COVID news and more 7/22/23

Jul 22, 2023

When was your last booster vaccine against COVID? For many people, it has been more than 8 months which can leave people susceptible to getting a new COVID infection. The new XBB booster is expected out sometime in September, but wastewater virus levels, emergency room visits and test positivity are starting to increase now, although they are starting from a low level. You may know someone who has a COVID infection now. The same precautions- staying home and testing if you feel sick, wearing masks indoors, staying up to date on vaccinations- can help to protect against getting COVID.

In the U.S. and some other countries, there is a new variant called EG.5 (a descendant of XBB) that has a growth advantage over other variants which means that it may cause a small wave of infection. We are just seeing virus levels increasing especially in the southern and northeastern United States. Los Angeles county public health announced that they are seeing a bump in COVID cases. In other places in the world, Okinawa, Japan is experiencing a new wave and so is the Dominican Republic where variant FL1.5.1 (also known as XBB.1.9.1.1) is dominant. It is not time to get too concerned about another wave, but it may be time to take a few precautions. Older folks and high risk people could get a BA.5 booster now and then get an XBB booster in the fall when it is available. The new variants are all descendants of XBB, so it is reassuring that an XBB specific mRNA booster is being prepared for September.

Deaths from COVID are at their lowest ever. This is great news. The New York Times proclaimed “In a sign that the pandemic really is over, the total number of Americans dying each day is no longer historically abnormal.” While deaths from COVID are very low, but as Katelyn Jetelina says "you can't die twice", meaning that the most fragile people may have already died of COVID. But, anyone can still get Long COVID which can be extremely disabling. Ten percent of vaccinated people who get an Omicron infection will get Long COVID.

The Biden administration announced that they will continue to provide free Covid vaccines to uninsured Americans through the end of 2024. Getting a COVID infection during an in vitro fertilization (IVF) cycle, reduces the number of top-quality embryos which decreases the chances of a healthy pregnancy from that IVF cycle. In-N-Out Burger will no longer allow employees to wear masks because of “the importance of customer service and the ability to show our Associates’ smiles”. If there is a risk of getting a COVID infection at work, that may be a reason not to smile however.

Long COVID

A small, proof of concept study from the Bateman Horne Center, showed that giving Valtrex and Celebrex together twice daily for 14 weeks significantly improved fatigue, pain, and symptoms of autonomic dysfunction and general well-being related to Long COVID in twenty-two female patients. Valacyclovir and celecoxib treatment is thought to suppress herpes viruses (HHV-6, possibly EBV) which may have been reactivated when the person got the SARS-CoV-2 infection.

A new study from UCSF shows that by looking at certain markers during an acute COVID infection may predict who will develop Long COVID (PASC). Those who went on to develop PASC had higher levels of SARS-CoV-2 RNA, infectious virus, and N-antigen; longer duration of viral shedding and lower Spike-specific IgG antibodies levels in the first 10 days of their acute COVID infection.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling and complex disease. People with ME/CFS are often not able to do their usual activities because of overwhelming fatigue that is not improved by rest and can result in being unable to leave bed. Some people with Long COVID transition to a more severe form of Long COVID with ME/CFS. A new study from Japan shows that serum ferritin levels can predict which Long COVID patients will get ME/CFS. Long COVID patients with ME/CFS were noted to have increased serum ferritin levels, thyrotropin levels and growth hormone levels and decreased IGF-1.

Dr. Alain Morreau of the University of Montreal recently gave a lecture at a conference on myalgic encephalomyelitis in which he said that circulating microRNAs can be used to predict clinical trajectories associated with Long COVID, including the risk of developing ME/CFS. His lab found that increased plasma levels of SMPDL3B and FGF-21 are associated with transition of Long COVID to ME/CFS which may mean that these pathways may be potential therapeutic targets. High plasma SMPDL3B levels in Long COVID patients with ME/CFS correlated with low cerebral oxygen levels in the right hemisphere of the brain. Interestingly, another study reported in November 2022 used a radioactive glucose tracer to do brain PET scans of Long COVID patients. Long COVID patients showed three large hypometabolic clusters mostly in the right frontal and right temporal lobes of the brain. Low cerebral oxygenation and glucose uptake in parts of the right hemisphere may give a window into common neuropsychiatric symptoms of Long COVID.

There are new genetic clues related to SARS-CoV-2 infection. The FOXP4 gene has been linked to an increased risk of Long COVID. This week, a study from Nature magazine shows that a common HLA allele, HLA-B*15:01, is associated with getting asymptomatic SARS-CoV-2 infections.

