Time for another great newsletter from Dr Ruth Ann Crystal, full of information you can use:
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COVID, H5N1 & more, 11/24/24
"Wastewater levels of SARS-CoV-2 are still LOW
in most places across the U.S. according to the CDC and WastewaterSCAN.
As of 11/22/24, JP Weiland predicts that there are approximately 182,000 new COVID infections per day in the US and that about 1 in every 183 people is currently infected. Overall, COVID wastewater levels and COVID cases are almost 4x less
than we had during the same week in prior years of the pandemic. So,
although we expect a COVID wave during and after the winter holidays
when people mingle together indoors, hopefully it will be a smaller wave
than in past years.
"This week, Mike Hoerger noticed that the CDC did something wacky to their SARS-CoV-2 wastewater graph.
It appears that the CDC changed the y-axis on their curve to make
wastewater levels appear lower. There is no longer a zero on the y-axis.
"Here in the Bay Area and in California, SARS-CoV-2 wastewater levels are low overall.
Variants
"Regarding SARS-CoV-2 variants, KP.3.1.1 is now at 44% of cases, down from 52% two weeks ago. XEC
is at 38% of cases. XEC has a growth advantage, but it is not growing
as fast as other variants have in the past. More good news is that the
updated COVID vaccines should protect against the XEC variant.
Acute COVID infections, General COVID info
"A zoo in Brazil reported that 19% of their animals tested positive for SARS-CoV-2.
The Alpha variant was found in a maned wolf and a fallow deer and
Omicron was seen in a western lowland gorilla. Genetic analysis suggests
human-to-animal viral transmission from the people who take care of the
animals.
Pregnancy
"Comparing
11 million births from before the pandemic to 7 million births during
the COVID pandemic (2020 to 2022), the number of infants born with a congenital heart condition had increased by 16%.
Professor Asma Khalil said, "Studying this large US dataset has
revealed an unexpected picture for how the pandemic has affected the
hearts of unborn babies...These results act as an important reminder for
pregnant women to get their Covid-19 vaccinations to help protect
themselves and their baby."
"A study from China looked at the impact of maternal COVID vaccination
before pregnancy on fetal immunity by analyzing umbilical cord blood
samples at birth from vaccinated and unvaccinated people who contracted
SARS-CoV-2 during pregnancy. Vaccination
before pregnancy increased neutralizing antibody levels against COVID
and enhanced immune regulation in the fetal circulation as
measured by cytokine levels found in umbilical cord blood at birth. A
single prior vaccine dose was associated with persistent immune
dysregulation and platelet activation in the fetal circulation, but two
or three doses provided protective effects for the fetus. These findings
support the benefits of pre-pregnancy COVID vaccination to help protect
the fetus against COVID infection in utero.
"The UK’s
Joint Committee for Vaccination and Immunisation (JCVI) announced that
they will stop offering free COVID vaccines to pregnant individuals
in the UK starting in 2025, raising concerns about maternal and infant
health. Vaccination during pregnancy reduces severe COVID risks for
mothers, lowers risks of miscarriage and stillbirth, and protects
newborns during their vulnerable early months by passing on antibodies.
Data show infants, especially those under six months of age, are at
higher risk of severe COVID than most age groups, but maternal
vaccination can significantly reduce these risks.
Vaccines
"A Pew Research Center survey reveals that approximately 60% of Americans do not plan on getting the updated 2024-25 COVID vaccine.
This is despite CDC recommendations for everyone aged 6 months and
older to get the updated vaccine to protect against severe illness from
COVID. As mentioned above, the new COVID vaccines protect well against
variants that are circulating now. Vaccine uptake is sharply divided
along partisan lines, with Democrats more likely than Republicans to say
they will get the vaccine- a trend especially pronounced among older
adults. Key reasons for not getting the updated vaccine include concerns
about side effects and a belief that the vaccine is not necessary for
them.
"A new study shows that people with rheumatoid arthritis or spondyloarthritis who stopped their JAK or IL-17 inhibitor medications
for 2 weeks at the time of COVID mRNA booster vaccination, did not
significantly increase the amount of COVID neutralizing antibodies made.
Stopping these medications did, however, cause a significant number of
patients to have a flare of their arthritis.
Long COVID
"A group from USC has made a mouse model of Long COVID
(Post-acute Sequelae of COVID infection, PASC) using C57BL/6 mice and a
SARS-CoV-2 virus strain that was adapted to mice. The “C57BL/6J mice
developed neurological impairments, including behavior changes related
to sensorimotor coordination, depression- and anxiety-like behaviors,
and inflammation in multiple organs including lung, liver and brain”
that persisted for at least 4 weeks after mild infection.
"A
press release from Dogwood Therapeutics reported on a small
double-blinded, placebo controlled study completed at the Bateman Horne
Center on 29 people with Long COVID who received either IMC-2 (valacyclovir 750 mg + celecoxib 200 mg twice daily) or placebo. People in the IMC-2 treatment group showed “clinically meaningful reduction” in Long COVID fatigue and sleep disturbances. Larger studies are planned.
"Tryptophan
is an essential amino acid that the body uses to produce serotonin,
melatonin and niacin. A group from Cork, Ireland found that tryptophan and its microbial indole metabolites in the gut
are linked to dysregulated immune responses in both hospitalized COVID
patients and those with Long COVID 6 months after acute infection.
Reduced expression of bacterial genes involved in tryptophan metabolism
may lead to altered levels of indole metabolites which can affect innate
and adaptive immune responses.
