COVID news and more 8/26/23
This summer’s wave(let) continues mainly with 3 subvariants that have F456L mutations, namely EG.5, FL.1.5.1, and XBB.1.16.6. Wastewater levels of the SARS-CoV-2 virus may be starting to peak as seen in some regions on Biobot, but it is too early to tell for certain. The CDC map of wastewater SARS-CoV-2 virus levels throughout the U.S. has a lot more orange and red on it this week meaning higher virus levels across the country. In California, wastewater virus levels are highest in Pacifica, San Francisco Oceanside, Sausalito and Laguna Niguel.
COVID hospitalizations increased by 22% this week across the U.S. and Emergency Department visits are still increasing, especially for babies age 0 to 1 years old. This is a trend that we don’t like to see.
If you are exposed to a person who has COVID, you should test every 48 hours x 3 (i.e. day 1, 3, 5, 7) if you have no symptoms. If you have any symptoms, test every 48 hours at least two times (day 1, 3, 5). It is best to wear an N95 or KN95 mask for 10 days after exposure to protect others and to isolate if you feel sick. Paxlovid and/or Metformin may be appropriate for some people. Although most places do not require masks at this time, the Hollywood studio Lionsgate now has a mask mandate after a COVID outbreak in their studio and Kaiser Hospital in Santa Rosa reinstated mask requirements due to rising cases of COVID in the area.
A new study shows that giving a COVID booster vaccination in pregnancy significantly increases levels of neutralizing antibodies which cross the placenta and protect the baby against COVID infection before and after birth. This week, Pfizer's maternal RSV (Respiratory Syncytial Virus) vaccine was also approved by the FDA. Giving this RSV vaccine during weeks 32 to 36 of pregnancy protected newborn babies from RSV for up to 6 months. This comes after an FDA approval in July for nirsevimab (Beyfortus) which is a long-acting monoclonal antibody against RSV that can be given to infants under age 8 months and older babies who are at increased risk of severe illness from RSV.
BA.2.86 (Pirola)
BA.2.86 is the highly mutated variant that is being watched closely around the world. It has been found in many countries on different continents and there is concern that it could cause another Omicron-like wave of infection because of its many spike mutations. So far however, BA.2.86 has not taken off to cause massive infection. There have been a few cases noted in Israel, Denmark, the U.S., the U.K., Thailand and BA.2.86 makes up 2% of the wastewater SARS-CoV-2 virus levels in part of Switzerland. Many experts believe that BA.2.86 may not be as dangerous as initially thought, but only time will tell.
The CDC did a risk assessment of BA.2.86 stating that home rapid antigen tests should be able to detect it, new updated Fall boosters against XBB.1.5 should protect people against severe disease, but BA.2.86 may cause breakthrough infections. There is no evidence that BA.2.86 causes more severe disease. BA.2.86 is continuing to be watched very closely.
Project NextGen
The U.S. Department of Health and Human Services (HHS) announced Project NextGen awards totaling $1.4 billion to create new vaccines and treatments for COVID infections. $1 billion was awarded to four BARDA Clinical Trial partners to support vaccine trials (ICON, Pharm-Olam, Technical Resources Intl, and Rho Federal Systems). $326 million is allotted to Regeneron for monoclonal antibody development for COVID-19 prevention. $100 million is slated for the BARDA Ventures investment portfolio for technologies to accelerate future responses. $10 million was awarded to BLUE KNIGHT™, a joint initiative between BARDA and Johnson & Johnson Innovation. Unfortunately, none of the $1.4 billion will be awarded to studying treatments for Long COVID.
Long COVID
A seminal article came out this week from Ziyad Al-Aly and colleagues which showed that there are many profound long term health consequences even after mild COVID infections that last at least 2 years. Although the Veterans Administration hospitals tend to skew towards white men over age 60, Dr. Al-Aly and colleagues studied the health records of 6 million people at the V.A. hospitals in order to be able to include 600,000 women and 20% Black individuals in the study. The researchers examined important post-acute sequelae of COVID infection which I summarized in these 2 tables:
This important article was reviewed by many many outlets including Dr. Eric Topol’s blog, CNN, Forbes and many others. This study shows that 2 years after a COVID infection, whether mild or severe, COVID is still causing significant long term disability and chronic disease. In fact, in 25% of mild COVID infections and in 21% of severe infections, new complications did not show up until the second year after infection. Measuring DALYs, or years of healthy-life lost per 1000 people, shows that at 2 years after infection, Long COVID is causing more disability than cancer and heart disease. Because the health emergency for the COVID pandemic was declared over, many people feel like COVID is no longer important. But unfortunately, COVID will continue to cause significant disease and disability and will have a long lasting impact on individuals and society for years to come.
