The summer wave of COVID infections has started. As of June 25, 2024, the CDC estimates that COVID-19 infections are growing or likely growing in 44 states, declining or likely declining in 1 state (Hawaii), and are stable or uncertain in 5 states and territories.
According to Michael Hoerger, Americans will get 500,000 to 600,000 COVID infections each day which means that 187,000 new people will end up getting Long COVID each week over the summer. COVID transmission in late June 2024 is 2x higher than in June 2023, 3x higher than in June 2020 and 5 to 6x higher than in June 2021. In June 2022, the BA.2 Omicron surge surpassed all prior summers.
Nationally, SARS-CoV-2 test positivity is up to 8.6%, emergency department visits for COVID and COVID deaths are increasing. Hospitalizations are no longer reported for most places in the US, but those that are reporting show an increase in hospitalizations for COVID. Tests done at Walgreens pharmacies show a total COVID test positivity of 34.1% for the people that choose to be tested.
Regarding wastewater monitoring of SARS-CoV-2, the CDC still reports the national level to be “LOW”, although we see on the chart below that the west coast virus levels are climbing, followed by increases in southern states. As the weather gets hotter, more people will need to go indoors into the air conditioning. Also, many people are traveling. JP Weiland reports that as of June 28, every 1 in 43 people in the West is currently infected and that in the South, every 1 in 76 people has COVID now. In the Midwest, 1 in 136 people are presently infected with COVID and in the Northeast it is 1 in every 189 people.
In California, Oceanside San Francisco (1277PMMoV) and Southeast San Francisco (1140 PMMoV) are at the highest SARS-2 wastewater levels, closely followed by Windsor (999). Three of the sewersheds in Santa Clara County are “HIGH” including San Jose which is at 650 PMMoV. Marin county is “MEDIUM”, but with an upwards trend. In Alameda County, Union City was very high at 1096 PMMoV but has now decreased to 428. Oakland is only at 210 PMMoV. In Los Angeles County, SARS-CoV-2 wastewater levels are fairly low still, but are starting to creep up. L.A.’s wastewater is between 81 and 129 PMMoV.
According to Raj Rajnarayanan, the top circulating lineages in California are KP.2.3, KP.2, KP.3.1, KP.3.3. In New York State, often considered the bellwether state, LB.1.7 and KP.2.3 are the top circulating SARS-CoV-2 lineages. COVID hospitalizations are "clearly trending up" in New York. Nationally, COVID variants are only being updated every 2 weeks by the CDC which were noted as KP.3, KP.2 and LB.1 last week.
In her June 25 “State of Affairs” newsletter, Katelyn Jetelina summarized what illnesses to watch out for this summer. She discusses the summer COVID wave, norovirus (stomach flu), whooping cough (pertussis) outbreaks in Delaware and Kentucky and the UK, heat related illness, tick-borne illnesses, and recent mpox infections seen in DR Congo.
Acute COVID infections
This week, Dr. Akiko Iwasaki tweeted about an article by Lindeboom et al. on immune signatures seen in those people who get COVID infections and those who do not. The Lindeboom group infected 16 unvaccinated volunteers who did not have prior COVID infection with a low dose of SARS-CoV-2. While this is ethically problematic given that any infection can cause Long COVID, it does allow us to understand the human immune response to the SARS-CoV-2 virus. Fortunately, none of the participants got Long COVID per Dr. Iwasaki.
Of the 16 unvaccinated people who were infected with SARS-CoV-2, “6 had sustained infection, 3 had transient, and 7 had abortive infection at this dose.” People with a sustained infection had a delay in local IFN I release and cellular immune responses. Volunteers who only had transient infections had rapid IFN-I and cellular recruitment into the nose and throat on day 1. Those who did not get COVID infection (had abortive infection) had higher baseline expression of HLA-QA2 mRNA.
An article this week describes a breath test for COVID that is very accurate. However, it is not a point of care test. During the Alpha and Delta COVID waves, exhaled breath samples were collected in 1L Tedlar bags and were then brought to a lab where they were analyzed using a novel silicon microreactor and ultra high-performance liquid chromatography-mass spectrometry (UHPLC-MS). Carbonyl compounds including 34 ketones and aldehydes were evaluated in breath samples. “The model still achieved 90.1% sensitivity, 98.3% specificity and 94.7% accuracy.”
