HELLO,

EAST TEXAS  area remains Covid quiet. 

HAPPY BIRTHDAY to all of the Norwegians that I know. 

MILTON THE TOMATO decided to head on back to the equator ‘where the weather is cooler.”

FROM BECKERS: GREAT, CONCISE, QUICK COVID SUMMARY IN US:

‘Escape variants’ account for 16% of US COVID-19 cases: 10 updates

FROM THE WASHINGTON POST:

QUESTION: I have had all of the vaccines and boosters — a total of five jabs to date. I’ve had many coronavirus tests, but none positive. Is it possible that I have had asymptomatic covid and didn’t know I had it? — Lynn, Tallahassee, Fla.

ANSWER:” While there is growing research surrounding people who have never contracted the coronavirus, researchers know a majority of Americans have been infected. So if someone has never tested positive for the coronavirus and has never experienced symptoms, there could be two reasons: One, they are among the lucky few who have managed to dodge the virus, or, two, the time when they took the test did not coincide with a peak infection in their body. The latter is especially true if a person has symptoms of a coronavirus infection but tests negative.

…Two tests can detect a coronavirus infection: a polymerase chain reaction (PCR) test and an at-home rapid test. The home test is not as reliable because it can only detect specific proteins from the virus, while PCR tests can identify lower levels of the virus. Neither test can detect a past infection.

…A serology test is the only way to identify if a person’s body has produced antibodies in response to SARS-CoV-2, thus identifying a previous infection.

…But even serology tests are not a guarantee as “antibody levels can decline over time, so a negative [antibody] test is not definitive proof of never having had COVID,” Daniel R. Kuritzkes, chief of the infectious-diseases department at Brigham and Women’s Hospital in Boston, told The Washington Post in an email. “A positive test is definite evidence of past infection; a negative test is less reliable over time…Kuritzkes adds there is not much reason clinically to order the test because antibody levels decay at different rates in different people….” 

FROM YOUR LOCAL EPIDEMIOLOGIST:

ACIP meeting: Updated info on COVID-19, vaccine safety for kids and pregnancy

(J. Harris: Up to date information about Vaccination for youngsters.)

FROM HOPKINS SELECTIONS:

1. UNITED STATES

The US CDC is reporting 96.8 million cumulative cases of COVID-19 and 1.06 million deaths. Daily incidence continues to decline, down to 37,052 new cases per day, the lowest average since mid-April. Average daily mortality also continues to decline, down to 323 deaths per day on October 18.**

2 “ SCRABBLE VARIANTS OR SUBVARIANT SOUP” (CDC)

IMMUNE EVASIVE OMICRON SUBVARIANTS While past surges in COVID-19 cases have been driven largely by single SARS-CoV-2 variants, experts are eyeing a collection of Omicron subvariants that could drive an anticipated wave of infections this fall and winter. In the US, BA.4.6 appeared to be gaining momentum, although BF.7, BQ.1, and BQ.1.1 are showing recent potential growth advantage. The same sublineages are also showing evidence of growth advantage over BA.5 in the United Kingdom. Additional variants, including the recombinant variant XBB, are fueling increases in cases in Southeast Asia and Europe. The US has yet to see a large surge due to these subvariants, with the number of new cases continuing to drop. But public health experts warn data on new cases is unreliable—many are turning to wastewater surveillance to help predict where and when surges may occur—and most expect the downward trend to reverse over the next few weeks. The collection of variants, sometimes referred to as “scrabble variants” or “subvariant soup,” accounts for nearly 1 in 3 new infections reported in the US last week. Globally, detecting these variants and developing accurate assessments of the risk they pose to public health is challenging, as many countries have rolled back their surveillance efforts…

…While available vaccines remain effective in preventing severe illness and death from COVID-19, there are concerns the emerging subvariants will be more immune evasive than previous variants, particularly due to mutations in the receptor binding domain that would prevent antibodies from docking and attacking the virus. AstraZeneca’s EvuSheld, the only monoclonal antibody authorized to prevent SARS-CoV-2 infection, is ineffective against BA.4.6. Other monoclonal antibodies in development already demonstrate vulnerabilities to newly emerging Omicron subvariants. With this new information, the Biden administration is searching for other potential candidates for use among immunocompromised persons…”

FROM THE ATLANTIC:

