COVID news and more 9/9/23

The EG.5 subvariant percentage went from 11.6% to 21.5% over the last three weeks and at the same time FL.1.5.1 levels increased from 4% to 14.5%. The good news is that both of these variants can be neutralized by antibodies from the new XBB.1.5 fall booster vaccines that are expected to be available next week. Scientists are also watching a “FLip" variant XBB1.16.6, which is increasing about 1 to 2% each week over the last four weeks.

Hospitalizations for COVID have increased for the seventh week in a row and emergency room visits for COVID continue to increase as well. Almost all respiratory illness seen in Emergency Departments is still COVID at this point, and babies age 0 to 1 are most affected, but children ages 5 to 11 and 12 to 17 have also increased ED visits for COVID. Some school districts in Kansas and Texas canceled in-person learning this week because of COVID outbreaks. 

The CDC’s wastewater map of the United States shows a lot more red and orange, which indicates high levels of SARS-CoV-2 in the community. Biobot also shows an increased COVID virus levels in all parts of the United States. Here in California, wastewater virus levels have decreased in Lompoc. Levels started to decrease in Pacifica and Sausalito,  but are now on their way back up. SARS-CoV-2 virus levels are increasing in Half Moon Bay, Coastal Laguna, Niguel, and Fremont.

JP Weiland is a mathematical modeler who is able to calculate the true number of current COVID infections based on wastewater data. His calculations show that the current wave of infection is high. In fact, COVID infections are almost as high as peaks seen from the original virus wave in 2020, the Alpha wave and the Delta wave. 

Since we are in another COVID wave with high levels of SARS-CoV-2 circulating in communities, one might expect that people would be wearing masks in hospitals again. Many hospitals dropped their masking requirements when the public health emergency was declared over in May 2023. Hospital admissions have more than doubled over the last month and positive tests have tripled in the past two months. JP Weiland’s calculations show that we are at a high level of infections as seen by wastewater virus levels. Forty percent of people are typically asymptomatic with COVID infection, but they can still transmit it to others even though they have no symptoms. Therefore, Dr. Judy Stone and others are recommending that healthcare facilities, including hospitals and nursing homes, restart the use of masks during the present SARS-CoV-2 surge.

Kids have started a new school year. Katelyn Jetelina wrote an interesting article on the types of viral infections seen in schools now and those that should be expected to increase soon. The common cold viruses and enteroviruses are increasing now as expected. Flu and RSV levels are still low. However, the CDC reported that RSV virus levels are starting to increase in the Southeast meaning that the RSV season has begun for the United States. This is very early for RSV compared to past years, but this year may mirror the unexpected pattern of respiratory illnesses from last year. In 2022, RSV peaked in early November, the Flu peaked in late November, and there was a COVID wave that peaked in late December. Fortunately, this year there is a new monoclonal antibody medicine (Beyfortus) to protect babies and some toddlers from RSV and a newly approved vaccine (Abrysvo) for pregnant individuals that can help prevent RSV infection in infants as well.

Drs. Eric Topol and Manisha Patel of the CDC will be holding an upcoming webinar on September 19th for healthcare providers on what to expect from the upcoming Flu, RSV and COVID-19 seasons.

BA.2.86 (Pirola)

BA.2.86 has many mutations and it has been found in many places around the world in small quantities. Because of its mutations, scientists were worried that BA.2.86 could possibly cause another Omicron-like massive wave, especially now that our immunity wall is less robust. It has been a long time since people have received vaccinations against COVID. 

In the last week, 4 studies (Cao, Murrell, Barouch, Sigal) using BA.2.86 pseudoviruses showed in vitro (in a test tube) that after a XBB infection, some people make antibodies that can neutralize BA.2.86, but some do not. The Sato lab reported that BA.2.86 was highly immune evasive in their pseudovirus studies which contradicted the other 4 labs’ findings. The BA.2.86 subvariant was found to be less infectious than other subvariants that are in circulation now which is reassuring. These studies were performed before we had data on the immune response to BA.2.86 from the new fall boosters. 

We now have actual data about neutralizing antibodies to BA.2.86 in humans from the new fall XBB.1.5 boosters and it is very encouraging. Moderna published a preprint yesterday showing that the new fall XBB.1.5 Moderna booster caused strong neutralizing antibodies against BA.2.86 in humans. This is great news. Pfizer also said that their new fall booster will protect against BA.2.86 according to NBC news, but Pfizer did not publish a preprint with their data like Moderna. Novavax reported that their Novavax XBB.1.5 protein vaccine induced neutralizing antibodies and CD4+ T cells against against XBB.1.5, XBB.1.16, XBB.2.3, EG.5.1, and XBB.1.16.6 subvariants in mice and nonhuman primates. They did not say if BA.2.86 would be covered and they did not show data in humans.

