CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 8/20/2022

This chapter for the Covid saga is fading locally. Harrison County is back in a “Low Danger” Zone. 

Have a nice weekend, but don’t monkey around. 

FROM EPIDEMIOLOGIST:

Why older people are at higher risk for severe COVID-19

(J. Harris: A brief, concise review of immunology that even I can almost understand. Incidentally, I think I’ll keep my nasal iodine solution handy. Anyone can sign up for this informative series.)

HOPKINS’ COVID WEBB SITE (CLICK)

J. Harris: Anyone can sign up for Hopkins viral sites. Free! They are quick to read and very thorough and the most complete and extensive source of information. They send out news several times per week. We haven’t talked about Hopkins’ services to humanity in the last couple of years. 

FROM HOPKINS SUGGESTIONS:

1. In an Effort to Address its Missteps During Covid, CDC Plans an ‘Ambitious’ Agency Overhaul (STAT News) The Centers for Disease Control and Prevention, an agency that has had its reputation battered by a series of missteps in the Covid-19 pandemic, and a slow response to the monkeypox outbreak, will undergo an “ambitious” overhaul, Director Rochelle Walensky announced Wednesday. In an email to staff, Walensky said the renewal effort will focus on making the agency more nimble and responsive to needs that arise in health emergencies. The priority will be to gather data that can be used to rapidly dispense public health guidance, rather than craft scientific pape

FROM BECKERS:

1. Pfizer’s antiviral drug could result in ‘Paxlovid mouth’

2. Century-old tuberculosis vaccine may protect against COVID-19, study finds

”A tuberculosis vaccine that’s 100 years old and costs less than a dollar per dose could have a shot at preventing COVID-19 infections, according to researchers from Boston’s Massachusetts General Hospital…

In a 15-monthslong trial conducted before COVID-19 vaccines were available, the researchers administered three jabs of the Bacillus Calmette-Guerin vaccine, which was first introduced in 1921, to 144 patients with Type 1 diabetes. The vaccine garnered 92 percent efficacy, according to an Aug. 16 press release….

The results, which are published in the Cell Reports Medicine journal, also showed high efficacy in combating other infectious diseases. The researchers hope to start a larger trial to further test the tuberculosis vaccine’s efficacy among patients with Type 1 diabetes, a group that has a high risk for severe illness from COVID-19.” 

FROM TIME MAGAZINE:

Your Kid’s School Needs Better Ventilation to Help Keep COVID-19 in Check

”…some parents and experts are trying to improve ventilation in schools, since better air quality in buildings can reduce COVID-19’s spread and even improve other health outcomes. But, despite readily available resources—including millions of dollars in funding from the federal government—many schools have not invested in upgrading their air quality…. experts recommend that classroom ventilation meets the threshold of six air changes per hour, meaning new, clean air is circulating through the room every ten minutes. …School leaders need to learn more about air quality issues in order to understand how important they are, experts say. Even if an administrator recognizes the value of better ventilation, they likely need to hire an HVAC expert to examine existing building systems, then vet that expert’s recommendations and evaluate potential upgrades—all of which may be “far beyond their area of expertise..”

TO ANSWER A QUESTION MANY ARE ASKING:

Do You Need a Polio Booster Shot?

AND LAST BUT NOT LEASED:

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 8/16/2022

HELLO, AREA ICU CASES HAVE INCREASED. HARRISON COUNTY IN “MODERATE” DANGER ZONE. MASKS IN CROWDS RECOMMENDED.

A reaction to the CDC guidance [READ HOW AN EXPERT FAMILY PERSON PLANS TO HANDLE COVID NOW]

(J. Harris: In my medical opinion, this young Ph.D epidemiologist is wise beyond her years. She writes beautifully while clearly exploring and explaining pertinent and practical medical and public health issues. My highest compliment is “ELEGANT,” and she is.)

FROM HOPKINS SELECTIONS:

1. COVID Rebound is Surprisingly Common — Even without Paxlovid (Nature) After the game-changing COVID-19 antiviral Paxlovid began to be used in late 2021, researchers noticed a perplexing trend. In some people taking the drug, symptoms and detectable virus vanish, only to mysteriously return days later. After months of grasping at straws, scientists are beginning to make some headway in understanding ‘Paxlovid rebound’. Two recent studies suggest that it is surprisingly common for SARS-CoV-2 to return in untreated cases of COVID-19, while hinting that the virus’s comeback is fiercer and more common in people who take Paxlovid.

2. Covid Vaccine Designed to Target Two Variants Approved for Use in UK (The Guardian) A vaccine designed to target two different forms of Covid has been approved by the UK regulator for use as booster jabs in people over the age of 18. Manufactured by the US firm Moderna, the vaccine targets not only the original coronavirus – as is the case for vaccines currently in use – but is designed specifically to target the Omicron variant BA.1, which fuelled a wave of Covid in the UK last winter. The UK is the first country to approve the bivalent vaccine, known as “Spikevax bivalent Original/Omicron”. It is now up to the UK’s Joint Committee on Vaccination and Immunisation (JCVI) to decide whether it will, as expected, be used in the planned autumn booster programme, expected to begin in September.

FROM BECKERS:

1. Longer Paxlovid course needed to prevent rebounds, experts say

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More Black Former N.F.L. Players Eligible for Concussion Payouts

Tests for dementia were rescored under the N.F.L.’s concussion settlement to avoid race-based criteria.

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Dozens of Black retired N.F.L. players will now be eligible for payouts worth hundreds of thousands of dollars from the league’s billion-dollar concussion settlement, reversing previous decisions made because of cognitive tests that used race-based measures to determine whether the players had dementia.

The decision, included in a status report filed by the settlement administrator that was entered into the court docket Thursday, came two years after two former players sued the league to end the use of race as a criterion in evaluating the players’ claims, a process known as “race-norming.”

The settlement administrator found that 646 players who had been tested for dementia but did not qualify for cash payouts could have their tests automatically rescored without using race as a criterion.

Of those, 61 were found to have moderate or severe dementia and may receive payouts worth $500,000 or more. The payouts vary based on a player’s age and the number of years he was in the league.

Another 246 former players were found to have mild dementia and will receive additional testing to monitor their conditions. Thousands of other players have qualified for examinations that will not use race as a factor; these players could qualify for payouts in the coming months and years.

The results were the latest chapter in the landmark concussion settlement that has resulted in about $1 billion in claims being paid to players with a range of cognitive and neurological diseases including dementia. For years, former players and their families have accused the league of making it difficult, if not impossible, to receive payouts from the settlement, and they have claimed that the plaintiffs attorney who represents every player in the class-action settlement was not doing enough to fight for them.

Click here to read the complete story 

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 8/12/2022

FROM THE EPIDEMIOLOGIST EXCELLENT ARTICLE FOR EDUCATORS AND PARENTS

A plan for the upcoming school year

(J. Harris: READABLE)

FROM BECKERS: 

 CDC UPDATES CURRENT: AUGUST 11, 2022:

”...While the CDC did away with quarantine recommendations, the new guidance says people exposed to COVID-19 should wear a high-quality mask for 10 days and get tested on day five…he new COVID-19 recommendations focus on mitigating the risk of severe disease, rather than infection itself…We’re in a stronger place today as a nation, with more tools — like vaccination, boosters and treatments — to protect ourselves and our communities, from severe illness from COVID-19…This guidance acknowledges that the pandemic is not over but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives.”

FIVE CDC UPDATES

1. The guidance underscores the importance of staying up to date with vaccination, “especially as new vaccines become available.” Omicron-targeted vaccines are expected to be available in the fall.2. The six-foot standard for social distancing is no longer an explicit recommendation. The guidelines place less emphasis overall on physicial distancing as a key measure to avoid exposure, instead describing it as “just one component of how to protect yourself and others.” The updated recommendations place more onus on individuals to assess the risks and take more precautions in particular settings, such as crowded indoor spaces.

3.  The CDC no longer recommends routine screening of people without symptoms in most community settings, including schools4. Isolation guidance for people with COVID-19 remains the same: Isolate for at least five days at home and wear a high quality-mask when around others. Isolation may be ended after five days if a person is fever-free for 24 hours without medication and symptoms are improving, though a mask should be worn through day 10. Immunocompromised people and those who had more severe illness should isolate through day 10. 

5. The FDA on Aug. 9 released a safety alert advising people to perform repeat testing to avoid false negative results when using at-home rapid antigen tests. If a symptomatic person tests negative, they should test again 48 hours later. People without symptoms who may have been exposed should take up to three tests after receiving their first negative result, each separated by a 48-hour period….Be aware that at-home COVID-19 antigen tests are less accurate than molecular tests,” the FDA said. “COVID-19 antigen tests may not detect the SARS-CoV-2 virus early in an infection, meaning testing soon after you were exposed to someone with COVID-19 could lead to a false-negative result, especially if you don’t have symptoms. This is the reason why repeat testing is important.”

