Coronavirus Updates December 2024

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The Dose (December 6) ​

Timing of Covid vaccines, common flu rumors, HPV vaccine win, and H5N1 in milk​

KATELYN JETELINA DEC 6

Fall respiratory weather report: RSV and flu are heating up​

We are at extremely low levels of Covid-19, but RSV is exponentially increasing, and the flu is heating up. Overall, national wastewater levels remain low, but flu and RSV will be the ones to watch first.

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Kids are experiencing a lot of sickness right now—mostly from colds and walking pneumonia (10 times higher than last year). Now, we can add parvovirus B19 to the list. The number of positive tests for parvovirus is the highest it’s been in the past seven years. It’s not totally clear why the spike is happening right now, but it may be due to reduced exposure during Covid-19, which caused herd immunity to drop.

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(Source: CDC)
This infection is famous for causing a rash that looks like “slapped cheeks” in children and joint pain in adults. Other symptoms include fever, headache, cough, sore throat, and rashes. For those with underlying health conditions (cancer, organ transplants, blood disorders), infections can cause complications like anemia.

Insight on timing Covid-19 vaccines​

It has been extremely difficult to determine the optimal timing of Covid-19 vaccines. However, new data offers some suggestions:

(Note: The following recommendations is for the Northern Hemisphere. Check out the paper for the Southern Hemisphere guidance.)​

If you haven’t been recently infected, early autumn is optimal for your Covid vaccine.

• The best time to get a booster is 2.7 months before the peak of a wave (assuming no recent infections). It can lead to a five-fold lower risk of infection.
• In the U.S., the winter peak has consistently been the first week of January. This means an annual booster on September 15th provides the lowest yearly probability of infection.

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Figure from Townsend et al.
If you’ve been recently infected with Covid-19, delaying the shot can significantly improve its effectiveness. For example, if you were infected in August, your best bet is to delay to February.

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Data from Townsend et al. Supplement; Table created by YLE
Importantly, this assumes our endemic waves (one in late Summer and one in Winter) will continue. Many epidemiologists think it will, but Covid-19 could always surprise us.

It’s National Influenza Vaccination Week! There are a lot of flu vaccine rumors.​

The flu vaccine prevents millions of cases, tens of thousands of hospitalizations, and thousands of deaths yearly.
There are a lot of common misconceptions about the flu vaccine. Here are a few addressed:

1. The flu vaccine cannot give you the flu. It has no active flu virus. (It either has fragments of the virus or an inactivated version.) Some people get the flu vaccine at the same time that flu is starting to circulate, and get an infection from the community—the vaccines are imperfect and take ~2 weeks for maximum protection.
2. The flu vaccines work—but it would be nice if they worked better. The flu vaccine typically is 40-60% effective in preventing illness. (This year may be a little lower, given what we know from the Southern Hemisphere’s flu season a few months ago.)
3. Flu vaccines are given annually since the flu virus changes quickly. Flu vaccine formulas are the best guess as to which strains will be prevalent in the upcoming season.
4. Severe health issues from the flu vaccine are extremely rare but real, like the risk of Guillain-Barre syndrome (GBS). Importantly, though, the risk of GBS is higher after a flu infection. One study found that people who got the flu vaccine had a rate of GBS of 6.6 per million people, whereas unvaccinated people had a rate of 9.2 per million.

An update on hospital overflow and ER boarding​

You may remember back in February, YLE wrote about the escalating problem of emergency room “boarding”—where patients get stuck waiting hours to days in the ER due to overly full hospitals, leading to unsafe patient care and increased death.
At the time, we invited you to comment on a proposed clinical quality measure that the U.S. government would require of hospitals. It would set standards, collect data, and help create financial incentives to fix boarding if approved.
We have an update for you.

• You guys did not disappoint: responses skyrocketed after publishing the YLE article. The measure has received an initial favorable assessment and is in another stage of vetting this month. (You can comment in support here.)

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• We are asking for your help again. This topic seems to be gaining momentum, as a different national organization that grades hospitals on safety and quality will potentially start including data on ER boarding in their annual hospital assessment. You can help make this happen by providing your public comment here by December 13 (select Section 6E), encouraging them to include measures of ER boarding in their annual assessment. This would be exceptional news, as it would mean more data and incentivization for hospitals to address the problem.

Change in health care is slow and often requires filling out surveys that only hospital administrators know about. But a large showing from the public is how we fix these problems.

