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Coronavirus Updates March 2024

missy

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Maybe this belongs under the healthcare in USA thread but I am sharing it here for now

"

Unmasking a Nurse's Journey Through Long COVID Gaslighting​

— "I was taken aback by the words coming from my doctor's mouth"​

by Jess Warner, RN March 1, 2024





This story is from the Anamnesis episode called Rx for Reality: Clinicians Confront Medical Gaslighting

The first weekend of February 2020 was Super Bowl weekend. I remember it was an unusually mild weekend, sunny and warm compared to our normally frigid and snowy winter weather. I was volunteering as a greeter at an indoor event at a local shop in our town to celebrate the Pagan holiday Imbolc.
I'm an introvert by nature, so this was definitely a step outside my comfort zone. I met people at the doors, ensured they had paid their entrance fee, and chatted with them while they waited to enter. I talked to people from all across the country. It was unexpected considering our little town's rural location in the middle of northern Colorado.
Within a few days, I was sick with symptoms of an upper respiratory infection -- sore throat, congestion, and a cough that was unlike anything I can remember experiencing. It was dry, nonproductive, kept me awake all night, and left me breathless. I also had swelling and tenderness in my left upper abdomen. A bit of an unusual symptom for a cold.

I was sick the whole month of February, and it took two rounds of antibiotics to knock it out.
After I was through this thick of the illness, I still had lingering symptoms. It felt like I was carrying heavy, wet sponges in my chest that bubbled and gurgled when I breathed. I had chest and throat tightness, shortness of breath, and a racing pulse with even the simplest tasks.
Taking a Shower Was Monumental
I tired so quickly. Taking a shower was monumental and exhausting. Over time, my voice changed and became raspy and hoarse, and some days I could barely speak louder than a whisper.
I returned to my primary care physician multiple times as my acute illness continued and began to resolve. But it felt like she minimized or brushed aside all my concerns. She added a new inhaler and then later increased the dosage. She told me I needed the flu and pneumonia vaccine to boost my immune system.

The next visit, she said my symptoms were just deconditioning, that I was overweight and needed to exercise, that I needed to be tested for sleep apnea again, even though three tests within the past 5 years showed that I didn't have it. With every visit, though, my blood work showed steadily declining kidney function. When asked, she said it was still within normal limits and there was nothing to be concerned about.
Initially, I rationalized everything away and chalked it all up to stress.
At the beginning of May, while traveling to the western slope of Colorado to look at potential properties after having gone over the Eisenhower Pass, a distance of roughly 6,000 feet in altitude and back, I began to experience sporadic chest pain that I initially thought was heartburn.
My stomach was queasy and it felt like there was a fire in my throat from reflux when I hadn't eaten anything spicy to bring it on. Then a subtle ache spread from my collarbone and jaw. I was shocked to realize that I might be experiencing the symptoms of a heart attack. So we cut our trip short and returned home to the Front Range.

I was able to see my doctor that afternoon and, for the first time, thoroughly shared with her my concerns that I still hadn't recovered from my illness in February, that it felt like my lungs were damaged and that really what I had was COVID-19. Her initial response was to defer and say that COVID wasn't in the U.S. then, so it's more likely that I just had picked up a bad flu.
But I would no longer be put off, and demanded a CT scan. So she ordered the scan. An EKG done in the office, while not indicating signs of a heart attack, did reveal nonspecific changes. And she wanted to rule out a pulmonary embolism. Within a few short hours, I received a call that the scan was negative for an embolism.
I Was Not Prepared for What It Did Show

But I was not prepared for what it did show -- evidence of severe inflammation and fibrotic scarring. I was terrified. I didn't know what it meant. Was it permanent? Was I going to feel like I couldn't take a deep breath for the rest of my life?
I met with a pulmonologist for further evaluation a few weeks later, but it did not go well. After explaining my symptoms and concerns about my scan, I shared my theory that I had COVID-19 in February. He immediately downplayed the scan results by shrugging and saying, "eh, it's just inflammation." Then, in an offhanded tone, almost jokingly, he replied, "Yeah, I'm in the ICU all day long, intubating patients with sputum flying everywhere, and I haven't caught it yet, so I doubt you got it. But we can do an antibody test if that will make you feel better."

