Coronavirus updates December 2023

[missy]

Can Paxlovid Improve Long COVID Symptoms?​

— Harlan Krumholz, MD, discusses his ongoing study and novel approaches to clinical trials​

by Jeremy Faust, MD, MS, MA, Editor-in-Chief, MedPage Today ; Emily Hutto, Associate Video Producer

• 
  
  Jeremy Faust is editor-in-chief of , an emergency medicine physician at Brigham and Women's Hospital in Boston, and a public health researcher. He is author of the Substack column Inside Medicine. Follow
• 
  
  Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

In this interview, Jeremy Faust, MD, editor-in-chief of MedPage Today, talks with Harlan Krumholz, MD, SM, of Yale School of Medicine in New Haven, Connecticut, about his ongoing study testing nirmatrelvir-ritonavir (Paxlovid) for long COVID symptoms and about the value of finding innovative, participant-centric ways to conduct research and get answers quickly.
The following is a transcript of their remarks:
Faust: Hi, this is Jeremy Faust, editor-in-chief of MedPage Today.

We're going to talk about long COVID and Paxlovid. Does Paxlovid actually help people with diagnosed long COVID get better? This is a study that is being conducted -- there are several studies -- and one of the investigators on one of those studies is cardiologist and Yale School of Medicine outcomes researcher, Dr. Harlan Krumholz.
Harlan, great to see you.
Krumholz: It's great to see you, Jeremy.
Faust: Alright, so long COVID. You have been studying this and you're currently engaged in a randomized clinical trial. Can you tell us what you guys are looking at?
Krumholz: Sure. And when you say "you guys," let me just say I have the great privilege of working with Akiko Iwasakiopens in a new tab or window. Honestly for me, the ability to work with a renowned scientist like that in the lab who can bring insights to aniline biology is essential to this kind of research. I mean, I'm a clinical investigator, I'm an outcomes researcher. I really care whether or not we can produce knowledge that can tangibly improve people's lives, help them feel better, actually relieve the suffering.

But I recognize in a condition like this, unlike where I'm usually studying, like heart disease is fairly well-characterized, it's pretty mature. We still have a lot to learn, but I've never been in a situation where we've got a disease that is puzzling to most people. They don't understand the underlying mechanisms, it's not clear what the taxonomy is or what we're actually dealing with, and what an honor for me to be able to work with someone who can actually help provide insight into the underlying immunologic dimensions of this condition.
That plus we got a whole team of people, really talented individuals, and we came together and said, there are various different underlying causes potentially of long COVID. One of them is this idea of viral persistence, that people just never get rid of the virus and it continues to cause mischief in a wide variety of ways.

Let's try an antiviral, and there may be many choices in that. In part, it was because as we were in conversation with various groups. Pfizer was interested in seeing Paxlovid applied in this way and was willing to provide funding for us to do it and willing to provide the drug.
So for us it was an idea that, let's get started. Let's try to create a platform where we can do remarkable research in highly efficient ways, utilizing digital data, and really see if we can do a decentralized study -- one where people don't have to go to sites, build up that platform, and if we can start with Paxlovid, let's start.
That's what we did. We got out of the gates with a trial that would focus on using Paxlovid for 15 days in people highly symptomatic with long COVID and see whether or not we could learn anything.

Faust: Right. And that's the distinction that I just always have to myself be reminded of, which is this is not a study of people who have COVID right now in the first few days of illness, they're getting Paxlovid for a certain amount of time and then we look down 3, 6, 9, 12 months later to see if they got long COVID.
That is not what this is. This is for people who actually already have the diagnosis of long COVID, right?
Krumholz: That's right. That's exactly right.
Those studies are meritorious too, but they're prevention studies. Can we make an intervention early that lowers the risk of people ever developing something like long COVID? I'm interested in those. I think we all should be.
But there are lots of people out there who are suffering from the ravages of COVID throughout the course of the pandemic who 3 months or longer later are still having debilitating symptoms. For many of them, their lives have been unraveled.

The question is: what can we do to help them? What is going on with them to cause the kind of symptoms that they've got?
The "what" is, obviously, we're trying to see whether or not an antiviral Paxlovid can make a difference for people who are suffering from long COVID. But we thought, can we innovate the way that we do trials? The idea was, could we create a digital, decentralized, and democratized approach to doing a clinical trial in which we didn't need any sites. We're actually going direct to consumer, we're going straight to the people, one IRB [institutional review board], no site contracts. And what we're doing is enlisting people to fill out a questionnaire. If they qualify, we get them to integrate their medical records; we can review the records at a distance. If they qualify, we call them up, make sure what's in the record really reflects their reality, what they understand as their conditions and comorbidities, and do they qualify for this study.

If they qualify, we're off to the races -- we can randomize them, we ship [the] drug, we send people to their homes to get biospecimens that go to Akiko's lab; they do daily diaries on their device. We're in constant communication with them, a lot digital, some by phone. They're filling out surveys, the patient-reported outcome measures, and we're getting the feeds from their medical records to look at their healthcare utilization. And all the time, everything's being done from the convenience, largely, of their home; they don't have to leave. Many of these people are quite debilitated, tired, fatigued, and really don't have the financial resources. For those who are working hourly, it would be a big deal to have to take off half a day to go to a site, even to drive and use gas.
There are no clinical trial deserts in this study, because no matter where you live, you can be part of it. And we enrolled rapidly. The study, once we sort of worked out the kinks and the processes, is going extraordinarily well. I think it can be a means by which we can do highly efficient trials going forward that are really consumer-centric, participant-centric.

The other thing is, we don't call these people "subjects." They're our partners in the project. We're going to return results to them, we're going to give them access to investigators through town halls when we're finished, and we work hard to treat them with respect. We want them to give us like a net promoter score of five. Like, "Hey, I would brag to my friends that they should be in trials like this because they treat me well and I'm part of the team and we're on a mission together."
So yeah, we're really excited about how we did this and think that this can be a standard going forward.
Faust: I'm really interested in the idea of not knowing. One of the real successes of our COVID experience was the ACTIVopens in a new tab or window trial and the RECOVERYopens in a new tab or window trial in the U.K. where just a lot of things were tried and we said, "We're not smart enough to know which of these things is going to work. We just know that maybe among this group of 10, one thing will play out."

Do you feel like you have so many people who are interested here that you could throw in at some point a metformin arm or some other arm of the study, because Paxlovid is one thing, but there are other candidates?
Krumholz: Yeah, I think that's a really great question and a very important point.
We would be best off to do these kinds of platform trials where in the course of it we're testing 20 things. If it's an early study, then it's signal-finding. If you were really actually trying to test the hypothesis formally, it has to be powered appropriately. But there are enough people out there who are suffering who could be parts of these.
We really are moving too slowly. If we just do things one at a time, we're not going to learn fast enough to really solve this problem in the near future.