Good news: HPV vaccinations are associated with reduced cervical cancer mortality in young women​

The flood of data continues: Another study shows the effectiveness of human papillomavirus (HPV) vaccines in reducing deaths from cervical cancer. Recommended to young women since 2006 (and now recommended to all children/adolescents), HPV vaccines have reduced deaths from cervical cancer by 62% in young women! The study looked specifically at women under 25 years.

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Source: JAMA; Annotated by YLE
While cervical cancer mortality rates were already decreasing, it looks like the vaccine supercharged the decline. The causal argument is very strong:

• There’s a consistent and strong effect across different populations,
• There’s biological plausibility (HPV causes cervical cancer, and there was an intervention that we know works on a biologic level) and,
• This was the first cohort of women widely advised to get vaccinated. (Note: The HPV vaccine is now recommended for children of all genders—HPV causes a number of cancers.)

Question grab bag: H5N1 in raw milk​

The Santa Clara Health Department found H5N1 in raw milk on the shelves through random milk testing. After further investigation, H5N1 was also found in the producer’s (Raw Farms) storage tanks and bottling facility. (Note: RFK Jr. is linked to this company). California has asked Raw Farms to stop producing milk, and a health warning is now out. One YLE reader asked, "Why is finding H5N1 in raw milk bad? Why does public health care so much? Wouldn’t this be survival of the fittest?”
There are a lot of unknowns right now, and public health works with a precautionary lens. We don’t know if people can get infected with H5N1 from raw milk. Thus, we don’t know whether drinking raw milk increases the probability of another pandemic for everyone. (For example, are there receptors in the gut that can cause H5N1 to mutate to become more transmissible for human spread?) And, we don’t really want to find out.
However, we do know that some mammals get serious H5N1 disease from drinking raw milk containing the virus. During a livestock outbreak in Texas in early 2024, half of the cats on the ranch died after drinking milk from infected cows. In mice fed virus-containing milk in a lab, autopsies found H5N1 had spread to most of their organs within a few days.

Bottom line​

You’re all caught up for the week! Have a wonderful weekend.

 

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Specialties & Diseases > Oncology & Hematology

Unusual and rare cancers have emerged over the last few years. Is COVID-19 to blame? | MDLinx

Certain viruses can cause or increase risks of cancer. Human papillomaviruses (HPVs) can cause cervical cancer, for example, and viruses like Epstein-Barr virus (EBV), hepatitis B (HBV) and C (HCV).

www.mdlinx.com

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Unusual and rare cancers have emerged over the last few years. Is COVID-19 to blame?​

By Claire Wolters | Fact-checked by Davi Sherman
| Published December 20, 2024
Industry Insights
“We were seeing this [rise in unusual cancers start] before the pandemic,” Dr. Jacoub says. “Perhaps COVID has just accelerated it.” - Jack Jacoub, MD, a board-certified medical oncologist
As doctors, you know that certain viruses can cause or increase risks of cancer. Human papillomaviruses (HPVs) can cause cervical cancer, for example, and viruses like Epstein-Barr virus (EBV), hepatitis B (HBV) and C (HCV), and human immunodeficiency virus (HIV) can increase risks of cancers, according to the American Cancer Society.[1]
In light of recent medical events, some physicians are starting to wonder whether COVID-19 should be added to the list of cancer-causing viruses. According to The Washington Post, doctors have been nervous about an emergence of ‘unusual’ cancers over the last few years, and scientists are calling on the United States government to prioritize asking—and potentially answering—whether COVID-19 could be playing a role.[2]
Jack Jacoub, MD, a board-certified medical oncologist and the medical director of MemorialCare Cancer Institute at Orange Coast and Saddleback Medical Centers in Orange County, CA, says that oncologists like himself have to be “fairly naive” not to recognize the importance of this question and the patient concerns that come with it.
He adds that it is not rare for a patient to wonder, “How did I get this?” when diagnosed with an unusual cancer or to ask whether their diagnosis is related to COVID-19. Dr. Jacoub says that, even more commonly, he receives questions about whether COVID-19 vaccines are related to emerging cancers—and if people should be worried about them.
COVID-19 vaccines have not been found to cause cancer, and Dr. Jacoub emphasizes this, along with the proven safety and effectiveness of the shots, to his patients. Particularly for patients at risk of or already diagnosed with cancer, these vaccines can be crucial, he adds. Still, he says it is important to acknowledge and not discredit patients' fears. He adds that he would never turn a patient away from treatment based on vaccination status or ideology, and it is important for doctors to treat their patients for cancer regardless of whether or not they are vaccinated.
On the other hand, if patients ask Dr. Jacoub whether COVID-19 was responsible for their cancer—which, he admits, happens less frequently—he is unable to give them a definitive answer. Many more studies will be needed to understand widespread trends vs anecdotal evidence and to specify causation vs correlation, he adds. Additionally, researchers will need to look into the complexity of any potential COVID-to-cancer relations. Understanding not just whether, but how, this virus could cause cancer is vital information that could help doctors prescribe helpful prevention and treatment interventions. Dr. Jacoub adds that researchers may need to look into other cancer risks that may be related to COVID-19.
“We were seeing this [rise in unusual cancers start] before the pandemic,” Dr. Jacoub says. “Perhaps COVID has just accelerated it.”

