COVID news and more 8/5/23
Variant EG.5.1, a descendant of XBB, is starting to surge in many places globally (20% of variants in Asia, 10% EG.5 in Europe, 12% EG.5.1 in the U.K) including the United States. There are other subvariants in the mix, but EG.5.1 was designated a “variant under monitoring” by the WHO. In New York, there is also an increase in FL1.5.1 which had been rising in the Dominican Republic. Wastewater levels are rising in many places, fortunately hospitalizations are only increasing modestly (up 12% from last week in the U.S.), and Emergency Department visits for COVID are also on the rise. JP Weiland states that we are now at a “medium level” of SARS-CoV-2 in wastewater and he calculated that about every 1 in 79 people is currently infected in the U.S.
On the San Francisco peninsula, wastewater levels are also increasing. Fortunately, our immunity wall from prior vaccinations and infections is helping to keep COVID hospitalizations to a smaller increase than in past waves. Dr. Prowell from Maryland and Dr. Verduzco-Gutierrez from San Antonio, Texas both warn that cold-like symptoms are probably not “just allergies” and it is time to do rapid antigen tests every 48 hours x2 (day 1, 3, 5) if you have symptoms. Early in a COVID infection, a rapid antigen test may be negative and then may become positive a day or two later once the viral load increases. Katelyn Jetelina wrote an interesting article called Riding the COVID-19 waves: 2023 style in which she predicted that about 10-15% of Americans will get infected with COVID this summer. The mantra “Test, Isolate, Paxlovid, Masks” is very important again.
Acute COVID infections
In the human body, type I interferon (IFN-1) helps to decrease SARS-CoV-2 replication early in an acute COVID infection, but too much IFN-I-signaling can cause inflammation and activate macrophages which can lead to lung damage. An experimental form of interferon called IFNmod, causes weak IFN-I signaling by the body and helps to reign in endogenous IFN-I. In rhesus monkeys, IFNmod decreased SARS-CoV-2 viral load, reduced inflammatory cytokines and macrophages in the lungs and body and decreased lung damage from SARS-CoV-2.
A new article shows that mask mandates saved substantial numbers of lives, and prevented economic costs, during the SARS-CoV-2 pandemic in Ontario, Canada. Ryan Gregory tweeted links to his recommended COVID protections including CO2 meters, portable air filters, rapid antigen tests, masks, and Corsi-Rosenthal box kits here. You can check if the expiration date of a rapid antigen test was extended by the FDA here.
Long COVID
Two articles came out this week looking at biomarkers seen at 2 years in Long COVID patients. Two years after acute infection, Long COVID patients had changes in their plasma metabolomes including abnormal concentrations of lactic acid and arginine, altered lactate-pyruvate and ornithine-citrulline ratios, and significantly higher levels of IL-17. From this data, the authors concluded that “mitochondrial dysfunction, redox state imbalance, impaired energy metabolism, and chronic immune dysregulation are likely to be the main hallmarks of long COVID even two years after acute COVID-19 infection.”
Another group looked at activated T cells seen on whole body PET scans. In this small study, people with Long COVID were found to have T cell activation, especially in the spinal cord and gut, seen on PET scan and were also found to have SARS-CoV-2 RNA on gut biopsy years after their initial COVID infection. This study shows that there can be viral RNA persistence and marked immune activation for more than 2 years in patients with Long COVID.
The Royal College of Speech & Language Therapists (RCSLT) reported on a study showing that after hospitalization for COVID infections, a significant number of people have swallowing, communication, voice and cognitive issues. These people would benefit from speech and language rehabilitation to improve their function. Communication compromise was reported in 23% of patients and was associated with younger age, female sex, social deprivation and being a healthcare worker.
Julia Moore Vogel said in her Op Ed in the L.A. Times, “Long COVID is debilitating to me and 65 million other people. Where is the urgency to treat it?” The NIH did report this week that they will finally start four studies on Long COVID treatments. The studies will focus on reducing viral persistence, cognitive problems such as brain fog, excessive sleepiness and sleep disturbances and autonomic nervous system issues like POTS. Many feel that this is “too little, too late”, but are nevertheless hopeful that treatment studies for Long COVID will finally happen.