So I like what you're saying and I totally agree with it, and that in part was the idea behind how we built this platform. We wanted to be able to build this so that now if you've got five or six more things, if we can get the funding for it, why wouldn't you just build it in? We're all sitting ready to go.
Faust: Here we are coming into December of 2023 already and people are eager for results. When do you think we're going to get a readout from your study?
Krumholz: I think we'll finish up soon after the first of the year. I would say by June, I hope we'll be able to have a report out.
Our primary endpoint is 28 days with the PROMIS [Patient-Reported Measurement Information System]-29opens in a new tab or window physical function scale. It's sort of a net overall of how your physical health is; it's the change from baseline. But we're collecting a lot of other information on mental health and a whole range of other things that we'll learn from.

Again, like I said, it should be signal-finding. Who were responders, if there were any, and then we'll be able to not only characterize them from who they were clinically, demographically, and so forth, but because of the work that Akiko will do in the lab, we'll also say were there any baseline biomarkers that were indicative of people who were likely to respond to the treatment, and that could advance our understanding of the underlying mechanism, but also maybe be able to help us figure out who should be treated and who's likely to benefit.
Faust: Harlan Krumholz, thanks so much for joining us.
Krumholz: Thanks, Jeremy. It's great to talk to you.

 

[missy]

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Some reasons to get off the fence about COVID booster​

Publish date: December 8, 2023
By
Debby Waldman
Though many people remain on the fence about getting the latest COVID vaccine booster, new research suggests a strong argument for getting the shot this winter: It sharply reduces the risk for COVID.
Researchers found that getting vaccinated led to a 69% reduction in long-COVID risk among adults who received three vaccines before being infected. The risk reduction was 37% for those who received two doses. Experts say the research provides a strong argument for getting the vaccine, noting that about 10% of people infected with COVID go on to have long COVID, which can be debilitating for one quarter of those with long-lasting symptoms.
The data come from a systematic literature review and meta-analysis published in October in Antimicrobial Stewardship & Epidemiology. Researchers examined 32 studies published between December 2019 and June 2023, involving 775,931 adults. Twenty-four studies, encompassing 620,221 individuals, were included in the meta-analysis.
“The body of evidence from all these different studies converge on one single reality — that vaccines reduce the risk of long COVID, and people who keep up to date on their vaccinations also fared better than people who got it once or twice and didn’t follow up,” said Ziyad Al-Aly, MD, a clinical epidemiologist at Washington University in St Louis.
Researchers have reported similar results for children. The National Institutes of Health RECOVER Initiative team found that vaccines are up to 42% effective in preventing long COVID in children, said Dr. Carlos Oliveira, MD, a pediatric infectious diseases specialist and Yale researcher who contributed to the study, which is in preprint.
Vaccines also protect children from multisystem inflammatory syndrome, a condition that can happen after COVID, as well as protect against other COVID-related problems, such as missed school days, Oliveira said. “Even if the vaccine doesn’t completely stop long COVID, it’s still good for kids to get vaccinated for all these other reasons.”
However, uptake for the latest boosters has been slow: the Centers for Disease Control and Prevention reported that by mid-November, less than 16% of people aged 18 years or older had received a shot. For children, the number was closer to 6%. A recent Kaiser Family Foundation survey found that booster rates for adults are similar to what it was 1 year ago.
The survey results suggest that people are no longer as worried about COVID, which is why there is less concerned about keeping up with boosters. Though the current mutation of the virus is not as debilitating as its predecessors, long COVID continues to be a problem: as of January 2023, 28% of people who had contracted the virus had experienced long-COVID symptoms. And though the mechanisms are still not fully understood, and researchers have yet to agree on a definition of long COVID, they are certain about this much: The best way to avoid it is to avoid getting infected to begin with.
The lack of a diagnostic test for long COVID and the fact that the symptoms mimic those of other diseases lead to inconsistency that can make studies hard to replicate. In the papers reviewed for the Antimicrobial Stewardship & Epidemiology study, long COVID was defined as having symptoms lasting from more than 4 weeks to more than 6 months. Alexandre Marra, MD, the lead author and a researcher at the Hospital Israelita Albert Einstein, in São Paulo, Brazil, and at the University of Iowa, said that a clear standard definition is needed to better understand the actual prevalence and evaluate vaccine effectiveness.
Al-Aly noted that there is a logical explanation for one finding in the paper: The percentage of individuals who had COVID and reported that long-COVID symptoms declined from 19% in June 2022 to 11% in January 2023.
Because a pandemic is a dynamic event, constantly producing different variantswith different phenotypes, the prevalence of disease is naturally going to be affected. “People who got infected early in the pandemic may have a different long COVID profile and long COVID risk than people who got infected in the second or third year of the pandemic,” Al-Aly said.
Most of the studies reported data from before the Omicron-variant era. Only eight reported data during that era. Omicron was not as lethal as previous variants, and consequently, fewer patients developed long COVID during that time.
One of those who did is Yeng Chang, age 40 years, a family doctor who lives in Sherwood Park, Alberta, Canada. Chang developed long COVID during fall 2022 after getting the virus in June. By then, she’d been vaccinated three times, but she isn’t surprised that she got sick because each vaccine she had was developed before Omicron.
“When I had COVID I was really sick, but I was well enough to stay home,” she said. “I think if I didn’t have my immunizations, I might have been hospitalized, and I don’t know what would have happened.”
Long COVID has left Chang with brain fog, fatigue, and a lack of physical stamina that forced her to pause her medical practice. For the past year and a half, she’s spent more time as a patient than a physician.
Chang had her fifth COVID vaccination in the fall and recommends that others do the same. “The booster you got however many years ago was effective for the COVID of that time but there is a new COVID now. You can’t just say, ‘I had one and I’m fine forever.’”
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[diamondringlover]

I got my covid booster about a month ago and I got a shingles vaccine as well, my daughter in law got shingles a couple of months ago and said it was horrible. My son who has long haulers covid is FINALLY getting over almost all of the symptoms, it will be 2 years in January when he had it.

 

[missy]

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New COVID Variant JN.1 Could Disrupt Holiday Plans​

Kathleen Doheny
DISCLOSURES | December 07, 2023

Dec. 7, 2023 — No one planning holiday gatherings or travel wants to hear this, but the rise of a new COVID-19 variant, JN.1, is concerning experts, who say it may threaten those good times.
The good news is recent research suggests the 2023-2024 COVID-19 vaccine appears to work against this newest variant. But so few people have gotten the latest vaccine -- less than 16% of U.S. adults -- that some experts suggest it's time for the CDC to urge the public who haven't it to do so now, so the antibodies can kick in before the festivities.
"A significant wave [of JN.1] has started here and could be blunted with a high booster rate and mitigation measures," said Eric Topol, MD, professor and executive vice president of Scripps Research in La Jolla, CA, and editor-in-chief of Medscape, WebMD's sister site.

COVID metrics, meanwhile, have started to climb again. Nearly 10,000 people were hospitalized for COVID in the U.S. for the week ending Nov. 25, the CDC said, a 10% increase over the previous week.

