oyvayblog: Dr Ruth's COVID news & more newsletter, 10/26/24

Here's the latest information-packed issue of Dr Ruth Ann Crystal's COVID news & more newsletter for 10/26/24:

"Wastewater levels of SARS-CoV-2 are LOW nationally. Last week's uptick in the Northeast has resolved according to CDC data. According to Sara Anne Willette’s composite wastewater data from both NWSS & WastewaterSCAN, Montana, Vermont and New Hampshire wastewater COVID levels are HIGH as of October 22, 2024. Most wastewater locations are only reporting a few times each week, so it is important to look at the date of the map in order to know if it is the most recent information. Also, there are a lot fewer sites reporting wastewater levels of virus now, which makes it more challenging to get good information. I wrote this post earlier today on “How to look up SARS-CoV-2 wastewater data in your area” which gives specific SARS-CoV-2 information about U.S. states and about other countries as well.

From: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html

"Emergency room visits for COVID in the U.S. have gone down considerably. According to JP Weiland, we are at a lull for cases, but COVID case numbers are expected to start to increase in early November. There are approximately 216,000 new COVID infections per day and 1 in every 154 Americans is currently infected. JP Weiland said that he believes that the December 2024 winter wave will be significantly lower than the recent summer wave in the West and in the South. He expects that the Northeast and the Midwest will have winter COVID waves that will be higher than their 2024 summer wave, but that their 2024-2025 winter COVID wave will have fewer cases than last year’s.

From: https://x.com/JPWeiland/status/1849946540867191171/photo/1

Variants

"In the United States, the proportion of KP.3.1.1 has remained at 57% of new COVID cases for the last several weeks. Recombinant variant XEC increased from 2% to 5% to 10% to now 17% of COVID cases over the last 4 weeks. XEC is increasing in many other countries as well and is expected to become the dominant variant.

"A new article from Yunlong Cao’s lab shows that these variants have special mutations, the S31del mutation of KP.3.1.1 and the T22N mutation of XEC, that allow them to add glycans to the Spike protein N-terminal domain (NTD). The additional NTD glycosylation appears to increase the ability of these variants to evade neutralizing antibodies.

Acute COVID infections, General COVID info

"In a large study of 28,966 immunocompromised adults admitted to the hospital for acute COVID infection between December 2021 and February 2024, iv Remdesivir significantly decreased mortality in people not on supplemental oxygen and also in those requiring supplemental oxygen. When stratified by immunocompromising conditions, "Remdesivir was also associated with lower mortality in subgroups of patients with cancer, hematological malignancies (including leukemia, lymphoma, and multiple myeloma), and solid organ/hematopoietic stem cell transplantation."

"A review of 31 studies looking at COVID transmission on airplane flights showed that there were sporadic clusters of COVID spread usually to people seated within 2 seats in any direction of the COVID infected people. Masking reduced the risk of COVID transmission.

Pregnancy

"A study from Shanxi Province, China found that maternal COVID infection during early pregnancy may increase the risk of congenital heart defects in newborns. In 119 pregnant individuals infected with COVID, 10.1% of their newborns had cardiac abnormalities, compared to 4.1% in the control group. In all but one of the cases, the pregnant person was infected with COVID early, before 8 weeks of pregnancy. The study also found a significant rise overall in congenital heart disease during the pandemic, peaking at 5.5% in 2023. "The significant increase in congenital abnormalities during the COVID-19 pandemic, particularly the early gestational infections associated with specific types of cardiac abnormalities, emphasizes the need for ongoing monitoring and support for children born during the pandemic," the authors concluded.

Pediatrics

"Two new studies, one from England and one from Kaiser Northern California, show that babies have a high likelihood to be hospitalized for COVID infection. The English study analyzed EHR records from 45,000 children who were admitted to the hospital for COVID infection between July 2020 and August 2023. Babies under age 1 were most likely to be admitted to the hospital for COVID and represented 43% of all pediatric hospital admissions over the three year period (July 2020 to August 2023) and 64% of pediatric COVID hospital admissions between August 2022 to 2023. For older children over age 1, the severity of hospitalizations, including critical care, decreased over time, and cases of pediatric inflammatory multisystem syndrome (PIMS-TS) dropped significantly. Infants under age 1 are the only age group where COVID hospital admissions did not decrease over time. The findings highlight that infants remain particularly vulnerable to respiratory illnesses like COVID-19 due to low immunity levels. Infants are not eligible to be vaccinated, so it is especially important to vaccinate pregnant individuals against COVID.

