A "Quad-demic" This Winter?

After 5 years, it still amazes me that so many people are more content to ignore the warnings than be prepared for the worst.

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From Fortune Well:

Public health experts are warning of a ‘quad-demic’ this winter. Here’s where flu, COVID, RSV, and norovirus are spreading

"As you deck the halls and traverse afar this holiday season, taking precautions to protect yourself from a quartet of infectious diseases can lessen your odds of bringing an illness into the new year.

"Flu, COVID, respiratory syncytial virus (RSV), and norovirus are making their winter rounds nationwide, and you may have heard the term “quad-demic” pop up online or in conversation (the first three are sometimes called a “triple-demic”). While the unofficial term for the four maladies circulating in tandem evokes a sense of impending doom, the quadruple threat isn’t so different from respiratory virus seasons past.

“All of the viruses are here, it’s just they’re affecting different areas a little bit differently,” Dr. Robert Hopkins Jr., medical director of the National Foundation for Infectious Diseases tells Fortune. “I don’t want to panic people, but I would say if you haven’t been vaccinated and you’re eligible for vaccination—that means everybody 6 months of age and older—get that COVID shot, get that flu shot.”

"An RSV vaccine is also available for adults 75 and older, adults 60 to 74 with certain chronic medical conditions, and expectant parents late in pregnancy, Hopkins stresses. “We have tools, we just have to use them.”

"Dr. William Schaffner, a professor in the division of infectious diseases at Vanderbilt University Medical Center, refers to this time of year respiratory virus vaccination season. Getting up to date on your immunizations is the best holiday present you can give yourself and your loved ones, he says.

“Benjamin Franklin had it right: ‘An ounce of prevention is worth a pound of cure,’” Schaffner tells Fortune. “Let’s do what we can to prevent serious illness this year. We’re under-vaccinating.”

"But how can we protect against norovirus, also known as “winter vomiting disease,” for which there’s no vaccine? Here’s where hand hygiene reigns supreme.

“Make ample use of soap and water,” Schaffner says, noting that alcohol-based hand sanitizer alone doesn’t defeat norovirus. “It’s highly contagious and you can probably pick it up on the environment, on your fingers, and then when you touch your nose and mouth, that’s how the transmission occurs.”

"The same public health measures you likely adopted during the early days of COVID can help stave off illness, too, Hopkins stresses.

“It’s important to cover your coughs, ideally with your sleeve or with a handkerchief, not your hands,” Hopkins says. “Stay away from people who are sick, stay home when you’re ill, contact your health care professional about whether you need to get tested and about symptomatic measures.

“It’s important to stay active, particularly outdoor activities. Stay healthy as far as your eating and your fluid intake. And depending on what your health status is, you may really want to be careful about being in crowds, because that’s a natural breeding ground for those viruses to spread from person to person.”

Flu activity elevated in most U.S. states

"The Department of Health and Human Services (HHS), of which the Centers for Disease Control and Prevention (CDC) is a part, often breaks the country up into 10 regions when mapping illnesses. The week ended Dec. 7, activity of influenza-like illness was elevated nationwide except in Region 8—Colorado, the Dakotas, Montana, Utah, and Wyoming—where the level was normal.

“Flu definitely has been picking up over the last six weeks and continues to increase week by week in terms of hospitalizations of flu,” Schaffner says, “not only in my neck of the woods, but around the country.”

"Nationwide, the A (H3) strain of influenza accounted for the plurality of infections the three weeks ended Dec. 7, CDC records show.

"A “very disappointing” segment of the population has been vaccinated against the flu this year, Hopkins says. According to the CDC, 40.8% of adults and 40.8% of children had been immunized as of the week ended Dec. 7. At that time last year, 40.6% of adults and 44.2% of children had been protected. If you missed the unofficial “vaccine before Halloween” deadline to get your flu shot, worry not, Hopkins says.

“It’s not too late,” Hopkins says. “It is not a bad time when we’ve got risk in front of us. And I would certainly prefer that people were vaccinated earlier, but I’m not going to make perfection the enemy of the good.”

Most adults haven’t gotten updated COVID vaccine

"It’s hard to believe we’re approaching the five-year anniversary of SARS-CoV-2, the virus that causes COVID, worming its way into the U.S. Though COVID is now endemic, it remains a highly infectious disease whose long-term consequences are unfurling. Unvaccinated individuals have a higher risk of severe infection, hospitalization, and death, and thanks in part to lingering COVID fatigue, uptake of the new 2024–25 vaccine has been less than ideal.

"Only one in five adults (21%) had gotten the updated jab as of the week ended Dec. 7, the CDC estimates. Still, uptake was slightly higher than that of the 2023–24 vaccine (16.9%) at the same time last year. Just 10.6% of children had been vaccinated, on par with last year’s 10.2%. The CDC recommends everyone 6 months and older get the vaccine targeting this season’s variants—even if they’ve had COVID or received an older version of the vaccine. If you have a compromised immune system, ask your doctor about your eligibility for extra booster doses.

