Dr Ruth's COVID & Other Viruses to Know About, 1/13/25

Here is the latest informative newsletter from Dr Ruth Ann Crystal.

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COVID & Other Viruses to Know About, 1/13/25

According to the CDC, as of January 13, 2025, the amount of acute respiratory illnesses causing people to seek healthcare is HIGH.

• COVID levels have increased across most of America and are HIGH. COVID levels are VERY HIGH in the Midwest and HIGH in the Northeast and South. Only the West is still MODERATE.

• Flu activity is HIGH everywhere in America.

• RSV is VERY HIGH in most parts of the country especially in young children.

From: https://www.cdc.gov/respiratory-viruses/data/index.html

SARS-CoV-2

Data through January 8, 2025 shows that most states are at least HIGH for COVID on Sara Anne Willette’s scale, including Arizona which has “Dizzying” levels of SARS-CoV-2

From Sara Anne Willette: https://iowacovid19tracker.org/

The good news is that it appears that emergency department visits for COVID have peaked and are starting to decline. Michigan, Maine, New Hampshire and South Dakota had slightly higher peaks for COVID emergency department visits in December as compared to their summer 2024 wave. For most other states, COVID peaks were significantly lower this winter per JP Weiland.

Vaccines

When you get a tattoo, the ink does not only stay in the skin. A new article shows that the tattoo ink also accumulates in macrophages in the lymph nodes causing systemic and local inflammation that kills some of the macrophages and makes others not work properly. The inflammation from the tattoo pigments weakens the immune response to the COVID vaccine for months leading to lower antibody production. The increased macrophage cell death can also cause the person (or mouse) to become more susceptible to infections. Effects vary by ink color and can persist for months.

Long COVID

A study of 1,300 consecutive Long COVID patients at Northwestern looked at whether vaccination prior to contracting COVID infection impacts neurological symptoms of Long COVID. They found that vaccination prior to infection did not appear to change cognitive and neurological symptoms of Long COVID, though pre-existing vulnerabilities may influence development​ of neurologic symptoms. Logically though, people can only get Long COVID if they have had a COVID infection. So, by reducing COVID infections, vaccination reduces Long COVID overall.

A case series report from Patient-Led Research Collaborative looked at 13 individuals with Long COVID who used extended courses of Paxlovid (nirmatrelvir/ritonavir), ranging from 7.5 to 30 days. Results were mixed- 5 people reported lasting improvement, 4 people with Long COVID had temporary improvement, and 4 people had no improvement. Extended antiviral therapy appears to benefit some people with Long COVID, but further research is needed to understand the optimal duration of treatment.

Long COVID Labs is crowdfunding to do clinical trials to find treatments for Long COVID by selling a crypto coin called $COVID. The auction is live through January 17, 8am PT here. The first trial planned will study combination treatment for Long COVID using an antiviral medication (Paxlovid) and monoclonal antibodies (Pemgarda) to try to get rid of SARS-CoV-2 viral reservoirs in the body. A similar combination cured founder Rohan Dixit of Long COVID, which he explains in this 2 minute video. Here is a clip of me from last week talking about my daughter who has Long COVID and the Long COVID Labs project.

H5N1 Bird Flu

The person in Louisiana who was hospitalized with H5N1 Avian Flu died this week. According to the WHO, about 50% of H5N1 human cases will die from the disease, but that is probably an overestimate since many human cases that are mild and are not factored into the calculation. Still, the mortality rate for humans who get a severe case of H5N1 is significant.

As infectious disease specialist Dr BK Titanji posted about the death of the H5N1 patient from Louisiana, “This is sad news. It is also a reminder that influenza virus infections can be severe and even lethal. The more H5N1 spreads unchecked the higher the likelihood of human infections. Some of these cases will not be mild.”

According to the CDC, more than 2,700 Americans including 11 children have died from seasonal influenza so far this year. The CDC recommends that everyone ages 6 months and older get an annual influenza (flu) vaccine. It is not too late.