HOPKINS SUGGESTS:

1 Omicron Subvariants Gain More Ground, Including BA.4.6 in the Midwest (CIDRAP) Though the 7-day average for new daily COVID-19 cases is slowly declining, the more transmissible and immune-evasive Omicron subvariants became even more dominant last week, with an offshoot called BA.4.6 gaining traction in some Midwestern states. Health officials brace for a possible spike in activity after school starts and people begin gathering more indoors in the fall. In its weekly variant proportion updates, the U.S. CDC said the proportion of BA.5 viruses in sequenced samples last week rose from 84.5% to 87.1%, while BA.4 declined slightly, from 8.2% to 6.6%. However, the proportion of BA.4.6 viruses rose from 4.2% last week to 4.8% this week. The subvariant has also been reported in other US regions, especially in the east.

2. Community transmission in the US is primarily driven by the Omicron BA.5 sublineage. BA.5 is now projected to account for 87.1% of sequenced specimens. The BA.4 sublineage accounts for about 6.6% of cases, while the BA.4.6 sublineage accounts for 4.8% of cases. Together, BA.2.12.1 and BA.2 now account for only about 2.9% of cases. According to the estimate, Omicron variants represent all new cases in the US.

3. EDUCATORS MIGHT NOTE:

INDOOR AIR WORKSHOP The Environmental Health Matters Initiative (EHMI) of the National Academies of Sciences, Engineering, and Medicine will host its first virtual workshop in a 3-part series on Indoor Air Management of Airborne Pathogens on August 18 from 11:30 am to 3:30 pm EDT. These workshops—follow ups to the 2020 workshop on the airborne transmission of SARS-CoV-2—will explore strategies needed for airborne disease control and risk reduction in enclosed places by drawing on accumulated community and institutional knowledge, on-the-ground observations of indoor environments management during the pandemic, and novel and promising scientific discoveries. For more information and to register, visit https://www.nationalacademies.org/event/07-21-2022/indoor-air-management-of-airborne-pathogens-lessons-practices-and-innovations.

 4. IMMUNE EVASION Immune escape, or immune evasion, is driving the COVID-19 pandemic’s extended life cycle. As the virus continues to infect humans, it will mutate and likely adapt to find its way around existing levels of vaccine-induced and natural immunity. The scientific community is not surprised that SARS-CoV-2 continues to evolve to evade our ever-changing immune systems, as many other viruses do the same. But because SARS-CoV-2 is a new virus to humans, attention is focused on emerging new variants and global anxiety is heightened, wondering what variant lies around the corner. 

Currently, there are many questions about whether the Omicron subvariants BA.2.75 or BA.4.6 will cause the next wave of infections. BA.2.75, which has been circulating widely in India for more than a month and has been detected in at least 20 other countries, does not currently appear likely to outcompete BA.5, the global leader of SARS-CoV-2 variants. BA.4.6, which is growing in prevalence in the US and Europe, appears to be just as transmissible as BA.2.75, but it remains unclear whether either subvariant will become predominant. Scientists continue to worry that either one of these Omicron subvariants, or an as-yet undetected variant, could gain global, regional, or local dominance. This cycle of new variant-driven waves, each with increased immune evasion, describes the global experience with COVID-19 to date, and many assume the pattern will continue into the future. This is what allowed BA.4 and BA.5 to spread widely despite widespread recent infections with the Omicron BA.1 and BA.2 subvariants. 

In addition to increased variant surveillance, more must be done to help further prepare for future increases in COVID-19 cases. The first priority is to address current infections by reducing transmission of circulating virus, limiting its chances to adapt and evade existing levels of immunity. However, limiting transmission is increasingly challenging, as many countries roll back mitigation measures and as funding for testing and vaccination programs dwindles. Many appear to be placing hope in the next generation of SARS-CoV-2 vaccines, which are expected to protect against a wider array of viral lineages. Several studies, including one conducted in non-human primates published this week in Science Translational Medicine, suggest that these vaccines may be a possibility, and they may be able to provide protection that extends to other coronaviruses, so-called pancoronavirus vaccines. While those vaccines remain a distant goal, manufacturers continue to work on current vaccine platforms that enable the fast production of variant-specific boosters. The CEO of Moderna recently compared the future of SARS-CoV-2 vaccines to the iPhone’s constant updates, with new generations developed as more data and technologies become available. 

5. NOVAVAX VACCINE Last month, the US FDA granted emergency use authorization (EUA) for a protein-based COVID-19 vaccine made by US-based manufacturer Novavax. Many public health advocates hoped that the vaccine’s authorization would lead to an increase in vaccinations among unvaccinated populations, having faith that the more traditional protein-based vaccine technology would ease concerns surrounding vaccination with vaccines using newer mRNA platforms. However, in the month since the EUA was issued, only about 7,400 doses have been administered in the US, with only 2,300 people receiving a 2-dose primary series using Novavax. According to the US CDC, 332,000 doses of the vaccine have been distributed nationwide. Originally, the vaccine was available at only 385 locations, although that number has grown to 986 sites. Notably, more than 53,000 locations have been used to provide other vaccinations throughout the pandemic. The limited uptake of the Novavax vaccine has received criticism given the large investment the company received from Operation Warp Speed. While it is too early to decide the fate of the vaccine in the US, Novavax recently reset its sales expectations, halving its forecast to US$2 billion to US$2.3 billion from US$4 billion to US$5 billion. 

AND LAST BUT NOT LEASED:

THE NORWEIGIAN REPORTS 1.5 INCHES OF RAIN. WHO SAYS PRAYER WON’T HELP. 

NEVER MIND. DON’T ANSWER THAT.

”THE DEVIL MADE ME DO IT:”

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 8/9/2022

COVID LEVELS IN OUR AREA ARE MODERATE AND HIGH 

SMITH AND CASS COUNTIES ARE HIGH.    USE CAUTION

FROM BECKERS:

Why US may be in for a severe flu season

”…Countries in the Southern Hemisphere are experiencing a severe flu season, which may be a harbinger of what’s to come for the U.S. this fall…

Health experts often look to the Southern Hemisphere’s flu season, which typically runs from April to September, as a predictor for the Northern Hemisphere’s upcoming flu season…Australia is facing its worst flu season in five years, with infections spiking for the first time since the COVID-19 pandemic began, according to data from Australia’s health department. Flu season also started earlier than usual in the country, giving the virus more time to circulate and infect the population….

Pharmacies and physician’s offices are expected to receive vaccine shipments in the coming weeks for the nation’s annual fall flu shot campaign. …”

Examination of SARS-CoV-2 In-Class Transmission at a Large Urban University With Public Health Mandates Using Epidemiological and Genomic Methodology

Findings  In this cohort study of 140 000 class meetings at a large US university, there were over 850 cases of SARS-CoV-2 infection identified through weekly surveillance testing of all students and faculty on campus during the fall 2021 semester. There were 9 instances of potential in-class transmission identified as identical lineages confirmed by SARS-CoV-2 genome sequencing, and none of these instances were confirmed to be in-class transmission.

Meaning  These results suggest that in-class transmission of SAR-CoV-2 in an urban university with masking and vaccine protocols in-place was negligible.

FROM JAMA:

1. Just the Plague: Reflections on State Control of Infectious Outbreaks

(J. Harris: A book review. The book is available at Amazon only in paperback at this time. I will wait for Kindle version.)

2. Animal Reservoirs—Where the Next SARS-CoV-2 Variant Could Arise

”…Understanding how the virus jumps between species—known to ecologists as a “spillover” event—is complicated but potentially critical in ending the COVID-19 pandemic….[including animals such as } big cats like tigers and lions but also domestic cats and dogs, gorillas, white-tailed deer, hamsters, farmed mink, otters, anteaters, manatees, hippopotamuses, and others… Interspecies transmission can produce new animal reservoirs where the virus can multiply or persist for prolonged periods, creating the potential for the pathogen to transmit back to human populations…”

(J. Harris: It is safer to sleep with a tomato than with a pet!)

3.Rate of SARS-CoV-2 Reinfection During an Omicron Wave in Iceland

”…Our results suggest that reinfection is more common than previously thought. Now the key question is whether infection with the Omicron variant will produce better protection against Omicron reinfection, compared with other variants…”

4. Association of Receiving a Fourth Dose of the BNT162b Vaccine With SARS-CoV-2 Infection Among Health Care Workers in Israel (Repeat I think)

”…In this multicenter cohort study of 29 611 health care workers in Israel, the breakthrough infection rate among those who received 4 doses was 6.9% compared with 19.8% in those who received 3 doses…”

Measuring work-related risk of COVID-19: comparison of COVID-19 incidence by occupation and industry – Wisconsin, September 2020-May 2021

”…During September 2020 – May 2021, the Wisconsin Department of Health Services collected occupation and industry data as part of routine COVID-19 case investigations. Adults aged 18-64 years with confirmed or probable COVID-19 in Wisconsin were assigned standardized occupation and industry codes….

