It’s time to get out your masks and air filters if you haven’t already. We are in a COVID wave that is as big or bigger than last winter’s wave in some places. The main variant causing COVID infections now is KP.3 (JN.1 + FLuQE) and its descendant KP.3.1.1 is trying to push it out. KP.3.1.1 has the addition of the S31deletion mutation which makes it more infectious and better able to evade antibody neutralization. Other subvariants with the same S:S31del mutation (e.g., KP.2.3 and LB.1) also have higher immune evasion compared to those without (e.g., JN.1, KP.2, and KP.3) and we are seeing the S31del mutations increasing COVID infections in different places.
COVID wastewater levels are “HIGH” nationally now per the CDC. The West Coast is particularly high. Emergency department visits are up across the United States for acute COVID infections, especially in some of the larger states like California, Texas and Florida. Between June 30 and July 12, WastewaterSCAN reported a 54% increase in SARS-CoV-2 virus levels, showing HIGH viral levels in most regions across the U.S. and MEDIUM in the Midwest.
From: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html
Sara Anne Willette’s analysis shows that SARS-CoV-2 wastewater levels are EXCESSIVE (HIGHEST) in Oregon, Utah, Florida, and Connecticut. They are VERY HIGH in Washington state, Nevada, Wyoming, New Mexico, Maryland, and New Hampshire, followed by HIGH levels in California, Idaho, Colorado, Texas, Louisiana, N. Carolina, W. Virginia, Minnesota, Vermont.
SARS2 Wastewater from Sara Anne Willette https://iowacovid19tracker.org/
Some of the highest levels of SARS-2 virus in wastewater this week according to WastewaterSCAN are in E Orange Co FL 3096 PMMoV, SW St Petersburg FL 2879 PMMoV, Little River Roswell GA 2847 PMMoV, W Bank New Orleans LA 2744 PMMoV, SW Orange Co FL 2648 PMMoV, Anchorage AK 2248 PMMoV, and Portland ME 1966 PMMoV. Here in the Bay Area, recent COVID levels in San Jose, Sunnyvale, Oceanside San Francisco and SE San Francisco have been higher than during in our winter wave.
According to JP Weiland, currently in the United States, there are 780,000 new infections each day and on a national level 1 in every 43 people is currently infected with COVID. However, in the West 1 in every 25 people is infected, in the South 1 in 34 people is infected, 1 in 59 in the Midwest and 1 in 73 infected in the Northeastern U.S. He expects that we will hit the peak of this COVID wave in the next few weeks. Although hospitalizations and deaths are lower than they were in the beginning of the pandemic, many people will continue to get Long COVID and other long term consequences of COVID infections such as increased risks of heart attacks, strokes and increased new onset diabetes.
From JP Weiland: https://twitter.com/JPWeiland/status/1814382044757024943/photo/1
As you most likely know, President Joe Biden has COVID now and so does Second Gentleman Douglas Emhoff, as does the mayor of Los Angeles. It has been a long time since most people have been vaccinated against COVID and the XBB.1.5 COVID vaccine from last fall does not protect against new variants like KP.3 that are circulating now. The updated KP.2 mRNA vaccines are expected to come out in the next month or two.
COVID cases have surged every summer since the pandemic began. Experts say this is due to more people traveling, large events like weddings and conferences, new variants of the virus, and people staying indoors because of the heat. It is very important to wear an N95 mask or KN95 mask on airplanes, especially while the plane is boarding and before it is in the air when the air filtration system turns on. Longer flights increase the risk of getting a COVID infection- for every 1 hour increase in flight length, there is a 53% increase in risk of getting infected. I’ve included links to wastewater SARS-2 levels in other countries that are still reporting in my “COVID notes” below.
Paxlovid still works against the latest variants, although it may be hard to get if you are traveling. Therefore, you may want to get Paxlovid before you leave on vacation in case you get a COVID infection on your trip. You can find which pharmacies have it in stock here. Remember to check to make sure that you do not have to stop any of your other medications while taking Paxlovid using the University of Liverpool drug checker here. The Pfizer PAXCESS program will reimburse your co-pay if you have insurance or may pay for the Paxlovid prescription if you do not have insurance. Make sure to join the PAXCESS program before going to the pharmacy to pick up Paxlovid. Remember, COVID rebound is about the same for people who took Paxlovid and for those who did not. The risk of rebound has more to do with the person’s immune system response and not the medication taken.