A new cross-study comparison of two large, open-label studies reports that in 2020, giving Remdesivir for patients hospitalized for COVID infection and low oxygen was associated with a 54% lower mortality than the standard of care.
Pediatric Long COVID
In a retrospective cohort study using EHR data from the RECOVER program, 1,864,637 children and adolescents under age 21 were studied from March 2020 and May 2023. Compared to a non-infected control group, kids and teens with COVID infection had a higher risk of adverse kidney outcomes after COVID infection. Children with kidney disease prior to their COVID infection all had worsening of their kidney disease as well.
Using levels of salivary biomarkers TOS, ADA2, total proteins, and AOPP in children, a group from Spain made a model that could predict which children had Long COVID and which were healthy controls. The addition of total proteins and ADA1 levels to the four salivary biomarkers above allowed the group to distinguish which kids had mild and which had severe Long COVID.
Children, especially those under 5, are particularly vulnerable to COVID infections. However, only about 14% of children were immunized against Covid-19 last fall. Many people mistakenly believe the virus is harmless to children. Children are also more likely to bring the virus home to their parents and grandparents. "By immunizing all groups, you're more likely to prevent the spread," Dr. Matthew Daley said.
The fall COVID vaccines will be especially important for pregnant individuals, not only to protect themselves, but also to safeguard their babies until they are old enough to be vaccinated at 6 months of age.
In 2023 to early 2024, the XBB.1.5 mRNA vaccine was 62% effective against COVID-19 hospitalization and 58% effective against emergency department or urgent care visits. Older versions of COVID vaccines did not reduce the risk of COVID hospitalization, regardless of the number of prior doses received. Therefore, it is important to get updated COVID vaccines to continue to be protected. “The combination of waning vaccine-induced immunity and continuous SARS-CoV-2 strain evolution eventually renders prior versions of vaccines ineffective."
Using single-cell analysis of spike protein (S)–specific memory CD4 T cells after SARS-CoV-2 infection or vaccination, the authors found that the inflammation from COVID infection durably imprinted memory CD4 T cells to be inflammatory. COVID infection primed the T cells to have epigenetic signatures of inflammation, but COVID vaccine primed T cells did not.
Rituxan (Rituximab) is a medication that depletes B cells that make antibodies. Vaccinating people with autoimmune rheumatic diseases before treating them with Rituximab allows them to have a good antibody response to COVID vaccination. If the person already had Rituximab, they will get the best antibody response to COVID vaccination if they wait at least 9 months after their last Rituximab dose to vaccinate.
Mask Bans
North Carolina passed a mask ban, and although it has an exemption for people who need to mask for health issues, anyone can ask the person to remove their mask at any time for “identification”. Now, several other places are considering mask bans. New York Democrats have created a bill that would ban wearing masks for all “assemblies” greater than 5 people. See my notes below for phone numbers to call to request that they stop this bill.
Science magazine reviewed the two recent articles from the Iwasaki group and from the den Dunnen group showing that giving IgG from people with Long COVID to mice caused the mice to get the same Long COVID symptoms. Drs Avindra Nath and Petter Brodin discussed that unlike most autoimmune diseases, there is not one particular autoantibody with the same target in all Long COVID patients. Recent trials show that medications efgartigimod and rituximab that work by decreasing autoantibodies did not improve Long COVID. Dr. Nath is currently studying IVIG for Long COVID.
Long COVID can be very heterogeneous with different phenotypes. Dr den Dunnen proposes using the same mouse study as a biomarker for Long COVID autoimmunity. If you inject a Long COVID patient’s IgG into a mouse and the mouse gets the same symptoms, then that person has the autoantibody-type Long COVID and could be offered a particular clinical trial.
Dr. Iwasaki believes that Long COVID patients with small fiber neuropathy (SFN) pain may be the ones who most commonly will be found to have autoantibodies leading to their pain. She bases this on a recent study by McAlpine et al. That retrospective case series studied 16 patients with new onset SFN after COVID infection. Ninety-two percent of these patients had post-exertional malaise characteristic of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Nine patients had been tested for autoantibodies and six of them were positive for either trisulfated heparin disaccharide (TS-HDS) or fibroblast growth factor receptor 3 (FGFR3) autoantibodies. Eight post-COVID SFN patients were treated with IVIG and had significant clinical improvement in their neuropathic pain symptoms. This study offered preliminary evidence that post-COVID SFN is responsive to treatment with IVIG and linked with neurovascular dysregulation and dysautonomia.