Who's Who in the Family Tree​

JN.1, an Omicron subvariant, was first detected in the U.S. in September and is termed "a notable descendent lineage" of Omicron subvariant BA.2.86 by the World Health Organization. When BA.2.86, also known as Pirola, was first identified in August, it appeared very different from other variants, the CDC said. That triggered concerns it might be more infectious than previous ones, even for people with immunity from vaccination and previous infections.
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"JN.1 is Pirola's kid," said Rajendram Rajnarayanan, PhD, assistant dean of research and associate professor at the New York Institute of Technology at Arkansas State University, who maintains a COVID-19 variant database. The variant BA.2.86 and offspring are worrisome due to the mutations, he said.

How Widespread Is JN.1?​

As of Nov. 27, the CDC says, BA.2.86 is projected to comprise 5%-15% of circulating variants in the U.S. "The expected public health risk of this variant, including its offshoot JN.1, is low," the agency said.
Currently, JN.1 is reported more often in Europe, Rajnarayanan said, but some countries have better reporting data than others. "It has probably spread to every country tracking COVID,'' he said, due to the mutations in the spike protein that make it easier for it to bind and infect.
Wastewater data suggest the variant's rise is helping to fuel a wave, Topol said.

Vaccine Effectiveness Against JN.1, Other New Variants​

The new XBB.1.5 monovalent vaccine, protects against XBB.1.5, another Omicron subvariant, but also JN.1 and other "emergent" viruses, a team of researchers reported Nov. 26 in a study on bioRxiv that has not yet been certified by peer review.
The updated vaccine, when given to uninfected people, boosted antibodies about 27-fold against XBB.1.5 and about 13- to 27-fold against JN.1 and other emergent viruses, the researchers reported.
While even primary doses of the COVID vaccine will likely help protect against the new JN.1 subvariant, "if you got the XBB.1.5 booster, it is going to be protecting you better against this new variant," Rajnarayanan said.

2023-2024 Vaccine Uptake Low​

In November, the CDC posted the first detailed estimates of who did. As of Nov. 18, less than 16% of U.S. adults had, with nearly 15% saying they planned to get it.
Coverage among children is lower, with just 6.3% of children up to date on the newest vaccine and 19% of parents saying they planned to get the 2023-2024 vaccine for their children.

Predictions, Mitigation​

While some experts say a peak due to JN.1 is expected in the weeks ahead, Topol said it's impossible to predict exactly how JN.1 will play out.
"It's not going to be a repeat of November 2021," when Omicron surfaced, Rajnarayanan predicted. Within 4 weeks of the World Health Organization declaring Omicron as a virus of concern, it spread around the world.
Mitigation measures can help, Rajnarayanan said. He suggested:

• Get the new vaccine, and especially encourage vulnerable family and friends to do so.
• If you are gathering inside for holiday festivities, improve circulation in the house, if possible.
• Wear masks in airports and on planes and other public transportation.

Sources:
CDC: "Variants Happen," "CDC Respiratory Virus Updates."

Rajendram Rajnarayanan, PhD, assistant dean of research and associate professor, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro.
Eric J. Topol, MD, professor and executive vice-president, Scripps Research, La Jolla; editor-in-chief, Medscape.
World Health Organization: "Initial Risk Evaluation of BA.2.86 and its sublineages
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[missy]

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Wide Regional Variation in Diagnosis of Long COVID​

Jake Remaly
December 08, 2023

TOPLINE:​

In the year after a SARS-CoV-2 infection, about 5% of patients receive a diagnosis of post–COVID-19 condition (PCC), according to data from the Veterans Affairs health system. But the rate varies substantially by region, ranging from less than 4% in one area to more than 24% in another.

METHODOLOGY:​

• Researchers analyzed data from 388,980 patients who had a positive test for SARS-CoV-2 between October 1, 2021, when the ICD-10 code for PCC was introduced, and January 31, 2023.
• Patients had an average age of 61 years; 87.3% were men.

TAKEAWAY:​

• In the Sunshine Healthcare Network in Florida, the 12-month incidence of U09.9 documentation was 3.39%, whereas in the VA Heart of Texas Healthcare Network it was 24.9%.
• The diagnostic code for PCC was documented more often in regions with dedicated PCC clinics, the researchers found.
• Common symptoms in patients with PCC included shortness of breath (37.1%), fatigue or exhaustion (22.3%), cough (18%), reduced cognitive function or brain fog (6.3%), and change in smell or taste (5.7%).

IN PRACTICE:​

"Accurate and consistent documentation of U09.9 is needed to maximize its utility in tracking," the researchers write.

SOURCE:​

Pandora L. Wander, MD, MS, with Veterans Affairs Puget Sound Health Care System in Seattle, is the study's corresponding author. The study was published online on December 8 in JAMA Network Open.

LIMITATIONS:​

The findings may not be generalizable outside of the VA health system.

DISCLOSURES:​

The study was supported by grants from the VA Health Services Research and Development Service.

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[missy]

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Saltwater Gargling May Help Avoid COVID Hospitalization​

Marcia Frellick




ANAHEIM, California — Gargling and nasal rinsing with saltwater several times a day appeared to be associated with significantly lower COVID-19 hospitalization rates in a small, randomized, double-blind, controlled study.
"The hypothesis was that interventions that target the upper respiratory tract may reduce the frequency and duration of upper respiratory symptoms associated with COVID 19," said Sebastian Espinoza, first author of the study; he is with Trinity University in San Antonio, Texas.
Adults aged 18-65 years who tested positive for SARS-CoV-2 on polymerase chain reaction (PCR) testing between 2020 and 2022 were randomly selected to use low- or high-dose saltwater regimens for 14 days at the Harris Health System in Houston, Texas. For patients to be included in the study, 14 days had to have elapsed since the onset of any symptoms associated with COVID.
The low dose was 2.13 grams of salt dissolved in 8 ounces of warm water, and the high dose was 6 grams. Participants gargled the saltwater and used it as a nasal rinse for 5 minutes four times a day.

Primary outcomes included frequency and duration of symptoms associated with SARS-CoV-2 infection; secondary outcomes included admission to the hospital or the intensive care unit, mechanical ventilatory support, or death.
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The findings were presented in a poster at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Meeting.
Fifty-eight people were randomly assigned to either the low-saline (n = 27) or the high-saline (n = 2 group; three patients were lost to follow-up in both these groups. The reference control population consisted of 9398 people with confirmed SARS-CoV-2 infection. Rates of vaccination were similar for all participants.
Hospitalization rates in the low- (18.5%) and high- (21.4%) saline groups were significantly lower than in the reference control population (58.8%; P < .001). No significant differences were noted in other outcomes among these groups.

The average age of patients in the control population (n = 939 was 45 years. The average age was similar in the low- and high-saline groups. In the low-saline group (n = 27), the average age was 39, and in the high-saline group, the average age was 41.
In all three groups, body mass index was between 29.6 and 31.7.
Exclusion criteria included chronic hypertension or participation in another interventional study.

"Low Risk, Small Potential Benefit"​

Allergist Zach Rubin, MD, a spokesperson for the ACAAI, told Medscape Medical News that the findings are in line with other small studies that previously reported some benefit in using nasal saline irrigation and gargling to treat a SARS-CoV-2 infection.

