Here is her latest newsletter:
In the United States, there are more than 1,000,000 new COVID cases each day now, with 1 in every 33 people infected now at the national level, 1 in 22 infected in the West and 1 in 25 infected with COVID in the South. Wow! These levels are exceptionally high for a summer wave and in some places they are higher than the winter wave. In many places, kids will be going back to school soon and this could affect COVID rates further.
The CDC now reports wastewater SARS-2 levels as “VERY HIGH” and it does not look like levels are peaking quite yet. On a state level, Oregon is EXCESSIVELY HIGH, as is Arkansas, Florida, North Carolina and Washington state. Texas, Wyoming, Utah, California, Alaska, Oklahoma, South Carolina, Louisiana and Minnesota are all considered “VERY HIGH” by Sara Anne Willette.
From: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html
National SARS-CoV-2 data from Sara Anne Willette: https://iowacovid19tracker.org/
According to WastewaterSCAN, Oswego NY’s level of SARS-2 in wastewater is at 5987 PMMoV. I do not know if we have ever seen SARS-CoV-2 levels that high except for the highest peak of the original Omicron wave. The highest levels of SARS-2 in wastewater in PMMoV after Oswego NY now are Warren MI 3308, Pascagoula Moss Point MS 3001, Little River Roswell GA 2936, N Parker CO 2707, NW St Petersburg 2633, New Orleans LA 2476, Kinston NC 2356, Novato CA 2120 PMMoV.
In California, the highest levels of SARS-2 in wastewater in PMMoV are Novato 2120, Vallejo 1215, SE San Francisco 980, Fremont 963, Lompoc 898, Oceanside San Francisco 714 PMMoV. Levels in Santa Clara county are still HIGH in all four sewer sheds. Weekly rates of COVID hospitalizations in California are almost as high as they were in last winter’s COVID wave and are higher than they were last summer per Katelyn Jetelina.
San Francisco, Marin and Contra Costa counties health officials recommend that “people wear a well-fitting mask like an N95 or a KN95 mask in public indoor spaces like grocery stores.” They also recommend testing when symptomatic and staying home when sick. From May 9 to July 9, concentrations of COVID in wastewater have more than quadrupled in Contra Costa county. Many people have not been vaccinated since last year and immunity has waned.
In Los Angeles County and Pasadena, health officials recommend that people wear masks and exercise greater caution as there has been a recent increase in COVID cases and in wastewater SARS-CoV-2 levels in the last few weeks due to KP.3.1.1 which is a highly transmissible and immune evasive COVID variant. For COVID conscious people, Olivia Belknap has come up with phrases to use when responding to people who minimize COVID risks. It is an excellent resource.
California mask recommendations are exactly the opposite of what Nassau County, New York recommends. This week, Nassau County, NY made it illegal to wear a mask in public. There are health and religious exemptions for the ban, but they are unclear and are up to the judgment of police officers. Wearing a mask in Nassau County, NY is a misdemeanor that includes a $1,000 fine and can include jail time.
From: https://twitter.com/MemoryDoc/status/1820894328795128287
Epidemiologist Dr. Maria Van Kerkhove, director of the WHO Epidemic & Pandemic Preparedness & Prevention, addressed the UN this week with 3 main messages regarding COVID:
COVID is still very much with us. The virus is circulating in all countries.
Governments need to provide their populations with the tools to protect themselves and to care for people suffering from acute and long-term effects of COVID-19 such as Long COVID.
As individuals it is important to take measures to reduce risk of infection & severe disease- including COVID vaccination within the last 12 months.
Using data from people on AncestryDNA who consented to the study, scientists analyzed the genetics of 18,334 people who got influenza and 276,295 controls who did not. They found an association with B3GALT5 and ST6GAL1 and influenza infection, but not COVID infection. In addition, published COVID risk genetic variants were not associated with influenza. COVID is not the flu in many different ways.
SARS-CoV-2 virus spike protein can cause heart cells to fuse into syncytia which can increase cell senescence which can lead to heart failure. "In pre-existing heart failure mice, the WNK1 inhibitor WNK463, anti-syncytial drug niclosamide, and senolytic dasatinib protect the heart from exacerbated heart failure triggered by SARS-2-S (SARS-CoV-2 spike protein).” Unlike the spike protein from the virus, the COVID mRNA vaccines do not cause syncytium formation or cellular senescence in heart cells.