Some people are choosing to take Metformin if they get a COVID infection, as it has antiviral properties and can reduce the risk of Long COVID as well. The dosage used in the randomized trial that showed Metformin to be effective against acute COVID infections was titrated over 6 days: 500 mg on day 1, 500 mg twice daily on days 2–5, then 500 mg in the morning and 1000 mg in the evening up to day 14.
The Tour de France has reinstated protective measures like mask mandates requiring race organizers, media, and guests to wear masks when in contact with riders and team staff. Riders Tom Pidcock, Juan Ayuso, Alexey Lutsenko and Michael Morokov all have COVID now and have dropped out of the Tour. Geraint Thomas is also infected with COVID but is continuing to race. The Paris Olympics start next week and will bring many athletes and spectators from around the world.
In a target emulation trial from Hong Kong using the EHR records of patients hospitalized for COVID, those treated with Paxlovid (nirmatrelvir-ritonavir) alone were calculated to have a lower risk of mortality, ICU admission, or the need for ventilatory support compared to those treated with Paxlovid and Remdesivir combination therapy or Remdesivir alone. Randomized controlled trials are needed to confirm these findings.
A new study from Scandinavia of 343,066 liveborn infants confirms that there is no increased risk of birth defects from COVID vaccination or COVID infection in the first trimester.
Long COVID
Ziyad Al-Aly and colleagues put out a new study this week showing that with the original virus in 2020, 10.3% of people got Long COVID in their Veterans Administration population. With Delta, 9.5% of unvaccinated people got Long COVID and 7.7% of unvaccinated individuals got Long COVID during the Omicron era. For vaccinated people, the rate of long COVID during Delta was 5.3% and 3.5% during Omicron. Fortunately, vaccination has helped decrease the amount of people getting Long COVID. Despite a decrease in the percentage of Long COVID cases however, many people continue to be infected with COVID which means that cumulatively many people continue to fall victim to this disabling disease.
We are presently in a COVID wave with 780,000 new infections each day. If all of those people are vaccinated, we would expect that about 27,300 would get Long COVID each day (780,000 x 3.5%). That means that about 800,000 people will end up with Long COVID this month alone. It continues to be important to try to avoid getting reinfected with COVID.
Toll on Disability-Adjusted Life Years (DALYs) shown in the graph below. Vaccination significantly reduced the risk of Long COVID. From: https://www.nejm.org/doi/full/10.1056/NEJMoa2403211
A new paper from Vienna shows that even mild COVID infections lead to long term changes in the immune system in people who “recovered” from COVID infection and did not develop Long COVID. Researchers followed non-vaccinated people for at least 10 months. Those who got COVID infections had long term reduction of innate and adaptive immune cells with a shift from Th1 to Th2 serum cytokine profiles seen at 10 months. They had reduced absolute granulocyte, monocyte, and lymphocyte counts, involving T, B, and NK cells.
In a mouse model of Respiratory PASC (a Long COVID phenotype with mostly lung symptoms), giving anti–interferon-γ (anti–IFN-γ) treatment after the acute COVID infection stopped the mice from getting Respiratory PASC. The authors suggest that treatment with a similar anti-interferon-gamma medication may help people with Respiratory Long COVID.
Emily Mendenhall wrote a piece in the Lancet about Ryan Prior’s book The Long Haul: How Long Covid Survivors Are Revolutionizing Healthcare. Prior had post-viral ME/CFS since he was a teen after a mononucleosis (Epstein-Barr Virus) infection. He fortunately is in remission. In his book, he describes the activism of Long COVID patients Fiona Lowenstein, Elisa Perego, Hannah Davis, Lisa McCorkell, Gina Assaf, Hannah Wei, and Athena Akrami which included organizing online groups and generating the first database of Long COVID symptoms. His book also looks at the work of post-viral illness researchers Drs Michael VanElzakker, Amy Proal, Ziyad Al-Aly, David Putrino and Akiko Iwasaki.