"The summer surge in COVID infections may be in the rearview mirror—case positivity peaked at 17.8% the week ended Aug. 10—but the national positivity rate has begun to creep back up in recent weeks. The rate was 5.4% the week ended Dec. 7, up from 4.2% three weeks earlier. Throughout the four weeks ended Dec. 7, test positivity was highest in Region 8 (6%) and Region 6 (5.2%), which includes Arkansas, Louisiana, New Mexico, Oklahoma, and Texas.

"While rapid COVID tests are now widely available in stores and online, it’s not too late to order four free tests for your household at COVIDtests.gov.

Less than half of adults 75+ have received RSV jab

"Unlike annual COVID and flu shots, the newer RSV vaccine—for now at least—is a one and done. The first FDA-approved RSV vaccine, Arexvy, manufactured by Fortune 500 Europe company GSK, didn’t become available until mid-2023 and uptake of the now three available vaccines has been slow.

“[RSV] can be very risky, but people are not as aware of it as a virus in itself,” Dr. Sujata Ambardar, an infectious disease specialist at Inova Fairfax Hospital in Falls Church, Va., previously told Fortune. “They think of COVID, flu, and other viruses.”

"Less than half of adults 75 and older (42.5%) had been vaccinated as of the week ended Dec. 7, compared to a third (33%) of adults 60 to 74, CDC records show.

"Test positivity was 7.6% the week ended Dec. 7, down from 12% at the same time last year. This rate was at least 11% across most of the Eastern Seaboard and South Central U.S., as far west as New Mexico. Region 3—Delaware, the District of Columbia, Maryland, Pennsylvania, and the Virginias—had the highest test positivity (16.4%).

Norovirus spread in U.S. hasn’t reached level of U.K. outbreak

"Norovirus infections have been largely increasing since early fall. Test positivity hit a season high (18.4%) the week ended Dec. 7, compared to 6% the week ended Sept. 7.

"Norovirus is tracked in Census regions rather than HHS ones. The week ended Dec. 7, test positivity was highest (21%) in Region 4, which covers the West, from Colorado to California to Hawaii.

“There’s a large outbreak in the U.K. at the moment, in Britain, and they’re very concerned about it,” Schaffner says. “We’ve had scattered reports of norovirus but nothing huge…we anticipate that we’ll get more of norovirus but we haven’t had the comparable increase that they’ve had.”

'Schaffner adds, “Holiday travel has already started and will become intense. We’ll have many holiday parties, family reunions, and the like. These are optimal circumstances for all of these viruses, all four, to spread from person to person.”

For more on infectious diseases:

• Yes, you can get the COVID, flu, and RSV vaccines at once. Here are the pros and cons
• New COVID vaccines are here. What to know about latest shots in wake of nation’s biggest summer surge
• New flu shots have arrived. Here’s the best time to get your annual vaccine
• RSV can be deadly, especially for older adults. What to know about symptoms and the new vaccine
• Norovirus causes up to 21 million illnesses in the U.S. every year. Here’s what to know about the contagious disease that hand sanitizer can’t kill
  

Your Local Epidemiologist, 12/19/24

Here's Dr Katelyn Jetelina's latest newsletter covering our respiratory state of affairs:

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Up, up, and away

Respiratory State of Affairs: December 19

Welp, I’ve spent the past two days on a couch with my 4-year-old, who has the flu. Who knew a toddler could watch 10,000 Disney princess movies and still have an appetite for more? Respiratory season is here. Apparently so is our princess era.

There are many viruses circulating right now, but we aren’t at peak season yet. Here’s the State of Affairs so you feel well-equipped for the holidays.

Influenza-like illnesses: Moderate and increasing

The climate of respiratory health in the United States—which the CDC defines as “influenza-like illnesses” (ILI)—has crossed the “epidemic” threshold and is growing. The trend seems to be tracking exactly with the 2019-2020 respiratory season. I’ve started wearing my mask while traveling.

ILI Levels, by year. Source: CDC; Annotated by YLE

ILI has lit up in the West and South. The Midwest is still pretty quiet. Eventually this entire map will be red and purple.

ILI levels, by state. Source: CDC; Annotated by YLE

Flu: Moderate and increasing

Flu is coming in hot, with an exponential spread across the United States. The spread is mainly due to Flu A strain; we typically see a Flu B peak in early spring. Nothing abnormal is jumping out about this year yet.

Percent positivity of tests among physicians. Source: CDC; Annotated by YLE

However, one concerning trend is flu vaccine coverage—it’s getting lower and lower every year in a step-wise fashion. This may explain last year’s high flu deaths among kids.

Flu vaccination coverage among kids under 18 years old. Source: CDC; Annotated by YLE

My daughter was vaccinated against the flu but still got infected. Unfortunately, the flu vaccine may not be a great match this year (~34% effectiveness in the Southern Hemisphere) because a specific strain is circulating. Regardless, a flu vaccine helps bring sickness from wild to mild. It’s not too late for a flu vaccine.

Also, hot tip: We used an at-home combo flu/Covid test. I wouldn’t normally care which virus infected her, but with flu, there is a specific action to take—a prescription for Tamiflu can help relieve symptoms one day earlier. This saved us a trip to the pediatrician’s office!

