We are officially in a COVID wave right now. The CDC reports that wastewater levels of SARS-CoV-2 are HIGH on a national level. COVID test positivity is increasing, as are emergency department visits for COVID infections. Hospitalization data is not being reported by most states. The CDC is only updating variant proportions every two weeks- last time it was reported was on July 6,2024. KP.3 and its descendent KP.3.1.1 are pushing out other variants on the mainland United States, as it has done in other countries and in Hawaii.
From: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html
Sara Anne Willette broke down the CDC NWSS data further showing that as of 7/13/24, wastewater SARS-CoV-2 in
Oregon and Florida are “EXCESSIVELY HIGH” (blue)
Nevada is “VERY HIGH” (purple)
California, Texas, Arkansas, Maryland are “HIGH” (pink)
From https://iowacovid19tracker.org/
The highest wastewater levels of SARS-2 in America per WastewaterSCAN are:
SW St Petersburg FL 3199 PMMoV,
Roswell GA 2847 PMMoV,
East Orange County FL 2567 PMMoV,
East Bank New Orleans LA 2494 PMMoV,
Wolcott Kansas City KS 2338 PMMoV,
NW St Petersburg FL 1865 PMMoV,
Millbury MA 1816 PMMoV,
Portland ME 1815 PMMoV,
Oceanside San Francisco CA 1513 PMMoV,
Woodlands Texas TX 1378 PMMoV
As of July 13 in California,
San Francisco and Sacramento counties have EXCESSIVELY HIGH (blue) SARS-CoV-2
Santa Clara County is VERY HIGH (purple on map) wastewater levels of SARS-CoV-2
San Mateo, Napa, Yolo and Yuba counties have HIGH (pink on map) SARS-CoV-2
From https://iowacovid19tracker.org/
In his July 12 update, JP Weiland reports that across the US 1 in every 54 people currently infected with COVID. Regionally, he reports that the ratio of people currently infected is
Weiland also forecasts that COVID cases will be peaking on the West Coast soon, in the South in late July, and the Northeast/Midwest cases will peak in August.
From: https://twitter.com/JPWeiland/status/1811844706940465498
Acute COVID and General COVID
A new study shows that the Histamine H1 receptor can act as an independent receptor for the SARS-CoV-2 virus to enter human cells and it can also help SARS-CoV-2 to enter cells via the ACE2 receptor. Using antihistamine drugs that block the H1 receptor can block the entry of the COVID virus into cells and may be able to help reduce COVID infections.
Social and Advocacy
This week, 18 year old Violet Affleck (daughter of Ben Affleck and Jennifer Garner) spoke at the Los Angeles County Board of Supervisors meeting. In 60 seconds, she was able to advocate for improved indoor air quality, show support for health equity and eloquently express her opposition to mask bans.
This week, the hashtag #YallMasking was trending on social media to increase awareness of the present COVID wave and the need to wear masks to help reduce the spread of disease.
From https://x.com/morgfair/status/1810854263519858731
Pregnancy
A new study shows that Long COVID may be slightly more prevalent among people infected while pregnant. With common symptoms of postexertional malaise, fatigue, and gastrointestinal symptoms, Long COVID could make it very hard to take care of an infant or toddler.
Seniors
A new study from Chongqing, China looked at 1,245 people aged 60 years or older who had the original SARS-CoV-2 strain as compared to 358 uninfected spouses. People with severe COVID-19 often showed signs of cognitive decline in the first year after getting infected, but decline appeared to slow after that. Having severe COVID infection, cognitive problems at six months, and high blood pressure were linked to ongoing cognitive decline in seniors.
Pediatrics
Children are exposed to many different bacterial and viral infections which often cause asymptomatic infections. The constant activation of the immune system in children allows them to be better equipped to fight off new infections. A new study shows that co-infections of bacteria or viruses during COVID infection appear to boost nasal mucosal immunity in children, allowing them to be more resistant to COVID infections.
On a state level, higher COVID vaccination rates in children protected against symptomatic asthma. Not only did COVID vaccination protect individual children against COVID infection, but COVID vaccination was found to protect against other human coronaviruses such as the common cold virus, by producing cross-reactive antibodies. In states with higher vaccination rates, community-level immunity may have helped reduce children’s asthma risk.
While older children lost math and reading skills during the pandemic, kids who were babies or toddlers during the height of the pandemic are now struggling in kindergarten. Kindergarten teacher Brook Allen relayed that “several students could barely speak, several were not toilet trained, and several did not have the fine motor skills to hold a pencil.” Swiping on smartphones and tablets instead of practicing fine motor skills like drawing shapes or letters has caused these children to fall behind significantly. If given extra help, these kids will hopefully catch up as older peers have in their classes.
Vaccines
A new NIH clinical trial is enrolling at Baylor, Emory and NYU for a Phase I trial to test a new nasal COVID vaccine in people who have had at least three prior doses of COVID vaccines via injection. The hope is that the nasal vaccine may work on many different future COVID variants to reduce COVID infections and transmission.
Antivirals treatments
Shanker and colleagues used artificial intelligence to help engineer antibodies that had improved binding and better virus neutralization against various SARS-CoV-2 variants. “These results demonstrate the potential for machine learning and protein language models trained on protein sequence information to contribute to protein engineering tasks even in the absence of task-specific training data."
Monocytes can become dysregulated during severe COVID infections. Giving dexamethasone helped to reverse the pro-inflammatory responses of monocytes in severe COVID.