Given BA.2.86’s lower transmissibility and that the new boosters will protect well against BA.2.86, scientists are no longer as worried about this variant taking off like Omicron did. BA.2.86 will continue to be monitored closely though, in case it gets any new mutations which could make it more of an issue. Paxlovid should work against BA.2.86 and rapid antigen tests for COVID should also pick up BA.2.86 infection.

On Friday, Eric Topol MD reviewed on his blog the BA.2.86 variant and the new boosters with much of the information above. He also said, 

“Please don’t forget about Long Covid. Reinfections do carry an increased risk for subsequently manifesting this chronic condition. Vaccines and boosters have consistently provided some level of protection (ranging from 15-40% reduction) vs Long Covid. There has been over-emphasis on the protection against severe acute Covid (hospitalizations and deaths), not enough on the chronic form [Long COVID], so consider the added protection of a booster for this purpose.”

Long COVID

This week, a study from Spain showed that recovery from Long COVID is rare during the first 2 years confirming other studies. In the Spanish study, only 7.6% of people recovered from Long COVID during follow-up and almost all of them were from the less symptomatic cluster A, dominated mainly by fatigue. The patients who recovered tended to be older males who had been hospitalized in the ICU with their COVID infection and who primarily had fatigue as a Long COVID symptom. Long COVID patients with multiple symptoms such as muscle pain, cognitive impairment, difficulty breathing, or tachycardia, were less likely to recover. These findings are consistent with other studies looking at recovery from Long COVID at 2 years. Until now, studies have often evaluated people who were infected with COVID towards the beginning of the pandemic before vaccines were available. It is not yet known if Long COVID patients who were infected with COVID after being vaccinated will recover by 2 years or not. Future studies will hopefully highlight those answers.

The common cold coronavirus OC43 may prime the immune system to develop Long COVID. A group studied people who had preexisting autoimmune rheumatic disease who either developed Long COVID or not. The people who developed Long COVID had weaker antibody responses to SARS-CoV-2 and had stronger antibody responses against the common cold virus OC43. The authors concluded that immunological imprinting to OC43 may be a driver of Long COVID, particularly in individuals with prior autoimmune rheumatic disease. 

A new review looked at viral reservoirs of SARS-CoV-2, including either the virus, the spike protein or its viral RNA signature, in people with Long COVID. SARS-CoV-2 has been found in many tissues in the body including the gastrointestinal tract, skin, breast tissue, nasal olfactory nerves, tonsils in children, the tongue, brain tissue and lung tissue and in plasma. The authors concluded that SARS-CoV-2 reservoirs may drive inflammatory, coagulation, microbiome, neuroimmune and other abnormalities in Long COVID.

While seniors are less likely to get Long COVID, older people are at risk for four clusters of new disorders after a COVID infection including new onset metabolic disorders (diabetes, high cholesterol), cardiovascular problems (heart disease, heart attacks and arrhythmias), gastrointestinal issues (diarrhea and constipation, pancreatitis, liver disease) and neurologic symptoms (including stroke and cognitive decline).

Dr. Tedros Ghebreyesus, director-general of the WHO, said earlier this year that about 1 in 10 infections may lead to Long COVID conditions, "suggesting that hundreds of millions of people will need longer-term care." As hospitalizations and emergency room visits for COVID infections go up, there are still ways to reduce the risk of getting a(nother) COVID infection: wearing a well-fitting N95 mask, avoiding crowds and people who are sick, testing for COVID and staying home if positive or if sick, and staying up-to-date with booster doses including the new updated fall booster that will be released soon. 

Dr. Wolfgang Hagen reported in his blog on the ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) Symposium in Vienna this week. Kathryn Hoffmann from Medical University of Vienna's Center for Public Health spoke about the closure of their Long COVID clinic and what that would mean for patients. She stated that private doctors in Austria will not be able to care for Long COVID patients in the same way as the University Clinic can. A significant proportion of people with Long Covid have ME/CFS, so they are seriously ill people. As the Vienna Health Association stated, "Caring for people with ME/CFS is complex and time-consuming and “cannot be easily taken over in private practice.” 