I was speechless. He didn't ask how I was exposed. He just took this infallible and condescending tone that somehow what he did was so much more critical and that if he hadn't caught it, I certainly couldn't have. Here I was, despite my medical knowledge, scared about what was happening with my body. Not knowing if I was ever going to recover or if this damage was permanent.
There was so little known about COVID at this point, it felt utterly reckless to make assumptions about what it was and wasn't doing in the body. It was incredibly frustrating to me that my health was in the hands of a provider who acted so nonchalantly about something that, to me, he obviously knew so little about. And for my concerns and fears to be minimized as if they weren't important.
I accepted the offer for the antibody test. In the meantime, the doctor's solution for my breathing issues was to give me a 1-month-supply sample inhaler, not a prescription, to add to my existing medications. He didn't feel it was necessary to schedule any follow-up appointment.

In June, I came across an article by Ed Yong in The Atlantic titled, "COVID Can Last for Several Monthsopens in a new tab or window." It changed everything. It detailed stories of people infected with the virus in the early spring, who still had strange ongoing symptoms.
This Was Me
I was stunned. This was me. I re-read that paragraph several times and honestly started sobbing right there.
It was the first time I had validation of what I was feeling and experiencing. Of what I already knew on an instinctual gut level. I had COVID in February of 2020. I was, I am a long-hauler.
In the summer of 2021, I saw my primary care physician to ask about trying a medication that research was beginning to suggest might help with long COVID. Without asking for the name of the drug or asking to see the research, she told me point-blank that I should give up hope on this whole long COVID thing. That I was a 47-year-old morbidly obese woman with a history of fibromyalgia, and that was likely the cause of all my issues.

Once again, I was taken aback by the words coming from my doctor's mouth. I had heard so many stories like this from other long-haulers in our community. So many had been told their symptoms were all in their heads, just manifestations of anxiety or depression and that they just needed to lose weight -- an experience known as medical gaslighting. I didn't think that it would happen to me.
Having been overweight most of my life, I'm used to doctors making the automatic leap that obesity equals illness.
While as a medical professional, I am willing to admit that my weight contributed to a worsening of my symptoms, it was not directly responsible for them. So when I responded to my doctor that before COVID, I did not have chronic kidney disease, POTS, or vocal cord paralysis, and I could at least take my dogs on walks around the block without being utterly exhausted and needing to nap for a week, she looked like a deer in headlights and didn't have an answer in response. I left her office and never went back to see her again.

As 1 year post-COVID has morphed into almost 4, my list of diagnoses has grown as well as the specialists I've seen.
Living with a chronic illness that no one knows much about, including most of the doctors you see, is very isolating and can at times be very stigmatizing.
Through it all, I've been willing to stick with providers who can say, "I don't know," and are open to partnering with their patients.
Research is coming out almost daily on long COVID and its associated conditions. I hope it will soon translate into better education for our providers and treatment therapies and successful outcomes for long-haulers. We desperately need it.
"
 

missy

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"

CDC Shortens COVID Isolation Recs​

— People testing positive for COVID no longer need to stay in isolation for 5 days​

by Associated Press March 1, 2024




A photo of a mature man looking at his phone in front of a bay window with the blinds drawn.

Americans who test positive for COVID-19 no longer need to stay in isolation for 5 days, CDC officials announced on Friday.
The CDC changed its longstanding guidance, saying that people can return to work or regular activities if their symptoms are mild and improving and it's been a day since they've had a fever.
The change comes at a time when COVID-19 is no longer the public health menace it once was. It dropped from being the nation's third leading cause of death early in the pandemic to 10th last year.