RSV: Peaked in some areas?

RSV may have peaked in the East/Southeast, like in Georgia, but definitely still increasing in other states, like California. This is typical of RSV—waves start in the Southeast corner and spread outward nationwide. Scientists don’t really know why.

RSV hospitalizations in Georgia and California, Source: CDC; Annotated by YLE

So far, we are having a middle-of-the-road season for RSV. I’m curious if/when we will see a population-level impact from RSV vaccinations and monoclonal antibodies. It doesn’t seem like this year is the year.

Covid-19: Low but increasing

Some epidemiologists were quietly questioning whether it was possible to have a no-Covid winter, given low activity over the past month or two. Historically, Covid-19 has started increasing in November and peaked around the first week of January.

However, those rumblings were put to rest this week as Covid-19 wastewater started increasing again. Levels are still relatively low but growing.

Covid-19 Wastewater Levels, Source: CDC; Annotated by YLE

My guess is that this winter’s Covid-19 wave has just shifted—it will peak in February. Given the relatively large summer wave, we’ll have a smaller peak than previous winters. We’ll watch to see if Covid-19 has any surprises for us.

Increasing Covid-19 (and other viruses during the winter) is largely due to three factors:

1. New variants. The latest Covid-19 variant is called XEC, and it has a few mutations that allow it to skip around our first line of defense, causing infections. Its growth advantage isn’t too big at 20-45%. (As a comparison, Omicron was 500%.) This signals the winter will be a wave, not a tsunami.

2. Cold weather leads people inside, which has poor ventilation. Also, some weather properties, like humidity, increase transmission.

3. Social networks. With the holidays, we see people we wouldn’t normally see, allowing viruses, like Covid-19, to transmit more.

If you’re one of those trying to time a Covid-19 vaccine before a wave to optimize protection against infection, the time to get vaccinated is now.

Other things going around

• Walking pneumonia is still high but finally decreasing after a nasty year. This causes a lingering cough that is typically not severe but a nuisance.

• Norovirus—think nausea, vomiting, diarrhea—is having quite the time, with the number of positive tests and outbreaks abnormally high. Norovirus spreads through contaminated surfaces, so as always, wash those hands. Unfortunately, this virus is one of the hardest viruses to kill because it doesn’t have a stable coating called a membrane. So, a quick dose of hand sanitizer doesn’t work. Bleach-based products on surfaces are the best. Read more in a previous YLE post.

Number of norovirus outbreak investigations by CDC. Source: CDC; Annotated by YLE

• Whooping cough is back to pre-pandemic levels, though it’s preventable with the Tdap/DTaP vaccine. According to a recent survey, a third of the public doesn’t know this disease is preventable. Adults need boosters—one every 10 years. Unfortunately, our second-generation vaccines are imperfect, and vaccine hesitancy is rising.

• H5N1 (bird flu)— Despite all the headlines this week, nothing much has changed for the general public: The virus keep spreading, severe cases are starting to pop up (latest in Louisiana) from people with direct contact with sick animals, and, thankfully, more resources are being channeled to public health (see CA State of Emergency). It’s clear this virus isn’t going away any time soon. The biggest concern is the potential for a mutation, especially since seasonal flu is now circulating. H5N1 could swap genes with seasonal flu and become more susceptible to humans.

Bottom line

Things are heating up! Stay healthy out there— get vaccinated, get that air moving, use masks, and stay home if you’re sick. (And if you’re stuck at home watching Disney movies like me, I highly recommend starting with Encanto).

Love, YLE 

Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. During the day, Dr. Jetelina runs this newsletter and consults with several nonprofit and federal agencies, including CDC. YLE reaches more than 290,000 people in over 132 countries with one goal: “translate” the ever-evolving public health science so that people feel well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below

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Sorry, Charlie! REAL Women Take Precedent Over Fake "Women"!

It's amazing how many people have acquired the politically correct disease and refuse to accept reality (or are too afraid of being 'cancelled' or fired by woke mobs).  Case in point:

NCAA prez suggests onus on female athletes to use other facilities if uncomfortable sharing with trans players

"NCAA President Charlie Baker sent a message to women's college athletes who are uncomfortable sharing locker rooms with transgender athletes on Tuesday, putting the responsibility for their own safety squarely on the women themselves."

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The delightful Senator Kennedy later asked him, “Why don't you go to Amazon and buy a spine online and take a stand?” 

I never imagined that this insanity would last this long, but the quicker it's cured, the better, both for real women and for society.

A Current COVID Lull, But For How Long?

We've had COVID lulls before, and then the rates would go up.  I wouldn't boast about this if I were them. It will only inspire more people to ditch the masks and vaccinations and gather in large groups, with predictable results.

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From Jamie Ducharme at TIME Magazine, 12/18/24:

COVID-19 Rates Are Strangely Low This Holiday Season

"This year, the U.S. may get the gift of a relatively light COVID-19 holiday season.