America Created Its Own Booster Problems

“…And with daily COVID vaccination rates only a notch above their all-time nadir and barriers to inoculation rising, the nation might be bogged down in its booster doldrums for a good while yet—leaving Americans potentially vulnerable to yet another catastrophic surge… The country’s booster problem is the culmination of months of such confusion. It is also an exacerbation of the inequities that plagued the country’s initial immunization efforts. Booster uptake may present its own issues, but those only piled on the problems that vaccination efforts had encountered in all the months before….this messy discourse warped into confusion, consternation, and apathy. “When the scientists don’t agree, what are the rest of us supposed to do?”…Nor have the logistics of booster recommendations been easy to follow. In the past few months, the FDA and the CDC have issued roughly half a dozen shifts in guidance—over not only who should boost, but also when they should boost, how many boosts to get, and whether booster brands should be mixed….The erratic narrative on vaccines writ large also hasn’t done the U.S. booster campaign any favors. When the shots were fresh out of the gate, Americans were set up to believe that they could take an initial course of doses and be done—with COVID vaccines, maybe even with the pandemic itself. But as more data emerged, it became evident that the shots’ protective powers had been oversold. Vaccines operate best in gradations, blunting and truncating the worst symptoms of disease; they never completely obliterate risk. “We failed to communicate that,”….Even if the message on boosters had been clearer from the get-go, that wouldn’t have ensured that people got them. Vaccination rates have tended to track with risk perception,..One fact about boosting hasn’t changed. Asking people to get an additional shot means … asking people to get an additional shot, and that’s become harder than ever. As shot uptake has dropped off, vaccination sites have closed, while community outreach has pulled back….Issues with access, at least, have straightforward (though still difficult-to-implement) solutions. “We need to make the process easier, and more convenient,” Fishman, of UPenn, told me. Reviving and more evenly distributing community vaccination efforts could help. Stand-alone sites could take walk-in appointments; teams of volunteers could bring vials and syringes directly to the places where people live and work. Paid sick leave, subsidized transportation, or even financial incentives for vaccinations could make a big difference too. Perhaps most crucial, additional federal funding to keep vaccines free for everyone would mean shots stay within reach of some of society’s most at-risk members….Clearer policies have a role to play too. Many workplaces, for instance, issued strict requirements for initial doses last year. But booster mandates have been sparser. With eligibility ever-changing, and the possibility of annual shots on the table, that’s logistically understandable, but it sends an implicit message, Lewis told me: “One inference people are making is If boosting was really that important, the government or my boss would be issuing a mandate…”

(J. Harris: Vaccines, masks, hand washing, distance, and go0d sense have clearly worked in controlled environments like smaller universities, the military, and well-managed companies. Personally, I’m about  ”talked out” on the vaccine question. Even some people with good sense won’t take the vaccines. Ok. You probably won’t die this late in the pandemic. But God help you if you wind up with a severe case of Long Covid. Tough luck, Dude. I’ll worry about folks who haven’t had a chance to take the vaccines and myself and my family. In the next few years, the magnitude of and devastation caused by Long Covid will be apparent and will swamp medical resources. )

AND LAST BUT NOT LEASED:

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WE STILL HAVE COVID IN THE AREA:

THERE SEEMS TO BE A CLUSTER OF CASES OF COVID IN  CASS COUNTY. 

FROM HOPKINS,  THE WASHINGTON POST,  AND NATURE COMMUNICATIONS ( three versions in increasing detail):

1. ‘We are in trouble’: Study raises alarm about impacts of long covid (Washington Post) A new long-covid study based on the experiences of nearly 100,000 participants provides powerful evidence that many people do not fully recover months after being infected with the coronavirus. The Scottish study found that between six and 18 months after infection, 1 in 20 people had not recovered and 42 percent reported partial recovery. There were some reassuring aspects to the results: People with asymptomatic infections are unlikely to suffer long-term effects, and vaccination appears to offer some protection from long covid

2.  Outcomes among confirmed cases and a matched comparison group in the Long-COVID in Scotland study

”…Large study provides powerful evidence of long covid’s lasting impact…”

”The Scottish study found that between six and 18 months after infection, 1 in 20 people had not recovered and 42 percent reported partial recovery. There were some reassuring aspects to the results: People with asymptomatic infections are unlikely to suffer long-term effects, and vaccination appears to offer some protection from long covid…“It’s one more well-conducted, population-level study showing that we should be extremely concerned about the current numbers of acute infections,” …We are in trouble….Crucially, this study also identified a sub-cohort of 11 percent who deteriorated over time. This is something seen often in patient groups but has not been discussed enough in the public conversation.”