Results

An estimated 11.6% of workers (347,013 of 2.98 million) in Wisconsin, ages 18-64 years, had COVID-19 from September 2020 to May 2021. The highest incidence by occupation (per 100 full-time equivalents) occurred among personal care and services workers (22.4), healthcare practitioners and support staff (20.7), and protective services workers (20.7). High risk sub-groups included nursing assistants and personal care aides (28.8), childcare workers (25.8), food and beverage service workers (25.3), personal appearance workers (24.4), and law enforcement workers (24.1). By industry, the incidence was highest in healthcare (18.6); the highest risk sub-sectors were nursing care facilities (30.5) and warehousing (28.5)…”

AND LASTLY:

My tolerance for idiots is extremely low these days. 

I used to have some immunity built up, but there must be a new strain out there?

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 8/4/202

COVID COUNTS ARE HIGH LOCALLY.

FROM THE NYT

1. By Jonathan Wolfe on 3 August:

”…Is the virus endemic?

Even though people across the world are trying to move on from Covid, it’s still here, all around us…Case in point: Half of all infections during the pandemic have taken place this year, … Given the current pace, it’s possible that more than 80 percent of all Covid cases will ultimately take place in 2022…

What do the coming months look like?

There are a lot of variables. [To] synthesize all of them, I would say that I think it’s likely that, for the foreseeable future, we’re living primarily with Omicron variants. That means the virus will find new ways to evade our immune response without totally eliminating the immune protections that we carried before….

In the fall, we will begin to see some limited rollout of new next-generation vaccines, but they won’t fundamentally change the trajectory of immune protection going forward. And we have very limited implementation of other social and political measures, such as mandating better air quality in schools and transportation systems and things along those lines….

”Where does that leave us? …That this is really an old person’s disease now. That was true at the beginning of the outbreak, but it’s becoming even more true now. It’s quite possible that we’ll see increasing relative vulnerability among the old, which is to say people who are in middle age are going to feel pretty safe living a totally normal life… But [older people]  may not ever. That’s because they have a much harder time building up immunity, which means they lose the benefits of the vaccines and previous exposure much more quicklyWe’re also seeing a significant death toll this year. We’ve more or less normalized it. We could have roughly equivalent numbers of especially elderly people dying as we did in the first years of the pandemic — and that’s tragic.”

FROM BECKERS:

Why we may be in ‘omicron land’ for a while

FROM HOPKINS SELECTIONS:Is the virus endemic?

Even though people across the world are trying to move on from Covid, it’s still here, all around us….attention to the US CDC’s guidance regarding isolation after COVID-19 diagnosis or a positive SARS-CoV-2 test. The CDC currently recommends isolation for a minimum of 5 days after the onset of symptoms or positive test. To end isolation, those who were symptomatic should wait until their fever has subsided for at least 24 hours and other symptoms are improving—and those leaving isolation should wear a mask in public through Day 10. Notably, the CDC indicates that individuals can test before they end their isolation, but the guidance emphasizes that testing is optional (ie, as opposed to recommended) for anyone who “wants to.” Those who elect to test and obtain a positive result should remain in isolation. The isolation and testing protocol implemented for President Biden went “above and beyond” the CDC recommendations, and CDC Director Dr. Rochelle Walensky indicated that the CDC must issue guidance that is feasible for most people to follow. Recent studies have demonstrated that many individuals continue to test positive for 6 days or longer, and most can shed the virus for 8 days or longer, which could enable them to infect others if they end isolation after 5 days. In light of this evidence, some experts have called on the CDC to revisit its guidance to slow transmission, particularly in light of the current Omicron surge.

2. ”… millions of people in the US have post-COVID-19 conditions, also known as long COVID. The US CDC estimates that nearly 1 in 5 individuals who have had COVID-19 continue to report long-term symptoms lasting 3 months or longer. Many of them have left their jobs because they have symptoms, such as fatigue or brain fog, that hinder their ability to perform daily or work tasks. Under federal guidance, people with long COVID can qualify for disability, meaning employers must offer accommodations to their workers. But many people with long COVID say negotiating accommodations or finding support from social assistance programs remains difficult. Some experts advocate for a better definition of the condition to facilitate diagnosis, more robust educational campaigns to warn people of the risk for long COVID, and more support for people with the condition. More than 100,000 US residents are diagnosed with COVID-19 everyday, some for a second or third time, and evidence suggests people who are infected more than once are at greater risk of long-term health consequences. It will be years before we fully understand the disease’s impacts on the public health, employment, and health coverage landscapes.

FROM THE ATLANTIC

This COVID Summer Is Nothing Like the Last One

”…We need multiple approaches to reduce transmission. It’s going bonkers right now, and this is not a sustainable way to coexist with this virus. I’m not saying that people need to have mask mandates forever, but when transmission rates are this high, it is a good idea to think about masking, to think about testing more often, paying attention to who is up-to-date on their vaccines and making sure that our approaches are complementing each other…

”It is true that hospitalization and death rates are down, but the more people you have infected, even a very small percentage can turn into an untenable number of hospitalizations and deaths. And every infection carries the risk of long COVID, or taking people away from school or work or their family. And the worrisome thing is, for the past few months, we’ve been at this bizarre plateau in terms of case counts not really coming back down and looking better…There’s not a lot of data to go off, so I’m going to be tentative here. I think we can expect them to be an improvement, but I can’t tell you if it’s going to be a 5 percent improvement or a 60 percent improvement. The other big asterisk on this is, what’s going to be around in September? Is it still going to be BA.5, is it going to be BA.6, or is it going to be another variant entirely?…We need multiple approaches to reduce transmission. It’s going bonkers right now, and this is not a sustainable way to coexist with this virus. I’m not saying that people need to have mask mandates forever, but when transmission rates are this high, it is a good idea to think about masking, to think about testing more often, paying attention to who is up-to-date on their vaccines and making sure that our approaches are complementing each other.

FROM EPIDEMOLOGIST:

How is monkeypox spread?

(J. Harris: This is concise and short. It will be all I have to say about Monkey Pox).

FROM THE LA TIMES:

Coronavirus Today: Experts are taking a softer stance on masking; it’s a different pandemic

(J. Harris: This is a good updated mask article. The majority of my readers are older folks with more than a few preexisting maladies — just like I have. I’m not going to goof off now and take careless chances at this late date. In addition, I don’t want to be dragging ass around in my last years with Long Covid. Masks and vaccinations and prudence have worked so far. Besides, I have to take care of both The Norwegian and Milton.)

FROM THE NEJM:

Grieving in a Pandemic

Viral and Symptom Rebound in Untreated COVID-19 Infection

”… Findings: In both the primary and secondary analyses, 12% of participants had viral rebound. Viral rebounders were older than non-rebounders (median 54 vs 47 years, P=0.04). Symptom rebound occurred in 27% of participants after initial symptom improvement and in 10% of participants after initial symptom resolution. The combination of high-level viral rebound to ≥5.0 log10 RNA copies/mL and symptom rebound after initial improvement was observed in 1-2% of participants. Interpretation: Viral RNA rebound or symptom relapse in the absence of antiviral treatment is common, but the combination of high-level viral and symptom rebound is rare.”

FROM JAMA

Association of Receiving a Fourth Dose of the BNT162b Vaccine With SARS-CoV-2 Infection Among Health Care Workers in Israel

Question: 

 Was there a benefit of vaccinating health care workers with a fourth dose of BNT162b2 vaccine during the Omicron variant outbreak of the COVID-19 pandemic?

Findings  In this multicenter cohort study of 29 611 health care workers in Israel, the breakthrough infection rate among those who received 4 doses was 6.9% compared with 19.8% in those who received 3 doses.

Meaning  These findings suggest that a fourth vaccine dose was effective in preventing breakthrough COVID-19 infections in health care workers, helping to maintain the function of the health care system during the [OMICRON] pandemic.

AND LASTLY, A SIGN SENT TO ME BY A CERTAIN NORWEGIAN:

A recent study has found women who carry a little extra weight live longer than men who mention it. 

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 7/25/2022

COVID State of Affairs: July 25 Katelyn Jetelina

(J. Harris: Great summary, readable. I am a paid subscriber.)

From THE NYT SATURDAY:

1. Combined nasal and throat testing swabs would detect more Omicron infections, two papers suggest.

”…coronavirus tests that analyze both nasal and throat swabs … pick up more Omicron infections than those that rely on just a nasal swab….

The first paper focuses on 14 people who enrolled in the study before or at the same time that their infections began, allowing the researchers to capture the earliest stage of infection….This group of participants provided a total of 260 nasal swabs, 260 throat swabs and 260 saliva samples over the course of their infections, allowing the scientists to make multiple comparisons between the amount of virus in different specimens and people at different times…

The researchers found significant differences in the viral load of different sample types from the same individuals….