The CDC randomly tests samples that are positive for Influenza A to see if they are the H5 type. A child from San Francisco tested positive for H5N1 avian flu this week. The child had symptoms of fever and conjunctivitis and has since fully recovered. The source of H5N1 for the child is unknown.

HMPV

I have seen on social media that some people are concerned about a surge of human metapneumovirus (HMPV) cases in China. Experts say that the HMPV surge can be attributed to the regular seasonal spike of this virus that affects almost all children at least once by age 5. Respiratory viruses like HMPV are known to circulate widely in the winter. Wearing a mask and washing hands can help reduce the spread of this common virus.

Wastewater HMPV levels in the United States now are not as high as they were last spring.

From: https://data.wastewaterscan.org/

Herpes Viruses and Dementia

Years of epidemiological data have shown that herpes infections raise the risk of Alzheimer’s disease in some people. Using a 3D human brain tissue model, researchers found that repeat mild brain injuries such as concussions can reactivate latent herpes simplex virus type 1 (HSV-1), leading to neurodegeneration and Alzeheimer’s dementia, especially in individuals carrying the APOE4 gene.

I find this fascinating given the article last week showing that incubating inactivated herpes simplex 1 virus (HSV-1) or SARS-CoV-2 virus with human cerebrospinal fluid (CSF) caused proteins in the CSF to make amyloid because of surface properties related to a process called heterogeneous nucleation (HEN). Amyloid proteins are implicated in both Alzheimer’s disease and in Parkinson’s disease.

A vaccine against another virus from the herpes family, Varicella Zoster virus (VZV), has been shown to reduce the risk of dementia. VZV causes the chicken pox and shingles which is a painful rash often seen in older adults. Getting the recombinant shingles vaccine significantly reduced the risk of dementia for at least 6 years after vaccination. As of now, there are no vaccines yet against HSV-1.

Other news:

My heart goes out to people affected by the wildfires in Southern California which have been hard to contain because of dry conditions and the Santa Ana winds. Firefighters from California, Mexico, Canada and other countries are working together to try to extinguish the blazes. If you would like to donate to help wildfire victims and firefighters, here are some links: Red Cross, World Central Kitchen, Los Angeles Fire Department Foundation and others. Also, N95 masks are available at Los Angeles public libraries.

The crazy U.S. health system

Primary care fields including Pediatrics, Family Practice and Internal Medicine are having trouble filling their residency slots. Low pay, high administrative burdens such as prior authorizations and little administrative support make these fields less desirable leaving many communities with a shortage of primary care providers.

This week, The Lown Institute's Shkreli Awards announced their annual “winners” for the most egregious US healthcare profiteering. The top 10 included Cigna refusing to pay for a baby who had to be flown to a medical center and sending the mother a $97,599 bill and United Healthcare pressuring doctors to spend less time with patients, but charge more.

Private equity firms have been buying up US hospitals over the last 10 years as investments. Not surprisingly, an article in JAMA shows that when private equity firms acquire hospitals, patient care experiences are worse.

The Consumer Financial Protection Bureau (CFPB) finalized a rule last week removing an estimated $49 billion in medical debt from credit reports. Debt due to unpaid medical bills have made it hard for many Americans to get mortgages, car loans or small business loans. The rule aims to prevent coercive debt collection practices and should raise credit scores for many Americans.

The Brain

Eric Topol MD wrote a very interesting article this week reviewing new data on how the brain gets rid of chemical waste during sleep via the glymphatic system and from brain blood vessel oscillations. He discusses, “How sleep prevents "dirty" brains that age faster.”

Other news

The world’s oldest known wild bird, Wisdom, has laid an egg at the age of 74. Typically, Laysan albatross birds live to about age 68 and lay about 1 egg per year as adults. The new egg is estimated to be Wisdom’s 60th egg laid during her lifetime.

Photo by Dan Rapp, USFWS

I’ll be taking off next week from the newsletter.

Have a great week,

Ruth Ann Crystal MD