H5N1
The July 19th update from the CDC on the H5N1avian flu states that “Since April 2024, 10 human cases of avian influenza A(H5) infection have been reported in the United States. Four of these cases were associated with exposure to sick dairy cows and six were associated with exposure to H5N1-infected poultry.” Human symptoms have been mild to date. The CDC also performed a seroprevalence study of 35 dairy workers in Michigan and found no H5N1 avian flu antibodies in their blood meaning that asymptomatic infections do not appear to be happening at least in this group.
Other news:
7/18/24 Bloomberg: Maternal Deaths Were Highest in States That Restrict Abortion https://buff.ly/4cFniV3
"Women were more than twice as likely to die in or around childbirth in some US states with severe abortion restrictions compared to those with greater access."
7/19/24 CDC: Listeria Outbreak Linked to Meats Sliced at Delis https://buff.ly/4cT4jq7
"Listeria is especially harmful to people who are pregnant, aged 65 or older, or with weakened immune systems. CDC always recommends people at higher risk for listeriosis avoid eating meats sliced at the deli or heat them to an internal temperature of 165°F or until steaming hot before eating."
7/19/24 STAT news: Microsoft global outage forces health systems to cancel appointments, delay procedures https://buff.ly/3Wx7372
An error in a Microsoft CrowdStrike update led to a widespread outage of health system computers and EHRs around the globe. The issue did not stem from a cyberattack.
7/15/24 Cell: Allogeneic CD19-targeted CAR-T therapy in patients with severe myositis and systemic sclerosis https://buff.ly/467tTFk
Off-the-shelf donor-derived CAR-T product targeting CD19 worked well in several patients to treat refractory autoimmune diseases.
7/8/24 Arthritis & Rheumatology: A genome‐wide association study suggests new susceptibility loci for Primary AntiPhospholipid Syndrome https://buff.ly/3YaYSOJ
“The comparison with other immune-mediated diseases revealed a close genetic relatedness to neuromyelitis optica, systemic sclerosis, and Sjögren's syndrome, suggesting colocalized causal variations close to STAT1-STAT4, TNPO3, and BLK.”
CNN: Boston Terrier Thor loves to swim. Watch Thor go bonkers with delight after his family builds him a pool in the garage.
Via AJ Willingham
Have a good rest of your weekend,
Ruth Ann Crystal MD
COVID news notes:
US Variant tracker: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
KP.3 is feeling pressure from KP.3.1.1 which has an additional S31del mutation. The S31del mutation is allowing KP.3.1.1, KP.2.3 and LB.1 to be more transmissible and to escape our immunity more.
7/17/24 BioRxiV (Kei Sato lab): Virological characteristics of the SARS-CoV-2 KP.3.1.1 variant https://buff.ly/3YfahNL
KP.3.1.1 has the addition of the S31deletion mutation which makes it more infectious and is able to evade antibody neutralization better than KP.3. Other subvariants with the same S:S31del mutation (e.g., KP.2.3 and LB.1) also have higher immune evasion compared to those without (e.g., JN.1, KP.2, and KP.3)
Variants
KP.3.1.1 (deFLuQE) with the S31del mutation is taking off around the world:
Valencia, Spain: https://x.com/Mau10415616/status/1813030999154110795/photo/1
UK: https://x.com/Mike_Honey_/status/1812785534907171146/photo/1
Globally, per Mike Honey, KP.3 (JN.1 + FLuQE) mutation is taking over. In many places, the added S31del in KP.3.1.1 is allowing it to take over ahead of KP.3.