In non-COVID news, chemical hair straightening products may be causing the increase in hormone-sensitive cancers such as breast, ovarian and uterine cancer in Black women. The hair straighteners contain phthalates, carcinogens and endocrine-disruptors that act like female hormones. There was a recall of Tydemy birth control pills because of reduced effectiveness.
Almost 6% of American women live in a county with no or low access to maternity (prenatal) care and no access to abortion care. These “maternal health double deserts” affect 3.7 million women of reproductive age in the US. States that restrict abortion also have fewer doctors providing care to pregnant people, resulting in higher rates of maternal and infant deaths.
Metformin, a generic drug used for diabetes and other diseases, when given to older adults before surgery was found to decrease muscle loss, fibrosis, and markers of inflammation post-operatively. Metformin has anti-aging cell properties. It also has antiviral properties and can be given during an acute COVID infection to reduce viral load and decrease the risk of Long COVID by 42%, at least in obese patients.
The Biden-Harris administration announced a new Medicare dementia care model which includes “care navigators” to help caregivers and dementia patients access services. Adults with Rheumatoid Arthritis appear to have significantly higher risk for developing Aortic Stenosis.
Artificial intelligence (AI) found 20% more breast cancers than doctors alone and decreased the doctors’ mammogram reading workload almost by half. AI software from Sonio Direct was approved by the FDA to improve fetal heart and brain assessments on prenatal ultrasound. I recently learned of a weekly newsletter written by Emma Chen, Pranav Rajpurkar and Dr. Eric Topol on the use of AI in healthcare and the life sciences called Doctor Penguin.
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
The EG.5 variant shows a growth advantage in the latest US SARS-CoV-2 genomics surveillance, increasing from 11 to 17% in past 2 weeks
FL.1.5.1 is also on the rise, especially in New York. The original XBBs are being pushed out.
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
COVID hospitalizations are up 12% from last week.
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/
Biobot: https://biobot.io/data/
Sewer Coronavirus Alert Network (SCAN) project by Stanford University:
Last 12 weeks:
8/3/23
Globally EG.5.1, a descendent of XBB.1.9.2
https://twitter.com/kallmemeg/status/1686785744508010501
South Korea https://ourworldindata.org/covid-cases
8/2/23 Palo Alto Online: COVID-19 cases rising along the Peninsula https://buff.ly/458Mgsl
h/t Charlene Liao
"We want everyone to stay up to date on their vaccinations. Get the new formulations in this new COVID vaccine when it comes out this fall. It'll be recommended for everyone six months and up. And we continue to recommend indoor masking, particularly when it's crowded or the ventilation is poor. That really works," Dr. Cody said.
Masks vs. Long COVID
8/1/23 Nature Sci Reports: The plasma metabolome of long COVID patients two years after infection https://buff.ly/454AeQa
100 samples collected from healthy controls, COVID-19 patients, and long COVID patients recruited in Mexico between 2020 and 2022. (small study n = 15?)
Compared to controls, 27 metabolites remained dysregulated even after two years in Long COVID patients.
Lactic acid, lactate/pyruvate ratio, ornithine/citrulline ratio, and arginine were identified as the most relevant metabolites for distinguishing patients with more complicated long COVID.
IL-17 levels were significantly increased in people with Long COVID.
Mitochondrial dysfunction, redox state imbalance, impaired energy metabolism, and chronic immune dysregulation are likely to be the main hallmarks of long COVID even two years after acute COVID-19 infection.
8/1/23 CIDRAP: Long COVID patients have altered metabolite levels 2 years after infection https://buff.ly/3rMyyMH
2 years after acute infection, Long COVID patients had different concentrations of lactic acid and arginine, altered lactate-pyruvate and ornithine-citrulline ratios, and significantly higher levels of IL-17.
9/2023 Seminars in Immunology (Petter Brodin): Immune responses to SARS-CoV-2 infection and vaccination in children https://buff.ly/45aE9Le
Rapid Antigen Tests extended expiration dates: https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/home-otc-covid-19-diagnostic-tests#list
8/1/23 Katelyn Jetelina: Riding the COVID-19 waves: 2023 style https://buff.ly/3Ogj23l
"We find ourselves in the middle of a COVID-19 wave. Again. If this summer follows the previous three, we should expect ~10-15% of Americans to get infected."