Dr Hagen and his colleagues in Vienna also wrote an open letter to the Austrian Medical Association requesting 1) better education for the public about COVID, 2) mandatory continuing medical education for doctors on the latest findings about COVID and Long COVID, and 3) use of preventative measures by healthcare staff including use of CO2 measuring devices, good ventilation, HEPA filters, testing and isolation, high quality masks, and special clinic hours for particularly vulnerable populations.  

Regarding Long COVID ME/CFS, a very small study without a control group showed that in 7 out of 10 patients with post-COVID ME/CFS, IgG depletion by immunoadsorption (IA) reduced fatigue and vasomotor symptoms. Autoantibodies, and particularly ß2-adrenergic receptor antibodies (ADRB2 AABs), play an important role in SARS-CoV2-triggered ME/CFS per the authors. Although autoantibody levels significantly decreased in all 10 patients after immunoadsorption, both responders and non-responders had increasing autoantibodies again after 4 weeks. They concluded that mechanisms other than mere autoantibody depletion may account for improvement in a subset of patients.

In non-COVID news, giving Semaglutide (GLP-1 drug) to people with newly diagnosed Type I Diabetes led to 7 of 10 people no longer need insulin. The other 3 of 10 people no longer needed insulin with meals. Hemoglobin A1C levels decreased from 11.7 to 5.7% in these 10 people and their fasting C-peptide increased from 0.65 to 1.05 ng/ml meaning that they had a significant intact beta-cell reserve for their bodies to produce insulin. Wow!

A study in Nature using genome-wide association studies (GWAS) of random glucose led to the discovery of 44 new genetic loci for glycemic traits. New findings from this study include that the gastrointestinal tract (ileum and colon) has a role in controlling blood glucose, that genetic testing can show which GLP-1R agonist medication could best benefit a person with Type II diabetes and that lung function is also modulated by blood glucose.

The CDC warned this week of infections with the "flesh-eating bacteria" Vibrio vulnificus. Typically, people become sick with Vibrio after eating raw or undercooked seafood. But, people can also get infected after swimming in the ocean with an open wound such as a new tattoo, piercing or a scrape.

Dr. Peter Hotez's new book "The Deadly Rise of Anti-Science" about the anti-vaccine movement and how it became a dangerous political campaign was reviewed in Science magazine. The author said that  Dr. Hotez is "a man whose compassion and dedication to healing are on display throughout the book, describes the personal costs he paid for his efforts."  According to Wikipedia, Drs. Hotez and Maria Elena Botazzi developed the Corbevax COVID vaccine that they gave patent-free to manufacturers in countries such as India so that they could be made inexpensively for about $3 a dose. The Corbevax vaccine development was financed with $7 million from mostly private investors, including a $1 million donation by Tito’s Vodka.

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

• EG.5, FL.1.51 are most seen. 

•  HK.3, EG.5.1.3 and XBB.1.16.6, all have the FLip mutation and are being watched.

Variants in different locations: https://outbreak.info/

Walgreens positivity rate: https://www.walgreens.com/businesssolutions/covid-19-index.jsp

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

Weekly ED visits for respiratory illnesses, by age and disease: https://www.cdc.gov/ncird/surveillance/respiratory-illnesses/index.html

Inside Med Dashboard (Benjy Renton): Hospital capacity, ICU capacity https://buff.ly/3s36yop

• COVID, Influenza, RSV Hospitalizations, by age, gender, state: https://public.tableau.com/app/profile/benjamin.renton/viz/InsideMedicineCOVID-19MetricsDashboard/Dashboard1

US Wastewater Monitoring:

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

Wastewater from NWSS and Biobot in a US

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

• Biobot just made a major correction 9/5/23. Wastewater levels in the South are not dropping and continue to rise. Northeast is also seen as rising faster on the corrected update as well.

California wastewater level updates:

–Wastewater SCAN:

https://data.wastewaterscan.org/

  California statewide view https://buff.ly/3YObiul

• Virus levels going down in Pacifica, Sausalito, Lompoc, 

• Virus levels increasing in Half Moon Bay, Coastal Laguna Niguel, Fremont,

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

JP Weiland: https://twitter.com/JPWeiland

9/8/23

Estimated COVID infections based on wastewater data show that the current wave is high and is almost to the level of the Original virus in 2020, the Alpha wave and the Delta wave.

Canada risk in different provinces: https://covid19resources.ca/covid-hazard-index/ 

• Click on “Today’s index scores, past scores”

9/7/23 Forbes (Dr. Judy Stone): Where Have All The Masks Gone? https://buff.ly/45JaUQg

• N95 masks work best.