In other post-acute COVID infection news, a study shows that there is an increase in new-onset hypertension after COVID infection as compared to influenza infection. Hospitalized COVID patients had 2.2x the risk of new-onset hypertension and non-hospitalized patients with milder COVID infection had 1.5x the risk of new hypertension. A different study from the Veterans’ hospitals shows that late mortality after a COVID infection is more than double (8.7%) that of the non-COVID infected death rate (4.1%). In this study, most late deaths related to COVID happened in the first 6 months after infection.
A study from Cornell shows that the SARS-CoV-2 virus can reprogram genes in Hematopoietic Stem and Progenitor Cells (HSPC) in both humans and mice. SARS-CoV-2 viral infection gene changes can activate inflammation and affect immune function for at least a year after COVID infection. Reprogramed monocytes were found to release cytokines and then migrate to the brain and the lung. IL-6 was implicated in this process.
In non-COVID news, the water in Maui’s Lahaina area is unsafe even if filtered, so bottled water is being delivered by boat. A new procedure uses stem cells from one eye to heal injuries in the opposite eye to improve vision. A Stanford group integrated pathology images from Twitter (#MedTwitter) to a large language model in order to improve accuracy of artificial intelligence that analyzes pathology slides. Finally, an adorable couple in Ohio who were born on the same day had twins on their birthday, August 18th.
Have a good rest of your weekend,
Ruth Ann Crystal MD
COVID news:
US Variant tracker: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
Variants in different locations: https://outbreak.info/
CDC COVID data tracker: https://covid.cdc.gov/covid-data-tracker/index.html#datatracker-home
CDC COVID Hospitalizations (blue) and Emergency Room (orange) visits tracker: https://covid.cdc.gov/covid-data-tracker/index.html#trends_weeklyhospitaladmissions_7dayeddiagnosed_00
From the last year only (August 2022 to August 2023)
Weekly ED visits for respiratory illnesses, by age and disease: https://www.cdc.gov/ncird/surveillance/respiratory-illnesses/index.html
Babies 0 to 1 year still have the most Emergency Department visits this week for respiratory illness and it is all COVID
US Wastewater Monitoring:
CDC Wastewater Monitor https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance
Wastewater shows a lot more orange and red (higher virus levels) this week
Biobot: https://biobot.io/data/
Wastewater SCAN: https://data.wastewaterscan.org/
Wastewater SCAN for California, statewide view https://buff.ly/3YObiul
Highest virus levels now in California are Pacifica, SF Oceanside, Sausalito, Laguna Nigel and Fremont wastewater.
Sewer Coronavirus Alert Network (SCAN) project by Stanford University:
https://twitter.com/JPWeiland/status/1694854829779071338
https://twitter.com/JPWeiland/status/1694845710032650273
8/24/23 CBS: COVID hospitalizations climb 22% this week — and the CDC predicts further increases as new variants spread https://buff.ly/45mvyW9
“Existing COVID-19 tests and medications "appear to be effective with this variant," the CDC said in a risk assessment published Wednesday, and updated vaccines scheduled to be rolled out next month are expected to "be effective at reducing severe disease and hospitalization" from BA.2.86.”
8/23/23 CDC: Risk Assessment Summary for SARS CoV-2 Sublineage BA.2.86 https://buff.ly/3EcRt6r
"Based on what CDC knows now, existing tests used to detect and medications used to treat COVID-19 appear to be effective with this variant.
BA.2.86 may be more capable of causing infection in people who have previously had COVID-19 or who have received COVID-19 vaccines.
Scientists are evaluating the effectiveness of the forthcoming, updated COVID-19 vaccine. CDC’s current assessment is that this updated (booster) vaccine will be effective at reducing severe disease and hospitalization.
At this point, there is no evidence that this variant is causing more severe illness."
8/23/23 Nature (D. Altman, R. Boyton): Persistent symptoms after COVID-19 are not associated with differential SARS-CoV-2 antibody or T cell immunity https://buff.ly/3P97IYm
It has been proposed that Long Covid is a consequence of either an excessive or inadequate initial immune response.