Photo: Freepik

"Like the findings in the English study above, a new study from Kaiser Permanente Northern California (KPNC) of 1,107,799 children of whom 423 were hospitalized for COVID, found that babies under age 6 months were most likely to be hospitalized for COVID infection. Pediatric hospitalization rates were found to increase with each new SARS-CoV-2 variant. In children under 6 months of age, the incidence of hospitalization per 100,000 person-months increased from 7 during the pre-Delta period to 22.4 during the Omicron period. Black and Hispanic children, as well as kids with comorbidities, were at a higher risk of hospitalization. Teens were more likely to be admitted to ICU care. The authors conclude that "To prevent severe disease in children and adolescents, everyone eligible should be vaccinated."

Vaccines

"In America, everyone over age 6 months is eligible for one dose of the 2024-2025 COVID vaccines. The CDC just updated their advice regarding certain groups. People ages 65 and older should get a second dose of vaccine approximately 6 months after their first. Moderately to severely immunocompromised people of any age can now get two or more doses of the updated COVID vaccine per year under shared clinical decision making with their clinician. “The recommendation acknowledges the increased risk of severe disease from COVID-19 in older adults and those who are immunocompromised, along with the currently available data on vaccine effectiveness and year-round circulation of COVID-19.”

Novavax

"The FDA has put the clinical trials of Novavax’s combined COVID-Influenza and its stand alone Influenza vaccine on hold after a trial participant reported nerve damage after receiving the combined vaccine.

Vaccines and Mucosal Immunity

"The entry point of the SARS-CoV-2 virus is often through the nasal mucosa. This week, there were two new articles in Science magazine about mucosal immunity in the nose after COVID vaccination. The first article by Lasrado et al. showed that the XBB.1.5 mRNA intramuscular vaccine from last winter substantially increased neutralizing antibodies in the blood, but did not increase mucosal IgA antibody levels in the nose.

"The second study showed that intramuscular mRNA COVID vaccines can increase mucosal immunity against SARS-CoV-2, but not in the expected way. Usually, IgA antibodies are made in nasal mucosal tissues, but in this case, antibodies found in the mucosa were actually IgG that migrated from the bloodstream into the nose. Other studies have shown that giving a nasal spray booster vaccine after mRNA intramuscular vaccination causes an increase of IgA antibodies against SARS-CoV-2 in the nasal mucosa which can help to block infection.

"Vaccine expert Dr. Vipin Vashishtha tweeted, “These differing results by two studies may be due to the number of SARS-CoV-2 vaccinations or exposures, time since last exposure, and experimental approaches, but this pair of papers underscores the need to better understand the mucosal immune response in humans.”

Long COVID

"To figure out the pathophysiology of SARS-CoV-2 spread in the body, and to understand possible viral persistence in post-acute COVID, scientists from France used a radiolabeled antibody to SARS-CoV-2 which they used to follow viral spread over time using Immuno PET scans in monkeys. Three months after SARS-CoV-2 infection, the researchers also found persistent SARS-CoV-2 antigens in the lungs and brain of the non-human primates on repeat PET scan. Histopathology confirmed these findings.

"This reminds me of a recent study from UCSF in humans that used a T cell radioactive tracer on Immuno PET scan showing that SARS-CoV-2 can persist chronically in the gastrointestinal system and in other organs of people with Long COVID for over 2 years. In people with brain fog and fatigue, the gut and the spinal cord lit up on Immuno PET scan. Those with lingering pulmonary symptoms had immune activation in their lungs. Long COVID patient Ezra shared his Immuno PET scan from the study and explained the findings in this fascinating video clip.