WASTEWATER SARS-CoV-2 levels around the world:
Western Australia:
https://www.health.wa.gov.au/articles/a_e/coronavirus/covid19-wastewater-surveillance
NSW Australia:
https://www.health.nsw.gov.au/Infectious/covid-19/Pages/sewage-surveillance.aspx
Austria: https://abwassermonitoring.at/dashboard/
Vienna, Austria: https://www.wien.gv.at/gesundheit/einrichtungen/abwassermonitoring/
Belgium: https://wastewater.sciensano.be/dashboard/covid19/en/
https://www.sciensano.be/fr/coin-presse/adaptation-du-rapportage-sur-le-covid-19-1
Canada: https://health-infobase.canada.ca/wastewater/
Czech:https://experience.arcgis.com/experience/edf5d157c31741a3b28e9aaa99d21d93
Denmark: https://en.ssi.dk/covid-19/national-surveillance-of-sars-cov-2-in-wastewater
Europe (EU): List of wastewater data for European countries
Dashboards for different countries
https://wastewater-observatory.jrc.ec.europa.eu/
Monthly bulletins on SARS-2 in European (and world) wastewater:
https://wastewater-observatory.jrc.ec.europa.eu/#/bulletin
Finland: https://www.thl.fi/episeuranta/jatevesi/wastewater_weekly_report.html
France: https://www.data.gouv.fr/fr/datasets/surveillance-du-sars-cov-2-dans-les-eaux-usees-sumeau/
Germany: https://infektionsradar.gesund.bund.de/en/covid/sewage
Berlin, Germany: https://hygiene-monitor.de/dashboard/corona
Bavaria, Germany: https://www.bay-voc.lmu.de/abwassermonitoring
Hungary: https://www.nnk.gov.hu/index.php/koronavirus/szennyvizvizsgalatok
India: https://lookerstudio.google.com/u/0/reporting/34a41c12-e9dc-4de9-94b7-a6203bcd6331/page/elQzC
Ireland: https://www.hpsc.ie/a-z/nationalwastewatersurveillanceprogramme/
Japan (Komatsu City): https://www-city-komatsu-lg-jp.translate.goog/soshiki/1042/surveillance/14588.html?_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=ja
Luxembourg: https://www.list.lu/en/covid-19/coronastep/
Netherlands: https://www.rivm.nl/en/coronavirus-covid-19/current/weekly-update
Poland: https://www.mpwik.com.pl/view/monitoring-wirusa-sars-cov-2-w-sciekach-w-aglomeracji-warszawskiej
Portugal: https://t.me/s/COVIDzeroPortugal
Scotland, UK: https://informatics.sepa.org.uk/RNAmonitoring/
Madrid, Spain: https://www.canaldeisabelsegunda.es/en/sistema-vigia
Madrid, Spain
6/11/24https://www.comunidad.madrid/sites/default/files/doc/sanidad/epid/informe_epidemiologico_semanal.pdf
Sweden: https://www.pathogens.se/dashboards/wastewater/covid_quantification/
Switzerland: https://wise.ethz.ch/
and https://www.idd.bag.admin.ch/topics/respiratory-pathogens#waste-water
South Africa:
United States, CDC: https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance
United States, Sara Anne Willette: https://iowacovid19tracker.org/
United States, WastewaterSCAN: https://data.wastewaterscan.org/
New Zealand: https://poops.nz/
Variants around the world: https://outbreak.info/
World wastewater maps (reflects COVID cases): https://www.arcgis.com/apps/dashboards/c778145ea5bb4daeb58d31afee389082
CDC COVID data tracker: https://covid.cdc.gov/covid-data-tracker/index.html#datatracker-home
COVID Emergency Dept visits: https://covid.cdc.gov/covid-data-tracker/#ed-visits_all_ages_combined
California:
Texas
Florida
Walgreens positivity rate: https://www.walgreens.com/businesssolutions/covid-19-index.jsp
US Wastewater Monitoring:
CDC wastewater reporting: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html
Data last updated 2024-07-18
CDC wastewater map: https://www.cdc.gov/nwss/rv/COVID19-currentlevels.html
National SARS-CoV-2 data from Sara Anne Willette: https://iowacovid19tracker.org/
SARS-CoV-2 in wastewater
EXCESSIVE (HIGHEST) in Oregon, Utah, Florida, Connecticut
VERY HIGH in Washington state, Nevada, Wyoming, New Mexico, Maryland, New Hampshire
HIGH in California, Idaho, Colorado, Texas, Louisiana, N. Carolina, W. Virginia, Minnesota, Vermont
SARS-CoV-2 HOSPITALIZATIONS for those states still reporting
Wastewater SCAN: https://data.wastewaterscan.org/
Some of the highest levels of SARS-2 virus in wastewater this week is in
E Orange Co, FL 3096 PMMoV,
SW St Petersburg FL 2879 PMMoV,
Little River Roswell GA 2847 PMMoV,
W Bank New Orleans LA 2744 PMMoV,
SW Orange Co FL 2648 PMMoV,
Anchorage AK 2248 PMMoV,
Portland ME 1966 PMMoV.
