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"The CDC reports that wastewater levels of COVID are still LOW as of one week ago on 11/2/24 and that the Midwest region is starting to show a slight uptick. Per JP Weiland, there are presently about 217,000 new COVID infections per day in the United States and 1 in every 153 people is currently infected in America. Mike Hoerger’s numbers are a bit higher and he predicts that about 1 in every 115 people is actively infectious now.
"The highest wastewater SARS-CoV-2 levels according to WastewaterSCAN now are Bangor, ME at 1271 PMMoV; S. Parker, CO at 1186 PMMoV; Ottumwa, IA at 1134; and Lewiston, ME at 1123 PMMoV. WastewaterSCAN does not have information on New Mexico and several other states though. Here in the Bay Area, wastewater levels of SARS-CoV-2 are LOW.
From: CDC NWSS: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html
"According to composite wastewater data from Sara Anne Willette using information from the CDC’s NWSS site and the WastewaterSCAN site on 11/6/24, we are seeing hot spots in Luna county, New Mexico; Mono county, California; Pike county, KY; and Lincoln county, ME.
From: https://iowacovid19tracker.org/
Variants
"The KP.3.1.1 variant decreased from 57% of COVID cases two weeks ago to 52% this week. XEC now represents 28% of cases, up from 17% two weeks ago. XEC is increasing, but it is not doubling like other variants have in the past and is not expected to cause a large COVID wave. The updated vaccines work against both of these variants. Scientists are starting to see new variant MV.1 in a few places in the US, but it has not made much of an impact.
Acute COVID infections, General COVID info
"Autoantibodies to interferon-α (IFN-α) in the blood are associated with severe acute COVID infection. However, using a technique called FlowBEAT, researchers from Emory found that transient IgA1 autoantibodies to interferon-α (IFN-α) in the nose were helpful to tamp down immune response to COVID infection and were associated with milder cases of COVID.
"Looking at almost 7 million people in South Korea from 2020 to 2022, researchers found significantly increased risks of autoimmune and autoinflammatory connective tissue disorders following COVID infection, especially in people with severe COVID-19 infection, those infected with the Delta variant, and in unvaccinated individuals.
From: https://jamanetwork.com/journals/jamadermatology/article-abstract/2825849
Seniors and Immunocompromised people
"A new randomized trial shows that for immunocompromised individuals and seniors aged 65+, easy access to home testing, telemedicine, and quick Paxlovid delivery lessened COVID infection severity, reduced ICU admissions and lowered healthcare costs.
Vaccines
"A new study from Regeneron shows that giving Regeneron monoclonal antibodies (mAbs) casirivimab plus imdevimab at the same time as vaccination caused the immune system to make less neutralizing antibodies in humans, nonhuman primates and in mice. Booster vaccinations were able to increase neutralizing antibodies to normal levels, however.
Antiviral treatments
"Ibuzatrelvir is a new antiviral drug from Pfizer that works against the Mpro of SARS-CoV-2. A new Phase 2b, double-blind, randomized clinical trial of 240 US adults showed that Ibuzatrelvir reduced viral load after 5 days at different doses of the medication. Ibuzatrelvir does not have the same drug-drug interactions as Paxlovid. A Phase 3 study would need to be completed before Ibuzatrelvir could go on the market.
"On 11/1/24, the EPA made recommendations for improvement of ventilation in indoor spaces like schools and offices to prevent the spread of respiratory viruses.
Long COVID
"A study from the University of Washington found that individuals with Long COVID experienced significant cognitive decline and reduced quality of life two years after infection. People who believed that they had recovered from Long COVID showed improvement of most symptoms, but they still had higher levels of fatigue, pain, and cognitive issues compared to people without Long COVID. These findings raise concerns about the long-term impact on individuals' ability to sustain participation in work, education, and social activities if they have or have had Long COVID.
Figure 2
From: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-10158-w
"A study from the Mayo Clinic compared 247 people with Long COVID to 40 controls. Long COVID patients frequently reported pain, neurological problems, sleep disturbances, skin conditions, and genitourinary issues. In addition, 58% of Long COVID patients screened positive for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), 27% for generalized joint hypermobility (GJH), and many had orthostatic intolerance. The authors discuss research and clinical findings to better help understand Long COVID and the commonly overlapping illnesses that are associated with Long COVID.
"In a new article, a team from Australia summarized mechanisms that may be causing post-acute sequelae of coronavirus disease 2019 (PASC or Long COVID) including immune dysregulation with exhausted T cells and autoimmunity, gut dysbiosis, and immunothrombosis.
Box 1. Proposed mechanisms for post-acute sequelae of coronavirus disease 2019 (PASC) pathogenesis
From: https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.52456
"Yesterday 11/8/24, PolyBio had their Fall 2024 symposium on Long COVID research. The Patient-Led Research Collaboration tweeted the talks in this mega thread. There were many great talks including research on lymph node germinal centers having a lower number of B cells in people with Long COVID (from Dr. Michela Locci, University of Pennsylvania), on the salivary proteome in Long COVID (Dr. Marcelo Freire, UCSD), and on potential SARS-CoV-2 persistence and T cell activity in the female reproductive tract (Dr. Nadia Roan, UCSF as part of the UCSF LIINC study of the Female Reproductive Tract).