Up to 18-weeks post-infection, we observe no difference in antibody responses to spike RBD or nucleoprotein, virus neutralization, or T cell responses. Also, there is no difference in the profile of antibody waning. ARS-CoV-2 adaptive immunity following mild or asymptomatic acute infection are unlikely to have contributed to Long Covid causality.
8/24/23
8/22/23 NIH: SARS-CoV-2 can cause lasting damage to cells’ energy production (mitochondria) https://buff.ly/44vwMNz
SARS-CoV-2, the virus that causes COVID-19, can cause lasting damage to energy production by mitochondria in many organs of the body.
Stopping the virus from hijacking mitochondrial energy production may be a novel way to prevent serious complications from SARS-CoV-2 infection.
Review of study from 8/9/23
8/24/23 Eric Topol: A Quick Update on the BA.2.86 Variant https://buff.ly/45pGl1R
BA.2.86 (Pirola) has more than 30 new mutations in the spike protein of the virus.
BA.2.86 does not appear to be taking off like Omicron did with exponential growth. We need to follow it to make sure that it doesn't get any new mutations to allow it to spread rapidly.
Unfortunately, wastewater virus testing is down in many places in the world.
We need a variant-proof vaccine instead of chasing each new variant.
So far, BA.2.86 variant has been detected in people in Israel, Denmark (3), the UK, the US (2 individuals, one coming back from Japan), and South Africa (2).
In wastewater, BA.2.86 was found at 2% level in one region of Switzerland, as well as detection in wastewater in Ohio and in Thailand.
https://twitter.com/TanjaStadler_CH/status/1694298380841996613
8/22/23 HHS: Project NextGen Awards Over $1.4 Billion to Develop the Future of COVID-19 Vaccines and Therapeutics (via BARDA) https://buff.ly/3KNzszl
Funding includes
$1 billion for vaccine clinical trials,
$326 million for a new monoclonal antibody, and
$100 million to explore novel vaccine and therapeutic technologies.
Regarding Project Next Gen,
8/22/23 Guardian: Hollywood studio Lionsgate brings back mask mandate amid Covid spike https://buff.ly/3qGCE96
After several employees tested positive for COVID, Lionsgate employees must wear medical grade masks, perform daily self-screenings and stay home if they have symptoms or have traveled internationally in the last 10 days.
8/21/23 Nature (Al-Aly): Post Acute sequelae of COVID-19 (PASC, Long COVID) at 2 years https://buff.ly/45gYC1y
N =138,818 individuals with SARS-CoV-2 infection and n = 5,985,227 non infected control group from the US Department of Veterans Affairs were followed for 2 years
Ziyad Al-Aly’s Twitter thread summary of the article
Risks remained elevated for many Long Covid conditions even 2 years infection.
A sizable chunk of Long Covid's high burden of disability and disease (25% non-hospitalized & 21% hospitalized) emerged anew in the second year after infection – pointing to a long-term risk horizon of SARS-CoV-2
DALY, is the most accepted metric of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.
Reviews of the Al-Aly article:
8/21/23 Long Covid symptoms create a greater burden of disability than heart disease or cancer, new study shows | CNN https://buff.ly/3sogxop
Each DALY represents one year of healthy life lost to illness.
Long COVID after mild COVID infection created a higher disability burden (80 DALYs/1000 for Long COVID) than heart disease (52 DALYs/1000) or cancer (50 DALYs/1000).
One third of original symptoms remained at 2 years in people with mild initial COVID infection. Lingering problems included blood clots, a slower than normal heartbeat, fatigue, diabetes, gastrointestinal problems, sleep problems, muscle and joint pain, headache, hearing and smell loss, and autonomic nervous system dysfunction.
Two-thirds of original symptoms remained at 2 years in people hospitalized with their initial COVID infection.
8/21/23 Eric Topol: Long-Term Long Covid https://buff.ly/44nqHTE
Review of recent papers on COVID effects 2 years after infection.
Ziyad Al-Aly et al's new paper in Nature on 6 Million people from the V.A. 2 years after COVID infection.
DALY, is the most accepted metric of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.
People hospitalized with severe COVID had worse outcomes and DALYs as compared to those with mild to moderate Covid (not hospitalized).
But in the non-hospitalized group a substantial proportion— about 30%— of the 80 sequelae, including GI and neurologic, remained significantly elevated.
About 20% of DALYs came up in the second year in both groups.
Studies showing differences in sequelae in women vs men.