Dysautonomia can be seen in Long COVID and in POTS, but it can also be related to heart failure. A new report shows that heart disease can trigger the infiltration of immune cells called macrophages into a special nerve bundle called the superior cervical ganglia (SCG). This may lead to the death of nerve cells in the SCG which normally innervates the pineal gland in the brain. The pineal gland is responsible for making melatonin which regulates sleep. Therefore, immune-mediated denervation of the pineal gland appears to underlie sleep disturbances in cardiac disease. People with Long COVID and dysautonomia often have sleep problems and perhaps there is a similar link.

Many people with Long COVID, especially those with ME/CFS, become severely disabled. But, applying for disability from Social Security has been very hard and frustrating for many people. Social Security just released a new guide for healthcare professionals on what medical evidence is needed for a Social Security disability claim for someone with Long COVID. SSDI requires a very thorough review of the person’s medical record including the impact of Long COVID over time.

In non-COVID news, professor Linsey Marr tells people how to prepare their home for wildfire smoke. Cannabis-related ER visits increased among children and young adults during COVID pandemic. The largest increases in visits were among children and young teens. Beyfortus, a new antibody drug, was approved by the FDA to protect babies and toddlers from RSV. Tornado damage to a Pfizer plant in North Carolina that makes iv drugs for anesthesia and iv antibiotics will probably create more hospital drug shortages. And, an article on neuroplasticity in people with unusual but functional brains, such as Elyse G. who has a large hole in her brain, is worth a read.

Have a good weekend,

Ruth Ann Crystal MD

COVID news:

WHO Weekly Epidemiological Updates: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

US Variant tracker: https://covid.cdc.gov/covid-data-tracker/#variant-proportions

EG.5 may have a growth advantage.

More simplified view of variants by Marc Johnson:

https://twitter.com/SolidEvidence/status/1680824480128700416

CDC COVID Hospitalizations (blue) and Emergency Room (orange) visits tracker: https://covid.cdc.gov/covid-data-tracker/index.html#trends_weeklyhospitaladmissions_7dayeddiagnosed_00

US Wastewater Monitoring:

CDC Wastewater Monitor https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance

Wastewater from NWSS and Biobot in a US map format:

https://iowacovid19tracker.org/

“Fantastic resource for WW (wastewater). Allows charting of individual states.”

WastewaterSCAN: https://data.wastewaterscan.org/

Biobot: https://biobot.io/data/

Sewer Coronavirus Alert Network (SCAN) project by Stanford University:

7/18/23 Katelyn Jetelina: COVID-19: Catch up quick https://buff.ly/44JCoEQ

After a few quiet months, COVID-19 is increasing in the Southern and Western United States.
Three early indicators—wastewater, ED visits, and test positivity— are all increasing, but are starting from a lower level than before.
COVID hospitalizations are just starting to increase too.
We have seen increases in COVID infections in the southern U.S. during summer when it gets hot and people have to go indoors.

Two other places have an increase in COVID:
- Okinawa, Japan: COVID-19 hospitalizations continue to increase exponentially.
- Dominican Republic: A new Omicron variant— FL1.5.1— is increasing exponentially. It is related to XBB.

Long COVID Advocacy: Click here to quickly write your congressperson about the Long COVID Act https://buff.ly/3Y21DzM

7/20/23 SF Gate: In-N-Out Burger confirms anti-mask policy, stresses importance of smiling https://buff.ly/3On5F2B

The new policy requires In-N-Out workers in Arizona, Colorado, Nevada, Utah and Texas to not wear masks at work unless they provide a medical note.
In California and Oregon, employees can continue wearing masks, but must wear an N-95 provided by the company.

7/20/23 LA Public Health press release about small increasing COVID transmission now https://buff.ly/3Y3kM4E

7/20/23 The World Bank: Pandemic Fund Allocates First Grants to Help Countries Be Better Prepared for Future Pandemics https://buff.ly/43zyBsz

The Pandemic Fund has announced grant allocations to 37 countries under its first round of funding to bring additional, dedicated resources for pandemic prevention, preparedness, & response.

7/20/23 Long COVID: A Guide for Health Professionals on Providing Medical Evidence for Social Security Disability Claims https://buff.ly/3Q2367p

“Medical reports you provide to us should include a thorough description of the individual’s medical history, with information on the diagnosis, onset, duration, and prognosis of the individual’s COVID-19; Long COVID; conditions that might be associated with, exacerbated by, or consistent with Long COVID; and any other conditions.
Longitudinal clinical records and detailed historical notes discussing the course of the condition(s), including any treatment prescribed and the individual’s response to treatment, are very useful for us because we are interested in the impact of the illness over time.
Include in your reports all clinical findings (such as results of physical examinations and mental status examinations) and laboratory findings (such as blood tests, magnetic resonance imaging, or any other clinically accepted form of testing), both positive and negative, including any findings used to support a diagnosis of COVID-19 or Long COVID. A positive viral test result for SARS-CoV-2 is not necessary for a diagnosis of COVID-19 or Long COVID.
It is essential that you submit all available objective findings concerning your patient’s condition, even if the findings may relate to another disorder or establish that the individual has a co-occurring condition.”

