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"For the third week in a row, there are about 1 million new COVID cases per day in the US, with about every 1 in 34 people currently infected per JP Weiland. He expects that once kids have settled into school, cases will decline more quickly. Almost all states have VERY HIGH or HIGH levels of COVID in wastewater now. The western states have appeared to peak and are starting to descend, but in other parts of the country, wastewater SARS-CoV-2 levels continue to rise. For a second week in a row, there were over 1,000 COVID deaths in the US. COVID test positivity is at 17.0%.
Wastewater SARS-CoV-2 activity:
From: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html
"Only Michigan is considered to have LOW levels of SARS-CoV-2 in wastewater per the CDC map below, which is surprising since some of the highest levels in the country are in Warren, MI (4071 PMMoV) and Ann Arbor, MI (3492 PMMoV) per WastewaterSCAN. Millbury, MA also has extremely high levels of SARS-2 in wastewater at 4071 PMMoV and Roswell, GA is at 3475 PPMoV.
From CDC wastewater map: https://www.cdc.gov/nwss/rv/COVID19-currentlevels.html
"Here in California, emergency department visits for COVID have peaked and are on a downward slope. Lompoc, CA near Santa Barbara still has very high SARS-CoV-2 levels in wastewater at 1650 PMMoV, but wastewater virus levels in most other counties in California are starting to descend.
"KP.3.1.1 represents 42.2% of cases now in America. This variant has taken over in most countries around the world. While the XEC variant is starting to pop up in some places like Germany, it is unclear if this variant will be will be an issue.
Vaccines
"Many people are starting to get their new 2024-2025 COVID vaccines as the mRNA KP.2 COVID vaccines were approved last week. Most pharmacies have vaccine appointments available and you can find locations at Vaccines.gov. The Novavax vaccine was authorized by the FDA yesterday. Novavax is based on the JN.1 variant and is authorized for people ages 12 and older. The latest mRNA vaccines (Moderna, Pfizer) are based on newer variant KP.2 and are approved for everyone over 6 months of age. It is safe to get both the updated COVID vaccine and the flu shot at the same time, although it is somewhat early to get the flu shot now, as it is usually given in October.
"Many people are asking when it is best to get the new COVID vaccines. This is a bit of a difficult question since most people will only qualify for one dose of vaccine this year if this year is similar to last. Many people are getting the updated vaccine now because we are in a large COVID wave with about 1 million new COVID cases each day. But, other people have decided to wait until October or November to be vaccinated since the vaccine’s protection wanes after about 3 months against infection and they want to be protected during the winter holidays. If someone has had a recent COVID infection, they should wait 2 to 3 months before getting the updated vaccine. Immunocompromised people are recommended to receive the vaccine now because we are in a large COVID wave. They may qualify for additional doses as has happened in past years. For other questions on the updated COVID vaccines, please see this helpful COVID vaccine Q&A from Johns Hopkins.
"Pemgarda is a monoclonal antibody that has been offered as a pre-exposure prophylaxis against COVID for immunocompromised people. Pemgarda worked against prior variants but is resistant to KP.3.1.1 which is the most common SARS-CoV-2 variant globally now. The FDA wrote a letter to the manufacturer this week letting it know that it may remove Pemgarda from the market soon.
"Scientists are working on pan-sarbecovirus vaccines that can protect against many different types of coronaviruses and other sarbecoviruses, so as to protect against new SARS-CoV-2 variants in the future. According to Dr. Eric Topol, a team from CalTech is working on a “promising pan-sarbecovirus vaccine.” Mosaic sarbecovirus nanoparticles were used as a booster in monkeys and mice that were pre-vaccinated and caused a broad antibody response to different sarbecoviruses like SARS-CoV-2.
Long COVID and Disability
"An article from the Federal Reserve Bank of St Louis shows that there has been a large increase in the number of disabled workers since 2019, with the biggest increases being in cognitive disability. Dr. Ziyad Al-Aly tweeted, “Since 2019, the number of disabled individuals has surged beyond the expected trend by nearly 2 million. This isn't just a statistical anomaly—it's a huge indicator of a deeper, underlying health crisis. Most alarming is the rise in cognitive disabilities. The population reporting only a cognitive disability has grown by nearly 1 million—a 43% increase since 2019… Could Long COVID be a contributing factor? Possibly yes!”
From: https://www.stlouisfed.org/on-the-economy/2024/aug/changing-composition-of-disability-among-workers
"An article in the WSJ highlights that Long COVID has forced around one million Americans out of the workforce, causing significant disruption to their careers and personal identities. More than 5% of U.S. adults have Long COVID, with the condition being most common among those in their prime working years. Many people have had to significantly change their daily activities due to the illness and recovery from Long COVID is not common, even after several years.
Pediatrics
"Many people believe(d) that COVID infection is of no consequence for children. But, a recent study in JAMA highlighted Long COVID symptoms in younger children and teens. An estimated 5.8 million children and young adults have Long COVID. A new article in Salon interviewed Dr. Rachel Gross who is one of the investigators in the RECOVER trial for children. “This is a public health crisis for children,” Dr. Gross said. “We know that child health is so critically important for how children grow and even as they become adults, that chronic illness during childhood and adverse experiences during childhood greatly affects the adults that they can become.”