"The SARS-CoV-2 virus, which causes COVID-19, has followed a predictable pattern over the last few years: after a fall lull, it begins to spread more widely in November, and infection rates peak in late December or early January. This year, however, has “been weird,” says Katelyn Jetelina, who writes the Your Local Epidemiologist newsletter.

"COVID-19 activity was minimal throughout November. And as of the week ending Dec. 7, the amount of SARS-CoV-2 virus detected in U.S. wastewater was still considered “low,” according to the U.S. Centers for Disease Control and Prevention. Levels have begun to tick upward but are still well below those of past Decembers.

"Projections by Jay Weiland, a data scientist and infectious disease-modeler who tracks COVID-19, suggest that roughly three times fewer people in the U.S. will catch COVID-19 during this holiday season compared to those of previous years, although some regions will likely be hit harder than others. By Weiland’s estimates, up to 300,000 people in the U.S. are currently getting sick with COVID-19 each day, compared to around 1 million cases per day around this time in recent years. Hundreds of thousands of infections per day is not nothing, of course, but “that’s not a bad place to be for December numbers,” Weiland says.

"This season’s lower numbers are probably because of the long-lasting COVID-19 wave the U.S. endured this past summer. An unusually large segment of the U.S. population—around 25% or possibly even more, by Weiland’s estimates—got sick over the summer. That sizable group still has relatively fresh immunity, meaning fewer people than usual are susceptible to infection right now. And as an added bonus, there haven’t been many worrisome new variants—which could potentially evade that immunity—in recent months, Weiland says.

"There’s still likely to be an uptick in cases this winter, fueled by holiday travel and gatherings and colder weather forcing people indoors. But current data suggest the wave will peak later than in previous years, and will perhaps be smaller overall. “There’s a good chance that this wave will be more mild than in previous winters,” Jetelina says.

"There are, however, other respiratory illnesses to consider this holiday season. Influenza and RSV are both on the rise, and the common cold is everywhere too. “There are a lot of reasons to take precautions even beyond COVID,” Jetelina says. Wearing a mask, especially in crowded indoor areas, can help minimize transmission of not just SARS-CoV-2, but all respiratory viruses. Regular hand-washing also remains important, as does staying home if you’re not feeling well.

"And if you haven’t gotten your updated COVID-19 shot, Jetelina says now is a great time to do so. COVID-19 vaccines are better at preventing severe disease and death than they are at blocking infections—but they do offer some protection against infection, especially in the first few months after receiving a dose. With viral spread likely to increase at least a bit as the winter goes on, “getting a vaccine right now is actually the ultimate timing,” Jetelina says."

Dealing With Unwanted Remarks About Long COVID & Other Diseases

Some people can be extremely tactless and inconsiderate. To "How are you today?" I'd always reply  "Fine" because it was less stressful for me not to have to explain myself to healthy people.  Because of them, I learned the art of lying about my own chronic health problems and countering their questions, unsolicited advice, or assertions with humor. 

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By Ludmila Praslova at From Fast Company 12/17/24:

5 things not to say to a coworker with long COVID-19

These myths about long-haulers can lead us to make blunders. Here’s what you need to know to be more empathetic to those dealing with the illness—or other chronic health conditions.

“Nobody ccoan be dizzy for two years.”

"With long COVID, many are.

“Oh, come on. Adults don’t need naps.”

"With long COVID, many do. And some need a lot more rest than they did before.

“It’s all in your head. A bit of walking can’t do you harm.”

"But with long COVID, it can.

“So, are you better yet?”

"Please, just don’t.

"Long COVID is a full-person syndrome that may lead to complex long-term effects that can last for years, impacting individuals’ daily lives. Research identifies four types of long COVID based on symptoms that tend to cluster together. Type 1 can particularly affect the heart, kidneys, and the circulatory system. Type 2 can involve lung problems, sleep disorders, and anxiety. Dominant symptoms of the Type 3 are muscle and connective tissue conditions, along with nervous system disorders. Finally, people with Type 4 tend to experience digestive and respiratory problems. However, many cases defy these patterns and produce a blend of struggles unique to the individual.  

"While the physical and psychological symptoms can be brutally debilitating, one of the hardest things about dealing with long COVID—including in the workplace—is the lack of understanding and compassion. Instead of much-needed empathy, long-haulers end up having to deal with the sting of skepticism,  misunderstanding, and unintentional or even intentional cruelty from others. Even well-intended comments and advice can hurt when they do not consider the nature of Long COVID and the perspective of those dealing with it.

"Here’s some practical advice on how to be a good coworker to someone with long COVID—starting with what not to say. These statements, even if meant as neutral or encouraging, are likely to hurt.

1. ‘But you seemed fine yesterday.’

"This phrase reflects a classic misunderstanding of what it means to experience a dynamic disability. Long COVID doesn’t play by the rules of predictability; it often manifests as episodes and flare-ups. One day, a person might be able to work almost like they used to, only to be unable to get out of bed for the next week. The fluctuations can be frustrating and confusing. And if you are frustrated and confused as an observer, imagine just how much more frustrating it is for the person whose body no longer makes sense to them.  