7/20/23 Science: Immune-mediated denervation of the pineal gland underlies sleep disturbance in cardiac disease https://buff.ly/3OpG7ll

Heart disease triggers the infiltration of macrophages into superior cervical ganglia (SCG), leading to neuronal cell death. The SCG normally innervates the Pineal gland in the brain that makes melatonin at night.

7/19/23 Eric Topol MD: From Asymptomatic Covid to Long Covid: Major Advances in Genetic Underpinnings https://buff.ly/44RCHx7

Review of 2 articles:

7/11/23 Nature: Gene FOXP4 linked to risk of Long COVID found in analysis of thousands of patients https://buff.ly/3Q0c58S
7/19/23 Nature: A common allele of HLA is associated with asymptomatic SARS-CoV-2 infection https://buff.ly/46Pf8XL

Strong association between HLA-B*15:01 and asymptomatic infection, observed in 2 independent cohorts.
HLA-B*15:01-mediated pre-existing immunity due to T cell immunity.

7/18/23 J Clinical Medicine: Utility of Serum Ferritin for Predicting Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in Patients with Long COVID https://buff.ly/44xjCka

Retrospective observational study
The ME/CFS group presented the highest scores on the self-rating symptom scales, including the Fatigue Assessment Scale (FAS), EuroQol, and the Self-Rating Depression Scale (SDS).
Serum ferritin levels, which were correlated with FAS and SDS scores, were significantly
- higher in the ME/CFS group (193.0 μg/L, interquartile range (IQR): 58.8–353.8) than in
- the non-ME/CFS group (98.2 μg/L, 40.4–251.5) and
- no-fatigue group (86.7 μg/L, 37.5–209.0).
High serum ferritin level was prominent in female patients.
Endocrine workup further showed that the Long COVID with ME/CFS group had
- Higher serum ferritin
- higher thyrotropin levels
- lower growth hormone levels in serum and
- Low insulin-like growth factor-I (IGF-1) levels were inversely correlated with ferritin levels (R = −0.328, p < 0.05).

7/17/23 Virios Therapeutics Announces Positive Data Demonstrating Improvement in Multiple Long COVID Symptoms Following Treatment with a Combination of Valacyclovir and Celecoxib in an Exploratory, Open-Label, Proof of Concept Study https://buff.ly/3NY4pS4

Study was conducted at the Bateman Horne Center.
Female patients with Long COVID (PASC) exhibited clinically and statistically significant improvements in fatigue, pain, and symptoms of autonomic dysfunction and general well-being related to Long-COVID when treated open-label with a combination of valacyclovir and celecoxib (“Val/Cel”) for 14 weeks.
Twenty-two female patients were treated with twice daily doses of valacyclovir and celecoxib, which is theorized to provide potent suppression of suspected tissue-resident herpes viruses activated by prior infection with the SARS-CoV-2 virus.

7/16/23 MedRxiV (UCSF): Early Biological Markers of Post-Acute Sequelae of SARS-CoV-2 (PASC, Long COVID) Infection https://buff.ly/3rq6UF6

Within the first 10 days of the acute phase of illness, those who went on to develop PASC demonstrated:
- higher levels of SARS-CoV-2 RNA, infectious virus, and N-antigen,
- longer duration of viral shedding, and
- lower Spike-specific IgG levels
No significant differences were identified among a panel of host immune markers, though there was a trend toward higher initial levels of certain markers (e.g., MCP-1, IFN-a, and IFN-g) in those who went on to develop PASC.
Early viral dynamics and the associated host immune responses play a role in the pathogenesis of PASC.

7/17/23 NY Times: A Positive Covid Milestone https://buff.ly/3pXwAsg

“In a sign that the pandemic really is over, the total number of Americans dying each day is no longer historically abnormal.” says the NY Times.
RAC: As Katelyn Jetelina says, you can't die twice. The most fragile people already died of COVID. But, you can still get Long COVID. Ten percent of vaccinated people who get an Omicron infection will get Long COVID. Long COVID is disabling.

7/13/23 JAMA: Oocyte- and Embryo-Related Outcomes Associated With SARS-CoV-2 Infection https://buff.ly/3NWye5x

Couples with SARS-CoV-2 infection during IVF cycle had significantly lower top-quality embryo and blastocyst, blastocyst formation, and available blastocyst rates than couples without infection.