Most people have some degree of immunity to the coronavirus from past vaccinations or from infections. And many people are not following the 5-day isolation guidance anyway, some experts say.
"Our goal here is to continue to protect those at risk for severe illness while also reassuring folks that these recommendation are simple, clear, easy to understand, and can be followed," said CDC Director Mandy Cohen, MD, MPH.
However, some experts worry that the change may increase the risk of infection for those people who are more vulnerable to developing severe illness.
Why Are the Guidelines Changing?
COVID-19 is not causing as many hospitalizations and deaths as it did in the first years of the pandemic. The change is an effort to streamline recommendations so they are similar to longstanding recommendations for flu and other respiratory viruses. Many people with a runny nose, cough, or other symptoms aren't testing to distinguish whether it's COVID-19, flu, or something else, officials say.

This may not be as stringent, but also emphasizes that all people with respiratory symptoms should stay home while they are sick, said David Margolius, MD, the head of Cleveland's health department.
There's been no recent change in the science of how long people with COVID-19 are likely contagious, said Jennifer Nuzzo, DrPH, director of the Pandemic Center at Brown University's School of Public Health.
"What has changed is how much COVID is harming us as a population," Nuzzo said.
What Are the New Guidelines?
If you have symptoms, stay home until your symptoms are mild and improving and it's been a day since you've had a fever. But then you can remain cautious by wearing a mask and keeping a distance from others.
There is no change to guidelines for nursing homes and healthcare facilities, however.
The agency is emphasizing that people should still try to prevent infections in the first place, by getting vaccinated, washing their hands, and taking steps to bring in more outdoor fresh air.

Is There Opposition to This Change?
Yes, and even some who understand the rationale for the change have concerns.
"My biggest worry in all of this is that employers will take this change in guidance to require employees to come back to work ... before they are ready to, before they feel well enough, and before they are not likely to pose harm to their co-workers," Nuzzo said.
Is This the First Change for COVID-19 Isolation Guidelines?
No. The CDC originally advised 10 days of isolation, but in late 2021 cut it to 5 days for Americans who catch the coronavirus and have no symptoms or only brief illnesses. Under that guidance, isolation only ends if a person has been fever-free for at least 24 hours without the use of fever-reducing medications and if other symptoms are resolving.
At the time, agency officials said the changes were in keeping with evidence that people with the coronavirus were most infectious in the 2 days before and 3 days after symptoms develop.

"
 

lilmosun

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Is This the First Change for COVID-19 Isolation Guidelines?
No. The CDC originally advised 10 days of isolation, but in late 2021 cut it to 5 days for Americans who catch the coronavirus and have no symptoms or only brief illnesses. Under that guidance, isolation only ends if a person has been fever-free for at least 24 hours without the use of fever-reducing medications and if other symptoms are resolving.
At the time, agency officials said the changes were in keeping with evidence that people with the coronavirus were most infectious in the 2 days before and 3 days after symptoms develop.

"

Admittedly, I don't get this. Why not change it to 3 days after testing positive/changing symptoms -or- at least wear a mask during that period. Asymptomatic spread is why Covid spreads like it does. Granted people can spread it 2 days before showing symptoms but why perpetuate the spread after?

Other than one night of coming home exhausted, I had no symptoms - woke up the next morning feeling completely fine - never had a fever or cough. I isolated until testing negative for 48 hours. I went past the 5 days as a courtesy/safety net for others. According to the new guidelines, I wouldn't have had to isolate at all. :confused:
 

missy

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Admittedly, I don't get this. Why not change it to 3 days after testing positive/changing symptoms -or- at least wear a mask during that period. Asymptomatic spread is why Covid spreads like it does. Granted people can spread it 2 days before showing symptoms but why perpetuate the spread after?

Other than one night of coming home exhausted, I had no symptoms - woke up the next morning feeling completely fine - never had a fever or cough. I isolated until testing negative for 48 hours. I went past the 5 days as a courtesy/safety net for others. According to the new guidelines, I wouldn't have had to isolate at all. :confused:

Great question Lilmosun...everything the CDC does is political to some extent. Sounds like they might be bowing to conservative pressure. My impression only. I agree with you. A little common sense and courtesy and caring about others can go a long way. Something this country and world is short on IMO :(
 

missy

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Unvaccinated Patients With Rheumatic Diseases Experienced Significant Risk Factors Throughout the Pandemic

