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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P.O. Box 721

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75688

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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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 9/23/2022

SO, WE CAN STOP THIS COUNT FOR NOW, AND, HOPEFULLY, FOREVER.

OUR AREA IN TEXAS IS NOW IN  A “LOW DANGER” AREA. I ANTICIPATE THAT MY MAILOUTS WILL BECOME INCREASINGLY INFREQUENT. I KNOW WE ALL HOPE SO. 

STAY WARY. 

FROM BECKERS:

BEST WAY TO TAKE A PILL AND GET QUICK RESULTS

(J. Harris: What a nice study. I never even thought about this. Quick clearance of the medications might really help when taking medicines that “burn” the stomach lining, like aspirin and other nonsteroidal anti-inflammatory drugs — as well as steroids. KEEP RIGHT!)

FROM THE NEJM:

NEW MODERNA VACCINE WORKS WELL AGAINST CURRENT VARIANTS

”The bivalent omicron-containing vaccine mRNA-1273.214 elicited neutralizing antibody responses against omicron that were superior to those with mRNA-1273, without evident safety concerns. ”

FROM MEDICARE:

”…Important: Updated COVID-19 vaccines are now available to provide increased protection against the currently circulating Omicron BA.4 and BA.5 subvariants….

If it has been at least 2 months since you completed your COVID-19 primary series or had your last booster, then you are eligible for an updated vaccine. 

Remember: Medicare covers the COVID-19 vaccine at no cost to you. 

FINE A VACCINE SITE NEAR YOU

FROM HOPKINS SUGGESTED ARTICLES: 

AS OF 22 SEPT: UNITED STATES

The US CDC is reporting 95.6 million cumulative cases of COVID-19 and 1,049,101 deaths. Daily incidence continues to decline, down to 55,332 new cases per day. Daily mortality appears to have plateaued, with an average of 356 deaths per day. 

1. Lancet Commission on COVID-19 response: ‘Massive global failure’

Lancet Commission on COVID-19 response: ‘Massive global failure’ (CIDRAP) A stinging new Lancet Commission report on the international COVID-19 pandemic response calls it “a massive global failure on multiple levels” and spares no one the responsibility—including the public—for millions of preventable deaths and a backslide in progress made toward sustainable development goals in many countries.

(J. Harris: This is a readable summary.)

2. Should Your Flu and COVID Shots Go in Different Arms? (The Atlantic) At a press briefing earlier this month, Ashish Jha, the White House’s COVID czar, laid out some pretty lofty expectations for America’s immunity this fall. “Millions” of Americans, he said, would be flocking to pharmacies for the newest version of the COVID vaccine in September and October, at the same appointment where they’d get their yearly flu shot. “It’s actually a good idea,” he told the press. “I really believe this is why God gave us two arms.” That’s how I got immunized last week at my local CVS: COVID shot on the left, flu shot on the right. I spent the next day or so nursing not one but two achy upper arms. Reaching high shelves was hard; putting on deodorant was worse. And it did make me wonder what would have happened if I’d ignored Jha’s teleological advice and gotten both jabs in the same arm.

3. Nation warned to brace for a difficult flu season (The Hill) Health experts are warning the nation to brace for what could be an exceptionally severe flu season this fall and winter, as more people who have not built up immunity over the last few years mix and mingle. There are two big reasons why more people could be vulnerable to the flu this year. The first is that with coronavirus restrictions such as the wearing of masks all but forgotten, people are more likely to come into contact with the flu virus this year than over the last two years. The second reason is that fewer people are likely to be immune from the flu virus this year because fewer people have been getting the flu over the last two years — as the pandemic locked people down and as people worried more about getting COVID-19.

4. Additionally, the WHO last week strongly advised against the use of 2 different antibody therapies—sotrovimab as well as casirivimab-imdevimab—to treat patients with COVID-19 because they have limited clinical activity against currently circulating viral variants. The US FDA previously pulled or limited the use of the drugs, and some experts criticized the WHO for waiting to make the updated recommendation. The WHO expanded its conditional recommendation for the antiviral remdesivir to cover patients with severe COVID-19 and those with non-severe infections but who are at high risk of hospitalization….

