"There are presently at least 900,000 new COVID infections each day in the United States, with 1 in every 37 people infected. Some areas like California, Texas and Florida appear to be peaking,
but with the addition of KP.3.1.1, we may see another bump in numbers.
The West and the South have almost double the level of virus in
wastewater as compared to last summer’s COVID wave. Per Sara Anne Willette, wastewater levels of SARS-2 virus are “Excessively High” in Utah, followed by “Very High” in Louisiana, Arkansas, Florida, Texas, Oregon, California, North Carolina and Oregon. In the Bay Area,
San Jose, San Mateo, Sacramento and parts of San Francisco show higher
levels of virus in wastewater than the winter wave last
December/January. The San Francisco Department of Health is advising people to wear masks indoors.
"Eric Topol came out with a new essay
yesterday that I highly recommend reading. He discusses this large
wave, why waves continue to happen and what we should be doing about
it.
"People have asked me how to look up information on their state. I recommend these 3 sources:
Pick your state under Location (see highlighted below)
Variants
"The KP.3.1.1 variant is pushing out KP.3 in America and around the world. KP.3.1.1 is the JN.1 variant with DeFLuQE mutations = [S31 deletion + F456L+ Q493E
mutations]. It is dominant in most of Europe and is rapidly increasing
in Canada and the United States. The DeFluQE mutations make KP.3.1.1 more immune evasive against our antibodies and more infectious.
"KP.3 and KP.3.1.1 have evolved to be very different antigenically from the
original SARS-CoV-2 virus and even from the original Omicron BA.1 virus.
That is why it is important to get updated booster vaccines when they
are available. A group in Germany made an antigenic map using a hamster
model which shows that all pre-Omicron variants are clustered together.
The original Omicron BA.1 and the Omicron subvariants show a lot more
antigenic diversity. The current dominant variant (KP.3 and KP.3.1.1)
are more antigenically different from the original Omicron (BA.1) than
Omicron (BA.1) was to the original wildtype SARS-CoV-2 virus.
"A
team from Virginia Tech found that SARS-CoV-2 is spreading from humans
to wild animals, especially in places with high human activity. They
found SARS-2 in six different wildlife species, the deer mouse, Virginia
opossum, raccoon, groundhog, Eastern cottontail, and Eastern red bat
from 2022 to 2023 across Virginia and Washington, D.C. Areas with more
people had a higher rate of animals infected. Human-to-animal transmission was seen in seven cases where the animal had a variant that matched those circulating in humans at the time.
"A US veterinary hospital network tested 1000 dogs and cats belonging to employees in 2020 to 2022. Positive SARS-CoV-2 antibodies were seen in 33% of 747 dogs and 27% of 253 cats
and positive COVID antibodies correlated with US human case waves.
"Antibodies persisted longer than previously documented (828 days in
dogs; 650 days in cats)." Cats were more likely to have COVID symptoms.
"COVID vaccines are safe and reduce the risk of COVID infection. COVID vaccines were also found to decrease the risk of major cardiovascular thrombotic disease.
In a study of 46 million adults in England, both arterial thrombotic
events (heart attacks and stroke) were lower after COVID vaccination.
Similarly, venous clotting events (pulmonary embolism, leg deep vein
thrombosis) were also lower after COVID vaccination.
"Scientists
discovered two complementary antibodies that they called Cv2.3194 and
Cv2.3132 from the memory B cells of a single person who had recovered
from a COVID infection with ancestral SARS-CoV-2. "When combined, Cv2.3194 and Cv2.3132 form a complementary SARS-CoV-2 neutralizing antibody cocktail" that work together to neutralize many different beta coronaviruses including SARS-CoV-2 variants.
"Recently, I found a great resource from NYC Health called the NYC Health COVID-19 Isolation and Exposure Guidance Tool
which gives guidance for isolation after COVID exposure. The tool
calculates the specific dates that one should isolate and test. They
recommend isolating and masking for 10 days after exposure and to test
on day 5. For symptoms, they recommend testing every 48 hours twice or
three times before coming out of isolation. Using a molecular COVID test
like Lucira allows people to come out of isolation sooner.
"Bernie Sanders and other senators proposed a bill this week called The Long COVID Research Moonshot Act of 2024
to provide $1 billion in funding each year for 10 years for Long COVID
research, treatments and for the expansion of care for patients. More
than 22 million adults and 1 million children have Long COVID in the
United States and there are no treatments or cures for this disabling
disease. I truly hope that this bill becomes a law, but we will need to
advocate at each of the 9 steps that it will go through to be approved.
"Dr. Trisha Greenhalgh and colleagues wrote a massive review article on Long COVID
this week which looked at risk factors, symptoms, phenotypes, clinical
rehab services and prevention for Long COVID. She wrote a tweet thread
discussing the article here. In addition, Dr. Greenhalgh wrote a substack post called “Long COVID – a dystopian game of pinball” that explained the review article for lay people. She also gave some great advice for avoiding Long COVID:
Get vaccinated against COVID-19, and make sure your boosters are up to date.
Try
not to catch COVID-19. Avoid crowded indoor spaces (wear a well-fitting
mask if you can’t avoid them), especially when local rates of COVID-19
are high.
If you catch COVID-19, rest up until you feel better and take anti-virals if you’re eligible.