Long COVID Advocacy

"Two patient-researchers with Long COVID, Julia Moore Vogel and Charlie McCone, wrote a piece in STAT news about the difficulties living with Long COVID, especially since there are no FDA approved treatments and since research is moving very slowly. 400 million people worldwide are suffering immensely from the disease. They recommend that until there are FDA approved treatments, health care providers should allow patients to try off-label drugs that have helped other people with Long COVID. They recommend guidelines and education about Long COVID for doctors regarding which off label treatments are most helpful for Long COVID symptoms.

"A study of young US Marines with mild COVID infections showed that 24.7% had post-acute sequelae of COVID (PASC) with symptoms like loss of taste or smell, shortness of breath, and cough. One year after mild or asymptomatic COVID infection, the young recruits had higher levels of depression and anxiety, and did worse on physical fitness tests due to slower run times. The findings show that even mild or asymptomatic COVID-19 can lead to significant long-term health effects in healthy young adults.

"A group from Sweden looked at the endothelial cells that line small blood vessels in people with post-acute COVID-19 syndrome (PACS or Long COVID). They found that 2 years after mild COVID infection, 41% of patients with PACS had microvascular endothelial dysfunction. N-terminal pro-B type natriuretic peptide (NT-proBNP) is a biomarker that increases with heart failure and cardiovascular stress. Long COVID patients with microvascular dysfunction were also found to have increasing levels of NT-proBNP over time, suggesting a link between endothelial dysfunction and potential heart-related complications in people with Long COVID.

"For healthcare providers, Stanford’s Long COVID clinical seminar “Unraveling Long COVID: Advances in Clinical Practice” is now available online.

H5N1

"According to the Seattle Times, 8 people who worked at a commercial egg farm in Washington State have tested positive for H5N1 bird flu on preliminary tests. Two of the 8 preliminary positive cases have been confirmed by the CDC and the other 6 cases are pending. The egg farm has been closed.

"Good news: CDC testing shows that there was no transmission of H5N1 bird flu between the Missouri H5N1 patient and 5 healthcare workers. There was no cluster. Genetic testing of the virus shows that the person was infected with the same H5N1 variant as found in cattle.

"The CDC summarizes human H5N1 Bird Flu cases in a table that is updated Monday evenings at 5pm ET at https://www.cdc.gov/bird-flu/situation-summary/index.html

Other news

"Two groups from the University of California have developed a way to repair genetic mutations before birth to potentially stop neurodevelopmental genetic conditions like Angelman and Rett syndromes. Using lipid nanoparticles (LNPs), the researchers were able to deliver Cas9 mRNA to 30% of fetal brain cells in mice which allowed the disease mutations to be repaired. This innovative treatment may some day help treat genetic disorders in-utero, preventing severe disease from developing after birth. “The implications of this tool for treating neurodevelopmental conditions are profound. We can potentially correct genetic anomalies at a foundational level during critical periods of brain development,” said the study’s senior author Aijun Wang, a UC Davis professor of surgery and biomedical engineering.

From: https://pubs.acs.org/doi/10.1021/acsnano.4c05169

"The CDC reported an E. Coli outbreak that is linked to McDonald’s Quarter Pounder hamburgers. As of 10/25/24, Taylor Farms initiated a voluntary recall of their onions that may have been used on the Quarter Pounder burgers.

"The FDA recalled 7,107 bottles of Cymbalta (Duloxetine) made by Towa Pharmaceutical Europe this week as the medication could cause "temporary or medically reversible adverse health consequences." Cymbalta (Duloxetine) treats depression, anxiety and chronic nerve pain. It is important NOT to stop Cymbalta without tapering off of it as that could cause withdrawal symptoms including severe vomiting.

"Walking pneumonia is a bacterial respiratory infection caused by Mycoplasma pneumoniae. Cases have been increasing since last spring and remain high, especially for young children ages 2-4 years which is unusual.

“For his impact as an actor, a literacy advocate, and a storyteller” – LeVar Burton was awarded the 2023 National Humanities Medal from the White House.