-------------------------------------------
COVID & Health News, 9/21/25
Ruth Ann Crystal MD, Sep 21, 2025
From the skeleton CDC data available, it appears that Emergency Department visits and test positivity for COVID infection have peaked which signals the descent of this COVID wave. Viral transmission post-peak is still significant though, so it is important to protect yourself and others by wearing N95 or KN95 masks, COVID testing before events and staying home if sick.
JP Weiland’s September 12 post showed that there were about 600,000 new COVID cases per day in the US and 1 in 55 Americans were infectious. Michael Hoerger and the PMC19.com dashboard state that we peaked at 1.3 million new COVID infections daily around September 15th and that every 1 in 38 people were infectious at a national level. Some states had an even higher prevalence of COVID on per Hoerger’s September 15th tweet as seen in these tables:
From: https://x.com/michael_hoerger/status/1967809763569234428
According to Dr. Hoerger, the CDC and Biobot made significant upward corrections to wastewater levels of SARS-CoV-2 reported last week, by 5% and 31% respectively, and this pushed the estimated COVID wave peak much higher to 1.3 million cases per day. I believe that he was using CDC data through 9/6/25. Without Emergency Department visits broken down by state and by age, we no longer know which age group is getting sick from COVID most now, but so far in this wave it has been children.
If you do get COVID, I recommend significant rest and taking antiviral Paxlovid if possible as it reduces severe COVID, hospitalizations, and death. Check with your doctor or healthcare provider to see if this is appropriate for you. A new study shows that Paxlovid does not decrease Long COVID, but Metformin has been shown to decrease the risk of Long COVID, especially in people who are overweight.
The US COVID Variant tracker is only updating once a month now, so it is not as helpful as it was. Data through 8/30/25 showed that XFG was the top variant in the US, followed by NB.1.8.1. These are the same variants seen globally through August 24th.
Durham County Department of Health posted another great infographic. If you feel sick, it is important to test for COVID. If you are negative, it may be too early to pick up a positive test. So it is important that you retest 48 hours later and perhaps another 48 hours after that. Since our bodies have seen the COVID virus before from infection and from vaccination, our immune system starts to attack it quickly which causes the sick symptoms. A positive home rapid antigen test for COVID tells you when your viral load is high enough for you to be contagious to others. This is different from PCR tests which can remain positive for a long time. If the rapid test is positive, you are infectious and you should isolate to protect others from getting COVID.
COVID infection poses cardiovascular risks across acute infection, Long COVID, and rarely after vaccination. A multi-society European consensus made guidelines for preventing and managing cardiovascular disease among COVID patients, recommending screening for cardiac risk, use of imaging when needed, cardiac rehab, optimizing use of statins, antithrombotics, and addressing lingering cardiac injury in Long COVID.
From: https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwaf540/8255559?login=false
A new study on metabolic signatures shows that ICU patients with severe COVID infection who developed pulmonary embolism display unique shifts in lipid metabolism, especially triglycerides and other lipids, hinting at early biomarkers for blood clot risk.
A multicenter cohort study of 307 patients with B-cell malignancies including lymphomas and chronic lymphocytic leukemia (CLL) showed that 26.1% had persistent COVID infections for ≥21 days. Patients on anti-CD20 therapy had 3x the risk and those admitted to the hospital had 5x the risk of prolonged SARS-CoV-2 infection. Early treatment with Paxlovid, Remdesivir and Sotrovimab monoclonal antibodies decreased risk of prolonged infection by 68% to 74%. It is important to treat patients with B cell malignancies early with antiviral therapy as a persistent SARS-CoV-2 infection could delay life-saving cancer treatments and also could increase the risk of evolution of new SARS-CoV-2 variants.
Former CDC director Dr. Walensky wrote an article showing that data from trials and real-world surveillance show COVID vaccines lower the risk of severe disease, MIS-C, and death in children. Even if mild infections still occur, vaccine protection against serious outcomes is real and important. Dr. Walensky also addressed misperceptions about vaccine risks in pediatric populations.