"In
June 2024, the National Academies of Sciences, Engineering, and
Medicine (NASEM) Committee published a consensus definition for Long
COVID in a 166 page document. This week, the Long COVID definition was published in the NEJM. First author Dr. Wes Ely also wrote a tweet thread about the definition here.
NASEM 2024 Long COVID definition:
Long
Covid is an infection-associated chronic condition that occurs after
SARS-CoV-2 infection and is present for at least 3 months as a
continuous, relapsing and remitting, or progressive disease state that
affects one or more organ systems.
"Using the Adult Developmental Eye Movement Test, people with Long COVID were found to have abnormal oculomotor results. This may relate to cognitive dysfunction in the brain or possibly to issues with muscles of the eye.
"People
usually know when they have loss of taste or loss of smell after a
COVID infection. Healthcare professionals should also be aware that
there is a significant risk of hearing loss in young adults after COVID infection too. In 6.7 million young adults aged 20–39 years in South Korea, COVID infection was associated with a 3.5x increased risk of hearing loss and sudden sensorineural hearing loss (SSNHL).
COVID and the Heart
"A new study from Hong Kong shows that different SARS-CoV-2 variants affect heart muscle cells differently. "Omicron BA.2 most efficiently infected and injured cardiomyocytes
in vitro and in vivo, and induced expression changes consistent with
increased cardiac dysfunction, compared to other variants tested."
COVID and the Placenta
"A
group from Italy studied individuals who had COVID in pregnancy,
including a group who had COVID infection at the time of delivery. "SPIKE
protein was detected in villi and decidua from women with ongoing
infection." Autophagy was seen in COVID infected placentas
with an increase in LC3B that decreased once the COVID infection had
resolved. CD147 levels were increased in the placental villi of people
with active COVID infection and also in those with recent COVID
infection that had resolved. Proangiogenic marker VEGF was seen in
placentas that were SARS-CoV-2 spike protein positive.
COVID and the Thyroid
"In a retrospective cohort study, scientists from China found that severe COVID-19 was a risk factor for Euthyroid Sick Syndrome (ESS) (OR=22.5).
ESS and low thyroid function were associated with increased risk of
death from COVID, while high levels of FT3 and FT4 were associated with a
lower risk of death, especially in women. Hyperthyroidism was uncommon
after COVID infection, but 7.7% of people became chronically hypothyroid
after COVID infection.
COVID and the Lungs and Kidneys
"Patients
hospitalized with severe COVID infection in China during the first
COVID wave were followed for 1 year (n=73) and 2 years (n=57). Pulmonary Long COVID
with fibrous stripes seen on CT scan was found in 8.7% of hospitalized
patients at 1 year and 17.8% of patients at 2 years and was related to
low serum surfactant-associated protein B. Renal Long COVID
was seen in 15.2% of hospitalized patients at 1 year and 23.9% of
patients at 2 years. It was associated with lower urinary protein
expression. Using machine learning, data collected during the 1st month
of the original severe COVID infection could predict Pulmonary Long
COVID and Renal Long COVID with an accuracy of 87.5%.
COVID and the Testes
"One in ten men with mild COVID infections were found to have SARS-CoV-2 RNA in their semen,
"which persisted for up to 90 days in one patient." Sperm count and
motility were lower when the viral RNA was present, but normalized with
long term follow up.
H5N1 Avian Flu
"In a small study, 15% of workers (2 of 14 workers) from two Texas dairy farms were found to have antibodies to H5N1
and one person continued to have a lingering cough. One of the two
people who tested positive worked in the cafeteria on the farm and not
with animals. This is concerning. The article did not say if the
cafeteria worker got H5N1 from another person, or if she had consumed
raw milk. "I am very confident there are more people being infected than we know about,"
senior author Gregory Gray, MD, MPH, a UTMB infectious disease
researcher, said "Largely, that's because our surveillance has been so
poor."
"An article in Lancet Public Health shows that younger people appear to be getting cancer at earlier ages than prior generations.
People born in the 1990s had cancer rates ranging from 12% to 169%
higher than those born in the generation with the lowest rates. The
mortality rates (MRRs) for some cancers like liver, uterine,
gallbladder, testicular, and colorectal also increased in younger
generations, while for other cancers, the mortality rates either
stabilized or decreased.
"Mpox infections
are spiking in ten African nations, but 96% of cases are reported in
the Democratic Republic of the Congo DRC. "As of July 28, 2024, a total
of 14,250 cases (2,745 confirmed; 11,505 suspected) and 456 deaths (case
fatality rate [CFR]: 3.2%) have been recorded in 10 African nations."
"A study of 1525 adults followed longitudinally since the early 1990s found that certain Alzheimer's disease biomarkers (Aβ42:β40 ratio and p-Tau181) in midlife
were linked to dementia in later life. Changes in the Aβ42:β40 ratio
and p-Tau181 and in NfL and GFAP from midlife were linked to all-cause
dementia.
Olympics
"There are so many amazing Olympic stories, but here are a few of my favorites. Katie Ledecky won her 13th Olympic medal this week making her the most decorated female US Olympian of all-time. Simone Biles showed us why she is the GOAT (Greatest Of All Time) as she won the Olympic gold medal in individual all-around gymnastics.
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