"Having to constantly prove their illness makes the experience even worse. Imagine having to constantly present proof that you really, honestly need eyeglasses, or perhaps shoes that are the right size. To signal openness to a conversation without judgment, it might be best to just make it clear that the answer to your “How are you feeling today?” does not have to be “Fine.”

2. ‘You just need to exercise.’

"It sounds like advice rooted in concern. Exercise is good for everyone, right? But for many with long COVID, this suggestion can feel like a dismissal of the reality that, for them, exercise is a potential trigger for flare-ups.

"One of the most common and cruel long COVID symptoms is post-exertional malaise (PEM), a worsening of symptoms following physical or mental exertion. And even after two years, fatigue is the most prevalent symptom. Telling someone to “just exercise” overlooks the fact that many people with long COVID may long to exercise, but cannot—and this can exacerbate the emotional toll and grief many experience. 

"What most people with long COVID need isn’t a push to exercise; it’s permission to rest without judgment. It’s understanding that their bodies don’t respond to exertion the way they used to.

3. ‘It’s probably just stress.’

"Stress is the cultural catch-all scapegoat. Feeling tired? Must be stress. Can’t concentrate? Probably stress. But attributing the symptoms of long COVID to stress alone dismisses the complex physiological impact of the virus. Long COVID is a multi-system condition with well-documented neurological, cardiovascular, immunological, and other effects. The very cells of our bodies no longer work as they used to.

"Reducing it to “just stress” ignores the genuine, measurable infection-linked changes happening in the body. It may also be interpreted as shifting the blame to the individual for not handling stress better rather than recognizing the real medical condition they are dealing with. Visible or not, the long COVID injury to the body is real, and so are the consequences of ignoring that injury. Instead of offering platitudes (which often involve the minimizing word “just”), recognize that being present with a listening ear and empathy can be more helpful than offering unsolicited input.

4. ‘You’re probably just tired. We’re all tired.’

"This may be intended as a statement communicating understanding, yet it can come across as insensitive and dismissive. Fatigue is a common symptom of long COVID, but it’s not just about feeling tired. It’s a bone-deep exhaustion that doesn’t go away with rest and often severely impacts daily functioning. Comparing this to everyday tiredness is like comparing getting a bruise to being in a life-altering accident; it diminishes the debilitating nature of chronic fatigue often associated with long COVID.

5. ‘At least you don’t have to commute every day/get more flexibility than I do/don’t have to do X anymore.’

"Framing accommodations as a “silver lining” trivializes challenges. Most people with long Covid would much prefer being able to work or commute without restrictions.

"People rarely like to acknowledge the envy over the accommodations—perceived as “perks” or “luxuries”—that the person with a chronic illness may receive. But check in with yourself: Is this your envy talking? If you find yourself feeling envious of someone with chronic illness, it could be a signal that you need to take better care of yourself, or perhaps that everyone at work could benefit from more flexibility. Instead of begrudging accommodations, advocate for a flexible and supportive work environment for all—and perhaps for more staffing if everyone had been stretched thin for a long time. (My book, The Canary Code: A Guide to Neurodiversity, Dignity, and Intersectional Belonging at Work, provides many suggestions for improving workplaces in ways that help include those who are most vulnerable and benefit everyone.)

How to Be an Ally: Working Through Your Emotions and Embracing Compassion

"Let’s be honest: Learning that a coworker has a chronic illness, such as long COVID, can evoke a range of uncomfortable emotions, from sadness to fear, frustration, pity, or helplessness. It can also evoke a profound sense of life’s unfairness. It’s not a pleasant thought that a virus anyone can catch might alter your life even if you “exercise and eat right.” It is painful to lose faith in this cultural mantra of control. It hurts when our belief in a just world—where people get what they deserve and deserve what they get—is challenged.

"The disquieting emotions are natural, but they are yours to manage and not your coworker’s responsibility. Do not suppress them. They will only bubble up at the worst moment, like when a major project is due. Work through these feelings constructively, seeking emotional or spiritual help if needed. Reflect on your beliefs and consider whether they serve you well in dealing with reality. Accepting that life isn’t always fair doesn’t mean giving up hope—it means making room for more patience and compassion."

Hands Off The Polio Vaccine!

I have no objection to RFK wanting to improve the health and diets of the American people by focusing on food additives and the like. However, it should be made clear to him that vaccines, especially the lifesaving polio vaccine, are strictly off limits!

Those of us from the older generation remember the polio horror stories told by our families, who had friends and relatives crippled or killed by that devastating disease.

Anyone who actually thinks the polio vaccine should be revoked should be forced to read this article from the Free Press: "Polio Ravaged My Family. Forget Its Horror at Your Peril", by Jana Kozlowski

Joe Biden's Delusional Gall of the Day

Take 2 tranquilizers before reading this story from the Jewish Press. The answer Israel should give to Biden must be a firm "NO!"

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Unbelievable: Biden Admin Asks Israel to Approve Military Aid to PA

"The Biden administration has privately asked Israel to approve an urgent request for U.S. military aid to Palestinian Authority forces, Arab, American and Israeli officials told Axios on Sunday night.