"A new small study from Hungary of 32 post-COVID-19 (PC) patients compared to 31 healthy volunteers shows a link between mitochondrial dysfunction and persistent symptoms in Long COVID patients. In Long COVID, researchers found structural abnormalities in the mitochondria and elevated markers of oxidative stress and disrupted mitophagy. Importantly, they found that lower levels of circulating cell-free mitochondrial DNA (ccf-mtDNA) were associated with increased symptom severity in Long COVID suggesting that ccf-mtDNA levels could be used as a novel biomarker for diagnosing and monitoring Long COVID.
Figure 3:
From: https://link.springer.com/article/10.1007/s11357-024-01398-4/figures/3
"There appears to be similarities between amyloid microclots in Long COVID patients and those found in ischemic stroke patients. Drs Pretorius and Kell have previously found fibrinaloid microclots in Long COVID that contain amyloid proteins and are very resistant to breakdown by fibrinolysis. In a new study, they show that in eight stroke patients were also found to have fibrinaloid clots in larger blood vessels that stain strongly for amyloid and were difficult to break down. "These findings represent a previously unreported characteristic of stroke clots, highlighting the potential for amyloid-targeted therapies to overcome their fibrinolytic resistance."
Figure 3: The fluorescent green dye shows amyloid in the clots from 2 stroke patients.
From: https://www.medrxiv.org/content/10.1101/2024.11.01.24316555v1
"The Bateman Horne Center put out a new Caregiver Resource Guide for people taking care of people with severe ME/CFS. Recommendations can also be useful for people without a caregiver.
"The Hypothalamic-Pituitary-Adrenal (HPA) axis is important in the body’s response to stress. In Long COVID, some studies show that morning cortisol levels are low, while other reports have shown high morning cortisol in some people with Long COVID. A new article shows that the gut microbiota regulate the circadian stress response of the HPA-axis in mice and that hyperactivation of the HPA-axis from microbial depletion in the gut can affect the way the body can respond to stress throughout the day including morning cortisol levels.
From: https://www.cell.com/cell-metabolism/fulltext/S1550-4131(24)00399-1
H5N1
"As of 11/6/24, Turlock, California which is known for dairy farming has an astronomical level of Influenza A in their wastewater. Turlock is at 2618 PMMoV of Flu A; Ottumwa, Iowa is at 368 PMMoV; and Los Angeles county doubled in the last few days to 155 PMMoV of Influenza A (probable H5N1) in wastewater. As more virus is circulating, there are more chances for humans and other animals to become infected. If the virus mutates to make it better able to spread from human-to-human, this could lead to another pandemic. We need to keep a close eye on H5N1.
From: https://data.wastewaterscan.org/
"A CDC study shows that 7% of dairy workers in Michigan and Colorado tested June through August 2024 had antibodies showing recent H5N1 bird flu infection. Without testing animals and people who work with them, H5N1 bird flu infections are going undetected. The results of the recent study prompted the CDC to expand testing, enhance PPE guidance, and recommend preventive Tamiflu for exposed, asymptomatic workers.
"A new preprint study from Cambodia shows that after almost a decade without human H5N1 bird flu infections, Cambodia had 16 cases of humans with bird flu between February 2023 and August 2024. Fourteen of the human cases involved a novel reassortant H5N1 virus that combined gene segments from both clade 2.3.2.1c which is endemic to Southeast Asia and clade 2.3.4.4b which has been seen globally. The new reassortant virus has new mutations including PB2 E627K which is linked to transmission between species and airborne transmission. In addition, in Figure 1b, it appears that 7 of the 16 humans died from the H5N1 bird flu infection as seen by the highlighted cross symbol.
Figure 1b shows the high mortality rate in people for the reassortant H5N1 bird flu virus.
From: https://www.medrxiv.org/content/10.1101/2024.11.04.24313747v1.full.pdf
Other news:
"In the last few days, doctors and nurses from Twitter have been leaving in droves to join BlueSky at https://bsky.app/. If you join, look for the Medsky feed and the Medsky Starter Packs to find friends. My Bluesky handle is @drruth.bsky.social.
"An article in Science magazine discussed the election and possible changes to policy and funding for the NIH and other governmental agencies with the new administration. Some scientists on Twitter recommend downloading available data from government websites as access may change.
"The FDA plans to discontinue the popular decongestant phenylephrine present in cold medicines because it doesn't work.
"A new blood panel called N3-MASH (CXCL10, CK-18, body mass index) is able to discriminate metabolic dysfunction-associated steatotic liver disease (MASLD) from healthy controls and can measure improvement without need for liver biopsy.
"A study shows that supplementing with indole lactate (ILA) in animal models of Multiple Sclerosis reduces brain inflammation and helps with remyelination of nerves.
"In a worlds' first, a group from Japan reports that 2 years after transplant of corneal epithelial cell sheets derived from human induced pluripotent stem cells (iPSCs), vision was improved in the 4 patients studied.
"Vancouver dad Douglas Lenhart won the Taylor Swift ‘Concert of a Lifetime’ grand prize with VIP box seats for 14 people to Swift's opening concert and $25,000. He is taking family and friends and also donated 4 of the seats to the Make-A-Wish-Foundation to grant the wishes of some critically ill children.
"Have a great rest of your weekend,
"Ruth Ann Crystal MD "
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