Test, Isolate, Paxlovid, Masks
Rapid antigen tests every 48 hours. Swab throat and saliva as well as the nose early in the infection.
People with Long COVID had T cell activation seen on PET scan in the brain and gut and had SARS-CoV-2 RNA on gut biopsy months and years later.
Although a small #LongCovid study, it's unique by doing whole-body PET T-cell imaging and GI tissue biopsies showing marked persistence (2+ years) of immune activation, and virus RNA, respectively, and some correlation with symptoms.
7/31/23 MedRxiV (UCSF): Multimodal Molecular Imaging Reveals Tissue-Based T Cell Activation and Viral RNA Persistence for Up to 2 Years Following COVID-19 https://buff.ly/3Ykp1Zs
PET scans of 24 people 27 to 910 days after acute COVID infection using [18F]F-AraG tracer that shows activated T lymphocytes.
In people who had prior COVID infections, with or without Long COVID, tracer uptake (T cell activation) was found in the brain stem, spinal cord, bone marrow, nasopharyngeal and hilar lymphoid tissue, cardiopulmonary tissues, and gut wall.
In Long COVID: T cell activation in the spinal cord and gut wall was associated with the presence of Long COVID symptoms.
Viral persistence: All patients had SARS-CoV-2 RNA in their gut on biopsy 158 to 676 days after their initial COVID illness.
7/31/23 Royal College of Speech & Language Therapists (RCSLT): New study finds high prevalence of communication and swallowing needs post COVID-19 https://buff.ly/3YvUc4p
h/t @Fewtrella1
70% of patients reported cognitive communication needs (also known as “brain-fog”).
ICU: 34% of patients who received support in an intensive care unit reported voice problems and 20% reported swallowing difficulties.
23% of patients hospitalized in any way by COVID-19 reported issues with communication.
7/31/23 BMJ Open Resp Research: Prevalence of swallow, communication, voice and cognitive compromise following hospitalisation for COVID-19: the PHOSP-COVID analysis https://buff.ly/3qkL2uB
Post-ICU Compromised Swallowing: in 20%; 60% with swallow problems received invasive mechanical ventilation and were more likely to have undergone proning (p=0.039).
Post-ICU Voice problems were reported in 34% who were more likely to have received invasive (p<0.001) or non-invasive ventilation (p=0.001) and to have been proned (p<0.001). Communication compromise was reported in 23% (527/2275) associations with younger age (p<0.001), female sex (p<0.001), social deprivation (p<0.001) and being a healthcare worker (p=0.010).
Cognitive issues were reported by 70% (1598/2275), consistent at both visits, at visit 1 respondents were more likely to have higher baseline comorbidities and at visit 2 were associated with greater social deprivation (p<0.001).
Swallow, communication, voice and cognitive problems are prevalent post hospitalisation for COVID-19 and were commonly associated with being younger, female and living in socially deprived areas.
a significant number of people are experiencing swallow communication voice and cognitive issues, and they are likely to require support and effective rehabilitation to improve their function.
Too little, too late?
7/31/23 Washington Post: NIH announces Long Covid treatment studies with hundreds of patients https://buff.ly/3rQSZs2
“It’s been close to three years,” since RECOVER began, “and it really shouldn’t take that long,” said Ziyad Al-Aly
“They don’t have the sense of urgency they needed to have.”
7/31/23 AP: Brain fog and other long COVID symptoms affect millions. New NIH treatment studies bring hope https://buff.ly/47bSAk7
“This is a year or two late and smaller in scope than one would hope but nevertheless it’s a step in the right direction,” said Dr. Ziyad Al-Aly.
7/14/23 JAHA: Relationship Between Azithromycin and Cardiovascular Outcomes in Unvaccinated Patients With COVID‐19 and Preexisting Cardiovascular Disease (CVD) https://buff.ly/44PVWHK
Azithromycin use in patients with COVID‐19 and prior history of CVD is significantly associated with an increased risk of Acute Heart Failure and all‐cause 30‐day mortality.
7/30/23 T. Ryan Gregory tweet on specific COVID protections recommendations:
General tool list
CO2 meters- Aranet4 ($300+), Vitalite Mini CO2 monitor ($65)
Smaller CO2 monitors tend to read a bit lower than the Aranet4.