FROM NEJM LETTER TO EDITOR/STUDY 

Protective Effect of Previous SARS-CoV-2 Infection against Omicron BA.4 and BA.5 Subvariants

(J. Harris: There is some Covid protection from subvariantants if you have had a prior infection with that strain or a similar strain — which makes sense. Vaccinations make more sense to me.)

FROM HOPKINS SELECTIONS:

1. EMERGING SUBVARIANTS The SARS-CoV-2 virus continues to evolve, with multiple emerging sublineages of the Omicron variant of concern (VOC) poised to play a dominant role in the next surge. As noted above, several sublineages are increasing in prevalence in the US as the current dominant strain, BA.5, begins to wane. At this point, it is unclear if the next principal variant would be capable of evading immunity conferred by vaccination, including Omicron-specific booster doses, or prior infection with other variants, but researchers are already working to identify key mutations and project their impact. In contrast to previous surges, the forecasted fall/winter surge may not be driven by a single variant, as was the case with the Delta and Omicron surges in 2021 and earlier in 2022. In fact, WHO officials recently indicated that they are currently monitoring more than 300 Omicron sublineages.

Several of these sublineages are particularly concerning, including BQ.1 and BQ.1.1 that evolved from BA.5 and BA.2.275 and XBB that evolved from BA.2. The BQ.1 and BQ.1.1 sublineages are currently circulating in Europe, which could forecast a fall/winter surge in other Northern Hemisphere countries. All 4 of these sublineages exhibit resistance to existing treatments and vaccines, and the XBB sublineage, in particular, threatens to render existing vaccines ineffective. In addition to the risk of global spread of a vaccine-resistant vaccine, the decline in testing volume worldwide and barriers to including at-home test results in SARS-CoV-2 reporting systems could make surveillance problematic. And the general absence of COVID-19 protective measures (eg, physical distancing, mask use) could facilitate community transmission. Additionally, governments seem to be unwilling to commit additional funding to COVID-19 responses, including research on future vaccines and therapeutics, as evidenced in the US government’s struggle to secure funding for Project COVID Shield, the follow-on to Operation Warp Speed to develop advanced SARS-CoV-2 vaccines. The world is simply in a much different place than it was in 2020 and 2021, which elevates the threat from these emerging sublineages.

As opposed to more radical antigenic “shifts”—like those observed with the emergence of the Delta variant or the original Omicron variant—the new sublineages of the Omicron variant are exhibiting more subtle antigenic “drift.” This is similar to the evolution observed in annual seasonal influenza epidemics, although on a much shorter timeline. New sublineages appear to be acquiring many of the same mutations, in various combinations, which signals that they may be converging on a common set of traits. Despite the recent pattern, however, it is still possible that the virus could take a more substantial shift, which could result in the emergence of a new major variant with much different characteristics.

2. Rising COVID levels in Europe especially affect seniors (CIDRAP) COVID activity continued to rise in many European countries last week, up 14% compared to the previous week in people ages 65 and older, the European Centre for Disease Prevention and Control (ECDC) said Friday in a regular update. In the United States, COVID indicators continue to fall, with the BA.5 Omicron variant still dominant, but newer subvariants are slowly making more of a mark.  

FROM NYT:

GOOD NYT ARTICLE ON FLU SHOTS AND PRACTICAL INFORMATION

FROM BECKERS:

Paxlovid can interact with heart medications, study suggests

FOR AREA VETERAN from the VA

Dear Veteran,

It’s That Time of Year Again!

The single best way to reduce the risk of seasonal flu and its potentially serious complications is to get the Influenza Vaccination each year.� Good health habits also reduce getting the flu like avoiding people who are sick, covering your cough, and washing your hands often can help stop the spread of germs and prevent respiratory illnesses like flu.

The Overton Brooks Medical Center influenza vaccination opportunity schedule is below.� Quadrivalent Flu shots are free to all enrolled Veterans in these ways:

• During a regular scheduled appointment or any Primary Care as a Flu Walk-In Visit.
• Shreveport Campus Front Circle Drive Thru Flu Clinic on October 8, or October 15, 2022 from 8:00 a.m. to 12 noon.
• To find a community pharmacy to receive a flu vaccine, use the VA Facility Community Partner using your zip code: http://www.va.gov/find-locations/
• Longview, Monroe, and Texarkana Community Based Clinics, Walk-In Flu Clinics are Wednesdays, October 5th thru December 28th from 1:00 p.m. to 3:00 p.m. with no appointment necessary, except November 23rd.
• To find a community pharmacy to receive a flu vaccine, use the VA Facility Community Partner using your zip code: http://www.va.gov/find-locations/�Please make sure the Community Partner is aware you are receiving this through the Community Partnership with VA.
• Moderna Vaccines (1^st dose, 2^nd dose and Bivalent Booster) are available at main campus in Shreveport Drive Thru Flu Clinic.
• Both vaccinations can be received at the same time, per CDC guidance.
• There will be a 15 minute wait after the vaccination.