• Many hospitals dropped their masking requirements after Biden declared the public health emergency over.

  • One physician stated "she regularly sees hospital-acquired Covid-19 and that many people come to work while ill."

• The CDC and local governments are no longer collecting timely data about Covid-19 cases. But wastewater levels are higher.

• “Hospital admissions doubled over the past month, and positive tests tripled in the past two.

• Given all these factors and that even asymptomatic people can transmit Covid-19, it makes zero sense for hospitals, nursing homes and other healthcare facilities to eliminate masking.” 

9/7/23 Katelyn Jetelina: State of affairs: Parent edition https://buff.ly/3Z796hD

• Fall is here, school is in session, and viruses continue to thrive. 

• “Flu and RSV activity is still low. Earlier this week, though, the CDC warned physicians of increased RSV activity in the Southeastern U.S. This typically signals the beginning of RSV season, in which the virus will subsequently spread to the Northeast and West over the next two months.”

Source: CDC

“What to expect?

If this season mirrors the last, we will have unusual patterns of respiratory viruses:

• RSV peaking in early November

• Flu peaking in late November

• Covid-19 peaking in late December”

9/7/23 

COVID-19, Flu, and RSV: How the 'Tripledemic' Impacts Your Practice https://buff.ly/3PuM3Ks

• Upcoming Webinar 9/19/23 4pm PT with Dr. Eric Topol and Dr. Manisha Patel (CDC)

Free COVID tests in Los Angeles area libraries

9/6/23 CNBC: Moderna, Pfizer say updated Covid vaccines were effective against highly mutated BA.2.86 variant in trials https://t.co/ckS2a6Q2Nu

Common cold coronavirus OC43 may prime the immune system to develop long COVID.

9/6/23 Science Translational Med: Humoral immunity to an endemic coronavirus OC43 is associated with post-acute sequelae of COVID-19 (PASC, Long COVID) in individuals with rheumatic diseases https://buff.ly/3Pb8Z05

• An antibody panel was tested in people with preexisting systemic autoimmune rheumatic disease (SARD) who either developed or did not develop PASC.

• Functional antibodies specific to human coronavirus OC43 were found to be higher in people with PASC.

• People with PASC had weaker SARS-CoV-2 antibody responses and stronger antibody responses against the endemic coronavirus OC43.

• Immunological imprinting specific to OC43 may be a driver of PASC, particularly in individuals with prior autoimmune rheumatic disease. 

(The quality or type of CMV antibodies did not differ between individuals who did and did not experience PASC but rather that potential imbalances in prior CMV infection may have skewed the importance of these antibody features in our model.)

9/4/23 Dr. Wolfgang Hagen reports on the ME/CFS Symposium in Vienna https://buff.ly/45DNagl

• (Translated by Google translate from German).

• ME/CFS affects many Long COVID patients.

• Talks included Gender differences, production of Nitrous Oxide (NO) diminished in people with ME/CFS which affects blood vessel dilation, closure of Long COVID clinics and the difficulties this presents for patients.

• Kathryn Hoffmann from Medical University of Vienna's Center for Public Health spoke about the closure of their Long COVID clinic and what that would mean for patients. Private doctors in Austria will not be able to care for Long COVID patients in the same way as the University Clinic because of the complexity of care.

• "Caring for people with ME/CFS is complex and expensive and cannot be taken over without any problems in the private sector" (Vienna health association). 

9/4/23 NY Times: First Lady Jill Biden Tests Positive for Covid, but President Biden Does Not https://buff.ly/3Z3HGJy

BA.2.86 (Pirola)

9/6/23 Press Release: Moderna’ updated COVID vaccine against XBB.1.5 (fall booster) generates a strong immune response in humans against BA.2.86 (Pirola) https://buff.ly/3LaU1G7 

9/8/23 MedRxiV (Moderna): Safety and Immunogenicity of XBB.1.5-Containing mRNA Vaccines https://buff.ly/462bqZt

• Moderna XBB.1.5-containing vaccines elicited potent neutralizing responses against variants of the omicron XBB-lineage (XBB.1.5, XBB.1.6, XBB.2.3.2, EG.5.1, and FL.1.5.1) as well as the recently emerged BA.2.86 variant. 

More COVID-19 studies suggest BA.2.86 is less immune-evasive than feared.