Rebecca Mashaw, Digital Managing Editor



Risk factors associated with severe COVID-19 among people with rheumatic diseases (RDs) who were not vaccinated against the virus were similar throughout the varying ‘epochs’ of the pandemic, researchers reported in Arthritis Care & Research.
“Patients with RDs and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance Registry between March 2020 and June 2022. An ordinal logistic regression model (not hospitalized, hospitalized, and death) was used with date of COVID-19 diagnosis, age, sex, race and/or ethnicity, comorbidities, RD activity, medications, and the human development index (HDI) as covariates,” the authors wrote. “The main analysis included all unvaccinated patients across COVID-19 pandemic epochs; subanalyses stratified patients according to RD types.”
The authors also noted that approximately one-third of the global population has not received a COVID-19 vaccine.
Of the 19,256 unvaccinated people with RDs and COVID-19 included in the study, older people, men, patients with multiple comorbidities, and those who used glucocorticoids, had greater disease activity, or lived in lower HDI regions experienced the worse outcomes across the various pandemic epochs, the investigators found.
“For those with rheumatoid arthritis, sulfasalazine and B-cell–depleting therapy were associated with worse outcomes, and tumor necrosis factor inhibitors were associated with improved outcomes,” they reported. Among patients with connective tissue disease or vasculitis, B-cell–depleting therapy was associated with worse outcomes.
“Ongoing efforts, including vaccination, are needed to reduce COVID-19 severity in this population, particularly in those with medical and social vulnerabilities identified in this study,” the authors concluded.


Reference:
Yazdany J, Ware A, Wallace ZS, et al. Impact of risk factors on COVID-19 outcomes in unvaccinated people with rheumatic diseases: a comparative analysis of pandemic epochs using the COVID-19 Global Rheumatology Alliance Registry. Arthritis Care Res. 2024;76(2):274-287
https://acrjournals.onlinelibrary.wiley.com/doi/abs/10.1002/acr.25220?campaign=wolearlyview


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missy

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"

SARS CoV-2 Is a Very Weird Virus​

F. Perry Wilson, MD, MSCE
DISCLOSURES
March 04, 2024

Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I'm Dr F. Perry Wilson of the Yale School of Medicine.

In the early days of the pandemic, before we really understood what COVID was, two specialties in the hospital had a foreboding sense that something was very strange about this virus. The first was the pulmonologists, who noticed the striking levels of hypoxemia — low oxygen in the blood — and the rapidity with which patients who had previously been stable would crash in the intensive care unit.

The second, and I mark myself among this group, were the nephrologists. The dialysis machines stopped working right. I remember rounding on patients in the hospital who were on dialysis for kidney failure in the setting of severe COVID infection and seeing clots forming on the dialysis filters. Some patients could barely get in a full treatment because the filters would clog so quickly.

We knew it was worse than flu because of the mortality rates, but these oddities made us realize that it was different too — not just a particularly nasty respiratory virus but one that had effects on the body that we hadn't really seen before.

1000302-fig1.jpg

That's why I've always been interested in studies that compare what happens to patients after COVID infection vs what happens to patients after other respiratory infections. This week, we'll look at an intriguing study that suggests that COVID may lead to autoimmune diseases like rheumatoid arthritis, lupus, and vasculitis.

The study appears in the Annals of Internal Medicine and is made possible by the universal electronic health record systems of South Korea and Japan, who collaborated to create a truly staggering cohort of more than 20 million individuals living in those countries from 2020 to 2021.

The exposure of interest? COVID infection, experienced by just under 5% of that cohort over the study period. (Remember, there was a time when COVID infections were relatively controlled, particularly in some countries.)

1000302-fig3.jpg

The researchers wanted to compare the risk for autoimmune disease among COVID-infected individuals against two control groups. The first control group was the general population. This is interesting but a difficult analysis, because people who become infected with COVID might be very different from the general population. The second control group was people infected with influenza. I like this a lot better; the risk factors for COVID and influenza are quite similar, and the fact that this group was diagnosed with flu means at least that they are getting medical care and are sort of "in the system," so to speak.