FROM YOUR LOCAL EPIDEMOLOGIST

Fall boosters, myocarditis, and benefits/risks for young people

Subscribe to Center for Health Security E-Newsletters, Updates, and Alerts

SIGN UP FOR HOPKINS FREE COVID SUBSCRIPTION (click it). 

HARRIS: A great way to keep up with Covid since things have “cooled off” a bit it by subscribing  the free subscription for all of the Hopkins publications. They are free and increasingly readable and useful. They generally have 1-3 short mailouts weekely. Their mail out today, Oct. 13, is wonderful. You can also subscribe. to the past issues. They run a few days behind some of our mailouts, but their information is still timely and trustworthy. I’d subscribe to all of thier offerings. They are free. They are trustworthy and have provided fabulous information.  Alas, they don’t have any jokes. Likely, I will still continue to wart you occasionally.  Good Luck. 

AND LAST BUT NOT LEASED:

Written by Regina Brett, 90 years old, of the Plain Dealer, Cleveland, Ohio :

Be eccentric now. Don’t wait for old age to wear purple.

Life isn’t tied with a bow, but it’s still a “gift.”

All that truly matters in the end is that you loved.

It’s OK to let your children see you cry.

Time heals almost everything. Give time time.

 When it comes to chocolate, resistance is futile

God loves you because of who God is, not because of anything you did or didn’t do.

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FROM YOUR EPIDEMIOLOGIST:

 COVID State of Affairs: Oct 5

”…Here we go again. The start of a new wave. Eyes are on Western Europe, as hospitalizations are uniformly increasing….Interestingly, no new subvariant is driving this wave, as the majority of cases are still the “old” BA.5 subvariant….[BUT]…subvariants are brewing. They only make up a small percentage of cases for now, but they are gaining ground; historically, we feel their impact when they make up ~30-50% of cases. These subvariants will eventually add fuel to the fire…If we combine five of the top new subvariant leaders in the U.S. (referred to as “Pentagon”), it’s clear that case acceleration is brewing below the surface. Given the current growth, we will likely see an impact on national metrics in mid-November….”

(J. Harris:I suggest that you read the whole article referenced above. You might even want to subscribe to her efforts and send her some money. I did, but it looks like I’ll need to send her some more. We are likely to have another bad winter. The most important thing we old folks can do is to stay completely vaccinated, be careful, avoid sick people if possible, and avoid unvaccinated people. Remember, about half the folks with Covid do not know that they have it or just caught it and don’t have symptoms yet. AND, get your FLU SHOT.)

FROM THE LA TIMES:

Coronavirus Today: How COVID lies spread on Facebook

(J. Harris: Wonderful summaries of several papers—READABLE version)

FROM SCIENCE ADVANCES.        Almost unreadable version:

”Losing the battle over best-science guidance early in a crisis: COVID-19 and beyond”

(J. Harris: I have a few readers who have advanced mathematical and statistical skills who can probably understand this article. I simply will have to agree with the conclusions.)

FROM BECKERS: 

CDC revises ‘up to date’ term on COVID-19 vaccination

”…The CDC revised its “up to date” COVID-19 vaccination term Sept. 30 to include the primary series and the recently authorized omicron-targeting booster.”

FROM THE WASHINGTON POST:

Can you get the omicron booster if you have never received the original coronavirus vaccine?

AND LAST BUT NOT LEACHED: 

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FROM THE ATLANTIC:

The Pandemic’s Legacy Is Already Clear

”...In furiously racing to rebuild on this same foundation, America sets itself up to collapse once more…”

”…America’s individualist bent has also shaped its entire health-care system, which ties health to wealth and employment. That system is organized around treating sick people at great and wasteful expense, instead of preventing communities from falling sick in the first place….

 UP TO DATE REASONS TO GET VACCINE BOOSTER!

(J. Harris: The numbers in favor of boosters are convincing.)