"Gross said the U.S. will see the “long-term impacts of experiencing Long COVID in childhood for decades to come.”
SARS-CoV-2, fibrin and blood clots
"A new article from the Gladstone Institutes changes what we thought that we knew about SARS-CoV-2, inflammation and neurological damage. It is known that when fibrinogen is converted to fibrin, it exposes the inflammatory epitope on fibrin. The Gladstone researchers found that the level of fibrinogen seen during acute COVID infection can be used as a biomarker to predict Long COVID cognitive dysfunction.
"Using mouse and in vitro models, scientists from the Gladstone Institute found that fibrin binds to the SARS-CoV-2 spike protein and forms unusual blood clots that drive inflammation, lead to damage of neurons in the brain and also suppress the body’s ability to clear the virus by affecting our natural killer cells. Prior studies have shown that targeting fibrin’s inflammatory epitope can treat some autoimmune and inflammatory diseases. In this study, monoclonal antibodies to the inflammatory part of fibrin were found to stop toxic inflammation in the lungs and halt microglial activation causing damage to neurons in the brain. Fibrin-targeting monoclonal antibodies “may represent a therapeutic intervention for patients with acute COVID-19 and long COVID,” the authors summarized.
“Knowing that fibrin is the instigator of inflammation and neurological symptoms, we can build a new path forward for treating the disease at the root,” said Katerina Akassoglou, PhD, director of the Center for Neurovascular Brain Immunology at Gladstone and UC San Francisco.
"Two weeks ago, an article from Yale showed that inflammation of the endothelial cells lining blood vessels were associated with neurological symptoms in Long COVID. Another review paper looked at the effects of COVID infection on endothelial dysfunction, platelet activation and inflammation leading to increased risk of atherosclerosis.
"This week, a review in the Journal of Thrombosis and Thrombolysis shows that blood clots in COVID infection have unique characteristics including “a highly inflammatory signature on a foundation of endothelial cell inflammation and neutrophil extracellular traps (NETs).” They state that “COVID-19, caused by the SARS-CoV-2 virus, is an acquired thrombophilia with a high incidence of thrombosis.” However, the Gladstone Institute article above shows that fibrin bound to the SARS-CoV-2 spike protein in clots is driving inflammation, including neuroinflammation in the brain.
Evolution of SARS-CoV-2
"Using two different mouse models, the authors found that SARS-CoV-2 evolves more in the immune-privileged central nervous system (CNS), which is usually protected by the blood-brain barrier, even if the body has pre-existing immunity from vaccination. Additionally, researchers found that the furin cleavage site (FCS) on the virus was important for infection in the lungs, but is less important in the CNS. Deleting the FCS allows the virus to infect brain cells more easily by bypassing the usual cell entry pathway via the ACE2 receptor.
COVID and autoimmunity
"A study from Northwestern shows that most people make autoantibodies associated with rheumatic autoimmune diseases and diabetes after a mild COVID infection, regardless of prior vaccinations. Eight months after COVID infection, Long COVID patients with persistent neurologic and fatigue symptoms (neuro-PASC) have substantially higher levels of autoantibodies than recovered controls. Since even mild COVID-19 infections can trigger long-lasting autoimmune responses, the authors recommend public health mitigation strategies to help decrease COVID infections.
Obesity
"Obesity is a risk factor for severe COVID infection. Using Mass General Brigham EHR records of more than 600,000 people, researchers found that obese people were 34% more likely to become infected with COVID as well.
H5N1
"The California Department of Food and Agriculture (CDFA) notes that H5N1 has been found in 3 herds of dairy cattle in California. The farms in the Central Valley have been quarantined, there are no human cases suspected and there is no threat to milk or the food supply per CDFA.
"Farmworkers in Colorado say they have been working with H5N1 infected cows with only gloves to protect them. Farms have not been supplying full PPE as recommended.
Mpox
"Countries in Europe, the United States and Japan have pledged to donate Mpox vaccines to African nations hit by the Clade 1 Mpox outbreak.
AI:
"More than 40% of FDA-authorized Artificial Intelligence (AI) tools for healthcare have not been clinically validated for safety and effectiveness. The authors propose a new validation standard for FDA authorization.
Other news:
"A Listeria monocytogenes outbreak linked to Boar's Head deli meats, has infected a total of 57 people and killed 9 people according to the CDC. Millions of pounds of pre-sliced, packaged deli meats have been recalled with expiration or sell-by dates ranging from July 2024 through October 2024.
"In an observational study, obese people without diabetes took GLP-1 receptor agonists medications over a 5 year period, treatment with GLP-1 drugs was associated with a significantly lower risk of all-cause mortality (hazard ratio 0.23) and several cardiovascular complications, including ischemic heart disease, heart failure, arrhythmias, hypertension, stroke and atrial fibrillation. In addition, GLP-1 medication use was associated with a lower risk of acute kidney injury and allergic reactions as well.
"A woman found a squirrel enjoying an outdoor fan that she had left on her porch on a hot Texas day. Over time, she set up a 'squirrel spa' with fans to keep the critters cool and food for them to eat including frozen fruit.
Photo: @Breeintheforest
"Have a great rest of your holiday weekend,
Ruth Ann Crystal MD"
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