MIS-C is a life-threatening inflammatory complication of COVID infection in children that typically happens a few weeks after COVID infection. According to Dr. Adrienne Randolph, “Every time COVID peaked in an area, about 30 days later, there’d be a peak of these kids presenting with what looked like septic shock in our network of ICUs, except they were negative for all kinds of infection.” A new study shows why some kids get MIS-C.
When someone gets a COVID infection, their B cells make antibodies to the SARS-CoV-2 nucleocapsid protein and other SARS-2 proteins. Using a new technique called Phage Immunoprecipitation Sequencing (PhIP-Seq), UCSF researchers were able to screen blood for known and unknown autoantibodies in MIS-C. Some children and teens with MIS-C were found to have antibodies that cross-reacted to both the SARS-CoV-2 nucleocapsid protein and also to the self-protein SNX8. The SNX8 protein is found throughout the body, in “various tissues including the brain, heart, gastrointestinal tract, kidneys and skin, with the highest expression in undifferentiated cells and immune cells.” Children with MIS-C were also found to have cross-reactive CD8+ T cells that target both the SARS-2 nucleocapsid (N) protein and SNX8. Autoimmunity in both B cells and T cells appears to cause MIS-C.
Long COVID
Yesterday, an all-star team of experts (Z. Al-Aly, H. Davis, L. McCorkell, L. Soares, S. Wulf-Hanson, A. Iwasaki, E. Topol) put out a mega-review on the science, research and policy effects of Long COVID. Approximately 400 million people around the world have Long COVID, costing the global economy about $1 trillion every year. SARS-2 viral persistence, immune dysregulation, mitochondrial dysfunction, complement dysregulation, endothelial inflammation and microbiome dysbiosis are thought to have some part in causing Long COVID (See Figure 3 below). Long COVID is not only disabling on an individual level, but because of its multisystemic nature, Long COVID puts strain on health systems and on the economy. A coordinated global effort in research and policy is needed for Long COVID, but has not yet happened. This review looks at the latest scientific evidence on Long COVID, its effects on health and the economy, and recommends plans for future research and policies.
From: https://www.nature.com/articles/s41591-024-03173-6/figures/2
Figure 3: Mechanisms of Long COVID
From: https://www.nature.com/articles/s41591-024-03173-6/figures/3
A large new review looked at blood biomarkers for Long COVID. The authors found that there was no single biomarker that could identify Long COVID, but using a profile of several biomarkers may be useful.
There are no approved treatments for Long COVID. A group of patients and physicians recommend using "patient-centered research and real-world data to generate hypotheses to assess the effectiveness of existing FDA approved drugs. Accelerated discovery of therapeutics for Long COVID can then be confirmed through efficient and cost-effective adaptive platform clinical trials." Using data shared from Long COVID patients on CURE ID (cure.ncats.io) along with EHR data, the authors hope to find promising treatments to study with clinical trials.
From: https://www.sciencedirect.com/science/article/abs/pii/S0024320524005307?via%3Dihub
In a study from Charite Berlin, twenty Long COVID patients with ME/CFS and elevated Β2-Adrenergic Receptor Autoantibodies received five immunoadsorption treatments. About 70% of patients had improvements in fatigue, post-exertional malaise, pain, cognitive dysfunction, dysautonomia and immunologic symptoms. Unfortunately, most patients' symptoms returned six months after treatment showing that autoantibodies may be causing Long COVID ME/CFS symptoms in these patients.
Some people with Long COVID report internal tremors and vibration feelings as if a cell phone were buzzing in their body. A new study shows that having tremors and vibration sensations is associated with worse health status, higher rates of new onset mast cell disorders and more neurologic symptoms than people with Long COVID who did not have these symptoms.
New Chronic diseases after COVID
Two to three years after being hospitalized for COVID in the UK, psychiatric and cognitive symptoms tended to worsen, with new symptoms often showing up in people who were symptomatic at 6 months. Identifying and treating these symptoms early might help prevent them from becoming more severe. Many people had to change jobs due to cognitive problems, so finding therapies that help them may help to reduce the impact on their daily lives and finances.