Deciding who should receive COVID boosters remains a challenge, as current recommendations rely on age and health conditions rather than actual immune status. A group from Japan examined antibody and T cell responses and identified three groups: those with durable immunity, those with limited immunity, and rapid-decliners whose neutralizing antibodies waned quickly. Rapid-decliners were more likely to experience breakthrough infections, which also correlated with weak spike-specific IgA responses. These findings suggest immune profiling could help guide additional groups who need COVID boosters.
This week ACIP met to discuss vaccines. It was a meeting fraught with misinformation and confusion. Recently, RFK Jr had fired the entire 17 person ACIP committee and had replaced the ACIP members with people who are not vaccine specialists and who are known to be anti-vaccine (aka pro-disease). When questioned, the newly-appointed ACIP members did not understand basic science related to some of the vaccines. They voted to remove the MMRV vaccine from the children’s vaccination schedule.
MMRV stands for Measles, Mumps, Rubella and Varicella (the virus that causes chicken pox and shingles later in life). Both the MMR and the Varicella vaccine require 2 doses, so combining these into one vaccine means that a child gets only 2 shots instead of 4. The MMRV is safe and effective. Access is the main driver of under vaccination of children, and by removing the MMRV, some families may miss getting the varicella component for their children.
ACIP was also supposed to discuss delaying Hepatitis B vaccination for newborns, but they have postponed this discussion for now. Making a family with a new baby come in for a separate visit to get a Hepatitis B vaccine will cause some families to miss getting the Hepatitis B vaccine for their baby altogether. The Hepatitis B vaccine helps to protect against Hepatitis B infection, but also protects against liver cancer.
https://x.com/AmerAcadPeds/status/1968805752711131410
States are working together to come up with their own vaccine recommendations now that the CDC and ACIP have been hijacked by anti-vaxer and HHS Secretary RFK Jr. The Northeast Public Health Collaborative announced that New York, Massachusetts, Maine, Rhode Island, Connecticut, New Jersey, Pennsylvania, Maryland, Delaware, Vermont and Maryland have banded together to recommend public health measures including vaccination. The West Coast Health Alliance (WCHA), which includes California, Washington, Oregon, and Hawaii, has posted their recommendations for COVID and Influenza vaccinations, allowing anyone who wants these vaccinations to be able to get one. In addition, Governor Newsom signed California state law AB 144, “authorizing California to base future immunization guidance on credible, independent medical organizations rather than the CDC’s increasingly politicized Advisory Committee on Immunization Practices.” This will help to have insurance companies cover these vaccinations in California.
From: https://www.cdph.ca.gov/Pages/public-health-for-all/publichealthforall.aspx
America’s Health Insurance Plans (AHIP) include Blue Cross, Blue Shield, Aetna, Cigna, Kaiser Permanente, Humana, Molina, Elevance and Centene. Together, they cover over 200 million Americans. UnitedHealthcare, the country’s largest health insurer, is not an AHIP member however. AHIP came out with this statement on 9/16/25:
“Health plans will continue to cover all ACIP-recommended immunizations that were recommended as of September 1, 2025, including updated formulations of the COVID-19 and influenza vaccines, with no cost-sharing for patients through the end of 2026.”
Insurance companies understand that vaccine protection keeps people out of the hospital which saves money. Prevention usually costs less than treating an illness.
In a cohort of 445,738 COVID patients, an EHR-based target trial emulation study showed that Paxlovid treatment during acute infection did not cut overall risk of Long COVID, but it was mildly protective for brain fog (RR 0.91) and fatigue (RR 0.94).
Long COVID incidence in adults and in children has not decreased over time as seen in an EHR study from the RECOVER initiative.
From: https://x.com/ahandvanish/status/1968026903157280941
An exploratory study found that certain IgG autoantibodies directed against Epstein-Barr virus (EBV) also mimic arginine-rich sequences in human proteins, and were elevated in women with Long COVID and those with ME/CFS. These autoantibodies were linked to symptom severity, suggesting EBV-driven molecular mimicry may underlie immune dysregulation in both Long COVID and ME/CFS.
A review from international researchers suggests Metformin may lower the risk of Long COVID and ease fatigue in ME/CFS by targeting metabolic dysfunction, mitochondrial impairment, and inflammation. Larger clinical trials are needed, but Metformin could become part of an early treatment strategy.
