The FLiRT mutations KP.2 and KP.3 now make up more than 40% of COVID cases in the United States. They are pushing JN.1 and its descendants out. Wastewater SARS-2 levels are “MINIMAL” overall for the nation, but are just starting to increase in the west. Some of this may be due to Hawaii which is at a “HIGH” or “VERY HIGH” level of SARS-CoV-2 in their wastewater. Delaware, Minnesota and Nevada have “MODERATE” levels of virus in wastewater. According to JP Weiland, nationwide 1 in every 217 people are currently infected with COVID. COVID hospitalizations are no longer being reported at the national level and Biobot has stopped reporting their wastewater data as well.
From https://iowacovid19tracker.org/
The new SARS-CoV-2 forecasting analytics website reports that as of May 21, 2024, COVID infections are growing in Hawaii, Arizona, Montana, Texas, Louisiana and Massachusetts. COVID infections are “likely growing” in Alaska, California, Oregon, Nevada, Wyoming, Virginia, New Jersey and Rhode Island. In the Bay Area, Palo Alto wastewater is now at a “HIGH” level for COVID virus although it seems to be plateauing and San Francisco Oceanside had a big uptick that quickly normalized.
Internationally, there are increases in COVID levels in Australia, New Zealand and Singapore. According to Mike Honey, a new variant descendant LB.1 is just starting to increase in Singapore, New Zealand and the United States. LB.1 is a “DeFLiRT” variant because it added a deletion mutation on the spike protein (S31Del) to the FLiRT mutation (F456L + R346T) combination which appears to increase its efficiency.
From https://x.com/Mike_Honey_/status/1792916810708209988
Vaccines
The BCG (Bacillus Calmette-Guérin) vaccine was developed against Tuberculosis over 100 years ago, but it is known to protect against other infectious diseases as well. A Phase III randomized clinical trial from Harvard shows that multiple doses of the BCG vaccine protected adults with Type I diabetes from COVID infections better than the initial mRNA COVID vaccines. It also protected this group against other infectious diseases. The BCG vaccine worked against COVID variants Delta and Omicron in this study.
Masks
A new mega-review from T. Greenhalgh and colleagues examined over 100 published reviews and primary studies on masking. It showed that masks are effective at reducing transmission of respiratory diseases if worn correctly. N95 respirator masks are more effective than surgical masks or cloth masks and there is a dose-response effect to wearing masks. The review also showed that mask mandates are effective in reducing community transmission of respiratory infections. Masks work! Fortunately, the North Carolina House of Representatives defeated the bill that had been approved by the NC Senate this week, so wearing masks in North Carolina remains legal.
Long COVID
A large study of almost 230,000 people from Italy shows that three years after a positive COVID test, there was a persistent increased risk of all major adverse cardiovascular and cerebrovascular events including heart attack, stroke, heart failure, atrial fibrillation and myocarditis or pericarditis with an odds ratio of 1.73.
From: https://academic.oup.com/cardiovascres/article-abstract/120/6/623/7631430
Dr. Svetlana Blitshteyn is a neurologist specializing in autonomic disorders like POTS. This week, I really enjoyed listening to a discussion between Dr. Blitshteyn and Dr. Eric Topol on his podcast. She had excellent recommendations on how to approach POTS and Long COVID and gave helpful insights into workup and treatment.
A small (n=12), sham-controlled, double-blind, randomized clinical trial examined the effects of transcutaneous vagus nerve stimulation (tVNS) on Postural Tachycardia Syndrome (POTS). Participants received either active tVNS on the tragus of the ear or sham stimulation on the earlobe for one hour daily for two months. Those in the active tVNS group had a decrease in antiadrenergic autoantibodies and inflammatory cytokines, and better heart rate variability. Larger studies are needed to confirm these findings.
A group from Germany used DMI (diffusion microstructure imaging) MRI to evaluate people with cognitive impairment, olfactory dysfunction and fatigue from Long COVID (Post-COVID-condition, PCC). They found “widespread alterations in cerebral microstructure, attributed to a shift in volume from neuronal compartments to free fluid, associated with the severity of the initial infection.” Cognitive impairment, olfactory dysfunction and fatigue in Long COVID were linked to microstructural changes in specific brain networks that could be seen on DMI MRI.
Fig. 2: Spatial distribution and direction of microstructural changes after COVID-19.
The definition of Long COVID is not standardized and varies among public health agencies, such as the CDC, WHO, and UK NICE, depending on the time elapsed since the initial COVID illness. A new review from AHRQ looks at how to define Long COVID and what models of care are being used to treat Long COVID in different places. They found that “Long COVID models of care were characterized by 5 key principles: a core “lead” team, broad multidisciplinary expertise, comprehensive access to diagnostic and therapeutic services, a patient-centered approach, and providing capacity to meet demand.” As more people are infected by COVID, more people are getting Long COVID. We need excellent models of care to best treat this chronic and disabling disease.
From: https://www.acpjournals.org/doi/10.7326/M24-0677
Great Britain Olympic-level rower O. Cousins has Long COVID. In an interview with the BBC, she complained that the “Lightning Process”, a three-day course costing more than £1,000, had tried to teach her that she was sick because of negative thoughts. She knew that she was physically ill from Long COVID and was being gaslit. Critics have said that the Lightning Process is exploiting people with Long COVID who are desperate to feel better. We need to focus funding on finding real treatments that actually work for Long COVID.