In a study of 37 college students who had been infected with COVID-19 and had recovered, arterial stiffness was noted, but was found to improve over time. However, both systolic and diastolic blood pressure were noted to be higher in COVID recovered college students long term. An increase in hypertension has been shown in previous studies in older Veterans Administration patients after COVID, but this study shows that young college students can be affected as well.
Olympics:
Sprinter Noah Lyles collapsed and needed to be taken away in a wheelchair after he ran the 200m race. He had been diagnosed with COVID two days prior and had moved into a hotel away from the Olympic Village. Lyles took Paxlovid and other medications and ran the race, winning a bronze medal. Like Australian swimmers who were actively infected with COVID, Lyles was allowed to race. He did not wear a mask when being tended to by medical staff, but he did wear a KN95 when speaking to reporters later.
From: https://x.com/luckytran/status/1821660964699119812
According to ESPN, more than 40 Australian Olympians have tested positive for COVID or other respiratory illnesses like Flu A. The Australian team brought their own PCR machine to the Olympics. Some Australian swimmers raced with COVID infection.
Gymnast Suni Lee had been bed ridden in December, but she competed and won several medals at the Paris Olympics after being treated for 2 chronic kidney diseases. “The 21-year-old gymnast took home bronze in the individual-all around and uneven bars competitions, and, of course, was part of the gymnastics team that brought home the gold for Team USA.”
AI:
After a professional ultrasound to date the pregnancy in the first trimester, novice users with no ultrasound training performed blind sweep ultrasounds between 14 to 27 weeks gestation using the Butterfly IQ+ ultrasound with AI and these scans were as accurate as "credentialed sonographers performing standard biometry on high-specification machines."
A new study shows that evaluating a heart CT scan with the CaRi-Heart AI platform allowed researchers to see dangerous inflammation of the coronary arteries which increased people's risk of dying from a heart attack over the next 10 years by 20 to 30-fold. These patients were then prescribed medication and lifestyle changes to help reduce this risk.
Other news:
Susan Wojcicki, Silicon Valley innovator and Google and YouTube visionary, died yesterday at the age of 56 after a two-year battle with non-small cell lung cancer. I knew Susan personally and found her to be bright, warm and kind. She will be truly missed.
When people speak of the gut-brain axis, they often talk about how the gut microbiome can send messages up to the brain via the vagus nerve. But it turns out that the brain sends messages down to the gut as well. The amygdala in the brain is important for emotion and stress and the amygdala can talk to the Brunner's glands in the small intestine via the vagus nerve. Stress can inhibit the amygdala which then causes the Brunner's glands to make less mucin in the gut, which in turn causes a decrease in the beneficial Lactobacillus bacteria in the gut. This can lead to "leaky gut" where bacteria and foreign substances can leak through spaces between gastrointestinal cells and into the blood leading to inflammation which affects immunity and the ability to fight off infections.
From: https://www.cell.com/cell/fulltext/S0092-8674(24)00779-7
The thymus is a gland in the chest that is part of the lymphatic system. It trains T cells to fight infection and also makes some hormones. It is active in childhood, but by puberty, the thymus starts to shrink or involute. Using single-cell, spatial biology, the authors discovered two atypical thymic epithelial cell (TEC) states called age-associated TECs (aaTECs). These cells are linked to immune aging and “could have implications for developing immune-boosting therapies in older individuals."
Medigap coverage allows seniors to have predictable expenses via a monthly premium. Another option is Medicare Advantage which is sold by private insurance companies that heavily market their plans. The major drawback of Medicare Advantage is they lock people into a specific doctor network meaning they may not be able to see certain specialists when needed. It can be almost impossible to switch to a Medigap plan after 6 months with Medicare Advantage because they can then raise rates or exclude pre-existing medical conditions. California tried to fix this Medicare loophole, but unfortunately failed.
“Bloomberg philanthropy donated $175 million each to medical schools at three historically Black colleges or universities (HBCUs)- Howard University College of Medicine, Meharry Medical College and Morehouse School of Medicine. Charles Drew University of Medicine & Science will receive $75 million. Xavier University of Louisiana, which is opening a new medical school, will also receive a $5 million grant. "The gifts are among the largest private donations to any historically Black college or university.”
Have a good rest of your weekend,
Ruth Ann Crystal MD
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