"This is a type of intervention that is low risk with some small potential benefit," he said.

The researchers did not evaluate the potential reason for the saline regimen's association with fewer hospitalizations, but Rubin said, "It may be possible that nasal saline irrigation and gargling help improve viral clearance and reduce the risk of microaspiration into the lungs, so it may be possible that this intervention could reduce the risk of pneumonia, which is a major cause of hospitalization."

Rubin, who is an allergist at Oak Brook Allergists in Illinois, said, "I generally recommend nasal saline irrigation to my patients for allergic rhinitis and viral upper respiratory infections already. It can help reduce symptoms such as nasal congestion, rhinorrhea, postnasal drip, and sinus pain and pressure."

The intervention may be reasonable beyond an adult population, he said.

"This could be used for pediatric patients as well if they are developmentally ready to try this intervention," he said.

Espinoza said further study is warranted, but he said that if confirmed in later trials, the simple intervention may be particularly helpful in low-resource settings.

Espinoza and Rubin have disclosed no relevant financial relationships.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on X (formerly known as Twitter) at @MLfrellick



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[missy]

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New COVID Variant JN.1 Could Disrupt Holiday Plans​

Kathleen Doheny


No one planning holiday gatherings or travel wants to hear this, but the rise of a new COVID-19 variant, JN.1, is concerning experts, who say it may threaten those good times.
The good news is recent research suggests the 2023-2024 COVID-19 vaccine appears to work against this newest variant. But so few people have gotten the latest vaccine -- less than 16% of U.S. adults -- that some experts suggest it's time for the CDC to urge the public who haven't it to do so now, so the antibodies can kick in before the festivities.
"A significant wave [of JN.1] has started here and could be blunted with a high booster rate and mitigation measures," said Eric Topol, MD, professor and executive vice president of Scripps Research in La Jolla, CA, and editor-in-chief of Medscape, WebMD's sister site.
COVID metrics, meanwhile, have started to climb again. Nearly 10,000 people were hospitalized for COVID in the U.S. for the week ending Nov. 25, the CDC said, a 10% increase over the previous week.

Who's Who in the Family Tree​

JN.1, an Omicron subvariant, was first detected in the U.S. in September and is termed "a notable descendent lineage" of Omicron subvariant BA.2.86 by the World Health Organization. When BA.2.86, also known as Pirola, was first identified in August, it appeared very different from other variants, the CDC said. That triggered concerns it might be more infectious than previous ones, even for people with immunity from vaccination and previous infections.

"JN.1 is Pirola's kid," said Rajendram Rajnarayanan, PhD, assistant dean of research and associate professor at the New York Institute of Technology at Arkansas State University, who maintains a COVID-19 variant database. The variant BA.2.86 and offspring are worrisome due to the mutations, he said.

How Widespread Is JN.1?​

As of Nov. 27, the CDC says, BA.2.86 is projected to comprise 5%-15% of circulating variants in the U.S. "The expected public health risk of this variant, including its offshoot JN.1, is low," the agency said.
Currently, JN.1 is reported more often in Europe, Rajnarayanan said, but some countries have better reporting data than others. "It has probably spread to every country tracking COVID,'' he said, due to the mutations in the spike protein that make it easier for it to bind and infect.
Wastewater data suggest the variant's rise is helping to fuel a wave, Topol said.

Vaccine Effectiveness Against JN.1, Other New Variants​

The new XBB.1.5 monovalent vaccine, protects against XBB.1.5, another Omicron subvariant, but also JN.1 and other "emergent" viruses, a team of researchers reported Nov. 26 in a study on bioRxiv that has not yet been certified by peer review.
The updated vaccine, when given to uninfected people, boosted antibodies about 27-fold against XBB.1.5 and about 13- to 27-fold against JN.1 and other emergent viruses, the researchers reported.
While even primary doses of the COVID vaccine will likely help protect against the new JN.1 subvariant, "if you got the XBB.1.5 booster, it is going to be protecting you better against this new variant," Rajnarayanan said.

2023-2024 Vaccine Uptake Low​

In November, the CDC posted the first detailed estimates of who did. As of Nov. 18, less than 16% of U.S. adults had, with nearly 15% saying they planned to get it.
Coverage among children is lower, with just 6.3% of children up to date on the newest vaccine and 19% of parents saying they planned to get the 2023-2024 vaccine for their children.

Predictions, Mitigation​

While some experts say a peak due to JN.1 is expected in the weeks ahead, Topol said it's impossible to predict exactly how JN.1 will play out.
"It's not going to be a repeat of November 2021," when Omicron surfaced, Rajnarayanan predicted. Within 4 weeks of the World Health Organization declaring Omicron as a virus of concern, it spread around the world.
Mitigation measures can help, Rajnarayanan said. He suggested:

• Get the new vaccine, and especially encourage vulnerable family and friends to do so.
• If you are gathering inside for holiday festivities, improve circulation in the house, if possible.
• Wear masks in airports and on planes and other public transportation.

Sources:
CDC: "Variants Happen," "CDC Respiratory Virus Updates."
Rajendram Rajnarayanan, PhD, assistant dean of research and associate professor, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro.
Eric J. Topol, MD, professor and executive vice-president, Scripps Research, La Jolla; editor-in-chief, Medscape.

World Health Organization: "Initial Risk Evaluation of BA.2.86 and its sublineages, 21 November 2023."




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[missy]

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COVID Strain JN.1 Is Now a 'Variant of Interest,' WHO Says​

Lisa O'Mary
December 21, 2023

The World Health Organization called the COVID-19 variant JN.1 a standalone "variant of interest" and said JN.1 will drive an increase in cases of the virus, the global health agency announced late Tuesday.

JN.1 was previously grouped with its relative, BA.2.86, but has increased so much in the past 4 weeks that the WHO moved it to standalone status, according to a summary published by the agency. The prevalence of JN.1 worldwide jumped from 3% for the week ending November 5 to 27% for the week ending December 3. During that same period, JN.1 rose from 1% to 66% of cases in the Western Pacific, which stretches across 37 countries, from China and Mongolia to Australia and New Zealand.

In the United States, JN.1 has also been increasing rapidly. The variant accounted for an estimated 21% of cases for the 2-week period ending December 9, up from 8% during the 2 weeks prior.


SARS-CoV-2 is the virus that causes COVID, and like other viruses, it evolves over time, sometimes changing how the virus affects people or how well existing treatments and vaccines work against it.
The WHO and CDC have said the current COVID vaccine appears to protect people against severe symptoms due to JN.1, and the WHO called the rising variant's public health risk "low."





"As we observe the rise of the JN.1 variant, it's important to note that while it may be spreading more widely, there is currently no significant evidence suggesting it is more severe or that it poses a substantial public health risk," John Brownstein, PhD, chief innovation officer at Boston Children's Hospital, told ABC News.