Both males and females with Long COVID had reduced signaling from monocytes and increased activity of NF-κB transcription factors. In both sexes, those with ongoing Long COVID showed higher levels of LAG3, a marker of exhausted T cells, lower ETS1 transcription factor expression across various lymphocyte types, and increased IL-4 levels within T cell subsets. These findings suggest that changes in ETS1 might lead to an abnormally high Th2-like response in Long COVID patients.
A huge study of 10 million people in South Korea and 12 million people in Japan shows a significant increase of neuropsychiatric issues in Long COVID including Guillain-Barré syndrome, cognitive deficit, insomnia, anxiety disorder, encephalitis, ischemic stroke and mood disorders. COVID vaccination protected against these long term symptoms.
A study of 1,988 U.S. Military Health System beneficiaries with Long COVID symptoms identified three Long COVID phenotypes that could be identified by risk factors and early post-infection biomarkers. The sensory cluster (loss of smell and/or taste) had all been outpatients with their initial COVID infection and had elevated ICAM-1 concentrations early after their acute COVID infection. People in the fatigue/difficulty thinking cluster had elevated D-dimer and IL-1RA early after their infections, while patients in the difficulty breathing cluster were more likely to have obesity and have been hospitalized with acute COVID infection.
At Yale, Dr. Harlan Krumholz is working with Dr. Akiko Iwasaki to create a decentralized, national clinical trial that is brought directly to the homes of people with Long COVID. Many people with Long COVID are disabled and would have difficulty traveling to Long COVID clinics. The Yale Long COVID (PAX LC) Trial sends the drug or placebo to the patients' homes. The Long COVID patients can fill out an electronic diary that is uploaded to Yale. Blood and saliva samples are collected either at home or at a lab near their home.
H5N1 is an Influenza A virus. Tamiflu (oseltamivir) usually can treat Influenza A viruses, but it turns out that Tamiflu is 16-times less effective against H5N1. So, if someone were infected by H5N1, they probably would need a much higher dose of Tamiflu than is usually prescribed which could potentially have side effects and would require the government to stockpile more medication.
Being exposed to light between 12:30 am and 6 am was found to be associated with an increased risk of developing Type 2 diabetes. “Light exposure at night can disrupt our circadian rhythms, leading to changes in insulin secretion and glucose metabolism,” senior researcher Andrew Phillips.
Anthony Borges was critically injured by gunman Nikolas Cruz in the 2018 Parkland, Florida high school mass shooting. In an unusual civil settlement, Borges now owns the rights to the gunman’s name. The gunman can no longer give any interviews or make money by telling his story without Borges' permission.
Data from the most recent two weeks may be incomplete due to delays in data reporting. These data sets are subject to change and are indicated by the gray shading.
As of June 25, 2024, the CDC estimates that COVID-19 infections are growing or likely growing in 44 states and territories, declining or likely declining in 1 state (Hawaii), and are stable or uncertain in 5 states and territories.
6/25/24 Scripps News: COVID cases on the rise in 39 states, marking the start of an anticipated summer surge https://buff.ly/3VIKB91
California, Arizona and Florida are experiencing the highest rise in cases driven by new variants like KP.3. COVID cases tend to increase in the summer because of people traveling and also because many take refuge inside in air conditioned buildings when it is hot outside.
“Don’t let COVID-19 ruin your summer vacation! We’re seeing an uptick in COVID-19 in California so take steps to reduce your COVID risk while traveling.
6/24/24 Nature Scientific Reports: Detection of COVID-19 by quantitative analysis of carbonyl compounds in exhaled breathhttps://buff.ly/3RIVgzD
A breath test for COVID with high accuracy which requires collecting samples in Tedlar bags and analyzing them elsewhere. During the Alpha and Delta COVID waves. Carbonyl compounds including 34 ketones and aldehydes were evaluated in breath samples.
6/19/24 Nature: First encounter with SARS-CoV-2: immune portraits of COVID susceptibility https://buff.ly/4bjhDCo
6/26/24 Clinical Infectious Diseases: Remdesivir for Treatment of COVID-19 Requiring Oxygen Support: A Cross-Study Comparison from Two Large, Open-Label Studies https://buff.ly/4cJ7hND
In 2020, giving Remdesivir for patients hospitalized for COVID infection and low oxygen was associated with a 54% lower mortality than the standard of care.
