave.”

Argenx announced this week that its Phase 2 clinical trial of Efgartigimod (VYVGART) in Long COVID POTS showed no significant improvement. 

A group from Marseille studied Long COVID patients with persistent symptoms “related to a brain impairment (dyspnoea, hyposmia/anosmia, dysgeusia/ageusia, memory/cognitive impairment, insomnia, pain).” Using [18F]fluorodeoxyglucose (FDG)-PET scans of the brain, they found that Long COVID patients have reduced brain metabolism in the bilateral limbic areas, as well as in the brainstem, and cerebellum. The hypometabolism pattern remained stable and did not improve or worsen over 9 months time in patients who continued to have symptoms.

From https://link.springer.com/article/10.1007/s00259-024-06775-x

A poll from the Harvard T.H. Chan School of Public Health and the de Beaumont Foundation shows that although news coverage showed a deeply divided America regarding COVID mitigation strategies such as masking and healthcare worker vaccinations, 70% of Americans overall felt that these were a good idea. The poll did show some differences by race and by political party on the four main pandemic policies however.

This week, many people in the Long COVID community posted about an article that interviewed Dr. Phillip Alvelda, a strong critic of how the pandemic has been handled by both presidents and by government bodies like the CDC and the WHO. But, the interview brought up several important points. He discussed the increased risk of Long COVID and disability with each COVID reinfection. He also talked about the importance of assuring the best indoor air quality for schools, hospitals and businesses. In addition, Dr. Alveda spoke about an increase in traffic accidents and traffic fatalities since the pandemic began which brings up the question, "Is the increase in car accidents related to COVID's long term effects on cognition and motor function, or is it being caused by something else?”

A group in the UK designed a stepwise plan of vocational rehabilitation to help people with Long COVID return to work. They said that this "roadmap resource has been developed to address many people’s experience of multiple poorly planned return-to-work attempts and inadequate adjustments."

From https://buff.ly/3z5zfo0

Other news

In a study of adolescent girls and young women in South Africa and Uganda, twice yearly Lenacapavir was found to be safe and highly effective for Pre-Exposure Prophylaxis ( PrEP) against HIV. No HIV infections were found in trial participants who received the Lenacapavir injections. 

This week, the Lancet presented six articles and a video on Gestational Diabetes which is “the most common medical pregnancy complication worldwide, affecting one in seven pregnancies.”

"The U.S. surgeon general, Dr. Vivek Murthy, announced on Monday that he would push for a warning label on social media platforms advising parents that using the platforms might damage adolescents’ mental health." 

Using functional MRI, symptoms, computerized testing and response to therapies, researchers at Stanford identified six biotypes of depression and anxiety. They hope that this will help “advance precision clinical care in psychiatry”.

The Epstein-Barr virus (EBV) causes mononucleosis, but it also is associated with several types of cancers including Burkitt lymphoma, gastric cancer, and nasopharyngeal carcinoma. A team from the University of Pittsburgh used CRISPR/dCas9-mediated EBV reactivation (CMER) in combination with antiviral ganciclovir to treat EBV-associated cancers in vitro with excellent results.

Virginia “Ginger” Hislop received a bachelor’s in education from Stanford in 1940, but World War II kept her from completing her master’s degree. After 80 years working in education, she finally received her master’s degree diploma in education from Stanford at the age of 105. Congratulations!

Photo: Charles Russo

Have a great rest of your weekend,

Ruth Ann Crystal MD

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