In most participants, the virus was detectable in saliva or throat swabs before it was detectable in nasal swabs. “You can have very high, presumably infectious, viral loads in throat or saliva before nasal swabs,…”

2. New sub-variant ‘Centaurus’ discovered in Australia | Coronavirus | 9 News Australia

(J. Harris: It was hoped that the BA2.75 which started in India would not be an important varisn. Now called “Centaurus” in Australia, it isn’t as deadly as some variants, but much like BA .5 in the US, it is filling up some of the hospitals. Most of the world’s deaths from Covid are in folks over about 74.)

FROM LOCAL EPIDEMOLOGIST:

1. NORVAX: MIX AND MATCH DATA. PLUS SUMMARY OF THE NEW “OLD” VACCINE

1. 3.  Time-Release Microparticles Could Deliver “Self-Boosting” Vaccines (GEN) Most vaccines, from measles to COVID-19, require a series of multiple shots before the recipient is considered to be fully vaccinated. To make that easier to achieve, MIT researchers have developed microparticles that can be tuned to deliver their payload at different time points, and which could be used to create what the scientists describe as “self-boosting vaccines.” Using these particles, which resemble tiny coffee cups sealed with a lid, researchers could design vaccines that would need to be given just once, and would then “self-boost” at a specified point in the future. The particles can remain under the skin until the vaccine is released and then break down, just like resorbable sutures. The same strategy could also feasibly be used to deliver a range of other therapeutics, including cancer drugs, hormone therapy, and biologic drugs.

2. Polio: An unfortunate reminder of the decline in routine vaccinations

(J. Harris: We have the first acute polio case in the US in quite a while.)

From THE CDC:

 Correlation Between Clinical and Wastewater SARS-CoV-2 Genomic Surveillance, Oregon, USA (CDC EID) SARS-CoV-2 variant proportions in a population can be estimated through genomic sequencing of clinical specimens or wastewater samples. We demonstrate strong pairwise correlation between statewide variant estimates in Oregon, USA, derived from both methods (correlation coefficient 0.97). Our results provide crucial evidence of the effectiveness of community-level genomic surveillance.

FROM JAMA:

1. Effect of Text Message Reminders and Vaccine Reservations on Adherence to a Health System COVID-19 Vaccination Policy

”Question  Can a behavioral nudge delivered through text messages with a reserved date for vaccination over a 2-week period accelerate employee adherence with a health system COVID-19 vaccination policy?

Meaning  This randomized clinical trial found that a behavioral nudge delivered by text message with a reserved date for vaccination accelerated adherence to a health system COVID-19 vaccination policy; however, other approaches may be needed to change overall adherence rates by the time of the policy deadline.”

2. Association Between Vaccination and Acute Myocardial Infarction and Ischemic Stroke After COVID-19 Infection

This study found that full vaccination against COVID-19 was associated with a reduced risk of AMI [HEART ATTACK] and ischemic stroke after COVID-19. The findings support vaccination, especially for those with risk factors for cardiovascular diseases.

3. Updated US Infection- and Vaccine-Induced SARS-CoV-2 Seroprevalence Estimates Based on Blood Donations, July 2020-December 2021

”…In this study of US blood donations, the combined seroprevalence from infection or vaccination reached 94.7% by December 2021. Despite this, record levels of infection and reinfections were reported as the Omicron variant became predominant in early 2022.2 The high infection rates are likely related to increased transmissibility and enhanced immune escape mutations of the Omicron variant, along with waning protection from previous vaccination and infection.3-5 During 2021, the infection-induced seroprevalence increased more in regions with low vaccination rates compared with those with high ones. The ability of SARS-CoV-2 variants to cause widespread transmission in the setting of high seroprevalence illustrates the value of COVID-19 vaccines, including recommended booster doses, to maximize protection.

FROM HOPINS SUGGESTIONS:

1. “…Published July 19 in Science, a study of spike protein function and neutralizing capability of 7 different SARS-CoV-2 vaccines against Omicron sublineages shows that a large number of the sublineage mutations lead to enhanced ACE2 binding and reduced plasma neutralizing activity. However, homologous or heterologous boosters markedly increased neutralizing antibody titers against BA.1, BA.2, BA.2.12.2, and BA.4/5 across all vaccines evaluated to provide sufficient protection against Omicron-induced severe disease. The vaccines evaluated included mRNA vaccines from Moderna and Pfizer-BioNTech, viral-vectored vaccines from J&J-Janssen, AstraZeneca-Oxford, and Sputnik V, as well as the Novavax and Sinopharm vaccines that use different platforms.

ADDITIONALLY FROM SCIENCE ARTICLE: ”…The recent evaluation of intranasal vaccine administration could also be important to not only prevent severe disease but also curtail viral infection and transmission through induction of mucosal immunity (75–78). For these reasons, it is important to monitor new variants, assess the effectiveness of currently available vaccines, and continue to test and implement new vaccination strategies that may provide stronger, longer lasting, or broader protection against SARS-CoV-2 and the entire sarbecovirus subgenus…”

2. US PANDEMIC PREPAREDNESS The administration of US President Joe Biden is reorganizing the US Department of Health and Human Services to elevate the Office of the Assistant Secretary for Preparedness and Response (ASPR) from a staff division into an independent operating division—similar to the US CDC, FDA, and NIH—responsible for leading the nation’s responses to future pandemics and health emergencies. Under the reorganization, ASPR will now be known as the Administration for Strategic Preparedness and Response, and efforts to stand up the new division will be phased in over the next 2 years. ASPR oversees the Strategic National Stockpile, the national Medical Reserve Corps, and contracts for and distribution of vaccines and certain medicines in health emergencies. Though many current and former HHS officials welcomed the move, other experts say that shifting some health emergency coordination responsibilities to ASPR could undercut response efficacy, create confusion and tension, and does not address ongoing challenges at CDC, which has much closer relationships with states. 

3. Prior Omicron Infection Protects Against BA.4 and BA.5 Variants (Nature) The Omicron BA.4 and BA.5 subvariants of SARS-CoV-2 have proven to be stealthier at evading people’s immune defences than all of their predecessors. But recent research shows that previous infection with an older variant (such as Alpha, Beta or Delta) offers some protection against reinfection with BA.4 or BA.5, and that a prior Omicron infection is substantially more effective. That was the conclusion of a study that evaluated all of Qatar’s COVID-19 cases since the wave of BA.4 and BA.5 infections began1. The work, which was posted on the medRxiv preprint server on 12 July and has not yet been peer reviewed, feeds into broader research on “how different immunities combine with each other”, says study co-author Laith Abu-Raddad, an infectious-disease epidemiologist at Weill Cornell Medicine-Qatar in Doha.

FROM SCIENTIFIC AMERICAN:

People with Long COVID May Still Have Spike Proteins in Their Blood

”...this spike protein found in the blood could be a “biomarker,” specifically for long COVID…”

”… researchers still haven’t pinned down what causes the condition or how to treat it…..Now researchers may have found a marker for the disabling condition: a piece of SARS-CoV-2, the virus that causes COVID, floating around in the blood of some long COVID sufferers well after their initial infection… detecting a fragment of SARS-CoV-2 in blood samples from long COVID sufferers up to a year after their original infection. The fragment is a spike protein, one of the protrusions around the outside of SARS-CoV-2 that give this coronavirus its namesake corona, or crownlike appearance. During an initial COVID infection, the spike protein typically breaks off into smaller pieces when it penetrates human cells, but the spike proteins observed in this study were still in one piece. The findings have not yet been peer-reviewed….“If you had an infection, and you cleared it, then normally, you would not see [the spike protein] because all the antibodies you produced would clear everything that enters the bloodstream,… Instead, …tissues such as those in the gut and brain could be a haven for SARS-CoV-2 within the body, preventing long COVID patients from fully clearing their infections and acting as a source of spike proteins. “Maybe the virus can just persist there. It evades the immune system somehow.”……[A] “The presence of circulating viral proteins may be helpful to identify which subset of long COVID patients might have the persistent viral etiology”—the version of long COVID caused by the ongoing presence of SARS-CoV-2 in the body—…The rest of the long haulers might suffer from other causes.” These other causes could include… [B] an overblown immune response that leads COVID patients’ body to develop immune proteins—“autoantibodies”—that attack its own cells in the same way they would attack an intruder such as a virus or bacterium. These autoantibodies have been found in people’s body during an initial COVID infection, as well as in the bodies of some long COVID patients…. [C]Another possibility is that a COVID infection makes people more susceptible to other viruses already present in the body, such as the Epstein-Barr virus. This pathogen lies dormant in most people but has been found reactivated in some long COVID patients…

FROM REUTERS:

Oral vaccine shows promise; hypertension ups COVID hospitalization risk

FROM BECKERS

BA.2.75 a ‘scariant,’ not the next variant to worry about, experts say

While there will likely be new COVID-19 variants to worry about in the future, omicron relative BA.2.75 is not the next big one to fret over, experts predict…

“BA.2.75 is a scariant. It’s not spreading anywhere besides a couple of provinces in India without BA.5 to compete with,” Eric Topol, MD, founder and director of the Scripps Research Translational Institute in San Diego, said in a July 19 tweet, citing a graph based on data from  global data-sharing virus platform GISAID that indicates the strain hasn’t spread much outside of several states in India. “There will be other new variants to be concerned about, but it doesn’t look like this is one of them.” 

