Dr Ruth's COVID news & more newsletter for 4/14/24

Here are excerpts from the latest welcome newsletter from Dr Ruth Ann Crystal.  As COVID news seems to keep dwindling, she is always reliable & informative:

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"We continue to be at “LOW” levels of COVID now in the U.S. according to wastewater levels of SARS-CoV-2. There are no states at the “HIGH” level this week which is good news. Hospitalizations, Emergency Department visits and deaths from COVID continue to decrease significantly. JN.1 and its progeny continue to make up almost all cases of COVID. According to JP Weiland, we are still at relatively low levels of SARS-CoV-2 transmission and approximately every 1 in 142 people is currently infected. 

"At times, it has been hard for some people to access Paxlovid for an acute COVID infection. That is why it was very helpful to have the Test to Treat program where a person who tested positive for either the flu or COVID could get free telehealth visits and free medications (Tamiflu for the flu, Paxlovid for COVID). The program which was supported by the NIH and the ASPR will be ending next Tuesday April 16, 2024, Dr. Judy Stone reported on Forbes. Regarding testing, a new over-the-counter test has been approved by the FDA from CorDx which will allow people to test at home for Influenza A, Influenza B and SARS-CoV-2 all in one multiplex test.

"Regarding acute COVID infections, a group from Stanford discovered that a special type of macrophage cell in the lungs called interstitial macrophages are responsible for the transition from a moderate COVID infection to a life threatening COVID infection associated with ARDS (Acute Respiratory Distress Syndrome). Macrophages are a type of white blood cell that surrounds and kills bacteria and viruses. They also remove dead cells in the body and they stimulate other immune system cells as needed.

"In the lungs, there are two types of macrophages- alveolar macrophages (AM) that reside within the alveoli in the area where oxygen and carbon dioxide are exchanged and interstitial macrophages (IM) that live in the interstitial area between the endothelial cells of tiny blood vessels in the lungs and the cells that line the alveoli. The SARS-CoV-2 virus enters most cells in the human body via the ACE2 receptor, but the virus infects interstitial macrophages via a different cell receptor called CD209. This study showed that IMs are the main site of viral infection deep in the lungs which can lead to inflammation and fibrosis of the architecture of lung tissues. Blocking the CD209 receptor may decrease the risk of severe COVID infection and ARDS.

"Looking at the entire population of Norway (5.4 million people), a new study shows that COVID vaccination reduced the risk of Long COVID by about 40%. COVID vaccination also reduced post-COVID thrombotic and cardiovascular complications (heart failure, venous blood clots, arterial blood clots) by 40 to 50%.

Long COVID incidence

"238,828 U.S. blood donors, of which 83,015 had a history of COVID infection, were surveyed in 2022. The most commonly reported long-term symptoms were difficulty thinking and fatigue. Prior COVID infection was associated with 2.5-fold increased risk of long-term symptoms, as compared to people who did not have a history of prior COVID infection. A KFF article shows that 1 in 10 people have Long COVID now and that 79% of them have limitations on their activities because of Long COVID. 

"Viral persistence of the SARS-CoV-2 virus somewhere in the body has been thought to be a cause of Long COVID. A new study from UCSF and Harvard shows that 25% of people tested showed viral persistence of SARS-CoV-2 proteins (spike, S1 or N proteins) in their blood up to 14 months after COVID infection. The risk of viral persistence was two-times more common in people who had been hospitalized with their acute COVID infection. This week, there was a well-written article in Science Magazine looking at ongoing clinical studies of medications and treatments for viral persistence of SARS-CoV-2 virus in Long COVID. Medications being tested for viral persistence in Long COVID include Paxlovid, the monoclonal antibody AER002, Larazotide (reduces gut permeability in Celiac Disease), SARS-2 antiviral Ensitrelvir and a trial of Truvada with Selzentry (Maraviroc) which are two HIV antiviral drugs."

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There's much more (including a link to a witty quip from the moon during the eclipse!), so check out Dr Ruth's newsletter yourself!