H5N1
"The California Department of Public Health (CDPH) reported on November 19th, that a child in Alameda County
with mild upper respiratory symptoms tested positive for several
viruses including H5N1 Bird Flu. The child was treated and is doing well
at home. They had no known contact with farm animals and all of their
human contacts have tested negative for H5N1.
"So far, there have been three people infected by H5N1 Bird Flu without an obvious source of infection including the person hospitalized in Missouri several weeks ago, the Canadian teenager who is critically ill in the ICU with ARDS, and now a young child in Alameda County
in California who tested positive. If these people did not get H5N1
Avian Flu from farm animals or from human contacts, where did they get
it from?
"New data shows that the Canadian teen in
Vancouver is infected with several variants of the H5N1 bird flu
including one with mutations that make it easier to infect human cells
and to replicate more easily in human cells. It appears that the teen
was originally infected with H5N1 seen in poultry that led to
conjunctivitis symptoms. But, the H5N1 virus may have evolved within the teenager’s body
to cause a severe lung infection days later. “It’s not the time to
panic,” said immunologist Scott Hensley at the University of
Pennsylvania. “But this should serve as a warning: this virus has the capacity to switch very quickly into a form that can cause severe disease.”
According to CIDRAP, public health officials are monitoring the
situation and are testing vaccines to prepare for potential outbreaks.
"The USDA has confirmed 62 new dairy cattle herds in California with H5N1 avian flu, bringing the total since late August to 398 herds in California and 612 infected cattle herds in the nation.
California is the nation’s largest dairy producer and one-third of its
dairy herds have been infected. Regarding poultry, new H5N1 outbreaks
have been reported in four states, including major cases in California
in Kern County and in a Marin County duck meat producer.
"In an essay entitled “The World Is Watching the U.S. Deal With Bird Flu, and It’s Scary”, South
African virologist Tulio de Oliveira discusses the subpar response by
the United States to contain the spread of H5N1 bird flu. He says,
“Failure to control H5N1 among American livestock could have global
consequences, and this demands urgent attention. The United States has
done little to reassure the world that it has the outbreak contained.”
He asks us to imagine how America would respond if there was
uncontrolled spread of a highly pathogenic virus in another country like
China.
"Researchers from Wake Forest University warn
that as the highly pathogenic avian influenza (HPAI) H5N1 spreads
quickly on American dairy farms, this threatens our food supply and our
safety. They show that viral spread between farms is happening more rapidly than what current surveillance methods can keep up with. They recommend biosecurity practices to be put in place instead of passive surveillance measures.
"Scientists
from around the world are sounding alarm bells for H5N1’s rapid spread
in cattle and poultry in the United States. Bird flu also spreads by
wild birds as they migrate to new locations. As seen by the case of the
previously healthy Canadian teenager, the H5N1 virus is able to evolve
within people to cause more severe infections in humans. If H5N1 obtains
another mutation to make it more transmissible from animal-to-human or
from human-to-human, we potentially could have another global pandemic.
We really need to get this under control now.
Norovirus
"Levels of Norovirus in wastewater is HIGH
in most of the US now, as seen by orange on the map below. Norovirus is
very contagious and is spread by eating contaminated food or by
touching infected people or contaminated surfaces. It causes nausea and
vomiting. People are most contagious when they have these symptoms and
for the first few days after they feel better. In some cases, norovirus
can still spread for 2 weeks after the nausea and vomiting have
resolved.
Artificial Intelligence (AI)
"A new AI foundation model called BiomedParse
is able to analyze nine different medical imaging modalities (CT, MRI,
Xray, Ultrasound, Pathology, Fundus exam, Dermoscopy, Endoscopy and OCT
in the eye) for diagnosis. It makes me wonder if we could use
BiomedParse to find Long COVID biomarkers or to better understand the
pathophysiology of Long COVID.
"Open Evidence
is an AI medical information platform that can “aggregate, synthesize,
and visualize clinically relevant [medical] evidence in understandable,
accessible formats that can be used to make more evidenced-based
decisions and improve patient outcomes.” It is free for healthcare
professionals and provides references for each answer.
Other news
"Measles
is one of the most contagious diseases known. But, many people don’t
know that measles can also cause “immune amnesia”. “When you're infected
with measles, your immune system abruptly forgets every pathogen it's ever encountered before – every cold, every bout of flu, every exposure to bacteria or viruses
in the environment, every vaccination. The loss is near-total and
permanent. Once the measles infection is over, current evidence suggests
that your body has to re-learn what's good and what's bad almost from
scratch.” It appears that this is due to long term infection of memory T
cells by the measles virus.
"Most people know to dial 911
for emergencies, but there is also a special phone number to call if
someone feels suicidal. 988 is the National Suicide Prevention Hotline
and we need to spread the word about this important service.
"How can you solve the problem of tons of plastic in the ocean? By making a plastic that can be broken down by salt water. A group from Japan has done just that and is featured in Science magazine.
"Finally, I wanted to share our new article, "Reimagining Kangaroo Care for Preterm Infants: A Novel Garment for Safe and Comfortable Bonding,"
that was published in the journal Children. Kangaroo care, or
skin-to-skin care, has been shown to have numerous benefits for
premature babies and their parents. But, it can be difficult to do in
the neonatal intensive care unit (NICU) because it is hard to secure the
baby’s lines and breathing tube. Using human-centered design with
feedback from nurses, neonatologists, respiratory therapists and
parents, we invented the Kangarobe.
This study completed in the NICU at Stanford shows that parents and
nurses found that using the Kangarobe was a safer, easier and more
comfortable way to do kangaroo care with premature babies.
The Kangarobe™
"I will be taking next week off from the newsletter for Thanksgiving.
"Wishing you a wonderful holiday,
"Ruth Ann Crystal MD "