As new variant spreads, a crucial drug to protect the most vulnerable goes vastly underused

(J. Harris: An IV drug against Covid for immunocompromised patients.)

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 7/21/2022

HOT OFF THE PRESS AND PERTINENT:

FROM THE NYT:

A guide to BA.5

”The Covid virus has a Darwinian quality. As variants emerge, they compete with one another to become dominant. The most contagious variants tend to win the competition because they can spread more quickly. It’s survival of the fittest...

That is why the virus has become more contagious over time. Today, the most contagious form of Covid yet — the BA.5 subvariant — is spreading around the globe. “It looks as if we are unable to control it,” Dr. Charles Chiu of the University of California, San Francisco, told The Times…In the U.S., cases have surged recently, as has the number of hospitalized patients with Covid (although some of them were admitted for other reasons and happened to test positive for the virus while in the hospital)…”

(J. Harris: And now President Biden has Covid.)

FROM HOPKINS COMPLETE REPORT:

COVID-19 Situation Repor [ AN UP TO DATE COVID SUMMARY]

Contributors: Clint Haines, MS; Noelle Huhn, MSPH; Amanda Kobokovich, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS.

”…CONCERN OVER BA.5 SUBVARIANT As the Omicron subvariant BA.5 drives increases in COVID-19 cases and hospitalizations in several regions and countries worldwide, health officials are, for the most part, holding back on sounding alarms. In the US, where the average number of cases and hospitalizations are at their highest levels since February, many state and local health authorities are characterizing the increase in cases as concerning but not disturbing, with many saying repeated warnings about COVID-19 surges are falling on pandemic-fatigued ears. However, US health officials are speaking out. White House COVID-19 Coordinator Dr. Ashish Jha has warned the BA.5 subvariant is the most immune evasive variant yet, urging US residents to stay up to date on their vaccines and expressing support for the reinstatement of mask mandates. Chief Medical Advisor to the US President Dr. Anthony Fauci called on eligible people to get vaccine boosters and said a decision about boosters for those under age 50 likely will soon be announced. In Europe, the WHO announced today that COVID-19 case numbers have tripled and hospitalizations have doubled across Europe over the past 6 weeks. WHO Europe Director Dr. Hans Kluge warned that people should not underestimate BA.5, calling on nations to bolster vaccine uptake and require mask wearing.

A dearth of data is complicating the true picture of how big BA.5-driven surges are, or will get, as publicly reported data has become less common due to the closing of testing sites and an increase in at-home test use. Some experts estimate that for every 1 reported case, there are 7-10 unreported cases. Additionally, BA.5 has several spike protein mutations that make it better at infecting human cells and evading immunity from vaccination or previous SARS-CoV-2 infection. These capabilities allowed the subvariant to gain predominance in the US in just over 2 months, and it is now causing 3 of every 4 new COVID-19 cases in the nation. BA.5 is so adept at skirting immune defenses that many people who were recently infected with a different Omicron variant are becoming reinfected. Some studies suggest that reinfections could cause lasting symptoms. And as the virus continues to circulate, there is a real risk of further mutations, meaning we likely will be living with some form of the virus for the foreseeable future.

VACCINE BOOSTERS The administration of US President Joe Biden is pressing the need for US residents aged 50 years and older and immunocompromised individuals to get their second COVID-19 vaccine booster as soon as possible due to the immune-evasive nature of the Omicron subvariant BA.5, as well as said a decision is expected soon about additional booster doses for all adults. According to US CDC estimates, BA.5 is now responsible for 78% of all new COVID-19 cases. Officials have stressed that booster doses provide additional protection against earlier Omicron subvariants and potentially later subvariants as well. However, current boosters have not yet been updated to more specifically target Omicron and its subvariants, leaving a dilemma for eligible individuals about whether to get a booster now or wait for updated versions. Additionally, some experts wonder and worry whether BA.5 will even be the predominant variant in the fall, potentially making new boosters less effective than expected.

Only 34% of the US population aged 5 years or older has received their first booster dose, COVID-19 pandemic response funding is dwindling, and public appetite for continued vaccinations is diminishing. All of these uncertainties create a perfect storm for risk communication difficulties for experts and officials alike, uncertain of the best course to recommend and how to inform the public about their choices. Some experts hope that next-generation vaccines, such as nasal vaccines—which may have a higher chance of preventing not just severe disease outcomes but also infection—or pan-coronavirus vaccines—which may work better against future variants as well as current variants—may help to boost vaccination rates. Additionally, the CDC is expected to make an announcement about its recommendations for the newly authorized Novavax vaccine later today. Some hope the protein-based vaccine also will help boost vaccination rates among unvaccinated individuals.

In related news, the British government on July 15 announced that individuals aged 50 or older, certain individuals in high-risk professions, and individuals over age 5 who are more likely to be at risk of severe disease outcomes will be eligible for a second booster dose in the fall. The announcement broadens eligibility beyond those who are aged 65 years and older.

YOUNG CHILD VACCINATIONS US medical experts and public health officials are expressing concern over low demand for COVID-19 vaccinations for the youngest children under age 5 and those ages 5-11. States were charged with ordering doses commensurate to expected demand, but some states’ orders only cover a small fraction of their child residents. For example, Mississippi has ordered enough vaccine doses to cover only 16% of its under-5 population with 1 dose. Florida did not preorder any doses for its under-5 population. Many parents there are struggling to find medical practitioners and health systems, which were able to independently order doses, that can provide the shots. The impacts are highest among families in underserved areas and those who rely on government-run health services. However, other experts caution that some states’ initial orders may not reflect future demands and childhood COVID-19 vaccination coverage. They say several factors may change over time, such as available vaccine storage, rampant misinformation, limited initial appointment slots, pushback from parents, reimbursement and logistical challenges, and some practitioners preferring to wait for full FDA approval prior to delivering vaccinations to younger populations.

Relatedly, Europe also may soon be administering vaccines to young children, as the European Medicines Agency (EMA) on July 18 began reviewing Pfizer-BioNTech’s vaccine for use in children aged 6 months to 4 years. Notably, increasing vaccination rates among young children at this point in the global response is paramount and could provide high impact. A recent study in JAMA Network Open found that antibody levels in previously infected individuals waned quickly over the first 200 days post-infection, with levels dropping most quickly in children under age 6.

WESTERN PACIFIC REGION A new wave of COVID-19 cases has hit the Western Pacific region, largely driven by the BA.4 and BA.5 Omicron subvariants. In Japan, cases are rising in every prefecture. The 7-day rolling average of new daily cases has surpassed February’s Omicron peak, and transmission does not seem to be slowing. The situation was further complicated by a 3-day weekend that saw high levels of activity at beaches and other tourist hotspots. The Japanese government is now trying to balance keeping the nation running with few restrictions while preventing hospitals from becoming overwhelmed. Cases also are rising in South Korea, where experts are predicting 200,000 daily cases by late-August, which would amount to half of the nation’s previous Omicron wave in March.

Hospitals in several Australian states are reaching capacity under the nation’s latest surge. Experts warn that while many emergency rooms are overwhelmed, most areas of the nation remain weeks away from their expected peak hospitalization rates. The situation is further complicated by a worse than average influenza season. According to data from the New York Times, New Zealand—a nation famous for early successes against COVID-19—now has the third highest daily confirmed rate of cases per 100,000 people of all nations, after Brunei and San Marino. Experts are concerned that the strain of new cases could lead to a collapse of the nation’s healthcare workforce. As a result, New Zealand officials are urging a renewed sense of urgency around COVID-19 precautions, including masking and testing.

In China, approximately 264 million people across 41 cities are under full or partial lockdown as part of the nation’s zero-COVID policy. Health experts are worried that the zero-COVID policy could become difficult to maintain given the increased transmissibility of the Omicron BA.4 and BA.5 subvariants. Some larger Chinese cities are rolling out new measures, such as mass testing and intense lockdowns, to try to curb the spread of the virus. There are growing concerns that increased COVID-19 prevention measures could further destabilize a struggling global economy.

ECONOMIC IMPACTS Fears of a global economic recession are on the rise. The global economic web was unsettled earlier this year when Russia invaded Ukraine, lowering the availability of energy, fertilizer, and food supplies. However, the largest disruptor of economic growth is the ongoing COVID-19 pandemic. The early phases of the pandemic disrupted the production of goods and the availability of services when governments implemented lockdowns to prevent transmission of the SARS-CoV-2 virus. However, the lockdowns prompted those stuck at home to begin ordering enormous volumes of goods over the internet. The combination of laborers stuck at home plus sky-high demand resulted in a global supply chain crisis. The supply chain crisis pushed prices for goods and services higher, and some industries have taken advantage of the global instability and their market dominance to secure record-breaking profits. Additional factors impacting inflation in the United States include an aggressive stimulus initiative and hesitancy by the Federal Reserve to increase interest rates.