California statewide view https://buff.ly/3YObiul
Los Angeles County
Lancaster 324 PMMoV, LA Hyperion 175, LA County 145 PMMoV
Alameda County
Sewer Coronavirus Alert Network (SCAN) project by Stanford University:
Recent COVID levels in San Jose, Sunnyvale, Oceanside San Francisco and SE San Francisco have been higher than in the winter wave.
Santa Clara County wastewater: https://covid19.sccgov.org/dashboard-wastewater
Marin county: https://coronavirus.marinhhs.org/surveillance
https://twitter.com/JPWeiland/status/1814382044757024943
JP Weiland July 19th update:
Another substantial increase this week (+26%). Wastewater signal now higher than last summer's peak, and over a month earlier.
780,000 new infections/day
1 in every 43 people currently infected
45% higher than 12 month avg.
Ratio of people currently infected by region:
Midwest: 1 in 59
South: 1 in 34
Northest: 1 in 73
West: 1 in 25
I expect a peak in the next couple of weeks nationally. Regionally, I think the West and South are closer to peak than the Northeast and Midwest.
Another reminder that deaths and hospitalizations are far lower than they were years back, despite high case counts. Long covid persists as a risk, but the acute risks [of hospitalizations and death] have decreased by ~20 fold since 2020 and 2021.
https://twitter.com/JPWeiland/status/1814389932078883245
Michael Hoerger modeling: http://pmc19.com/data/
NYC: https://twitter.com/nycHealthy/status/1813922987390701888
United Kingdom
7/13/24 UK https://x.com/1goodtern/status/1812200705635049802
From:
Acute COVID infections, General COVID info
https://twitter.com/JoeBiden/status/1813715902250017022
7/17/24 The Guardian: Joe Biden tests positive for Covid and cancels campaign event, White House says https://buff.ly/3SfMkSB
White House press secretary Karine Jean-Pierre told a crowd in Las Vegas that President Biden had tested positive for COVID. She included a “note from the president’s doctor” saying that the president had a runny nose, a non-productive cough and “general malaise”, and would be taking the antiviral drug Paxlovid. He will be recovering at his home in Delaware.
President Biden had COVID in July 2022. He took Paxlovid and recovered, but then had rebound COVID into August 2022.
7/18/24 Washington Post: Covid summer wave spreads across U.S., even infecting Biden https://buff.ly/3xTCGy7
Summer COVID waves are due to more people traveling, large events like weddings and conferences, new variants of the virus, and people staying indoors because of the heat, which helps the virus spread.
WastewaterSCAN, a private group that tracks wastewater data, found a 54% increase in viral RNA in wastewater solids from June 30 to July 12.
Summer COVID waves are challenging for public health officials, who focus on fall vaccination campaigns. The current vaccine targets older XBB variants. New vaccines won’t be available for at least another month.
Reinfections are still a health risk, especially for high-risk groups. The federal government has stopped widespread distribution of free masks and test kits. The federal Bridge Access Program to offer free coronavirus vaccines to uninsured people ends in August.
7/14/24 Bicycling: Tour de France Reinstates COVID-19 Measures as More Cases Emerge in the Peloton https://buff.ly/3WtKxM4
The Tour de France has reinstated COVID-19 protective measures, requiring race organizers, media, and guests to wear masks when in contact with riders and team staff.
Riders who have abandoned the race due to the virus include Tom Pidcock (INEOS Grenadiers), Juan Ayuso (UAE Team Emirates), and Michael Mørkøv (Astana-Qazaqstan). Geraint Thomas (INEOS Grenadiers) remains in the Tour despite testing positive, as the rules currently allow.
7/15/24 Lancet ID (U Hong Kong): Comparative effectiveness of combination therapy with nirmatrelvir–ritonavir and remdesivir versus monotherapy with remdesivir or nirmatrelvir–ritonavir in patients hospitalised with COVID-19: a target trial emulation study https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00353-0/fulltext#%20
In a target emulation trial using the EHR records of patients hospitalized for COVID, those treated with Paxlovid (nirmatrelvir-ritonavir) alone were calculated to have a lower risk of mortality, ICU admission, or the need for ventilatory support compared to those treated with Paxlovid and Remdesivir combination therapy or Remdesivir alone.