Pediatric Long COVID
6/26/24 MedRxiV: Post-acute and Chronic Kidney Function Outcomes of COVID-19 in Children and Adolescents: An EHR Cohort Study from the RECOVER Initiative https://buff.ly/45Lmz1L
In a retrospective cohort study using EHR data from the RECOVER program, 1,864,637 children and adolescents under age 21 were studied from March 2020 and May 2023. Compared to a non-infected control group, kids and teens with COVID infection had a higher risk of adverse kidney outcomes. Children with kidney disease prior to COVID infection all had worsening of their kidney disease after COVID infection.
5/30/24 Frontiers | Salivary biomarkers as pioneering indicators for diagnosis and severity stratification of pediatric long COVIDhttps://buff.ly/3VG2sxE
h/t Tom Kindlon
Samples taken in 49 from children with long COVID and 56 controls using a salivette.
13 salivary biomarkers were studied.
"Notably, a multivariate logistic regression pinpointed TOS, ADA2, total proteins, and AOPP as pivotal variables, culminating in a remarkably accurate predictive model distinguishing long COVID from controls. Furthermore, total proteins and ADA1 were instrumental in discerning between mild and severe long COVID symptoms."
Vaccines
6/26/24 Nature: Megastudy shows that reminders boost vaccination but adding free rides does not https://buff.ly/4cIhklO
“offering people free round-trip Lyft rides to pharmacies has no benefit
“behaviourally informed COVID-19 vaccination reminders, which increased the 30-day COVID-19 booster uptake by 21% (1.05 percentage points) and spilled over to increase 30-day influenza vaccinations by 8% (0.34 percentage points) in our megastudy.”
6/27/24 NY Times: New Covid Shots Recommended for Americans 6 Months and Older This Fall https://buff.ly/3L2M1GM
The CDC has recommended that all Americans aged 6 months and older receive one of the new fall Covid-19 vaccines. This recommendation comes in response to a summer wave(let) of Covid-19, with infections rising in at least 39 states and territories.
Using single-cell analysis of spike protein (S)–specific memory CD4 T cells after SARS-CoV-2 infection or vaccination, the authors found that COVID infection primed the T cells to have epigenetic signatures of inflammation, but the vaccine primed T cells did not.
6/24/24 JAMA: Estimated Effectiveness of the BNT162b2 XBB Vaccine Against COVID-19 https://buff.ly/4cFDw05
In 2023 to early 2024, the XBB.1.5 mRNA vaccine was 62% effective against COVID-19 hospitalization and 58% against emergency department or urgent care visits.
“The combination of waning vaccine-induced immunity and continuous SARS-CoV-2 strain evolution eventually renders prior versions of vaccines ineffective."
6/23/24 ACR: COVID‐19 Vaccination Before Initiating Rituximab Treatment Induces Strong Serological Response in Autoimmune Rheumatic Disease, Reducing Post‐Pandemic Concerns About the Impact of Rituximab https://buff.ly/3W0ikfC
Vaccinating people with autoimmune rheumatic diseases before treating them with Rituximab allows them to have a good antibody response to COVID vaccination. If the person already had Rituximab, they will get the best antibody response to COVID vaccination if they wait at least 9 months after their last Rituximab dose to vaccinate.
“The NY Democrats bill would ban masks for all "assemblies", regardless of whether they are "lawful" or not, which in NY state means that it would be illegal to wear a mask in a group of 5+ people. That's ridiculous.
The NY Democrats mask ban bill already has some momentum, with 6 co-sponsors in the Assembly, including @AmyPaulin who despite being the chair of the health committee is co-sponsoring an anti-public health bill.
@mattbc has a great sample script (below), quoted here:
"My name is [name], I'm a constituent of [elected's name], I live on [street] in [municipality]. I'm calling to urge [elected's name] "to urge [elected's name] to oppose any ban on masks. Masks are vital protection against airborne pathogens, wildfire smoke, and other health harming pollutants.
Optional, if this fits your situation: as a [ disabled / immunocompromised ] resident of [city],
I need to be able to wear a mask to protect my health."
6/25/24 J of Infectious Diseases: Precision symptom phenotyping identifies early clinical and proteomic predictors of distinct COVID-19 sequelae https://buff.ly/4cGIglU
1,988 SARS-CoV-2 positive U.S. Military Health System beneficiaries with Long COVID symptoms were included in this study. Biomarkers.