The COVID-19 pandemic also is responsible for economic downturns in other nations with a large impact on the global market, including China. China has adopted an aggressive and highly controversial zero-COVID policy that has led to forced lockdowns in many of the country’s large cities. The lockdowns have prevented normal industrial operations that supply a large portion of the world’s manufactured goods. The disruption in production and shipping of goods has significantly slowed growth for the Chinese economy, which shrank by 2.6% during the latest quarter. This slowdown, which denotes a growth of only 0.4% from the end of June last year, represents the lowest growth rate since early 2020, when the nation completely shut down to fight the pandemic. The latest economic reports have cast doubt on whether China can reach its 5.5% growth target for the year set by the ruling Communist party.

However, a couple of recent studies hint that aggressive COVID-19 responses might limit economic damage in the long-term. One study, an assessment of business closure policies in New York City published by the International Monetary Fund, set out to determine the impact of closures in specific industries on the spread of COVID-19. According to the results, reopening businesses early allowed New York City to recover functionality as an economic hub but at the cost of a large wave of infections in 2020. The study also found that an alternative policy that extended lockdowns made future travel safer and was ultimately more cost-effective. Another study, examining the impact of long COVID on the workforce of the UK, estimated that 80,000 people have left the UK workforce due to long COVID as of March 2022. According to the authors, continued pandemic waves will lead to more people missing work, losing jobs, or permanently leaving the workforce due to long COVID. While many experts agree that a zero-COVID policy is unrealistic, it is becoming rapidly apparent that pretending like the pandemic is over may also lead to long-term and impactful health and economic consequences.

GLOBAL VACCINE ACCESS Last month, the 12th World Trade Organization (WTO) Ministerial Conference agreed to a version of a proposal for a global intellectual property waiver to allow countries to more easily use patented technologies to develop COVID-19 vaccines. Originally proposed only a few months into the pandemic by India and South Africa, and endorsed by more than 100 other nations, the approved deal on a Trade-Related Aspects of Intellectual Property (TRIPS) waiver is much narrower in scope than the original proposal and likely comes too late to make a significant impact on vaccine access. The deal does not include intellectual property waivers for diagnostics, treatments, or other COVID-19-related medical tools, and it excludes countries with “existing” production capacity. The power imbalances in both the COVID-19 pandemic and the WTO negotiations are apparent, from vaccine nationalism to sluggish negotiations. But over the past 2 years, low- and middle-income countries (LMICs) from South America to Africa have worked to solidify plans to cooperate on mRNA technologies in order to develop and produce their own versions of vaccines for SARS-CoV-2 and other diseases. This effort to collaboratively develop an mRNA vaccine technology transfer hub, which is supported by the WHO and the US NIH, must overcome significant challenges but provides hope for a new model to enable more LMICs to overcome future disease outbreaks more effectively, without having to rely on high-income countries or corporations…”’

”CRUISE SHIPS The US CDC announced on July 18 that its COVID-19 Program for Cruise Ships is no longer in effect. Although the agency will continue to publish guidance to help cruise ships provide safer and healthier environments for crews and passengers, the color-coded chart and spreadsheet that detailed the level of spread on ships is no longer available. According to a statement in the webpage’s FAQ section, the CDC is ending the program because it depended on each cruise line having the same testing and screening guidelines, which now all differ among companies. However, cruise ships will continue to report COVID-19 cases to the CDC, and passengers have the option of directly contacting their cruise line for information on outbreaks aboard their ship.

*****

FROM LOCAL EPIDEMOLOGIST:

NORVAX: MIX AND MATCH DATA. PLUS SUMMARY OF THE NEW “OLD” VACCINE

1. 3.  Time-Release Microparticles Could Deliver “Self-Boosting” Vaccines (GEN) Most vaccines, from measles to COVID-19, require a series of multiple shots before the recipient is considered to be fully vaccinated. To make that easier to achieve, MIT researchers have developed microparticles that can be tuned to deliver their payload at different time points, and which could be used to create what the scientists describe as “self-boosting vaccines.” Using these particles, which resemble tiny coffee cups sealed with a lid, researchers could design vaccines that would need to be given just once, and would then “self-boost” at a specified point in the future. The particles can remain under the skin until the vaccine is released and then break down, just like resorbable sutures. The same strategy could also feasibly be used to deliver a range of other therapeutics, including cancer drugs, hormone therapy, and biologic drugs.

2. Correlation Between Clinical and Wastewater SARS-CoV-2 Genomic Surveillance, Oregon, USA (CDC EID) SARS-CoV-2 variant proportions in a population can be estimated through genomic sequencing of clinical specimens or wastewater samples. We demonstrate strong pairwise correlation between statewide variant estimates in Oregon, USA, derived from both methods (correlation coefficient 0.97). Our results provide crucial evidence of the effectiveness of community-level genomic surveillance.

FROM JAMA:

Mix-and-Match COVID-19 Boosters After Inactivated Virus Vaccine

(J. Harris: It works)

FROM THE DMN:

Dallas County moved its internal COVID-19 risk level to “extreme caution” as case counts and hospitalization rise

”…BA.5 is most similar to BA.2, another omicron subvariant that picked up speed in Texas in March, although it has a few additional mutations on its spike protein,…A BA.5 infection seems to come with the same symptoms as the original omicron strain, including headache, a sore throat, a runny nose, fever and fatigue.

While the loss of taste and smell were tell-tale signs of COVID-19 infection with the alpha and delta variants, they’re much less likely with infections from omicron and its subvariants. A May study from researchers at Virginia Commonwealth University found that chances of smell and taste loss were just 17% for omicron, compared to 50% for the alpha variant….There’s also the risk of long COVID, which can lead to sometimes debilitating symptoms like fatigue and neurological issues for months after an initial infection. It’s estimated that anywhere from 10% to 30% of COVID-19 patients might experience long COVID, according to the American Medical Association…CDC and other federal health officials have repeatedly said that people should get boosted now… go ahead and get it and not wait until the new versions of the vaccine are released, especially if you’ve got anything of significance that you’re planning in the next two or three months like a trip or a wedding,” he said. “You don’t want COVID to mess those plans up.”

Recommendations for avoiding COVID-19 in the red risk level

Wear a mask indoors when in public.

Stay up to date with COVID-19 vaccines, including booster doses.

Get tested if you notice any COVID-19 symptoms.

Increase ventilation when indoors by turning on fans or opening windows to increase air circulation.)

(J. Harris: I think avoid crowds and gatherings is very important in our area. Marshall  counts are down only because nobody is counting. The majority of the clinics and doctors and hospitals are not in Marshall. Fortunately, we have plenty of funeral homes.)

FROM REUTERS:

Australians urged to work from home as winter Omicron wave swamps hospitals

LASTLY:

And I just couldn’t resist this current ”photo”:

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 7/19/2022

 HELLO:  Take your time. 

You don’t have to read it all at once. Frequently, I find a need to include additional material for my physician readers. This is one of those editions. 

FROM BECKERS:

1. WHAT’S NEXT WITH COVID?

”…The dominance of the COVID-19 omicron variant continues to persist throughout the U.S., with subvariant BA.5 now accounting for 53.6 percent of the nation’s cases, but one expert says it could be hard to predict what will happen next….Right now, it’s all about which virus can outcompete the next one in terms of transmission. And in some cases, [the] ability to cause disease transmission is really a prime driver,…And that can be tied to its ability to evade immune protection to the host.”…’This is a stay-tuned moment’: Dr. Michael Osterholm on omicron uptick…”

2. Is it time to update the definition of ‘fully vaccinated’?

”…Based on the CDC’s definition, individuals are considered fully vaccinated against COVID-19 if they’ve received their primary series, which entails two doses of Pfizer or Moderna’s vaccine or one dose of Johnson & Johnson’s. …The CDC says people who receive recommended booster doses are “up to date” on their vaccines and best-protected, but While research shows BA.5 can evade immunity from vaccination and past infection, vaccines are still effective at protecting against severe disease, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said during a July 12 White House briefing.

, I’d like being  “fully vaccinated” as well as “up to date” on boosters with two of them — for a total of 4 jabs.  Now, I’m anxious to hear about the new, slightly altered designed vaccines to cover more variants. I’m also intherested in “mix and match” vaccinations with some of the more old fachion vaccines that seem to work. Obviously, I believe in the vaccines usefulness.)