Social and Advocacy
7/13/24 Lancet: Long COVID politics and activism https://buff.ly/4cUENk8
Pregnancy
7/17/24 BMJ: Covid-19 infection and vaccination during first trimester and risk of congenital anomalies: Nordic registry based study https://buff.ly/4cKSlyX
A new study from Scandinavia of 343,066 liveborn infants shows that there is no increased risk of birth defects from COVID vaccination or COVID infection in the first trimester.
Vaccines
Long COVID
7/17/24 NEJM: Postacute Sequelae of SARS-CoV-2 Infection in the Pre-Delta, Delta, and Omicron Eras https://buff.ly/3W877IM
In unvaccinated people, pre-Delta, 10.4% of adults got Long COVID and during Omicron, 7.7% of infected adults developed Long COVID. With vaccination, Long COVID has decreased to 3.5% of vaccinated adults getting Long COVID after a COVID infection. Although the percent of people getting Long COVID has decreased, the sheer number of people getting COVID means that millions of people are getting Long COVID which can be a devastating disease. The cumulative effect of more and more people getting Long COVID will lead to an enormous number of people with chronic illness and disability.
Ziyad Al-Aly’s tweet thread about the article https://x.com/zalaly/status/1813682291149086989
Overall, the cumulative incidence of #LongCovid declined from a high of 10.4 per 100 unvaccinated persons infected in the pre-delta era to 3.5 per 100 vaccinated persons infected in the omicron era
Much of the decline (~ 70%) was attributable to vaccination and about 30% was attributable to era effects
We noted a shift in the features of #LongCovid with increased risk of GI and metabolic disorders in omicron – these went up (not down) in omicron compared to prior eras
Each variant has its own Long Covid fingerprint.
The remaining risk of 3.5% among vaccinated people infected in the omicron era is substantial. This will contribute millions of additional Long Covid cases - adding to an exorbitant toll of chronic disease & disability
Toll on disability-adjusted life years (DALYs) shown in the graph below
7/14/24 Allergy (Vienna, Austria): Differential decline of SARS‐CoV‐2‐specific antibody levels, innate and adaptive immune cells, and shift of Th1/inflammatory to Th2 serum cytokine levels long after first COVID‐19 https://buff.ly/3Lm3Hxf
Even mild COVID infections lead to long term changes in the immune system. A group in Vienna followed non-vaccinated people for at least 10 months. Those who got COVID infections had long term reduction of innate and adaptive immune cells with a shift from Th1 to Th2 serum cytokine profiles at 10 months. These are people who had “recovered” from COVID infection and did not have Long COVID.
10 months after COVID-19, convalescent patients compared to controls had reduced absolute granulocyte, monocyte, and lymphocyte counts, involving T, B, and NK cells, in particular CD3+CD45RA+CD62L+CD31+ recent thymic emigrant T cells and non-class-switched CD19+IgD+CD27+ memory B cells.
Cellular changes were associated with a reversal from Th1- to Th2-dominated serum cytokine patterns.
Serum IgG antibody levels specific for S, RBD, and NC decline strongly few months after the first SARS-CoV-2 infection, especially in younger individuals
7/17/24 Science: Comparative single-cell analysis reveals IFN-γ as a driver of respiratory sequelae after acute COVID-19 https://buff.ly/3LwZVRy
In a mouse model of Respiratory PASC, giving anti–interferon-γ (anti–IFN-γ) treatment after the acute COVID infection stopped the mice from getting Respiratory PASC. The authors suggest that treatment with a similar anti-interferon-gamma medication may help people with respiratory Long COVID.
H5N1
The July 19th update from the CDC on the H5N1avian flu states that “Since April 2024, 10 human cases of avian influenza A(H5) infection have been reported in the United States. Four of these cases were associated with exposure to sick dairy cows and six were associated with exposure to H5N1-infected poultry.”
Avian Flu H5N1 Influenza A https://www.cdc.gov/nwss/wastewater-surveillance/Flu-A-data.html
Thank you Dr. Ruth as always for all the actionable information you’ve provided.
Questions:
When considering treatment, is there data comparing the efficacy between Paxlovid & Metformin?
Can both medications be taken at the same time?
If so, is it advisable for those at high risk?
💜💜💜
Do you have a source for this statement (I've been looking for this information): "XBB.1.5 COVID vaccine from last fall does not protect against new variants like KP.3 that are circulating now."
Everything I've found claims there's not enough information to confirm this.