John Hopkins Long COVID study is hoping to get people with Long COVID anywhere in the world to answer a one-time 20 minute questionnaire. The survey is available in multiple languages at https://covid-long.com/.
A few days ago, Charlie McCone posted on Twitter about Rutgers researcher Dr. William Hu who said, “The findings from our study lead us to believe that interferon — the body’s natural antiviral — and other drugs which target COVID-19 will be most beneficial in people with long COVID.” His study in Cell was on “Clinical and CSF single-cell profiling of post-COVID-19 cognitive impairment”. Medical journalist Liz Highleyman responded to Charlie’s tweet that interferon-alpha was used to treat Hepatitis C before newer Hepatitis drugs were created. But unfortunately, interferon-alpha has many side effects including very unpleasant, flu-like symptoms. A study in the NEJM in February 2023 showed that a single dose of a different interferon, Pegylated Interferon Lambda, protected people with acute COVID infection from being hospitalized or needing to go to the Emergency Department. I wonder if PEG Interferon Lambda could be used to treat Long COVID. PEG Interferon Lambda has fewer side effects than other interferons and has broad antiviral properties.
A.I.
Yesterday, the BBC reported that Google’s new AI Overview feature told users that the best way to keep cheese on pizza was to use a non-toxic glue. Google AI Overview also recommended eating at least one small rock a day for its vitamins and minerals. AI can be very helpful for certain tasks, but it is important to check its answers against reliable sources.
From: Google.com
Epic announced that they have launched an open-source AI validation tool via GitHub for healthcare systems to be able to evaluate AI models that integrate with any EHR
H5N1 Avian Flu
Wastewater testing for Avian Flu H5N1 will now be tracked by a 190-site network across 36 states run by Stanford, Emory and Verily Life Sciences at WastewaterSCAN. The tracking is funded by philanthropy. Sara Anne Willette used USDA and US WastewaterSCAN data to show H5N1 viral activity below:
The CDC reported that a second dairy worker was infected with H5N1 Bird Flu which presented with conjunctivitis like the first infected person. This week, scientists were able to generate a full genetic sequence of H5N1 virus from store-bought milk. Tracking H5N1 in commercial milk may offer another way to follow the H5N1 bird flu outbreak since some dairies are hesitant to report.
Several people have asked me if they could become immunized against bird flu from drinking either pasteurized or unpasteurized milk contaminated with the H5N1 avian flu virus. Drinking unpasteurized milk could make a person extremely sick. Pasteurized milk is safe to drink. Any inactivated viral proteins would be broken down by the gastrointestinal system and would not lead to immunization however.
A new study showed that mice given raw milk from H5N1-infected cows got extremely ill with systemic avian flu infection and the H5N1 virus was found to have spread to their lungs, hearts, kidneys, spleens, livers, mammary glands, and brains. Of note, the two mice whose mammary glands were infected had not been lactating. Cats that drank raw milk infected with H5N1 showed severe neurological symptoms including blindness, and half of them died from the disease. Ingesting raw milk with H5N1 could be very dangerous.
Other news
The CDC unveiled a new Daily Heat Risk Map which allows people to type in their zip code to see what health risks there may be from heat that day. A “heat dome” this week caused power outages and led to deaths of howler monkeys in Mexico because of heat stroke. The extreme heat is expected to increase hurricanes this season as warm ocean temperatures can fuel the storms.
Male fertility has been decreasing and it appears that microplastics and pesticides are affecting sperm counts. Microplastics were found in testicles from humans and from pet dogs and are believed to cause inflammation leading to reduced sperm counts. A French fertility clinic reports that more than 55% of sperm samples tested contained high levels of glyphosate which is the pesticide in the weed killer Roundup. Not only can it affect sperm counts, but the authors found that glyphosate may also affect DNA of sperm which could have repercussions for his progeny.
Because of recent meningitis infections in visitors returning from Saudi Arabia, the CDC recommends that people traveling to the Hajj pilgrimage in Saudi Arabia or the Umrah pilgrimage be sure that they are up to date on travel vaccinations including the quadrivalent meningococcal vaccine.
Using satellite radar imaging, scientists have discovered an ancient branch of the Nile river which may have been used to transport boulders to build the pyramids. Scientists had wondered why the pyramids had been built in that particular chain formation. It turns out that the river branch ran right along the area where 31 pyramids were built.
From: https://www.nature.com/articles/s43247-024-01379-7/figures/1
Congratulations to Bay Area nurse and grandmother Amy Appelhans Gubser who successfully swam almost 30 miles from the Golden Gate Bridge to the Farallon Islands! The water was a chilly 43 degrees, but that didn’t stop this “ultraswimmer” from completing the route.
Space
The European space telescope Euclid sent back 5 amazing pictures including one of Messier 78, “a vibrant star nursery enveloped in interstellar dust”. Messier is an "enormous cradle of baby stars" 1,300 light-years away.
From European Space Agency: Messier 78, a vibrant star nursery enveloped in interstellar dust https://www.esa.int/Science_Exploration/Space_Science/Euclid/ESA_s_Euclid_celebrates_first_science_with_sparkling_cosmic_views
This photo of Abell 2390 shows over 50,000 galaxies.
https://www.esa.int/Science_Exploration/Space_Science/Euclid/ESA_s_Euclid_celebrates_first_science_with_sparkling_cosmic_views
Have a good rest of your weekend,
Ruth Ann Crystal MD
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