3. COVID-19 admissions to rise through July + 2 more forecasts

4. Don’t wait for an omicron-tailored booster, experts warn

FROM JAMA:

1. Reactogenicity of Simultaneous COVID-19 mRNA Booster and Influenza Vaccination in the US

Key Points:

Question  Are systemic reactions more common after simultaneous administration of COVID-19 mRNA booster and seasonal influenza vaccines than after COVID-19 mRNA booster alone?

Findings  In this cohort study of self-reported data from 981 099 persons aged 12 years or older, simultaneous administration of a COVID-19 mRNA booster dose and an influenza vaccine was associated with 8% to 11% increases, respectively, in systemic reaction compared with COVID-19 mRNA booster alone. These differences were statistically significant.

Meaning  Findings from this study suggest that simultaneous administration of COVID-19 mRNA booster and influenza vaccines may be associated with increased likelihood of systemic reactions.

(J. Harris: Reactions were mild. See the following Opinion piece. I plan to take the flu shot with my next Covid booster.)

2. Reactogenicity and Concomitant Administration of the COVID-19 Booster and Influenza

 Vaccine

”…Although emphasis on the benefits of vaccination and minimization of their adverse events might seem a reasonable approach to limiting nocebo effects, negative information about the COVID-19 vaccine is common, and from an ethics standpoint, individuals have the right to complete information so they can decide whether they want to receive the vaccine. Some argue that the best approach to gaining the public’s trust is to offer both the positive and negative scientific evidence, with refutational 2-sided risk and benefit messages.6 Thus, while messaging could include the fact that serious reactions are rare even when the vaccines are given concomitantly, in light of these data, clinicians can confidently inform patients that concurrent administration of the COVID-19 booster and seasonal influenza vaccine is both safe and associated with only a slight increase in adverse events compared with the COVID-19 booster alone……

Substantial efforts have been undertaken to increase rates of COVID-19 vaccination and boosting; however, less effort has focused on influenza vaccination. Nationally, during the 2020 to 2021 season, influenza vaccination coverage was only 50.2%.7 Significant disparities have also been noted by race and ethnicity. Influenza results in significant morbidity annually which could be averted by increased vaccination coverage. Despite the limitations detailed above… the data reported by Hause et al3 suggest that the development of public health campaigns to increase dual vaccination should be undertaken. Although logistical challenges may serve as barriers to the implementation of dual vaccination, organizing for provision of both influenza vaccination and COVID vaccination within clinical settings and at community-based nonclinical venues would be advantageous and may increase the likelihood of uptake. Given the small increase in rate of adverse events reported by Hause et al,3 health care systems should be encouraged to develop routine and streamlined processes for coadministration of these vaccinations.

2. Incidence and Relative Risk of COVID-19 in Adolescents and Youth Compared With Older Adults in 19 US States, Fall 2020

”…These results suggest that, contrary to reports from Europe and Asia, infection rates and relative risk among US adolescents and youth exceeded that in older adults from the start of the COVID-19 pandemic through fall 2020, before vaccines were available.”

3. Effectiveness of Casirivimab-Imdevimab and Sotrovimab During a SARS-CoV-2 Delta Variant Surge

”Findings of this study suggest that casirivimab-imdevimab [Regen-Cov] and sotrovimab[ Xevudy] were both associated with reduced risk of hospitalization or death and had similar effectiveness, although they did not meet the prespecified criteria for statistical inferiority or equivalence.

(J. Harris: These are injectable Monoclonal Antibodies)

4. Association Between COVID-19 Booster Vaccination and Omicron Infection in a Highly Vaccinated Cohort of Players and Staff in the National Basketball Association

Individuals who were fully boosted experienced 608 confirmed SARS-CoV-2 infections and were significantly less likely to be infected than fully vaccinated individuals who were booster eligible and had not received a booster, who had experienced 127 confirmed infections  The secondary analyses evaluating symptomatic infection showed a similar association… No hospitalizations or deaths occurred. Omicron was the dominant variant, representing 93% of 339 sequenced cases.

Discussion | This study found that in a young, healthy, highly vaccinated cohort frequently monitored for SARS-CoV-2, booster vaccination was associated with a significant reduction in incident infections during the Omicron wave.

FROM HOPKINS SUGGESTIONS:

1. One Coronavirus Infection Wards Off Another — but Only If It’s a Similar Variant (Nature) Natural immunity induced by infection with SARS-CoV-2 provides a strong shield against reinfection by a pre-Omicron variant for 16 months or longer, according to a study1. This protection against catching the virus dwindles over time, but immunity triggered by previous infection also thwarts the development of severe COVID-19 symptoms — and this safeguard shows no signs of waning. The study… which analyses cases in the entire population of Qatar, suggests that although the world will continue to be hit by waves of SARS-CoV-2 infection, future surges will not leave hospitals overcrowded with people with COVID-19. The research was posted on the medRxiv preprint server on 7 July.

2. COVID-19 Pandemic Fuels Largest Continued Backslide in Vaccinations in Three Decades (WHO) The largest sustained decline in childhood vaccinations in approximately 30 years has been recorded in official data published today by WHO and UNICEF. The percentage of children who received three doses of the vaccine against diphtheria, tetanus and pertussis (DTP3) – a marker for immunization coverage within and across countries – fell 5 percentage points between 2019 and 2021 to 81 percent. As a result, 25 million children missed out on one or more doses of DTP through routine immunization services in 2021 alone. This is 2 million more than those who missed out in 2020 and 6 million more than in 2019, highlighting the growing number of children at risk from devastating but preventable diseases.

(J. Harris: Routine childhood and adult vaccinations and boosters must still be performed!)

3. FROM HOPKINS SUGGESTIONS TODAY:

The Durability of Natural Infection and Vaccine-induced Immunity Against Future Infection by SARS-CoV-2 (Proceedings of the National Academies) 

”…We estimated typical trajectories of waning and corresponding infection probabilities, providing the distribution of times to breakthrough infection for each vaccine under endemic conditions. Peak antibody levels elicited by messenger RNA (mRNA) vaccines mRNA-1273 [MODERNA] and BNT1262b2 [PFIZER] exceeded that of natural infection and are expected to typically yield more durable protection against breakthrough infections (median 29.6 mo; 5 to 95% quantiles 10.9 mo to 7.9 y) than natural infection (median 21.5 mo; 5 to 95% quantiles 3.5 mo to 7.1 y). Relative to mRNA-1273 and BNT1262b2, viral vector vaccines ChAdOx1[Oxford-AstraZeneca] and Ad26.COV2.S [Johnson & Johnson/Janssen] exhibit similar peak anti-S IgG antibody responses to that from natural infection and are projected to yield lower, shorter-term protection against breakthrough infection (median 22.4 mo and 5 to 95% quantiles 4.3 mo to 7.2 y; and median 20.5 mo and 5 to 95% quantiles 2.6 mo to 7.0 y; respectively)….’By quantifying the peak antibody levels for each vaccine relative to peak antibody levels following natural infection, we found that mean antibody response to the mRNA vaccines mRNA-1273 and BNT162b2 exceeded the mean antibody response to natural infection. In contrast, the mean antibody response to viral vector vaccines ChAdOx1 and Ad26.COV2.S was lower than the mean antibody response to these mRNA vaccines and similar to that of natural infection (Table 1)…These first estimates of the durability of immunity following vaccination provide essential knowledge to policy decision-making that can curb transmission long term, mitigating morbidity and mortality consequent to SARS-CoV-2 infection. Our quantitative estimates will be improved as data on long-term immunological responses to SARS-CoV-2 infection and vaccination are generated, providing increasingly precise knowledge that can refine our estimates not only for currently available vaccines, but for vaccines of the future as well….”

4. Investigating Trends in those who Experience Menstrual Bleeding Changes after SARS-CoV-2 Vaccination (Science Advances) Early in 2021, many people began sharing that they experienced unexpected menstrual bleeding after SARS-CoV-2 inoculation. We investigated this emerging phenomenon of changed menstrual bleeding patterns among a convenience sample of currently and formerly menstruating people using a web-based survey. In this sample, 42% of people with regular menstrual cycles bled more heavily than usual, while 44% reported no change after being vaccinated. Among respondents who typically do not menstruate, 71% of people on long-acting reversible contraceptives, 39% of people on gender-affirming hormones, and 66% of postmenopausal people reported breakthrough bleeding. We found that increased/breakthrough bleeding was significantly associated with age, systemic vaccine side effects (fever and/or fatigue), history of pregnancy or birth, and ethnicity. Generally, changes to menstrual bleeding are not uncommon or dangerous, yet attention to these experiences is necessary to build trust in medicine.

LASTLY:

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EastTexasExposed.com

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Scottsville Texas

75688

CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 7/15/2022

Note that Shreveport, Tyler, and Dallas are at a High Level of Covid danger. Follow “Daily /100,000 in the chart below.