Barouch lab confirms findings from Yunlong Cao’s and Ben Murrell’s labs

9/5/23 BioRxiV (Barouch lab): Neutralization Escape by SARS-CoV-2 Omicron Subvariant BA.2.86 https://buff.ly/3EsULCL

• NAb responses to BA.2.86 were lower than to BA.2 (evades antibodies) but were comparable or slightly higher than to the current circulating recombinant variants XBB.1.5, XBB.1.16, EG.5, EG.5.1, and FL.1.5.1. 

9/4/23 BioRxiV (Yunlong Cao lab): Antigenicity and infectivity characterization of SARS-CoV-2 BA.2.86 https://buff.ly/45CiQTw

• BA.2.86 has high immune evasion to nAbs, but has lower ability to infect.

9/4/23 BioRxiV (Murrell lab): Sensitivity of BA.2.86 to prevailing neutralising antibody responses https://buff.ly/3P78tQE

• BA.2.86 is not as immune evasive, likely attributable to multiple immunizations and prior infections.

9/5/23 Katelyn Jetelina: BA.2.86 update https://buff.ly/3P5w8kq

• Paxlovid works against BA.2.86.

• Rapid antigen tests for COVID work to pick up BA.2.86.

Long COVID at 2 years

9/4/23 Lancet: Determinants of the onset and prognosis of the post-COVID-19 condition: a 2-year prospective observational cohort study https://buff.ly/3Z65exg

• 548 individuals, 341 with PCC (Long COVID), followed for a median of 23 months

• History of headache, or presence of tachycardia, fatigue, neurocognitive and neuro sensitive complaints and dyspnea at COVID-19 diagnosis predicted the development of PCC.

• 3 groups with clustered Long COVID symptoms were found:

  • Cluster A (41% of subjects) presented primarily with fatigue.

  • Cluster B (45% of subjects) had fatigue plus dyspnea, neurocognitive complaints, headache, myalgia, arthralgia, chest pain and tachycardia. 

  • Cluster C (14% of subjects) had the same dominant symptoms of cluster B plus skin and smell alterations, dysphagia, diarrhea, and neurosensitive symptoms.

• Only 26 subjects (7.6%) recovered from PCC during follow-up; almost all of them were from less symptomatic cluster A, with mostly only fatigue.

  • Recovery from PCC was more likely in subjects who were male, required ICU admission, or had cardiovascular comorbidities, hyporexia and/or smell/taste alterations during acute COVID-19.

  • Subjects presenting with muscle pain, impaired attention, dyspnea, or tachycardia, conversely, were less likely to recover from PCC.

• Recovery from PCC (Long COVID) is extremely rare during the first 2 years.

9/4/23 Nature Immunology REVIEW: SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC) https://buff.ly/44EizxS

• Review of data on SARS-CoV-2 virus and/or viral RNA reservoirs—potentially capable of being translated to produce viral proteins—in Long COVID (PASC).

• "SARS-CoV-2 reservoir may drive inflammatory, coagulation, microbiome, neuroimmune and other abnormalities in PASC.

• Where are the SARS-CoV-2 reservoirs in the body?

9/3/23 NY Times: Long Covid Poses Special Challenges for Seniors https://buff.ly/3sKFmLs

• “There’s almost no organ system long Covid doesn’t touch,” said Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University School of Medicine.

• While older people are not more prone to long Covid overall, Dr. Al-Aly’s research using large Veterans Affairs databases shows that they are more at risk for four particular clusters of symptoms:

  • Metabolic disorders, including new-onset diabetes and high cholesterol.

  • Cardiovascular problems, including heart disease, heart attacks and arrhythmias like atrial fibrillation.

  • Gastrointestinal problems like diarrhea and constipation, pancreatitis and liver disease.

  • Strokes, cognitive decline and other neurological symptoms.

• Vaccination and boosters reduce the risk of Long COVID by 15% to 50%.

9/2/23 USA Today: What to know about COVID as hospitalizations go up and some places bring back masks https://buff.ly/3EpuG7v

• COVID hospitalizations have increased for the 6th week in a row.

• Some school districts in Kansas and Texas canceled in-person learning this week because of COVID outbreaks. 

• More than 10 million people in the United States have Long COVID with symptoms including constant fatigue, "brain fog," cardiac issues, neurologic symptoms and others.

• Dr. Tedros Ghebreyesus, director-general of the WHO, said earlier this year that about 1 in 10 infections could lead to conditions after a COVID infection, "suggesting that hundreds of millions of people will need longer-term care."

• While risk of a serious outcome from acute infection still remains higher for people with underlying conditions and the elderly, Topol said risk for long COVID is present for anyone regardless of their age or prior health status.