COVID VACCINE AVAILABLE IN MARSHALL NOW FREE:

We have plenty of Pfizer COVID 19 vaccines (primary and booster) doses available. If you have a business or group that would like us to schedule an onsite vaccine clinic, please let me know.

Jennifer Hancock, RN, BSN  

Executive Director – Marshall-Harrison County Health District

805 Lindsey Drive  |  Marshall |  TX 75670

Tel 903.938-8338  |  Fax 903.938.8330

www.mhchd.org

SHORT VIDEO ANIMATION OF HOW MRNA VACCINE WORKS

(Thank you, Ken Belson, NYT)

FROM HOPKINS SELECTIONS”

1. COVID-19—Clinical Practice

Long COVID Has Forced a Reckoning for One of Medicine’s Most Neglected Diseases (The Atlantic) ME/CFS involves a panoply of debilitating symptoms that affect many organ systems and that get worse with exertion. The Institute of Medicine estimates that it affects 836,000 to 2.5 million people in the U.S. alone, but is so misunderstood and stigmatized that about 90 percent of people who have it have never been diagnosed. At best, most medical professionals know nothing about ME/CFS; at worst, they tell patients that their symptoms are psychosomatic, anxiety-induced, or simply signs of laziness. While ME/CFS patients, their caregivers, and the few doctors who treat them have spent years fighting for medical legitimacy, the coronavirus pandemic has now forced the issue.

2. Public & Global Health:

Five things about covid we still don’t understand at our peril (The Washington Post) Since a new coronavirus launched the global pandemic that has now killed more than 6.5 million people — 16 percent of them in the United States alone ― scientists in record numbers have devoted themselves full time to unraveling its mysteries. In less than three years, researchers have published more than 200,000 studies about the virus and covid-19. That is four times the number of scientific papers written on influenza in the past century and more than 10 times the number written on measles. Still, the virus has kept many of its secrets, from how it mutates so rapidly to why it kills some while leaving others largely unscathed — mysteries that if solved might arm the world’s scientists with new strategies to curb its spread and guard against the next pandemic. Here are some of the most pressing questions they are trying to answer.

3. Moderna seeks FDA nod for Omicron-targeted COVID shot for adolescents, younger kids (Reuters) Moderna Inc said on Friday it has requested U.S. authorization for use of its Omicron-targeting COVID vaccine in adolescents and children. The company is seeking emergency use authorization of its updated vaccine in two age groups – adolescents aged 12 to 17 years and children aged six to 11. The application for the bivalent vaccine for children between the ages of six months and under six years is expected to be completed later this year, the company said in a tweet.

4. (27 Sept): PANDEMIC PREDICTIONS Recent increases in COVID-19 cases in the UK could signal that the US is heading into a fall and winter COVID-19 surge. Historically, the US lags the UK in case trends by about one month, and the UK trend began rising the week of September 17. Some models predict US case trends will continue to decrease into October before beginning to rise, and while current predictions suggest a big increase in infections, the infection-detection rate likely will remain low due to declines in testing. Because the US population has some underlying immunity, and most experts agree the country has the pandemic under control, the death toll is expected to be rather modest….

But this modeling is based on the Omicron BA.5 subvariant, and the emergence of a new variant or subvariant could upend these predictions, particularly if there is a reduction in cross-variant immunity. BA.5 continues to account for the majority of new COVID-19 cases in the US (83.1%), but BA.4.6 (12%) and BF.7 (2.3%), an offspring of BA.5, are beginning to show growth advantage over BA.5. BF.7 has an additional genetic mutation in the spike protein compared with BA.5, which could reduce the efficacy of the monoclonal antibody treatment Evusheld, one of the few remaining therapies effective against BA.4 and BA.5. The mix of variants in the UK appears to be about the same as the US, although epidemiologists are watching to see whether emerging variants such as BQ.1.1 and BA.2.75 grow in proportion.

FROM YOUR LOCAL EPIDEMOLOGIST:

1. BOOSTERS STIMULATE YOUR IMMUNE SYSTEM TO RESIST SOME NEW VARIANTS

”…an updated booster will increase the diversity of our antibodies and that memory will be retained by our immune systems…”

2. mRNA in breastmilk. That’s okay. And more on COVID19 vaccines and pregnancy

(J. Harris: Extensive review of Covid and pregnancy biochemistry/immunology.)

FROM THE NYT

1. In a Game Built on Violence, No Player Is Safe

(A football article written by honorary Marshallite, Ken Belson)

AND LAST BUT NOT LEASED:

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