"The request comes after the P.A. launched a rare counter-terror raid in Jenin, where Ramallah for years refused to act against Iranian-backed terrorist groups, in violation of its commitments under the Oslo Accords.

"Ramallah launched its operation, dubbed “Defense of the Homeland,” following the Dec. 5 seizure by Hamas and Islamic Jihad of a P.A. vehicle and amid fears that terrorists in the Samaria city could attempt a coup inspired by the swift rebel takedown of Bashar Assad’s regime in Syria."

"According to Arab media reports, two Arab terrorists have so far been killed by the P.A., including Yazid Jaysa, a leader in the Islamic Jihad-led Jenin Brigades who was reportedly also wanted by Israel.

"The ongoing operation “is a make or break moment for the Palestinian Authority,” one official in Ramallah told Axios. “Either [you] act like a state you say you are or go back to being a militant organization.”

"P.A. and U.S. officials told the outlet that P.A. leader Mahmoud Abbas’s office had briefed the Biden administration and President-elect Donald Trump’s team ahead of the raid. U.S. security coordinator Gen. Mike Fenzel met with the Palestinian Authority police chiefs in preparation for the operation and went over their plans, the P.A. official claimed.

"Ramallah reportedly gave Fenzel a list of equipment its forces urgently need, including ammunition, helmets, bulletproof vests, radios, night vision equipment, bomb disposal suits and armored vehicles.

"The Biden administration reportedly also asked Jerusalem to release some of the P.A. tax revenues it has frozen so Ramallah can pay the salaries of its forces. The Israeli government has frozen the funds in response to the P.A.’s “pay for slay” policy in which it pays monthly stipends to terrorists and the families of slain terrorists.

"The Biden administration reportedly also asked Jerusalem to release some of the P.A. tax revenues it has frozen so Ramallah can pay the salaries of its forces. The Israeli government has frozen the funds in response to the P.A.’s “pay for slay” policy in which it pays monthly stipends to terrorists and the families of slain terrorists."

Dr Ruth's COVID, H5N1 & more, 12/14/24

Here's the latest edition of Dr Ruth Ann Crystal's informative newsletter, COVID, H5N1 & more.

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Wastewater levels of SARS-CoV-2 are LOW nationally, but are MODERATE in the Midwest as of December 7th according to the CDC. We are just starting to see a rise in virus levels. Through December 7, the CDC reported that New Mexico, Arizona, Massachusetts, and Minnesota were VERY HIGH. Missouri and South Dakota are also VERY HIGH, but there are very few sites reporting in those two states which makes it harder to analyze.

Wastewater SARS-CoV-2 per the CDC (NWSS):

Zoomed in

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

Looking at the CDC wastewater numbers, Mike Hoerger estimates that 1 in every 73 people in the Midwest were actively infectious with COVID on December 7th. If cases continued to rise in a similar way, he calculated that by December 13th, 1 in every 41 people would be actively infectious with COVID in the Midwest. JP Weiland predicts that we will have a much smaller winter COVID wave this year. He predicts a peak under 400,000 new COVID infections per day in early January, but Mike Hoerger believes that the numbers will be higher and expects about 750,000 new infections per day by January 1st. Whichever it is, this winter wave does look like it will be significantly lower than what we have seen in prior years.

From: https://bsky.app/profile/jpweiland.bsky.social/post/3lcw6izzxzs2y

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Variants

The US variant tracker only updates every 2 weeks now. Last week, XEC surpassed KP.3.1.1 reaching 44% of COVID cases, while KP.3.1.1 was 39%. Variant hunters on Twitter are watching LP.8 more closely as it is increasing in a Brazilian state. Today, Ben Murrell posted on the growth advantage of LP.8.1 which appears to have about a 30% growth advantage over XEC. Federico Gueli‬ posted, “As expected, very little changed: LP.8.1 is the fastest likely with a slightly more clear advantage over everything.” Even if LP.8.1 takes over, it does not look like it would cause a huge COVID wave.

From: https://github.com/MurrellGroup/lineages?tab=readme-ov-file

Acute COVID infections, General COVID info

Scientists from UCLA created a nanoengineered immunosensor that can quickly see if someone has a blood clot by measuring four markers (CRP, calprotectin, sP-selectin, and D-dimer) in the blood. The sensor was tested on 53 people with acute COVID infection and was rapidly able to predict clotting events with 92% accuracy.

A group from Florida and Italy made an artificial intelligence (AI) model called SARITA which can predict how the SARS-CoV-2 spike protein S1 will mutate. When trained on Alpha, Beta, and Gamma variants, SARITA was able to correctly predict how future S1 mutations would evolve and was able to accurately predict mutations in later variants including Delta and Omicron. Because SARITA is able to predict how the SARS-2 virus will evolve, this technology could be beneficial in designing new COVID vaccines and treatments.

This week, the World Health Organization’s Director-General Dr. Tedros Adhanom Ghebreyesus said at a media briefing on December 10th, "We cannot talk about COVID in the past tense. It’s still with us, it still causes acute disease and Long COVID, and it still kills. The world might want to forget about COVID-19, but we cannot afford to." He is right.