Three Long COVID phenotypes were found:
a sensory cluster (loss of smell and/or taste),
a fatigue/difficulty thinking cluster, and
a difficulty breathing/exercise intolerance cluster.
The people in the sensory cluster had all been outpatients with their initial COVID infection and had elevated ICAM-1 concentrations early after their acute COVID infection.
People in the fatigue/difficulty thinking cluster had elevated D-dimer and IL-1RA early after their infections.
The people in the difficulty breathing cluster were more likely to have obesity and have been hospitalized with acute COVID infection.
6/25/24 Nature Human Behaviour: Short- and long-term neuropsychiatric outcomes in Long COVID in South Korea and Japan https://buff.ly/3RKFZyh
A study of 10 million people in South Korea and 12 million people in Japan shows a significant increase of Guillain-Barré syndrome, cognitive deficit, insomnia, anxiety disorder, encephalitis, ischemic stroke and mood disorders. COVID vaccination protected against these long term symptoms.
6/25/24 Medscape: How to Fix $1.6 Billion Long COVID RECOVER Program: Experts Weigh In https://buff.ly/3XA0QIg
Dr Ziyad Al-Aly said about the RECOVER program, "We can't correct course if we don't make changes. We'll end up hitting the same wall again and again."
Long COVID patient advocate Charlie McCone:
"We need pharmaceutical interventions that have a plausible mechanism for intervening with the pathophysiology of this disease," said McCone.
“For me and millions of people suffering, the stakes for RECOVER couldn't be higher.”
Four steps to improve the study of Long COVID include improving coordination between Long COVID experts, moving beyond just symptom management, increasing the number of clinical trials and figuring out the pathophysiology so that treatments can be found.
6/14/24 Yale: A New Kind of Clinical Trial: Bringing Long COVID Research Into Patients’ Homes https://buff.ly/3zigJJk
The Yale Long COVID (PAX LC) One of the trial participants said, “The effort to bring the trial into people’s houses is valiant, especially for a population that is chronically ill,” he says. “For disabled people to become a part of clinical trials already requires so much of us."
6/21/24 Science: Antibodies from Long Covid patients prompt symptoms in mice https://buff.ly/3VB7bk5
Discussion of 2 articles showing that giving IgG from people with Long COVID to mice gave the mice the same LC symptoms that the people had.
Long COVID can be very heterogeneous with different phenotypes. Den Dunnen proposes using a mouse study as a biomarker for Long COVID autoimmunity:
Scientists could inject a patient’s IgG into a mouse. “If the mouse gets sick,” he says, “then yes, you’re in a trial.”
6/19/24 MedRxiV (Putrino, Iwasaki): A causal link between autoantibodies and neurological symptoms in long COVID https://buff.ly/4c7HMWi
5/31/24 BioRxiV (den Dunnen lab): Transfer of IgG from Long COVID patients induces symptomology in mice https://buff.ly/4bJ1uax
“I wish we had a shared autoantigen for these patients also - it makes diagnosis easier. However, in its absence, we can use passive IgG transfer in mice as a diagnostic tool for now!
This allows us to identify and target those with "AAB-LC" endotype for RCT to tests strategies (e.g., FcRn inhibitors, IVIg, BC 007, plasmapheresis, anti-CD20 mAb or CAR-T) to reduce AAB. We suspect that people with SFN/pain phenotype will most likely benefit.
11/8/2023 MedRxiV (McAlpine et al): Small Fiber Neuropathy after COVID-19: A Key to Long COVID https://buff.ly/47567cM
A retrospective case series of 16 patients with new onset Small Fiber Neuropathy (SFN) after COVID infection. Six of them were positive for either trisulfated heparin disaccharide (TS-HDS) or fibroblast growth factor receptor 3 (FGFR3) autoantibodies.
Eight post-COVID SFN patients were treated with IVIG and had significant clinical improvement in their neuropathic symptoms.
preliminary evidence that post-COVID SFN is responsive to treatment with IVIG and linked with neurovascular dysregulation and dysautonomia.
6/19/24 BioRxiV (Stanford): Sex differences and immune correlates of Long COVID development, persistence, and resolution https://buff.ly/4eS6Mmj
Multi-omic analysis of Long COVID shows that there are “sex differences and immune correlates of Long COVID development, persistence, and resolution.”