In its Tuesday risk analysis, the WHO did acknowledge that it's not certain whether JN.1 has a higher risk of evading immunity or causing more severe symptoms than other strains. The WHO advised countries to further study how much JN.1 can evade existing antibodies and whether the variant results in more severe disease.
The latest CDC data shows that 11% of COVID tests reported to the agency are positive, and 23,432 people were hospitalized with severe symptoms within a 7-day period. Last week, the CDC urgently asked people to get vaccinated against respiratory illnesses like the flu and COVID-19 ahead of the holidays as cases rise nationwide.
"Getting vaccinated now can help prevent hospitalizations and save lives," the agency advised.

"

 

[missy]

"
FROM THE AMERICAN JOURNAL OF EMERGENCY MEDICINe

Monoclonal Antibodies: A New Treatment for Long COVID?​

FROM THE AMERICAN JOURNAL OF EMERGENCY MEDICINe
A treatment used to treat acute COVID-19 infection has also been found to be effective against long COVID, a new small study has found. The research, which assessed the benefits of monoclonal antibodies, suggests relief may finally be ahead for millions of Americans with long COVID for whom treatment has remained elusive.
The study, published in the American Journal of Emergency Medicine, found three Florida patients with long COVID made complete — and sudden — recoveries after they were given the monoclonal antibody cocktail casirivimab/imdevimab (Regeneron).
“We were struck by how rapid and complete the remissions were,” said study coauthor Paul Pepe, MD, MPH, a professor of management, policy, and community health at the School of Public Health at the University of Texas Health Sciences Center. “We found that no matter how long the patients were sick for — whether it was 5, 8, or 18 months — within 5 days, they appeared to be completely cured.”

All three patients had been initially infected with COVID-19 early in the pandemic, in 2020 or the first half of 2021. They were given Regeneron either after a reinfection or exposure to COVID-19, as a preventative, at state-run COVID clinics in Florida.
“In each case, the infusions were given to help prevent their long COVID from worsening,” said Dr. Pepe.
The researchers collected medical histories for all three patients, asking about symptoms such as physical fatigue, exercise intolerance, chest pain, heart palpitations, shortness of breath, cognitive fatigue, and memory problems. They asked patients to rate symptoms pre-COVID (baseline), during the long COVID phase, post-vaccine, and finally a week after their monoclonal antibody treatment. They also interviewed family members.
They found that across the board, symptoms improved significantly and often completely vanished. Their loved ones corroborated these reports as well.
One of the patients, a 63-year-old Floridian woman, came down with a mild case of COVID-19 at the start of the pandemic in March 2020 that lasted about 2 weeks. But several weeks later, she developed extreme, debilitating fatigue, along with chest pain and shortness of breath.
“I was chasing my 6-pound Yorkie one day after she got loose, and I was struck with such intense chest pain I fell down,” the woman, asking not to be identified, said in an interview.
Her symptoms progressed to the point where she no longer felt safe babysitting her grandchildren or driving to the grocery store.
“My short-term memory was completely gone. I couldn’t even read more than a paragraph at a time,” she said.
When she was exposed to COVID-19 in October 2021, her doctor suggested Regeneron as a preventative. She agreed to it.
“I was terrified that a second round would leave me permanently disabled and stuck in bed for the rest of my life,” she said.
About 4 days after her monoclonal antibody treatment, she noticed that some of the brain fog that had persisted after COVID was lifting.
“By day 5, it felt almost like a heavy-weighted blanket had been lifted off of me,” she recalled. “I was able to take my dog for a walk and go to the grocery store. It felt like I had gone from 0 to 100. As quickly as I went downhill, I quickly went back up.”

Reasons for Recovery​

Researchers have come up with a few theories about why monoclonal antibodies may help treat long COVID, said study coauthor Aileen Marty, MD, professor of translational medicine at the Herbert Wertheim College of Medicine at Florida International University. Among them:

• It stimulates the body to fight off any residual virus. “We suspect that many of these patients simply have levels of virus that are so low they can’t be picked up by conventional testing,” said Dr. Marty. “The virus lingers in their body and causes long COVID symptoms. The monoclonal antibodies can zero in on them and knock them out.” This may also help explain why some patients with long COVID reported a temporary improvement of symptoms after their COVID-19 vaccination.
• It combats dysfunctional antibodies. Another theory is that people with long COVID have symptoms “not because of residual virus but because of junky antibodies,” said Dr. Marty. These antibodies go into overdrive and attack your own cells, which is what causes long COVID symptoms. “This may be why monoclonal antibodies work because they displace the dysfunctional antibodies that are attached to a patient’s cells,” she explained.
• Reactivation of other viruses. Long COVID is very similar to chronic fatigue syndrome, which is often thought to be triggered by reactivation of viruses like the Epstein-Barr virus, noted coauthor Nancy Klimas, MD, director of the Institute for Neuro-Immune Medicine at Nova Southeastern University in Fort Lauderdale. “It may not explain all of the cases of long COVID, but it could make up a subgroup,” she said. It’s thought that the monoclonal antibodies may perhaps neutralize this reactivation.

Where Research Is Headed​

While Regeneron worked well in all three patients, it may be because they developed long COVID from either the initial virus or from early variants like Alpha, Beta, and Delta, said Dr. Pepe. As a result, it’s unclear whether this treatment would work for patients who developed long COVID from newer strains like Omicron.

“What concerns me is I believe there may be many people walking around with mild long COVID from these strains who don’t realize it,” he said. “They may assume that if they have difficulty walking upstairs, or forget why they went into another room, that it’s age related.”


The next step, the researchers said, is to create a registry of volunteer patients with severe long COVID. Dr. Klimas plans to enroll 20 volunteers who were infected before September 2022 to see how they respond to another monoclonal antibody initially used to treat COVID-19, bebtelovimab. (Like Regeneron, bebtelovimab is no longer approved for use against COVID-19 by the US Food and Drug Administration because it is no longer effective against variants of the virus circulating today.)

As for patients who developed long COVID after September 2022, research is ongoing to see if they respond to other monoclonal antibodies that are in development. One such study is currently enrolling participants at the University of California San Francisco. The center is recruiting 30 patients with long COVID to try a monoclonal antibody developed by Aerium Therapeutics.

“They created an investigational monoclonal antibody to treat acute COVID, but it proved less effective against variants that emerged in late 2022,” said lead investigator Michael Peluso, MD, an assistant professor of medicine in the Division of HIV, Infectious Diseases, and Global Medicine at the University of California San Francisco. The hope is it may still work to fight long COVID among patients infected with those variants.

In the meantime, the three patients with long COVID who responded to Regeneron have resumed life as they knew it pre-COVID. Although two subsequently became infected with COVID again, they recovered quickly and did not see symptoms return, something which, for them, seems nothing short of miraculous.

“I had prepared myself to be disabled for life,” said one of the patients, a 46-year-old Floridian woman who developed long COVID after an infection in January 2021. “I had crippling fatigue and dizziness so intense I felt like I was walking on a trampoline. My brain fog was so pronounced I had to write everything down constantly. Otherwise, I’d forget.”