Long COVID
Using a special Immuno PET scan with radioactively tagged T cells, researchers from UCSF show that SARS-CoV-2 can persist chronically in the gastrointestinal system and in other organs of people with Long COVID for over 2 years. For people with brain fog and fatigue, the gut and the spinal cord lit up on Immuno PET scan. Those with lingering pulmonary symptoms had immune activation in their lungs. Long COVID patient Ezra shows his Immuno PET scan from the study and explains the findings in a fascinating video here.
Using a new technique called MENSA, Media Enriched with Newly Synthesized Antibodies, researchers from Emory University looked at antibodies made from circulating human plasmablasts to provide a current “immune snapshot” of viral triggers. If they had looked at antibodies in the blood without the MENSA technique, they would see antibodies to past illnesses and vaccines as well as those to current infections.
The authors found that 40% of Long COVID patients were MENSA positive for SARS-CoV-2 persistence compared to none of the COVID recovered patients. In addition, MENSA tests were also positive for persistence or for reactivation of Epstein-Barr Virus (EBV) in 37%, Cytomegalovirus (CMV) in 23% and herpes simplex virus 2 (HSV2) in 15% of the people with Long COVID. In COVID recovered controls, only 17% were positive for EBV, 4% were positive for CMV and 4% were positive for HSV-2.
Graphic abstract from https://www.medrxiv.org/content/10.1101/2024.07.05.24310017v1
A study of EHR records from 3 million people showed that people often have COVID reinfection symptoms in a similar severity to their first COVID infection. Long COVID was found to be more common after the first COVID infection compared to reinfections during the Omicron period.
Long COVID may be a chronic relapsing and remitting disease. “People who have recovered from Long COVID can suffer relapses or flare-ups from new viral infections — not just from COVID but from cold, flu, and other viral pathogens, researchers have found.” Dr. Alba Azola said that anecdotally, flare-ups seem to occur more commonly in people who had autonomic dysfunction or ME/CFS symptoms with Long COVID. Dr. Putrino added that Long COVID patients can "recover (or feel recovered) from long COVID until the next immune challenge — another COVID infection, flu infection, pregnancy, food poisoning (all examples we have seen in the clinic) — and experience a significant flare-up of your initial COVID infection." Relapses may be short-lived in some.
ASIA syndrome (Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA), also known as Shoenfeld’s syndrome, includes several autoimmune conditions that can happen after exposure to substances with adjuvant activity. Adjuvants are added to some vaccines to increase immune response, but rarely it can cause ASIA syndrome. Viral persistence can act like an adjuvant to cause the syndrome as well.
A group from Spain proposed a model to explain possible ASIA syndrome in Long COVID, ME/CFS and post-COVID vaccine syndrome. Abnormal CD4 T cell responses may lead to CD8 T cell hyperactivation and also to autoantibodies against the part of the pituitary gland that makes the ACTH hormone. The inflammation in the pituitary (hypophysitis) from these autoantibodies could lead to decreased production of ACTH in the pituitary which then leads to decreased cortisol production from the adrenal glands.
The authors review a multitude of pathways (see Figure 1 below which is one of the busiest diagrams that I have ever seen) and propose that “treatment with antivirals, corticosteroids/ginseng, antioxidants, and metabolic precursors could improve symptoms by modulating the immune response, pituitary function, inflammation and oxidative stress.”
Figure 1 Schematic model of the development and treatment of long COVID, post-COVID-19 vaccine syndrome and myalgic encephalomyelitis/chronic fatigue syndrome.
From: https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1422940/full
Neutrophil Extracellular Traps (NETs) appear to stabilize fibrin amyloid microclots (FAM) in people with Long COVID which can cause blockage of capillaries and reduced oxygen delivery to tissues. The fibrinolytic-resistant FAM microclots trap inflammatory molecules including proteins that prevent clot breakdown. The spike protein from the SARS-CoV-2 virus can induce fibrinolytic-resistant FAM as well. High FAM in the blood of people with Long COVID can increase the amount of microclotting in small blood vessels and can increase Long COVID pathology.
H5N1
The Department of Public Health in Colorado reported that 3 people who worked with chickens at an infected egg laying facility have H5N1 avian flu. Up to 55 people have symptoms and are being tested this weekend.
Avian H5N1 influenza usually binds to α2,3-linked sialic acid receptors in birds. But, the virus has mutated in cows and now can link to α2,6-linked sialic acid receptors. This is very concerning because there are high levels of α2,6-linked sialic acids in the upper respiratory tract of humans. This mutation in the H5N1 influenza A can make it more easy to transmit among humans and some other mammals.
Other news
A new study reports an association between GLP-1 medication semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) which can cause blindness. The increase in NAION was seen in people with Type II diabetes as well as those taking semaglutide for obesity.
Researchers found that an imbalance in types of T cells is a root cause of Lupus.
The hormone CCN3 is produced during lactation and helps breastfeeding women to maintain strong bones even though they lose calcium into their milk. “Based on this discovery, they now refer to CCN3 as Maternal Brain Hormone (MBH).”
In Idaho, a pregnant woman started hemorrhaging and leaking amniotic fluid at 20 weeks gestation in her third pregnancy and she needed an emergency abortion. The doctor put her on a plane to another state instead of treating her.
This week, Bloomberg Philanthropies donated $1 Billion to Johns Hopkins for medical student tuition and for financial aid for nursing and public health students as well.
The original Dr. Ruth passed away yesterday at age 96. Dr. Ruth Westheimer was a Holocaust orphan, a single mother, and a student who received her doctorate in education from Columbia University before doing a postdoc in sex therapy. A witty and endearing person, she will be dearly missed.
Have a good rest of your weekend,
Ruth Ann Crystal MD
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