UCSF study showing persistent T cell activation seen on PET scan in the brain stem, spinal cord, lymph nodes, cardiopulmonary tissues, and gut wall, which correlated with Long Covid symptoms.
8/21/23 Forbes explainer on above study:
Long COVID. Shorter Life? New research reveals an arduous road to recovery https://buff.ly/47F58AL
“It’s a difficult and protracted road for recovery in people who were hospitalized to start with,” Al-Aly says. “But most importantly, even for people who are not hospitalized, it is still a long risk horizon for many, many sequelae and multiple organ systems.”
Topol, who was not involved in the St. Louis study, says it provides “important new evidence of the durable multi-system sequelae of long COVID.” When I asked whether the public really understands the long-term risks associated with the disease, he replied, “No, only the people affected and their friends and families.”
Different study at the VA Hospitals:
8/21/23 JAMA: Late Mortality After COVID-19 Infection in Veterans vs Risk-Matched Comparators https://buff.ly/3OS8tDZ
8.7% mortality for Veterans who had Covid which was more than double that of the non-infected who had a 4.1% death rate. Deaths happened mostly in the first 6 months after COVID infection.
8/21/23 Forbes (Dr Judy Stone): CDC Poised To Weaken Masking, Infection Control https://buff.ly/45yPncC
HICPAC’s proposals also fail to include ventilation, UV disinfection and HEPA filtration, all essential tools against an airborne pathogen.
8/21/23 Incidence of New-Onset Hypertension Post–COVID-19: Comparison With Influenza https://buff.ly/3sqhdJI
At 6 months after a COVID infection, as compared to people who had a flu infection,
Hospitalized COVID patients had 2.2x risk of new-onset persistent HTN
Non-hospitalized COVID patients had 1.5x risk of new-onset persistent HTN.
At 6-month follow-up, new-onset persistent hypertension was seen in
20.6% of hospitalized patients with COVID-19 and
10.9% of non-hospitalized patients with COVID-19.
This could lead to a major health burden and screening at-risk patients for hypertension following COVID-19 illness may be warranted.
8/18/23 Cell: Epigenetic memory of coronavirus infection in innate immune cells and their progenitors https://www.cell.com/cell/fulltext/S0092-8674(23)00796-1#%20
Epigenetic reprogramming of hematopoietic stem and progenitor cells (HSPC) may underlie altered immune function following COVID infection for up to a year.
IL-6 early in a COVID infection contributed to these persistent phenotypes in human COVID-19 and a mouse model.
The SARS-CoV-2 viral infection causes certain gene transcription factors to be turned on in HSPCs, leading to changes in usual inflammatory pathways and durable increases in myelopoiesis.
This increases monocytes who send out cytokines and then migrate to the brain and the lung.
https://twitter.com/MVGutierrezMD/status/1693444577632403506
8/14/23 Vaccine: COVID-19 booster vaccination during pregnancy enhances maternal binding and neutralizing antibody responses and transplacental antibody transfer to the newborn https://buff.ly/3OOlKxq
mRNA vaccines during pregnancy elicited robust binding and nAb responses.
Booster vaccination during pregnancy elicited significantly higher Ab levels at delivery and in cord blood than 2-dose primary series, including against Delta and Omicron BA.1 variants.
COVID-19 vaccines, including booster doses, should continue to be strongly recommended during pregnancy.
Other news:
8/21/23 Reuters: US FDA approves Pfizer's maternal RSV vaccine to protect infants https://buff.ly/45mWoha
The RSV vaccine should be given to pregnant people from 32 to 36 weeks to prevent lower respiratory tract infection and severe disease in infants until they are six months old.
8/16/23 NPR: After Maui's deadly fires, one doctor hits the road to help those in need https://buff.ly/3YL9cuZ
8/19/23 AP: Maui water is unsafe even with filters, one of the lessons learned from fires in California https://buff.ly/3YI2VAg
"People in torched areas of Maui should not try to filter their own drinking water because there is no “way to make it safe,” Maui county officials.
The Maui fires damaged hundreds of drinking water pipes, resulting in a loss of pressure that can allow toxic chemicals along with metals and bacteria into water lines.
8/18/23 AP: Stem cells from one eye show promise in healing injuries in the other eye https://buff.ly/44k3K3D
Ohio couple born on same day have twins on their birthday https://buff.ly/45B3qyu
AI:
8/17/23 Nature (Stanford): A visual–language foundation model for pathology image analysis using medical Twitter https://buff.ly/3OFH7km
Thank you !!!!