When she became infected with COVID again in September 2021, “I thought I was going to die because I had no idea how I could possibly get worse,” she recalled. Her doctors recommended Regeneron infusion treatment. Forty-eight hours later, her symptoms improved significantly.

“I was able to go out to a cocktail party and dinner for the first time in months,” she said. “I would not have been able to do either of those things a week before.”

It’s also profoundly affected her husband, who had had to take over running the household and raising their five children, aged 11-22 years, for months.

“I can’t tell you how many school events and sports games I missed because I physically didn’t have the strength to get to them,” she noted. “To this day, my husband gets upset whenever we talk about that time. Long COVID literally took over all of our lives. It was devastating to me, but it’s just as devastating for loved ones, too. My family is just grateful to have me back.”

"

 

[missy]

"

Long COVID: New Info on Who Is Most Likely to Get It​

Solarina Ho
December 27, 2023

The COVID-10 pandemic may no longer be a global public health emergency, but millions continue to struggle with the aftermath: Long COVID. New research and clinical anecdotes suggest that certain individuals are more likely to be afflicted by the condition, nearly 4 years after the virus emerged.
People with a history of allergies, anxiety or depression, arthritis, and autoimmune diseases and women are among those who appear more vulnerable to developing long COVID, said doctors who specialize in treating the condition.
Many patients with long COVID struggle with debilitating fatigue, brain fog, and cognitive impairment. The condition is also characterized by a catalog of other symptoms that may be difficult to recognize as long COVID, experts said. That's especially true when patients may not mention seemingly unrelated information, such as underlying health conditions that might make them more vulnerable. This makes screening for certain conditions and investigating every symptom especially important.

The severity of a patient's initial infection is not the only determining factor for developing long COVID, experts said.
"Don't judge the person based on how sick they were initially," said Mark Bayley, MD, medical director of the Toronto Rehabilitation Institute at University Health Network and a professor with the Temerty Faculty of Medicine at the University of Toronto. "You have to evaluate every symptom as best you can to make sure you're not missing anything else."





Someone who only had a bad cough or felt really unwell for just a few days and recovered but started feeling rotten again later — "that's the person that we are seeing for long COVID," said Bayley.

While patients who become severely sick and require hospitalization have a higher risk of developing long COVID, this group size is small compared with the much larger number of people infected overall. As a result, despite the lower risk, those who only become mild to moderately sick make up the vast majority of patients in long COVID clinics.
A small Northwestern Medicine study found that 41% of patients with long COVID never tested positive for COVID-19 but were found to have antibodies that indicated exposure to the virus.
Doctors treating patients with long COVID should consider several risk factors, specialists said. They include:

• A history of asthma, eczema, or allergies
• Signs of autonomic nervous system dysfunction
• Preexisting immune system issues
• Chronic infections
• Diabetes
• Being slightly overweight
• A preexisting history of anxiety or depression
• Joint hypermobility ( being "double-jointed" with pain and other symptoms)

Screening for Allergies​

Alba Azola, MD, assistant professor of Physical Medicine and Rehabilitation at Johns Hopkins Medicine, said a history of asthma, allergies, and eczema and an onset of new food allergies may be an important factor in long COVID that doctors should consider when evaluating at-risk patients.
It is important to identify this subgroup of patients because they respond to antihistamines and mast cell stabilizers, which not only relieve their allergy symptoms but may also help improve overall fatigue and their tolerance for basic activities like standing, Azola said.
A recently published systemic review of prospective cohort studies on long COVID also found that patients with preexisting allergic conditions like asthma or rhinitis may be linked to a higher risk of developing long COVID. The authors cautioned, however, that the evidence for the link is uncertain and more rigorous research is needed.
"It stands to reason that if your immune system tends to be a bit hyperactive that triggering it with a virus will make it worse," said Bayley.

Signs of Dysautonomia, Joint Hypermobility​

Patients should also be screened for signs and symptoms of dysautonomia, or autonomic nervous system disorder, such as postural orthostatic tachycardia syndrome (POTS) or another type of autonomic dysfunction, doctors said.
"There's a whole list because the autonomic nervous system involves every part of your body, every system," Azola said.
Issues with standing, vision, digestion, urination, and bowel movement, for example, appear to be multisystemic problems but may all be linked to autonomic dysfunction, she explained.
Patients who have POTS usually experience a worsening of symptoms after COVID infection, Azola said, adding that some patients may have even assumed their pre-COVID symptoms of POTS were normal.
She also screens for joint hypermobility or hypermobile Ehlers-Danlos syndrome, which affects connective tissue. Research has long shown a relationship between autonomic dysfunction, mast cell activation syndrome (repeated severe allergy symptoms that affect multiple systems), and the presence of hypermobility, Azola said. She added that gentle physical therapy can be helpful for patients with hypermobility issues.
Previous studies before and during the pandemic have also found that a substantial subset of patients with myalgic encephalomyelitis/chronic fatigue syndrome, which shares many similarities with long COVID, also have connective tissue/hypermobility disorders.

Depression, Anxiety, and Female Patients​

People with a preexisting history of anxiety or depression also appear to be at a higher risk for long COVID, Bayley said, noting that patients with these conditions appear more vulnerable to brain fog and other difficulties brought on by COVID infection. Earlier research found biochemical evidence of brain inflammation that correlates with symptoms of anxiety in patients with long COVID.
"We know that depression is related to neurotransmitters like adrenaline and serotonin," Bayley said. "The chronic inflammation that's associated with COVID — this will make people feel more depressed because they're not getting the neurotransmitters in their brain releasing at the right times."
It may also put patients at a risk for anxiety due to fears of post-exertional malaise (PEM), where symptoms worsen after even very minor physical or mental exertion and can last days or weeks.
"You can see how that leads to a bit of a vicious cycle," said Bayley, explaining that the cycle of fear and avoidance makes patients less active and deconditioned. But he added that learning to manage their activity can actually help mitigate PEM due to the anti-inflammatory effects of exercise, its positive impact on mood, and benefits to the immune and cardiovascular systems.
Meanwhile, a number of epidemiologic studies have found a higher prevalence of long COVID among women. Perimenopausal and menopausal women in particular appeared more prone, and at least one study reported that women under 50 years were five times more likely to develop post-COVID symptoms than men.
A recent small UK study that focused on COVID-19 hospitalizations found that women who had lower levels of inflammatory biomarkers at admission were more likely to experience certain long-term symptoms like muscle ache, low mood and anxiety, adding to earlier research linking female patients, long COVID, and neuropsychiatric symptoms.

History of Immune Dysfunction, Diabetes, Elevated Body Mass Index (BMI)​

Immune dysfunction, a history of recurrent infections, or chronic sinus infections are also common among patients under Azola and her team's care. Those who have arthritis or other autoimmune diseases such as lupus also appear more vulnerable, Bayley said, along with patients who have diabetes or a little overweight.

