CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 6/17/2022

I WISH YOU A NICE WEEKEND, BUT DON’T TAKE UNNECESSARY CHANCES.

REPEAT COMMENTS FROM JUNE 8 NYT REGARDING BA .4 AND .5

”…Globally, the most recent data suggest that BA.4 and BA.5 still represent a relatively small share of cases, but that could change in the weeks ahead. In a recent report, the U.K. Health Security Agency noted that in many countries, the two subvariants were replacing BA.2 about as quickly as BA.2 replaced the original version of Omicron….The subvariants have become especially common in parts of the southern United States. In the region comprising Arkansas, Louisiana, New Mexico, Oklahoma and Texas, BA.4 and BA.5 account for more than one in five infections, according to the new figures….”

”…Latest trends IN LA FROM NYT

An average of 1,421 cases per day were reported in Louisiana in the last week. Cases have increased by 38 percent from the average two weeks ago. Deaths have increased by 38 percent..”

(J. Harris: Bossier and Caddo Parishes are right next door. They may test more there, but we 

will be increasingly plagued by the new BA.4 and BA.5 variants. I have just been told that “BA” stands for Bad Ass in Norwegian.)

IF YOU HAVE HAD COVID BUT ARE STILL TEST POSITIVE, ARE YOU CONTAGIOUS?

1. Some Test Positive for COVID for 10 Days or Longer

2. Early data suggests many individuals still COVID+ after 5 days of isolation, challenging return-to-work recommendations

3. From Positive to Negative to Positive Again—The Mystery of Why COVID-19 Rebounds in Some Patients Who Take Paxlovid

FROM NEJM:

Effects of Previous Infection and Vaccination on Symptomatic Omicron Infections

RESULTS:

1. The effectiveness of previous infection alone against symptomatic BA.2 infection was 46.1%

2. The effectiveness of vaccination with two doses of BNT162b2 and no previous infection was negligible , but nearly all persons had received their second dose more than 6 months earlier.

3. The effectiveness of three doses of BNT162b2 and no previous infection was 52.2%

4. The effectiveness of previous infection and two doses of BNT162b2 was 55.1%

5. The effectiveness of previous infection and three doses of BNT162b2 was 77.3%.

CONCLUSIONS:”No discernable differences in protection against symptomatic BA.1 and BA.2 infection were seen with previous infection, vaccination, and hybrid immunity. Vaccination enhanced protection among persons who had had a previous infection. Hybrid immunity resulting from previous infection and recent booster vaccination conferred the strongest protection.

(Most of the people with whom I confer, have had a total of 4 jabs of vaccine — and are waiting now for a recommendation for a new vaccine or a “mix and match” with existing vaccines.

ALSO FROM NEJM LETTER TO THE EDITOR:

In this study, we characterized infection-induced immunity and vaccine-induced immunity against newly emerged omicron subvariants. Booster vaccination provided sufficient neutralizing-antibody titers against the BA.4/5 and BA.2.12.1 subvariants, albeit to a lower extent than against BA.1 and BA.2.4,5 These findings underscore the importance of booster vaccination for protection against emerging variants.

FROM HOPKINS:

1. ACUTE HEPATITIS & LONG COVID Researchers from Israel published findings from their study on instances of long-term COVID-19 liver manifestation among children. The study, published in the Journal of Pediatric Gastroenterology and Nutrition, involved a retrospective investigation of 5 patients hospitalized in an Israeli children’s hospital. Each of the patients had a confirmed SARS-CoV-2 infection and presented with long-term liver injury stemming from their infection. Two of the patients in the study, both under 6 months of age, presented with acute liver failure, the other 3 patients, ranging between ages 8 and 13 years, presented with acute hepatitis and cholestasis.

This review adds to the growing list of evidence tying post-acute sequelae of COVID-19 (PASC/Long COVID) to cases of acute hepatitis of unknown origin. Last month, multiple technical and news media publications documented an international cohort of children with severe hepatitis. Many experts have suggested that COVID-19 could be a potential source for this unexplained manifestation, considering the lack of apparent epidemiological explanations. The US CDC is examining a series of US cases of acute hepatitis as well, and a recent update indicates that adenovirus type 41 could be a possible causative agent as well. While much has been written about Long COVID, many questions remain, and advocates continue to call for expanded research efforts into explanations and treatments.

2. BA.4 & BA.5 SUBVARIANTS IN EUROPE The European CDC published an epidemiological update on the emergence and prevalence of the BA.4 and BA.5 sublineages of the SARS-CoV-2 Omicron variant of concern (VOC). The subvariants were first detected in Europe in March, and in May, Portugal was the first European country to report a COVID-19 surge associated with one of the subvariants (BA.5). Notably, Portugal’s daily incidence appeared to peak in late May/early June. While most European countries have reported relatively low prevalence of these subvariants, they represent an increasing proportion of new sequenced specimens in multiple countries over the past several weeks, including Austria, Belgium, Denmark, France, Germany, Ireland, Italy, Netherlands, Spain and Sweden. In particular, the BA.4 and BA.5 subvariants represent more than 25% of sequenced specimens in Belgium over the second half of May, and more than 10% in some communities in Spain. The increasing prevalence of BA.4/BA.5 corresponds to increasing COVID-19 daily incidence in most of those countries as well. 