7/13/23 CNBC: Biden administration to provide free Covid vaccines to uninsured Americans this fall through end of 2024 https://buff.ly/43xaSJj

6/3/23 Dr. Alain Moreau, alain.moreau@umontreal.ca speaking at the 15th Invest in ME Research International ME Conference 2023 near Cambridge, UK #IIMEC15 on youtube : https://buff.ly/3Dkv0Up

“The Long COVID to ME/CFS transition”

High plasma SMPDL3B levels correlate with low cerebral oxygen levels

In the chart below, Blue curve is the left hemisphere, orange curve is the right hemisphere of the brain.

COL-044 = Long COVID patient who is developing ME
ME-135 = ME patient
Short COVID = healthy patient recovered from COVID infection

Key takeaways from Dr. Moreau’s lecture:

Circulating microRNAs can be used to predict the clinical trajectories associated with Long COVID, including the risk of developing ME/CFS.
Elevation of plasma levels of SMPDL3B and FGF21 are associated with transition of Long COVID to ME/CFS and they represent potential therapeutic targets.

11/3/22 European Journal of Nuclear Medicine and Molecular Imaging (Nancy, France):

Brain 18F-FDG PET imaging in outpatients with post-COVID-19 conditions (PASC, Long COVID): findings and associations with clinical characteristics https://buff.ly/3DX5tBY

The most common radiotracer in use today is 18F-fluorodeoxyglucose (18F-FDG) which is a radiolabeled sugar (glucose) molecule. Imaging with 18F-FDG PET is used to determine sites of abnormal glucose metabolism.
n = 28 consecutive non-hospitalized COVID patients who presented with post-COVID-19 conditions (PASC, Long COVID) between September 2020 and May 2022.
Brain PET scans showed three large HYPOmetabolic clusters in the brains of PASC/Long COVID patients located mostly in the Right Frontal and Temporal lobes,but not seen in healthy controls.
- The brainstem and the cerebellum were not involved unlike prior studies that included COVID patients who had been hospitalized.
Hypometabolism clusters were associated with a higher number of symptoms with initial COVID infection.
Our study identified that longer duration of symptoms was associated with lower metabolism in identified clusters, which suggests that post-COVID conditions are becoming chronic.
Anatomic localization of HYPOmetabolic brain areas in PASC/Long COVID outpatients compared to healthy controls

Other news:

6/28/23 USA Today ft. Linsey Marr: How to prepare your home for wildfire smoke https://buff.ly/44MUzJC

Close windows
If Central HVAC, use the highest efficiency filters (MERV 11 or higher), and set the fan to run continuously.
Window AC: add filter, turn off outside air
Portable HEPA filter on high
Build low cost Corsi-Rosenthal box to filter air
Do not run the bathroom fan or kitchen vent hood.
If you must go outdoors, wear an N95 mask.

7/13/23 ABC: Cannabis-related ER visits increased among young Americans during COVID pandemic: CDC https://buff.ly/46OsiUZ

CDC’s Morbidity and Mortality Weekly Report, the report analyzed nearly 540,000 cases nationwide where people under 25 years old wound up in a hospital due to complications from cannabis use.
The largest increases in visits were among children aged 10 and younger as well as adolescents between ages 11 and 14.

7/14/23 Healthcare’s hacking problem is nearing a crisis: report https://buff.ly/3rwJRbM

1 in 4 cyberattacks in 2022 targeted the healthcare industry

7/17/23 AP: New drug to protect babies and toddlers from RSV gets FDA approval ahead of cold season https://buff.ly/3pK2xEE

Beyfortus, is a lab-made version of an antibody that helps the immune system fight off RSV.
Under the FDA approval, babies — including preterm infants — can receive a single injection to protect against their first season of RSV.

7/18/23 Nature: Digital health for aging populations https://buff.ly/3Q3IKKV

Fig 2. A vision of future home-centered geriatric care, powered by digital technologies and devices.

7/20/23 AP: Tornado damage to Pfizer plant will probably create long-term shortages of some drugs hospitals need https://buff.ly/44O9G69

The North Carolina plant makes iv drugs for anesthesia, medicines that treat infections and drugs needed for surgeries.

7/14/23 Science News: Elyse G.’s brain is fabulous. It’s also missing a big chunk https://buff.ly/3OgswN9

She is a part of the Interesting Brains Project at MIT.

7/17/23 Pediatrics: IQ After [One] Pediatric Concussion https://buff.ly/3K5He7j

There was no evidence of differences in IQ scores at 2 weeks or at 3 months post-injury when comparing pediatric concussion and mild pediatric orthopedic injury (control group), suggesting that pediatric concussions do not alter IQ.