Recent research out of the University of Queensland found that being overweight can negatively affect the body's immune response to the SARS-CoV-2 virus. Blood samples collected 13 months after infection, for example, found that individuals with a higher BMI had lower antibody activity and a reduced percentage of relevant B cells that help build antibodies to fight the virus. Being overweight did not affect the antibody response to the COVID-19 vaccines, however, giving further support for vaccination over infection-induced immunity as an important protective factor, researchers said.

Narrowing the Information Gap​

The latest Centers for Centers for Disease Control and Prevention's Household Pulse Survey estimates that 14% of all American adults have had long COVID at some point, with > 5% of the entire adult population currently experiencing long COVID. With millions of Americans affected, experts and advocates highlight the importance of bridging the knowledge gap with primary care doctors.
Long COVID specialists said understanding these connections helps guide treatment plans and manage symptoms, such as finding the right medications, improving tolerance, optimizing sleep, applying cognitive strategies for brain fog, dietary changes, respiratory exercises to help with shortness of breath, and finding the fine line between what causes PEM and what doesn't.

"Whenever you see a disease like this one, you always have to ask yourself, is there an alternative way of looking at this that might explain what we're seeing?" said Bayley. "It remains to be said that all bets are still open and that we need to continue to be very broad thinking about this."

"

 

[Daisys and Diamonds]

Anti-vaxxer confronts judge in court

A man found guilty of selling bleach as a cure for Covid-19 walked up to the bench where a District Court judge sat, waving documents around before...

www.odt.co.nz

who would be a judge ?

 

[jeaniefish]

"

Long COVID: New Info on Who Is Most Likely to Get It​

Solarina Ho
December 27, 2023

The COVID-10 pandemic may no longer be a global public health emergency, but millions continue to struggle with the aftermath: Long COVID. New research and clinical anecdotes suggest that certain individuals are more likely to be afflicted by the condition, nearly 4 years after the virus emerged.
People with a history of allergies, anxiety or depression, arthritis, and autoimmune diseases and women are among those who appear more vulnerable to developing long COVID, said doctors who specialize in treating the condition.
Many patients with long COVID struggle with debilitating fatigue, brain fog, and cognitive impairment. The condition is also characterized by a catalog of other symptoms that may be difficult to recognize as long COVID, experts said. That's especially true when patients may not mention seemingly unrelated information, such as underlying health conditions that might make them more vulnerable. This makes screening for certain conditions and investigating every symptom especially important.

The severity of a patient's initial infection is not the only determining factor for developing long COVID, experts said.
"Don't judge the person based on how sick they were initially," said Mark Bayley, MD, medical director of the Toronto Rehabilitation Institute at University Health Network and a professor with the Temerty Faculty of Medicine at the University of Toronto. "You have to evaluate every symptom as best you can to make sure you're not missing anything else."





Someone who only had a bad cough or felt really unwell for just a few days and recovered but started feeling rotten again later — "that's the person that we are seeing for long COVID," said Bayley.

While patients who become severely sick and require hospitalization have a higher risk of developing long COVID, this group size is small compared with the much larger number of people infected overall. As a result, despite the lower risk, those who only become mild to moderately sick make up the vast majority of patients in long COVID clinics.
A small Northwestern Medicine study found that 41% of patients with long COVID never tested positive for COVID-19 but were found to have antibodies that indicated exposure to the virus.
Doctors treating patients with long COVID should consider several risk factors, specialists said. They include:

• A history of asthma, eczema, or allergies
• Signs of autonomic nervous system dysfunction
• Preexisting immune system issues
• Chronic infections
• Diabetes
• Being slightly overweight
• A preexisting history of anxiety or depression
• Joint hypermobility ( being "double-jointed" with pain and other symptoms)

Screening for Allergies​

Alba Azola, MD, assistant professor of Physical Medicine and Rehabilitation at Johns Hopkins Medicine, said a history of asthma, allergies, and eczema and an onset of new food allergies may be an important factor in long COVID that doctors should consider when evaluating at-risk patients.
It is important to identify this subgroup of patients because they respond to antihistamines and mast cell stabilizers, which not only relieve their allergy symptoms but may also help improve overall fatigue and their tolerance for basic activities like standing, Azola said.
A recently published systemic review of prospective cohort studies on long COVID also found that patients with preexisting allergic conditions like asthma or rhinitis may be linked to a higher risk of developing long COVID. The authors cautioned, however, that the evidence for the link is uncertain and more rigorous research is needed.
"It stands to reason that if your immune system tends to be a bit hyperactive that triggering it with a virus will make it worse," said Bayley.

Signs of Dysautonomia, Joint Hypermobility​

Patients should also be screened for signs and symptoms of dysautonomia, or autonomic nervous system disorder, such as postural orthostatic tachycardia syndrome (POTS) or another type of autonomic dysfunction, doctors said.
"There's a whole list because the autonomic nervous system involves every part of your body, every system," Azola said.
Issues with standing, vision, digestion, urination, and bowel movement, for example, appear to be multisystemic problems but may all be linked to autonomic dysfunction, she explained.
Patients who have POTS usually experience a worsening of symptoms after COVID infection, Azola said, adding that some patients may have even assumed their pre-COVID symptoms of POTS were normal.
She also screens for joint hypermobility or hypermobile Ehlers-Danlos syndrome, which affects connective tissue. Research has long shown a relationship between autonomic dysfunction, mast cell activation syndrome (repeated severe allergy symptoms that affect multiple systems), and the presence of hypermobility, Azola said. She added that gentle physical therapy can be helpful for patients with hypermobility issues.
Previous studies before and during the pandemic have also found that a substantial subset of patients with myalgic encephalomyelitis/chronic fatigue syndrome, which shares many similarities with long COVID, also have connective tissue/hypermobility disorders.

Depression, Anxiety, and Female Patients​

People with a preexisting history of anxiety or depression also appear to be at a higher risk for long COVID, Bayley said, noting that patients with these conditions appear more vulnerable to brain fog and other difficulties brought on by COVID infection. Earlier research found biochemical evidence of brain inflammation that correlates with symptoms of anxiety in patients with long COVID.
"We know that depression is related to neurotransmitters like adrenaline and serotonin," Bayley said. "The chronic inflammation that's associated with COVID — this will make people feel more depressed because they're not getting the neurotransmitters in their brain releasing at the right times."
It may also put patients at a risk for anxiety due to fears of post-exertional malaise (PEM), where symptoms worsen after even very minor physical or mental exertion and can last days or weeks.
"You can see how that leads to a bit of a vicious cycle," said Bayley, explaining that the cycle of fear and avoidance makes patients less active and deconditioned. But he added that learning to manage their activity can actually help mitigate PEM due to the anti-inflammatory effects of exercise, its positive impact on mood, and benefits to the immune and cardiovascular systems.
Meanwhile, a number of epidemiologic studies have found a higher prevalence of long COVID among women. Perimenopausal and menopausal women in particular appeared more prone, and at least one study reported that women under 50 years were five times more likely to develop post-COVID symptoms than men.
A recent small UK study that focused on COVID-19 hospitalizations found that women who had lower levels of inflammatory biomarkers at admission were more likely to experience certain long-term symptoms like muscle ache, low mood and anxiety, adding to earlier research linking female patients, long COVID, and neuropsychiatric symptoms.