Pediatrics

In a study of about 385,000 children and adolescents, the Pfizer BNT162b2 mRNA COVID vaccine was found to reduce the risk of Long COVID during Delta and Omicron periods. During the Delta wave, the Pfizer mRNA COVID vaccine was 95% effective against Long COVID in teens. During Omicron, it was 60% effective against Long COVID in children and 75% effective in teenagers.

Long COVID

In 2021, the NIH launched the RECOVER initiative with $1 billion allocated for research on Long COVID. Three years later, people were critical because most of the $1 billion funding was spent on observational studies without a focus on treatments or cures.

The NIH has now allocated $147 million to $515 million announced earlier this year for RECOVER, bringing the new total to $662 million in new funding to support ongoing observational studies, pathobiology research, and the RECOVER-Treating Long COVID (RECOVER-TLC) clinical trials program which focuses on developing and testing treatments. $18 million will be directed toward studies exploring biological mechanisms of Long COVID which may help identify potential therapies as well.

An analysis of symptoms from 172,303 people with Long COVID identified ten key symptoms of Long COVID, and categorized them into four subtypes: 30% ENT (smell, taste, and hearing loss), 10% cardiopulmonary (shortness of breath, postural tachycardia, chest tightness or pressure), 23.5% neurological (brain fog and speech difficulty), and 38% with mild general fatigue. Risk factors for Long COVID included severe COVID-19 infection and multiple reinfections. Vaccination reduced the risk.

Long COVID affects women more than men and there are sex differences in immune responses in Long COVID. In a new article, Physical Medicine and Rehabilitation doctors discuss special issues around Long COVID rehabilitation in women stating, "Rehabilitation efforts for long COVID in women must address health equity concerns and consider the historic context of stigmatized infection-associated chronic conditions."

A study from the University of Georgia highlights the financial hardships caused by Long COVID, particularly for lower-income individuals and those without college degrees. Among nearly 10,000 participants with Long COVID, many reported food insecurity, difficulty paying bills, and risk of losing utilities. These challenges disproportionately affected those in lower socioeconomic groups.

A group in British Columbia analyzed health-related quality of life (HRQoL) in 3,463 Long COVID patients using the EQ-5D-5L questionnaire. Results revealed significant reductions in HRQoL, with 95% of participants scoring below 90 and 50% below 60, highlighting Long COVID impacts on mobility, pain, mental health, and daily activities. The study found that social determinants of health (age, sex, employment, and ethnicity) significantly influence HRQoL, emphasizing the need for tailored, equity-focused interventions to support diverse populations affected by Long COVID.

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H5N1

On December 10, Marin county reported a child with suspected H5N1 bird flu. “The child presented to a local emergency department with fever and vomiting after drinking raw milk. The child tested positive for Influenza A.” The H5N1 virus is a type of Influenza A. The CDC could not verify if this was due to H5N1 Avian flu or seasonal flu because of low levels of viral RNA in the samples sent. The Marin county health department strongly warned people not to drink raw milk. As Infectious Disease doctor Dr. Titanji posted on BlueSky, “drinking raw milk can expose a person to Listeria, Brucella, Bovine Tuberculosis, Campylobacter, Shigella, E coli, and now H5N1.”

A wildlife rehab in Kansas City reported many calls about "Geese falling out of the sky". H5N1 bird flu has infected migrating wild geese which are now sick and are literally falling out of the sky. “We are not admitting geese to our facility at this time as this is a highly contagious disease that is spread by respiration, fecal matter and contact,” organization leaders said on Friday. “And we must protect the birds already in our care at risk." Who had "Geese falling out of the sky" on their 2024 bingo card?

From: https://www.kctv5.com/2024/12/06/geese-falling-out-sky-avian-flu-begins-infect-birds-kc-metro/

Other news:

This week, the New York Times posted a letter from 77 Nobel laureates asking the Senate to oppose Robert Kennedy Jr’s nomination for Secretary of Health and Human Services stating that he “would put the public’s health in jeopardy.” “In addition to his lack of credentials or relevant experience in medicine, science, public health or administration”, Mr. Kennedy is staunchly against public health measures including life-saving vaccinations, the fluoridation of water and he promotes conspiracy theories about AIDS and other diseases.

Senate Republican Leader Mitch McConnell warned Robert F. Kennedy Jr after one of Kennedy's top advisers had filed petitions to revoke approval for the polio vaccine and other immunizations. McConnell himself had polio as a child and saw what it could do to children.

According to STAT News, “Pediatrics is becoming medicine’s largest skeleton crew”. Thirty-percent of Pediatric residencies did not match this year. Low pay and political pressure on pediatricians by the anti-vaccine movement are causing medical students to choose other medical specialties.

A sophisticated cyberattack called “Salt Typhoon” infiltrated major U.S. telecommunications networks, exposing vulnerabilities in aging infrastructure and compromising sensitive surveillance data. Chinese government hackers breached 8 US telecom and internet services including AT&T and Verizon, as well as many other telecom companies in other countries. The breach is part of a spy operation conducted by China. Last week, the FBI warned Americans to use encrypted messaging like WhatsApp instead of texting. U.S. officials convened industry leaders emphasizing the urgent need for cybersecurity upgrades in our telecom systems despite the risk of significant disruptions.