• Ways to reduce risk of getting COVID:

  • Wearing a high-quality, well-fitting respirator

  • Avoiding crowds and people who are sick

  • Testing for COVID and staying home when positive or while sick

  • Staying up-to-date with booster doses, including the one that will be released this fall 

9/1/23 MedRxiV (Charite, Berlin): Observational Study of Repeat Immunoadsorption (RIA) in Post-COVID ME/CFS Patients with Elevated ß2-Adrenergic Receptor Autoantibodies – an Interim Report https://buff.ly/4882wvu

• In a subset of 7 out of 10 patients with post-COVID ME/CFS, IgG depletion by immunoadsorption (IA) reduced fatigue and vasomotor symptoms. 

• Autoantibodies (AABs), and particularly ß2-adrenergic receptor antibodies (ADRB2 AABs) play an important role in SARS-CoV2-triggered ME/CFS. 

• Limitations: low number of patients completing therapy so far and the non-controlled treatment. 

• AAB levels significantly decreased after IA in all patients, both responders and non-responders and increased again after 4 weeks. 

  • Mechanisms other than mere AAB depletion most likely account for improvement in a subset of patients, perhaps due to apoptosis of AAB-producing B cells.

8/31/23 Novavax XBB.1.5 Spike Protein COVID-19 Vaccine Induces Broadly Neutralizing and Cellular Immune Responses Against EG.5.1 and Emerging XBB Variants https://buff.ly/466NVi5

• Monovalent XBB.1.5 recombinant spike protein COVID-19 vaccine (Novavax) induces cross-neutralizing antibodies against XBB.1.5, XBB.1.16, XBB.2.3, EG.5.1, and XBB.1.16.6 subvariants, promotes higher pseudovirus neutralizing antibody titers than bivalent (Prototype + XBB.1.5) vaccine, induces SARS-CoV-2 spike-specific Th1-biased CD4+ T-cell responses against XBB subvariants, and robustly boosts antibody responses in mice and nonhuman primates primed with a variety of monovalent and bivalent vaccines.

Other news:

9/1/23 CNN: CDC warns re: cases of "flesh-eating bacteria" Vibrio vulnificus https://buff.ly/3sNpnfn

• “While most people have become sick [with Vibrio] after eating raw or undercooked seafood, people can also get infected after swimming in the ocean with an open wound," new tattoo, etc

• Vibrio is often found in states along the Eastern Coast of the U.S.

9/6/23 NEJM: Semaglutide in Early Type 1 Diabetes https://buff.ly/3PsWLRv

• At the onset of new Type I Diabetes diagnosis, giving Semaglutide (GLP-1 drug) led to 7 of 10 people with recent Type 1 (autoimmune) diabetes to no longer need insulin, and the other 3 of 10 did not need insulin with meals.

• Also Hemoglobin A1C levels decreased from 11.7 to 5.7% in the 10 people.

• The fasting C-peptide increased from 0.65 to 1.05 ng/ml (62%) in these 10 individuals, which shows a significant intact beta-cell reserve to produce insulin. 

9/6/23 NY Times: As Abortion Laws Drive Obstetricians From Red States, Maternity Care Suffers https://buff.ly/44AUuIB

• Idaho’s obstetrics exodus is not happening in isolation. Across the country, in red states like Texas, Oklahoma and Tennessee, obstetricians — including high risk Ob doctors — are leaving. 

9/7/23 Nature Genetics: Genome-wide association studies (GWAS) of random glucose in 476,326 individuals provide insights into diabetes pathophysiology, complications and treatment stratification https://buff.ly/3P3BDA2

• 44 new loci for glycemic traits were found.

• New findings:

  • Gastrointestinal tract (ileum and colon) has a role in controlling blood glucose.

  • Study of Glucagon-like peptide-1 receptor (GLP1R) genetics show that GLP-1R agonist therapy may benefit that particular person with Type II diabetes.

  • Lung function was found to be modulated by blood glucose and pulmonary dysfunction is a diabetes complication. 

9/5/23 CBS: "Historic flooding event" in Greece dumps more than 2 feet of rain in just a few hours https://buff.ly/3Z708kt

9/7/23 Science: The Legacy of Covid Denial https://buff.ly/485ZkAs

• Review of Dr. Peter Hotez's new book "The Deadly Rise of Anti-Science", "a man whose compassion and dedication to healing are on display throughout the book, describes the personal costs he paid for his efforts.." 

• Dr. Peter Hotez discusses how an antivaccine movement became a dangerous political campaign promoted by elected officials and amplified by news media, causing thousands of American deaths.