History of Immune Dysfunction, Diabetes, Elevated Body Mass Index (BMI)​

Immune dysfunction, a history of recurrent infections, or chronic sinus infections are also common among patients under Azola and her team's care. Those who have arthritis or other autoimmune diseases such as lupus also appear more vulnerable, Bayley said, along with patients who have diabetes or a little overweight.

Recent research out of the University of Queensland found that being overweight can negatively affect the body's immune response to the SARS-CoV-2 virus. Blood samples collected 13 months after infection, for example, found that individuals with a higher BMI had lower antibody activity and a reduced percentage of relevant B cells that help build antibodies to fight the virus. Being overweight did not affect the antibody response to the COVID-19 vaccines, however, giving further support for vaccination over infection-induced immunity as an important protective factor, researchers said.

Narrowing the Information Gap​

The latest Centers for Centers for Disease Control and Prevention's Household Pulse Survey estimates that 14% of all American adults have had long COVID at some point, with > 5% of the entire adult population currently experiencing long COVID. With millions of Americans affected, experts and advocates highlight the importance of bridging the knowledge gap with primary care doctors.
Long COVID specialists said understanding these connections helps guide treatment plans and manage symptoms, such as finding the right medications, improving tolerance, optimizing sleep, applying cognitive strategies for brain fog, dietary changes, respiratory exercises to help with shortness of breath, and finding the fine line between what causes PEM and what doesn't.

"Whenever you see a disease like this one, you always have to ask yourself, is there an alternative way of looking at this that might explain what we're seeing?" said Bayley. "It remains to be said that all bets are still open and that we need to continue to be very broad thinking about this."

"

Missy,
Thank you for your posts! The CDC and other health agencies don‘t seem to be motivated to give briefings, or any other updates on the new Covid variants and the upticks in infections around the country. There is rarely any discussion of the new variant on any of the nightly news broadcasts. People don’t seem to be all that interested anyway. When I go out , I wear a mask before going indoors anywhere. . Usually I am the only person wearing one. I have gotten used to “ the looks “ from some people. It’s rather sad , but also the reality we must deal with today… to be as informed as you can be and do what you must to protect yourself and your loved ones.

 

[missy]

"

Brain Impairment Persists at Least 18 Months After COVID Hospitalization​

— Cognitive dysfunction similar to that seen in other illnesses of comparable severity​

by Judy George, Deputy Managing Editor, MedPage Today December 28, 2023

Cognition was impaired for at least a year and a half after severe SARS-CoV-2 infection, but overall cognitive problems were like those seen in patients hospitalized for other severe diseases, a prospective study showed.
Compared with healthy controls, people hospitalized for COVID-19 had significantly worse long-term overall cognition, measured by the Screen for Cognitive Impairment in Psychiatry (SCIP) and the Montreal Cognitive Assessment (MoCA), according to Michael Eriksen Benros, MD, PhD, of Copenhagen University Hospital in Denmark, and co-authors.

But compared with people hospitalized for other severe illness -- pneumonia, myocardial infarction, or other conditions requiring intensive care -- scores on the SCIP (P=0.12) and the MoCA (P=0.07) at 18-month follow-up were similar, the researchers reported in JAMA Network Openopens in a new tab or window.
Patients hospitalized with COVID-19 also performed like other seriously ill patients on most other long-term psychiatric and neurological tests, except they had worse executive function scores.
Long-term links between COVID and cognition might not be specific to SARS-CoV-2 but associated more with overall illness severity and hospitalization, Benros noted.
"Our study shows that individuals with COVID-19 requiring hospitalization were more affected on their brain health regarding neurological, cognitive, and psychiatric symptoms than matched healthy controls," he wrote in an email to MedPage Today. "However, when comparing COVID-19 patients to non-COVID-19 patients matched on similar disease severity -- due to, for instance, other non-COVID infections -- both groups were comparably affected."

Previous research showed that 10.7% of hospitalized patients discharged after severe SARS-CoV-2 infection in Brazil had long-term impairmentopens in a new tab or window that persisted for 1 year. And among COVID-19 survivors discharged from Wuhan hospitals in early 2020, the incidence of cognitive impairment 12 months lateropens in a new tab or window was 12.45%. But other research suggested long-term neurocognitive dysfunction might be more pervasive, with one study showing that nearly half of people hospitalizedopens in a new tab or window for COVID may have at least one cognitive domain affected.
"Clinical studies with long-term follow-up comparing sequelae after COVID-19 to sequelae after other severe medical conditions have been vastly lacking," Benros observed.
The researchers enrolled 120 hospitalized COVID patients at two Copenhagen hospitals from March 2020 through March 2021, matching them with 100 healthy controls and 125 hospitalized controls. Hospitalized controls were admitted for non-COVID pneumonia (50 people), myocardial infarction (50 people), or non-COVID intensive care (25 people). People with pre-existing cognitive impairment were excluded from the study.
Hospitalized COVID patients were about 61 years old on average, and 58% were men. Participants were invited for an in-person follow-up evaluation an average of 19.4 months after hospital discharge and had structured face-to-face interviews with two trained physicians.

The primary outcome was overall cognition based on SCIP and MoCA scores. SCIP scores start at 0 and have no upper limit; lower scores indicate greater impairment. MoCA scores range from 0 to 30; scores below 26 are considered abnormal and indicate cognitive impairment. Secondary outcomes included executive function, anxiety, depressive symptoms, and neurological deficits.
At 18-month follow-up, mean SCIP scores were 68.8 for healthy controls, 59.0 for hospitalized COVID patients, and 61.6 for hospitalized controls. Mean MoCA scores were 28.2 for healthy controls, 26.5 for hospitalized COVID patients, and 27.2 for hospitalized controls.
Secondary outcome scores were worse for hospitalized COVID patients than healthy controls, but generally were similar between hospitalized COVID patients and hospitalized controls. However, on the Trail Making Test Part B to assess executive function, COVID patients had worse scores than hospitalized controls, showing a relative mean difference of 15% (P=0.04).
"Previous studies of cognitive function among patients with COVID-19 showed persistent cognitive impairment among 12% to 50% of individuals 1 year after infection," Benros and co-authors noted. "We found that 38% of patients with COVID-19 had MoCA scores below 26 at 18-month follow-up and performed worse in all cognitive tests compared with the healthy population, consistent with previous research."
The study period covered different strains of SARS-CoV-2 with varying virulence and potential for long-term effects, the researchers acknowledged. Other limitations included the use of the SCIP, which has a relatively small cognitive test battery. In addition, pre-pandemic cognitive scores were unavailable.



Primary Source

JAMA Network Open

Source Reference: opens in a new tab or windowPeinkhofer C, et al "Brain health after COVID-19, pneumonia, myocardial infarction, or critical illness" JAMA Netw Open 2023; DOI: 10.1001/jamanetworkopen.2023.49659.
"