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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
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.
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
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