A new study in JAMA shows that psilocybin, the psychedelic compound found in magic mushrooms, can be used successfully to reduce depression in frontline clinicians who worked during the COVID pandemic. The authors state, “The findings establish psilocybin therapy as a new paradigm of treatment for this postpandemic condition.” I would add that making certain that proper PPE and N95 masks are well stockpiled in case of another pandemic, like H5N1, could also be helpful psychologically to clinicians.

Researchers taught rats to drive small cars and it turns out that the rats love driving. If given a choice to walk directly to a treat or to have to go out of their way to get to their car to drive to the treat, they prefer to drive.

CNN

Have a great rest of your weekend,

Ruth Ann Crystal MD

COVID For Christmas

From CIDRAP - Center for Infectious Disease Research & Policy: Indicators show US flu and COVID activity rising

"Flu activity continues to rise, and COVID-19 indicators are also starting to rise from very low levels, the US Centers for Disease Control and Prevention (CDC) said today in its weekly respiratory virus illness updates.

"For flu, the test positivity rate rose to 5.1% at clinical labs last week, up from 3.5% the previous week, and it is increasing across 8 of 10 regions of the country. Emergency department (ED) visits and hospitalization rates also rose, and outpatient visits for flulike illness are at 3.4% and are now above the national baseline. 

"Six jurisdictions reported high activity, a measure of outpatient visits for flu: California, Oregon, Arizona, Louisiana, New Jersey, and the District of Columbia.

"At public health labs, more than 97% of flu virus detections were influenza A, and, of subtyped samples, about 60% were H3N2 and nearly 40% were 2009 H1N1.

"The highest hospitalization rate was in seniors. No new pediatric flu deaths were reported, keeping the season's total at two.

COVID activity up from low levels

"In its respiratory virus snapshot, the CDC said the overall respiratory virus illness level remains moderate for the second week in a row. The agency noted that COVID activity—as reflected by wastewater detections, ED visits, and test positivity—is starting to rise in some parts of the country from low levels. 

"We predict COVID-19 illness to increase in the coming weeks, as it usually does in the winter," the CDC said.

"Wastewater detections are still in the low range and are highest in the Midwest, followed by the West and the South.

"Meanwhile, respiratory syncytial virus (RSV) activity continues to increase in most US regions, especially in young children, the CDC said. RSV-related ED visits and hospitalizations are rising in children, with hospitalizations on the rise in older adults in some areas."

Droning On and On and On...

John Kirby talks a lot but says nothing. He must think the American people are stupid when it comes to our anxiety over drones that our government seems uninterested in. If these drones are something our own government is involved in, then why didn't Biden address the public a month ago and say something like, "You will be seeing lots of lights in the sky from drones. There's nothing to be alarmed about -- we're just conducting some military tests on the new technology"?  If they had levelled with us, instead of giving us no info at all, then there'd be no uproar. Instead, the lack of information as well as the lack of urgency makes it appear that our government has something to hide.

Our enemies must be laughing at us, and they're delighted to see how unprepared this country is. What better time to conduct a terrorist attack during this time of weakness and apathy?

This is another reason why everyone is counting down the days until Trump is sworn in as President.

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This succinct headline is from The Hill: New Jersey lawmaker rips Kirby over drone remarks: ‘That guy is an idiot’

"New Jersey Assemblymember Brian Bergen (R) responded to White House national security spokesperson John Kirby’s remarks about the increase in unidentified drones flying over the state, calling him an “idiot” and a “fool.”  

“That guy is an idiot. That I can tell you right now,” Bergen, a former U.S. Army helicopter pilot, said Thursday evening in an interview on Fox News.

"His criticism comes as an uptick in reported drone sightings above the Garden State have alarmed residents and lawmakers alike, with Gov. Phil Murphy (D) saying Monday that he is taking the matter “deadly seriously.” However, Kirby seemingly brushed off concerns, telling reporters earlier Thursday that the drones are “manned aircraft” that are “being operated lawfully.” 

“That guy, I don’t even know his name, who was on here a couple of minutes ago, is a fool if he is going to say there is no issue,” Bergen said, responding to a clip from Kirby’s remarks at Thursday’s White House press briefing.

"Another local official, mayor Sam Morris of Mine Hill, has also spoken out against Kirby saying the drones do not pose a national security threat, calling the dismissive comments “ridiculous.”

“I would invite Mr. Kirby to Mine Hill. Come on out, Mr. Kirby, and let’s go on out one night about 9:3-10 o’clock. I’ll go out behind my town hall. And you can count them with me all night,” he told ABC News.

"On Thursday, a group of senators from New Jersey and New York sent a letter to the Federal Aviation Administration, the Department of Homeland Security and the FBI, asking for a briefing on the drones hovering in the skies at night.

"The drones are currently being investigated by the FBI, although the Department of Defense has said there was “no evidence” the unidentified drones are a result of a foreign entity or “the work of an adversary.”