Only a handful of COVID-19 therapeutics remain useful against currently circulating SARS-CoV-2 strains. While researchers quickly developed 4 effective treatments for hospitalized COVID-19 patients in the year between January 2020 and February 2021, no new therapies for hospitalized patients have been authorized since February 2021, raising concerns about whether treatment advancements have stalled. 

4. There’s a Shortage of Moderna Covid Boosters in the US (Bloomberg) Some pharmacies are reporting shortages of Moderna Inc.’s new bivalent booster shot for Covid-19 as one factory used in producing the vaccine remains offline following a safety inspection. The US government supply of Moderna’s shot is currently limited, causing appointments for the product to vary across the country, a Walgreens Boots Alliance Inc. pharmacy spokesperson said in an emailed statement. Meanwhile, CVS Health Corp. says some of its drugstores have used all of the updated shots they received from the government, and the company is trying to get more doses. Moderna has been coping without one of its vaccine-manufacturing facilities.

FROM YOUR EPIDEMIOLOGIST:

State of Affairs (Sept 19): COVID19, MPX, Polio, and… Flu

1. SARS-CoV-2 continues to mutate, and there are a few Omicron variants, like BA.2.3 and BJ.1, on the horizon with potentially concerning combinations of mutations. But evidence thus far is extremely limited. Most eyes are on BA.2.75.2, which is a second generation subvariant and has three additional spike protein mutations. Two preprints have shown substantial immune escape, even compared to BA.5. This means it has the potential to cause future waves. The number of BA.2.75.2 cases is still very small across the globe, but counts are doubling every week. If this growth rate continues, BA.2.75.2 may be one that causes the much anticipated winter wave.

2. Flu: Finally, flu. The flu season in Australia wrapped up, and it wasn’t pretty. This is notable because, historically, Southern hemisphere patterns predict what is to come in the Northern hemisphere….U.S. flu activity remains low, as is typical this time of year, but flu season is just around the corner. Given the Southern hemisphere’s warnings, we predict that this activity will change. However, right now, the only predictable thing about viral behavior is that it is unpredictable.

3. The “common” viruses for our kids may be back

(J. Harris: Check this out if you are around kids or grandkids or school kids.)

FROM THE CONVERSATION:

Polio vaccination rates in some areas of the US hover dangerously close to the threshold required for herd immunity – here’s why that matters

”…even today, there are communities in the U.S. that have lower-than-necessary polio vaccination rates. Because many people have not been vaccinated, there is now a real possibility of a resurgence of polio in the U.S….on Sept. 9, 2022, New York declared a state of emergency due to ongoing poliovirus transmission. As of that date, using wastewater surveillance, officials had identified 57 samples of poliovirus in wastewater from four New York counties…As a result of the continued poliovirus detection in wastewater, the Centers for Disease Control and Prevention declared that the U.S. now meets the World Health Organization’s criteria for “a country with circulating vaccine-derived poliovirus.”….There are two key types of polio vaccine in use around the world today. The inactivated poliovirus vaccine is given as a shot, and the oral attenuated (or weakened) poliovirus vaccine is administered as oral drops, sometimes on a sugar cube…

Since 2000, the U.S. has exclusively used the inactivated poliovirus vaccine, which cannot cause disease since it does not contain live virus. But in countries where the poliovirus continues to circulate, such as Pakistan and Afghanistan, the oral attenuated poliovirus vaccine is still used…..In extremely rare cases, the weakened live vaccine used in other countries can mutate back into its virulent form and lead to paralysis. This is how the adult in New York is believed to have come into contact with the virus….For poliovirus, researchers estimate that between five and seven individuals would be infected for each case if those people were susceptible. Based upon these calculations, experts determined that at least 80% of a community or population should be vaccinated against poliovirus to prevent its spread…]]

UT Southwestern opens first academic medical center campus for southern Dallas County

AND LAST BUT NOT LEASED:

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