Portable air filters
Rapid Antigen Tests
Nasal sprays (?)
Updated booster vaccines
Masks
Corsi-Rosenthal boxes (cheap air filters)
Wastewater surveillance in Ontario, Canada
Tracking variants
7/28/23 Impact of Community Masking on SARS-CoV-2 Transmission in Ontario after Adjustment for Differential Testing by Age and Sex https://buff.ly/3DBQigB
Mask mandates saved substantial numbers of lives, and prevented economic costs, during the SARS-CoV-2 pandemic in Ontario, Canada.
7/28/23 Science Immunology: Modulation of type I interferon responses potently inhibits SARS-CoV-2 replication and inflammation in rhesus macaques https://buff.ly/3rSVhqA
Too much IFN-1 can cause trouble:
Early IFN-I protects against SARS-CoV-2 replication, but excess IFN-I-signaling can hyperactivate inflammatory immune cells like macrophages which leads to lung damage.
IFNmod is a mutated form of IFNα2 that elicits weak IFN-I signaling and restrains endogenous IFN-I.
IFNmod decreased viral loads and reduced pathology in the lung.
IFNmod reduced inflammatory cytokines, chemokines, and macrophages in the airways and decreased expansion of circulating inflammatory monocytes.
Non-COVID news:
7/18/23 PBS: A ‘perfect storm’ led to an ADHD medication shortage. Here’s why https://buff.ly/44xYQkl
h/t Sophia Yen
7/28/23 NBC: “Deaths related to excessive alcohol consumption are rapidly rising in the United States, especially among women.” https://buff.ly/3KlOFaA
7/28/23 Health Day: Could Metformin Help Seniors Bounce Back After Surgery? https://buff.ly/3Ohatp5
small study, n = 20
Metformin decreased muscle loss, fibrosis, and markers of inflammation. Metformin has anti- senescent cell properties.
The original study:
7/25/23 Aging Cell: Disuse‐induced muscle fibrosis, cellular senescence, and senescence‐associated secretory phenotype in older adults are alleviated during re‐ambulation with Metformin pre‐treatment https://buff.ly/44RzGgM
Metformin pre-treatment improved extracellular matrix (ECM) remodeling after disuse in older adults by possibly altering cellular senescence and cellular senescence/senescent associated secretory phenotype (SASP) in skeletal muscle and in fibro-adipogenic progenitors (FAPs).
7/31/23 The Hill: Biden-Harris administration announces new Medicare dementia care model https://buff.ly/45f2QX7
“They will assign people with dementia and their caregivers to ‘care navigators’ who will help them in accessing services and support.
7/31/23 JAMA: Aortic Stenosis Risk in Rheumatoid Arthritis https://buff.ly/3Ol2jMa
Adults with RA appear to have significantly higher risk for developing aortic stenosis.
8/1/23 ABC: Maternal care deserts overlap with lack of abortion access, analysis shows https://buff.ly/44RPoZo
Women's Health Double Deserts
8/1/23 KFF: Black Women’s Use Of Chemical Hair Straighteners May Explain Higher Rates Of Hormone-Related Cancers https://buff.ly/3DGBnlh
Social and economic pressures have long compelled Black girls and women to straighten their hair to conform to Eurocentric beauty standards, but these products are linked to increased breast, uterine and ovarian cancers as well as early puberty, preterm birth, obesity, and diabetes.
Relaxers can contain carcinogens, phthalates, and other endocrine-disrupting compounds which can mimic the body’s hormones.
8/1/23 CNN: AI-supported mammogram screening increases breast cancer detection by 20%, study finds https://buff.ly/3QpHemG
8/2/23 AI-Enabled Fetal Ultrasound Software Gets FDA Clearance https://buff.ly/47lMkWT
Sonio Detect AI software increases the efficiency of fetal heart and brain assessment.
8/2/23 NBC: Tydemy birth control pills recalled because they may have reduced effectiveness, FDA warns https://buff.ly/3YnslDp
So You Want to Work in Digital Health by Halle Tecco https://buff.ly/44RrhtN
“Finding a job, accepting an offer, and getting up to speed on digital health.”