During acute COVID infection, females who would develop LC demonstrated increased expression of XIST, an RNA gene implicated in autoimmunity. Males who would develop LC at 3 months had widespread increases in TGF-β signaling during acute infection in proliferating NK cells.
At 12 months after acute infection, females had increased IL1 signaling in monocytes.
"Both males and females with LC had reduced co-stimulatory signaling from monocytes and broad upregulation of NF-κB transcription factors.”
“In both sexes, those with persistent LC demonstrated increased LAG3, a marker of T cell exhaustion, reduced ETS1 transcription factor expression across lymphocyte subsets, and elevated intracellular IL-4 levels in T cell subsets, suggesting that ETS1 alterations may drive an aberrantly elevated Th2-like response in LC."
Long COVID in Olympic athletes: Becca Peters tweeted that British athletes Holly Bradshaw and Sarah McDonald will miss their Olympic Trials due to Covid [Long COVID]
6/26/24 Reuters: Finland to start bird flu vaccinations for humans, in world first https://buff.ly/3zjedT0
Finland will offer the H5N1 vaccine to people who work in high risk jobs.
6/25/24 Star Tribune: Seventeen manure pits reportedly overflow at large feedlots in southern Minnesota https://buff.ly/3VYTJI4
The concern is that flood waters could potentially spread viruses like H5N1 if cattle nearby are infected.
‘6/24/24 Forbes (Carolyn Barber MD): A head-in-the-sand approach’: The U.S. strategic drug stockpile is inadequate for a bird flu outbreak https://buff.ly/3xB3P8N
6/25/24 JACC State-of-the-Art Review (Atul Butte, Eric Topol): Transforming Cardiovascular Care With Artificial Intelligence: From Discovery to Practice https://buff.ly/3RL17nT
Other news
6/18/24 Scientific American: We’ve Hit Peak Denial. Here’s Why We Can’t Turn Away From Reality https://buff.ly/3RzDn5Y
A very important article on denial and minimization of uncomfortable things including the long term effects of SARS-CoV-2 infection. I highly recommend reading it.
6/24/24 JAMA Pediatrics: Infant Deaths After Texas’ 2021 Ban on Abortion in Early Pregnancy https://buff.ly/4eGVkJS
"The Texas abortion ban was associated with unexpected increases in infant and neonatal mortality in 2022.
"Abortion restrictions may have negative spillover effects on infant health."
6/25/24 AP: Judge allows disabled voters in Wisconsin to electronically vote from home https://buff.ly/3VBNRTT
A judge in Wisconsin will allow disabled voters to vote electronically from home, although since it is considered an absentee vote, they still will need to mail in the form or drop it off at a polling station.
"In symptomatic children, a blood test with high-level tissue transglutaminase antibody (tTG) IgA (>10 times the upper limit of normal) and presence of endomysial antibody (EMA) in a second blood sample are suggested for diagnosis of celiac disease. In symptomatic adults who are unwilling or unable to undergo upper endoscopy, high-level tTG IgA and presence of EMA can be used to establish a diagnosis of likely celiac disease ."
6/27/24 Health Day: Bright Light at Night Could Raise Odds for Type II Diabetes https://buff.ly/3xCeBeS
More exposure to light between 12:30 a.m. and 6 a.m. is linked to a higher risk of developing type 2 diabetes.
“Light exposure at night can disrupt our circadian rhythms, leading to changes in insulin secretion and glucose metabolism,” senior researcher Andrew Phillips.
6/4/24 Lancet Regional Europe: Personal light exposure patterns and incidence of type 2 diabetes: analysis of 13 million hours of light sensor data and 670,000 person-years of prospective observation https://buff.ly/4cxIUm0
Personal light exposure patterns predicted risk of incident type 2 diabetes in UK Biobank participants, using ∼13 million hours of light sensor data.
6/28/24 CNN: Parkland school shooting survivor gains rights to gunman’s name in unique civil settlement https://buff.ly/3L2QadB
187,000 MORE Long Covid sufferers in this country alone (and many of them under 50) is a heart-breaking thought. But a thought that must be faced, not denied. I wish there were people paying attention to this, and can never thank you enough times for all you do to share what’s going in in public health and research. Have a great week off. ❤️
187,000 MORE Long Covid sufferers in this country alone (and many of them under 50) is a heart-breaking thought. But a thought that must be faced, not denied. I wish there were people paying attention to this, and can never thank you enough times for all you do to share what’s going in in public health and research. Have a great week off. ❤️