The ECDC projects that BA.4 and BA.5 will become the dominant variants across Europe “in the coming weeks” and that the continent can expect an associated COVID-19 surge like those in the countries noted above. The daily incidence in Europe has increased nearly 30% since June 6, with even larger increases in the UK. While there is “no evidence” these subvariants pose higher risk of severe disease, the ECDC notes that an overall increase in transmission can be associated with subsequent increases in hospitalizations and mortality.

J. Harris: So why is the USA reducing vigilance in travelers from Europe? 


3. WASTEWATER SURVEILLANCE Researchers from the University of Illinois and University of Florida published (preprint) findings from a study on the implementation of neighborhood-scale SARS-CoV-2 wastewater surveillance systems. The COVID-19 pandemic has popularized wastewater surveillance as a tool to provide early warning of impending outbreaks; however, most of these efforts have focused on large-scale sewer systems. Neighborhood-scale systems can provide more targeted early warning capacity, but as the catchment population decreases, the volume of fecal matter is less consistent, which can make it more difficult to analyze the concentration of SARS-CoV-2 and accurately detect emerging outbreaks. This study covered 7 neighborhood-scale wastewater surveillance systems in Champaign County, Illinois, from January-November 2021, with catchment populations ranging from 853 to 2,402 individuals. In an effort to improve the system’s accuracy, the researchers developed a methodology to normalize the concentration of SARS-CoV-2 N gene fragments by the concentration of pepper mild mottle virus (PMMOV) detected in the system. The presence and concentration of PMMOV served as an analogue for the presence of fecal matter in the sample, which enabled the researchers to establish more accurate baseline metrics and better analyze the relative concentration of SARS-CoV-2. Based on the concentration of SARS-CoV-2 N gene fragments to PMMOV, the system output a binary risk assessment (ie, Low or High). Over the 11 months of the study, the 7 neighborhoods experienced 26 total local COVID-19 outbreaks, and the surveillance system identified High COVID-19 risk corresponding to 19 of those time periods (73% sensitivity). The system identified 17 total High-risk time periods, and 12 of those corresponded to local COVID-19 outbreaks (71% specificity). The researchers also indicated that the surveillance system was capable of providing sufficiently accurate risk assessment for specific variants of SARS-CoV-2, which could provide early warning of the geographic spread of variants of concern. This study provides evidence that smaller-scale wastewater surveillance systems can provide indication of increased transmission risk among specific communities, particularly during periods of relatively low local incidence 



 



 

4. Newest Omicron Covid-19 Lineages Gaining Ground in United States (STAT News) The Omicron lineage BA.2 and its spinoff, BA.2.12.1, drove cases this spring, building into waves of infections in places like the Northeast and parts of California. Now, two other forms of Omicron, BA.4 and BA.5, are eating into the BA.2 group’s dominance. More than 1 in 5 Covid-19 infections last week were caused by BA.4 and BA.5, according to updated estimates posted  by the Centers for Disease Control and Prevention. That’s up from 13% the week prior. The rest of the cases are from the BA.2 lineages. BA.4 and BA.5 are picking up speed because they’re able to evade the body’s antibody response even more so than other variants, meaning they’re very good at establishing infections in people who have some level of protection.

5. Pfizer Reports Additional Data on PAXLOVID (Pfizer) Today, we shared data from the Phase 2/3 EPIC-SR study evaluating the use of PAXLOVID™ tablets and ritonavir tablets in patients who are at standard risk for developing severe COVID-19. In previously reported interim analyses, the company disclosed that the novel primary endpoint of self-reported, sustained alleviation of all symptoms for four consecutive days was not met, and a non-significant 70% relative risk reduction was observed in the key secondary endpoint of hospitalization or death (treatment arm: 3/428; placebo: 10/426). An updated analysis from 1,153 patients enrolled through December 2021 showed a non-significant 51% relative risk reduction (treatment arm: 5/576; placebo: 10/569). A sub-group analysis of 721 vaccinated adults with at least one risk factor for progression to severe COVID-19 showed a non-significant 57% relative risk reduction in hospitalization or death (treatment arm: 3/361; placebo: 7/360).

6. How Months-long COVID Infections Could Seed Dangerous New Variants (Nature) Virologist Sissy Sonnleitner tracks nearly every COVID-19 case in Austria’s rugged eastern Tyrol region. So, when one woman there kept testing positive for months on end, Sonnleitner was determined to work out what was going on. Sonnleitner and her colleagues collected more than two dozen viral samples from the woman over time and found through genetic sequencing that it had picked up about 22 mutations. Roughly half of them would be seen again in the heavily mutated Omicron variants of SARS-CoV-2 that surged around the globe months later. “When Omicron was found, we had a great moment of surprise,” Sonnleitner says. “We already had those mutations in our variant.”  

(J. Harris: Here’s the article from Nature: )

How months-long COVID infections could seed dangerous new variants

FROM JAMA:

1. Effect of Text Messaging and Behavioral Interventions on COVID-19 Vaccination Uptake

”There was no detectable increase in vaccination uptake among patients receiving text messaging compared with telephone calls only or behaviorally informed message content.”

FROM BERCKER SELECTIONS”

Former Houston Methodist employees lose appeal in vaccination mandate case

FROM THE NYT:

Here’s how long some popular at-home virus test kits actually last, according to the F.D.A.

AND LAST BUT NOT LEASED:

EARLY PHOTO OF NORWEGIAN INVASION OF TEXAS:

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