CDC raises Dallas, Collin, Tarrant Counties’ COVID-19 risk level to red

5 things to know about the COVID-19 red risk level in North Texas

”…The CDC is at red…The CDC measures community spread level using a combination of three metrics: total new COVID-19 cases per 100,000 people, total new COVID-19 hospital admissions per 100,000 people, and percentage of inpatient beds occupied by COVID-19 patients…“Transmission is definitely increasing a lot, hospital numbers are going up, and people should be more cautious,” Huang said. “I wouldn’t say it’s an inconsistent message. I think they’ve got a different scoring system.

Mask up indoors

Under the red designation, which signifies high community spread, the CDC recommends everyone wear masks indoors when in public and on public transit. That a step up from the yellow designation, which recommends indoor masking only for people with a high risk of severe illness.

FROM THE NYT:

Novavax’s latecomer Covid-19 vaccine gets U.S. authorization.

”…The Food and Drug Administration on Wednesday authorized a Covid-19 vaccine developed by Novavax, a biotechnology company in Maryland that received significant federal funding to produce the shot. The vaccine will be a new option for Americans as vaccination rates stagnate…..After two years of development, the vaccine has finally overcome manufacturing problems to become the fourth shot to earn clearance in the United States….The two-dose vaccine was authorized as a primary immunization series for adults, rather than a booster, which is likely to limit its market at first. …Novavax’s vaccine, given in [two] doses spread three weeks apart, works differently from mRNA vaccines. It provokes an immune response with nanoparticles made up of proteins from the surface of the coronavirus that causes Covid-19. Similar protein-based vaccines have been widely used around the world for decades….The authorization comes with a warning that Novavax’s vaccine is linked to an elevated but small risk of forms of heart inflammation known as myocarditis and pericarditis. In their review of Novavax’s data, F.D.A. scientists identified six cases of the side effect in about 40,000 trial volunteers…In a number of clinical trials, Novavax found that its vaccine was highly protective against symptomatic infection. But the original formulation is probably not as effective against the Omicron variant, which emerged in November and has evaded some of the protection afforded by authorized vaccines from other companies…..The company says it plans to accelerate its research on shots specifically tailored for two newer versions of Omicron, known as BA.4 and BA.5….Trials have also shown that Novavax’s shot works well as a booster, and the company is expected to seek authorization for boosters soon. The company may then be able to attract vaccinated people who want to switch to a new option to protect against new variants…Dr. Moore speculated that some people might switch to Novavax for a booster this fall because it produced relatively few cases of aches, fatigue and other passing side effects in clinical trials. ..”

FROM YOUR LOCAL EPIDEMOLOGIST:

BA.5 is here. Time to ride the wave

”…BA.5 has arrived. An estimated 10-15% of Americans will be infected. Unfortunately, hospitalizations and death will follow, albeit at lower rates than we’ve seen before…Do not use the CDC community levels for masking… This tells us when to take collective action so the hospitals don’t surge. ..This does not tell us when to wear a mask for individual protection. The old CDC transmission map is painted red (which doesn’t even take into account under-reporting) and shows 98% of Americans should wear a mask in crowded, indoor spaces if they don’t want to get sick. Transmission is high across the states and will get higher.

(J. Harris: This is a good, understandable read and goes stepwise through what you need to do if you get sick now.)

FROM WEBB MD

Coming Soon: More Breathable, More Comfortable Face Masks

FROM nature:

Wastewater sequencing reveals early cryptic SARS-CoV-2 variant transmission

(A PREPRINT: …”…We develop and deploy improved virus concentration protocols and deconvolution software that fully resolve multiple virus strains from wastewater. We detect emerging variants of concern up to 14 days earlier in wastewater samples, and identify multiple instances of virus spread not captured by clinical genomic surveillance. Our study provides a scalable solution for wastewater genomic surveillance that allows early detection of SARS-CoV-2 variants and identification of cryptic transmission…”

FROM HOUSTON CHRONICLE:

”…COVID-19 hospitalizations have nearly doubled in the Houston area over the last month, according to re-published Texas Medical Center data, which paints a clearer picture of the risk associated with newer, increasingly transmissible versions of the virus…

HOPKINS SUGGESTS:

1. Risk of Myocarditis and Pericarditis Following BNT162b2 and mRNA-1273 COVID-19 Vaccination (Vaccine) Evidence indicates that mRNA COVID-19 vaccination is associated with risk of myocarditis and possibly pericarditis, especially in young males. It is not clear if risk differs between mRNA-1273 versus BNT162b2. From December 14, 2020 – January 15, 2022 there were 41 cases after 2,891,498 doses of BNT162b2 and 38 cases after 1,803,267 doses of mRNA-1273. Cases had similar demographic and clinical characteristics. Most were hospitalized for ≤1 day; none required intensive care. Both vaccines were associated with increased risk of myocarditis and pericarditis in 18-39-year-olds. Risk estimates were modestly higher after mRNA-1273 than after BNT162b2.

(J. Harris: This study indicates virtually no significant risk for vaccine induced pericarditis or myocarditis due to vaccine and only mild cases if is shoud, rarely, occour.)

2.  PFIZER-BIONTECH VACCINE FOR ADOLESCENTS The US FDA last week expanded full approval of the Pfizer-BioNTech SARS-CoV-2 vaccine to adolescents aged 12 to 15 years. The vaccine, known as Comirnaty, has been available for this age group since the FDA provided emergency use authorization (EUA) in May 2021, and the agency originally approved the vaccine for individuals aged 16 years and older in August 2021. To date, more than 9 million 12-15-year-old children have received the 2-dose primary series. Pfizer and BioNTech indicated they have also filed clinical trial data for approval among this age group with the European Medicines Agency (EMA) and other regulatory agencies around the world.

3. Pandemic Fueled Surge in Superbug Infections and Deaths, CDC Says (Washington Post) The coronavirus pandemic caused a surge in superbug infections and deaths in U.S. hospitals, reversing years of progress fighting one of the gravest public health challenges in modern medicine, according to a new analysis released by the Centers for Disease Control and Prevention. In 2020, the first year of the pandemic, infections and deaths among several serious pathogens increased about 15 percent overall from 2019, the report said. In 2020, more than 29,400 people died of antimicrobial-resistant infections commonly associated with health care, the report found. Of these, nearly 40 percent acquired the infection while hospitalized. The remaining infections occurred outside the hospital, including in nursing homes and other community health-care facilities.

FROM JAMA:

Long-term Immune Response to SARS-CoV-2 Infection Among Children and Adults After Mild Infection

”…n this cohort study, we evaluated the dynamic changes of the SARS-CoV-2 binding antibody titers in 252 family clusters mostly affected by asymptomatic or mild COVID-19 up to 12 months after initial infection. The findings suggest that anti–SARS-CoV-2 S-RBD IgG may persist more than a year from infection in all age groups, with antibody titers that inversely correlate with age….randomly determined; having a random probability distribution or pattern that may be analyzed statistically but may not be predicted precisely….”

FROM BECKERS:

1. What BA.2.75 means for COVID-19 vaccines: 2 notes

”…A new COVID-19 omicron subvariant, BA.2.75, has appeared amid a rising case count spurred by other variants, and early data suggests it’s more transmissible than other strains. Here’s what that could mean for vaccines. … Before BA.2.75 entered the stage, on June 30 the FDA recommended vaccinemakers to prioritize omicron subvariants BA.4 and BA.5 as they test modified vaccine compositions for this fall. It may be too early to point to which subvariant to be most concerned for, but playing catch up is a slow process, experts warn….”The virus has almost been quicker than we are,” Stanford (Calif.) University Professor of Medicine Dean Winslow, MD, told CBS News. “We can’t really spool out vaccine production in just a couple of weeks. It takes quite a while to actually spool out vaccine production for some of these newer variants.”

2. Though health experts are wary to draw conclusions before more data is available for the subvariant, which has been spotted in only three U.S. cases as of July 8, Glenn Wortmann, MD, infectious diseases section chief at MedStar Washington (D.C.) Hospital Center, told radio station WTOP the current COVID-19 vaccine should be effective against any subvariants, including BA.2.75.

3. Moderna’s omicron-targeted vaccine nearly twice as effective against BA.4, BA.5

”…As vaccine-makers race to show promising results for their updated, omicron-targeted vaccines set to debut this fall, Moderna forged ahead to prove its candidate is nearly twice as effective as its original vaccine…In a phase 3 trial, Moderna’s updated vaccine candidate increased neutralizing antibody titers 6.3-fold against omicron subvariants BA.4 and BA.5, while its original vaccine increased neutralizing antibody titers 3.5-fold, according to a July 11 press release….Moderna said it shared the data with regulators and is awaiting peer-review for publication..”

FROM NEJM JOURNAL WATCH:

Which Form of Immunity Fared Best Against Symptomatic Omicron Infection?”…Importantly, against severe COVID-19 outcomes, all forms of immunity[natural or either vaccine] were highly effective — the silver lining of successive pandemic waves…”

and LASTLY:

Why can’t a green chili pepper shoot an archery bow?

No habenero

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