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Younger People and Long COVID: Underreported, Undertreated​

Sara Novak

December 23, 2024



John Bolecek, 41, of Richmond, Virginia, was diagnosed with long COVID in May of 2022. While his acute infection was mild, once everyone else in his family had recovered, the heavy fatigue he experienced from the start has never lifted.

“When I wake up in the morning, I feel like I haven’t gone to sleep at all,” Bolecek said. “It’s this super fatigue that’s just never gone away.”

The urban planner who once rode his bike to work daily and spent weekends cycling had to quit working and now can barely get through a light walk before long COVID symptoms of post-exertional malaise, an intense fatigue after previously tolerated physical or mental activity, set in. His unrefreshing sleep, fatigue, and dysautonomia — a disruption of the autonomic nervous system that causes dizziness, heart rate changes, and nausea — have made it nearly impossible to share household duties with his wife. She has to do most of the cooking, cleaning, and tending to their two sons, ages 6 and 8 years.

It’s an increasingly familiar story for those hit with long COVID in their prime, a period of life when young and middle-aged adults are the most productive and the busiest, often in the thick of parenting while also taking care of their aging parents. And it’s a group that is among the hardest hit by long COVID both because of the sheer number of patients with the condition and the mental and financial strain that it’s putting on this age group. According to the Centers for Disease Control and Prevention (CDC), 6.9% of adults aged 18-34 years and 8.9% of adults aged 35-49 years have the disorder compared with 4.1% of older adults aged > 65 years who are the least likely to have long COVID.

In a study published recently in Scientific Reports, researchers found that in a population of California residents with long COVID, older individuals (who were sicker to start) had more severe symptoms associated with the condition. But researchers also found that younger people (aged 18-49 years) were more likely to experience symptoms that reduced their productivity and quality of life. They suggested this is both because they have more to do in a given day and because they have a longer life ahead of them living with a chronic condition.



“Much of California’s population falls within the 18-49 age group, [so] we would expect to see the highest overall burden coming from these individuals,” said lead study author Sophie Zhu, a researcher in the Division of Communicable Disease Control at the California Department of Public Health.

The Impact on Work and Life Productivity​

Adults and especially those in middle age tend to have a lot of competing stressors during this period of life, said Nisha Viswanathan, MD, director of the UCLA Health Long COVID program. “Patients may need to decrease some of the pressures of life for their health and that can be impossible to do because they have so many other people who are depending on them,” she said.

It’s a different set of circumstances compared with older individuals who may have more severe symptoms because they have underlying conditions. But older Americans are also more likely to be retired and don’t have children who are financially dependent on them. Previous research has shown the burden that long COVID is having on the workforce. A study published in the August 2023 edition of The Lancet Regional Health found that 5.8% of participating patients with long COVID reported occupational changes like moving to part time or remote work, including 1.6% who had completely dropped out of the workforce.

Middle age is also a time of life when patients may not have time to seek the care they need. The chronic nature of long COVID means that treatment can be time consuming and expensive, all of which drains resources from patients who are often supporting spouses, children, and sometimes older parents. A study published last month in Disability and Health Journal found that patients with long COVID have significantly higher rates of housing instability and financial concerns, such as worries about paying rent or a mortgage, than those without the condition.

The Financial Strain of Long COVID​

For those who can’t work, the process of applying for long-term disability can also be complicated. That’s especially true for people whose illness keeps them from doing even basic tasks like filling out paperwork and dealing with disability insurance claims. It requires those applying as a result of their long COVID symptoms to show all records connected to long COVID as well as a medical history, the beginning of their symptoms, and their current treatments.

Even then, many patients complain of having their claims rejected, which can be financially disastrous to families already struggling to get by. Still, experts contend that it’s important to understand that as of July 2021, long COVID is considered a disability under the Americans with Disabilities Act (ADA).

“Long COVID is recognized as a disability under Section 504 of the ADA, and yet day after day, we see violations of the ADA for people with long COVID not getting the accommodations that they need in order to work,” said David Putrino, PhD, the Nash Family director of the Cohen Center for Recovery from Complex Chronic Illness at Mount Sinai in New York City and a renowned expert in long COVID.