In a UK study of over 12,000 women, those with Long COVID had heavier menstrual flow, longer periods and more intermenstrual bleeding. Long COVID symptom severity also was found to peak during the menstrual and proliferative phases. “Serum and endometrial analysis revealed higher serum 5α-dihydrotestosterone and lower endometrial androgen receptors in long COVID versus no COVID. Other ovarian hormones showed no significant differences.” Immune cell aggregates were found in menstrual endometrium in Long COVID. The authors concluded that “differences in peripheral and endometrial inflammation may contribute to abnormal uterine bleeding (AUB) and long COVID symptom severity” in a bidirectional manner.
Researchers from the Netherlands reviewed 81 animal studies and 26 imaging studies to evaluate whether existing models can replicate the complexity of PASC. They found that no single species fully mirrors human Long COVID, though mice, hamsters, and primates reproduce parts of the syndrome. The authors recommend tailoring animal and imaging choices to specific symptoms or organ systems to improve translational research.
A new review of metabolic neuroimaging using PET scans and MRI/MRS (Magnetic Resonance Spectroscopy) shows that although ME/CFS and Long COVID share patterns of energy disruption in the brain (altered brain glucose use, oxygen metabolism, and neurotransmitter balance) and neuroinflammation, ME/CFS and Long COVID differ in specific metabolite signatures. Longitudinal neuroimaging holds promise for identifying biomarkers, improving diagnosis, and guiding treatment development.
As of September 16, 2025, there have been a total of 1,491 confirmed measles cases reported in the United States, 12% of cases have been hospitalized (181 of 1491) and there have been 3 confirmed deaths.
This week, I discovered the John Hopkins US Measles Tracker.
From: https://publichealth.jhu.edu/ivac/resources/us-measles-tracker
Two babies in Louisiana have died of Whooping Cough, a vaccine preventable disease. All pregnant patients and their families should be vaccinated against Whooping cough (Pertussis) to protect the newborn. Louisiana is experiencing its worst Whooping cough outbreak in 30 years. Local health officials urge vaccination and vigilance, stressing infants are among the most vulnerable and symptoms such as coughing spells and congestion should not be ignored.
In 15 people with severe, treatment-resistant autoimmune disease, CD19 CAR-T therapy achieved durable remission in Lupus and allowed patients to stop taking immunosuppressants. Side effects were manageable.
Multiple Sclerosis (MS) is a chronic autoimmune disease associated with demyelination in the brain. A new review shows that Epstein-Barr Virus (EBV) reactivation may trigger or worsen MS by pushing B cells into inflammatory states. Understanding this link could open paths for new treatments.
From: https://www.neurology.org/doi/10.1212/NXI.0000000000200460
In Flint, Michigan, a program called Rx Kids gives every pregnant individual $1,500 during pregnancy, plus $500 per month for the first year of the child’s life. The initiative is unconditional (i.e. not limited to low-income only) and aims to reduce infant poverty and improve maternal and infant health outcomes. Early findings suggest the payments help with essentials (housing, food, supplies), reduce postpartum depression, prevent evictions, and lower rates of prematurity and low birth weight, thus saving the city millions in NICU costs.
A man with corneal blindness has regained sight thanks to a tooth-in-eye surgery. “Brent Chapman can see again after doctors pulled out one of his teeth, flattened it, drilled a hole in it, placed a lens inside, [grew tissue around it by implanting it in his cheek and then] implanted the tooth in one of his eyes”. He now has 20/40 or 20/30 vision in that eye.
Tooth with the implanted lens
From: Dr. Greg Moloney Providence Health Care
While tubing down the Cowichan River in Canada, a teenage boy heard a tiny, week-old beaver crying for help. The family searched for the kit’s mother, but they were unable to find her or their den as it appeared that the baby had been swept downstream. They drove the baby beaver to the North Island Wildlife Recovery, where experts said that she would not have survived without help. Little Timber is doing well and will be released back to the area where she was found once she is old enough to take care of herself.
From: https://www.niwra.org/
Have a great week,
Ruth Ann Crystal MD
.jpg)
No comments:
Post a Comment