He added that short- and long-term disability claims are sometimes denied because of a lack of diagnostic testing to prove a patient has the condition. “This is nonsensical and absurd because the CDC does not require a blood test for the diagnosis of long COVID. It’s at your physician’s discretion,” Putrino said.

Viswanathan agreed. She said that for many of her patients, getting long-term disability has been particularly challenging because there’s no blood test for long COVID to prove patients have the condition. “As a result, for many of our patients, especially when they’re young, they may have to return to work in one form or another,” Viswanathan said.

The Impact of Long COVID on Quality of Life​

What’s worse, the full impact is yet unknown because this is likely an underestimated cohort as many of these patients had mild cases of acute COVID-19 and fewer underlying conditions. For others, their long COVID is undiagnosed.

“Much of the impact on productivity and quality of life for this group remains hidden,” said Ziyad Al-Aly, MD, a global expert on long COVID and chief of research and development at the Veterans Affairs St. Louis Health Care System in St. Louis.


Unfortunately, the impact on Bolecek’s life isn’t so hidden. He can’t work, which has been a financial stressor on the family. He spends much of the day in bed so that he can help with a few things when his wife gets home from work. He can’t cycle anymore and, as a result, has lost many of the friends associated with his favorite hobby.

But he remains hopeful, and more than anything else, he’s thankful for his family. His wife and kids have given him the strength to push on even when the days are hard. “I just don’t know where I’d be without them,” Bolecek said.



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BCG Vaccine May Protect Against Long COVID Symptoms​

Edited by Satish Kumar M

December 2024

TOPLINE:​

Administering the Bacillus Calmette-Guérin (BCG) vaccine during the active phase of COVID-19 may help protect against the development of long COVID.

METHODOLOGY:​

• A phase 3 clinical trial initiated in early 2020 investigated the effect of the BCG vaccine injected during active infection on COVID-19 progression in adults with mild or moderate COVID-19. The current study summarizes the 6- and 12-month follow-up data with a focus on long-COVID symptoms.
• Patients who tested positive for severe acute respiratory syndrome coronavirus 2 were randomly assigned to receive either 0.1 mL of intradermal BCG (n = 191) or 0.9% saline placebo (n = 202) within 14 days of symptom onset and were followed up at 7, 14, 21, and 45 days and at 6 and 12 months postinjection.
• Overall, 157 BCG (median age, 40 years; 54.1% women) and 142 placebo (median age, 41 years; 65.5% women) recipients completed the 6-month follow-up, and 97 BCG (median age, 37 years; 49.5% women) and 95 placebo (median age, 40 years; 67.4% women) recipients completed the 12-month follow-up.
• The researchers primarily assessed the effect of the BCG vaccine on the development of the symptoms of long COVID at 6 and 12 months.

TAKEAWAY:​

• Hearing problems were less frequent among BCG recipients at 6 months compared with those who received placebo (odds ratio [OR], 0.26; 95% CI, 0.045-1.0; P = .044).
• At 12 months, participants who received the BCG vaccine exhibited fewer issues with sleeping (P = .027), concentration (P = .009), memory (P = .009), and vision (P = .022) along with a lower long-COVID score (one-sided Wilcoxon test, P = .002) than those who received placebo.
• At 6 months, BCG demonstrated a sex-specific paradoxical effect on hair loss, decreasing it in men (P = .031), while causing a slight, though statistically nonsignificant, increase in women.
• Male sex was the strongest predictive factor for long COVID, cognitive dysfunction, and cardiopulmonary scores at both follow-up assessments.

IN PRACTICE:​

"[The study] findings suggest that BCG immunotherapy for an existing ailment may be superior to prophylaxis in healthy individuals," the authors wrote.

SOURCE:​

The study was led by Mehrsa Jalalizadeh and Keini Buosi, UroScience, State University of Campinas, Unicamp, São Paulo, Brazil. It was published online onNovember 19, 2024, in the Journal of Internal Medicine.

LIMITATIONS:​

Previous mycobacterial exposure was not tested among the study participants. A notable loss to follow-up, particularly at 12 months, may have introduced bias into the results.

DISCLOSURES:​

The study was supported by the Coordination for the Improvement of Higher Education Personnel, Federal Government of Brazil, the General Coordination of the National Immunization Program, Ministry of Health (Brazil), and the National Council for Scientific and Technological Development-Research Productivity. The authors declared no conflicts of interest.

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This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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