1000302-fig4.jpg

But it's not enough to simply identify these folks and see who ends up with more autoimmune disease. The authors used propensity score matching to pair individuals infected with COVID with individuals from the control groups who were very similar to them. I've talked about this strategy before, but the basic idea is that you build a model predicting the likelihood of infection with COVID, based on a slew of factors — and the slew these authors used is pretty big, as shown below — and then stick people with similar risk for COVID together, with one member of the pair having had COVID and the other having eluded it (at least for the study period).



1000302-fig5.jpg

After this statistical balancing, the authors looked at the risk for a variety of autoimmune diseases.

Compared with those infected with flu, those infected with COVID were more likely to be diagnosed with any autoimmune condition, connective tissue disease, and, in Japan at least, inflammatory arthritis.


1000302-fig6.jpg

The authors acknowledge that being diagnosed with a disease might not be the same as actually having the disease, so in another analysis they looked only at people who received treatment for the autoimmune conditions, and the signals were even stronger in that group.

1000302-fig7.jpg

This risk seemed to be highest in the 6 months following the COVID infection, which makes sense biologically if we think that the infection is somehow screwing up the immune system.

1000302-fig8.jpg

And the risk was similar with both COVID variants circulating at the time of the study.

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The only factor that reduced the risk? You guessed it: vaccination. This is a particularly interesting finding because the exposure cohort was defined by having been infected with COVID. Therefore, the mechanism of protection is not prevention of infection; it's something else. Perhaps vaccination helps to get the immune system in a state to respond to COVID infection more… appropriately?


1000302-fig9.jpg

Yes, this study is observational. We can't draw causal conclusions here. But it does reinforce my long-held belief that COVID is a weird virus, one with effects that are different from the respiratory viruses we are used to. I can't say for certain whether COVID causes immune system dysfunction that puts someone at risk for autoimmunity — not from this study. But I can say it wouldn't surprise me.

F. Perry Wilson, MD, MSCE, is an associate professor of medicine and public health and director of Yale's Clinical and Translational Research Accelerator. His science communication work can be found in the Huffington Post, on NPR, and here on Medscape.

"
 

missy

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Paul Offit on Vaccine Science, COVID's Future, and the Anti-Vax Movement​

— "You're seeing a real pushback against the kind of weapons that are needed in public health"​


by Jeremy Faust, MD, MS, MA, Editor-in-Chief, MedPage Today ; Emily Hutto, Associate Video Producer March 8, 2024



In part 1 of this exclusive video interview, MedPage Today editor-in-chief Jeremy Faust, MD, and Paul Offit, MD, director of the Vaccine Education Center at Children's Hospital of Philadelphia, discuss the science of vaccines, the future of COVID, and the politics of the anti-vax movement.

The following is a transcript of their remarks:


Faust: Hello, Jeremy Faust, editor-in-chief of MedPage Today.

We are joined today by Dr. Paul Offit. Dr. Offit is a professor of pediatrics at CHOP, Children's Hospital of Philadelphia. He's the co-inventor of the rotavirus vaccine and he serves on the Vaccine and Related Biological Products Advisory Committee for the FDA. His new book is entitled, Tell Me When It's Over: An Insider's Guide to Deciphering COVID Myths and Navigating Our Post Pandemic Worldopens in a new tab or window.



Dr. Paul Offit, thank you for joining us.

Offit: Thank you.

Faust: Let's start with the conversation about vaccines and science, and then we'll go over to some public health issues that you talk about in the book.

The first thing I'd like you to help people understand is actually a biological thing that you talked about in the book, which is that there's a difference regarding whether a virus can be eradicated depending on its incubation period. Can you just explain that for people who either didn't go to med school or who went to med school a while ago?

Offit: Sure. So if you take a virus that has a long incubation period, like measles for example, if you're vaccinated or naturally infected, you'll develop antibodies in your bloodstream which will protect you against mild disease for 3 to 6 months until those antibodies start to come down. But you'll also develop memory cells, memory B cells, memory T helper cells, memory cytotoxic T cells, which are generally long-lived and sometimes lifelong.



For a long incubation period disease where it takes 10 days, 14 days to first develop symptoms, you actually don't need antibodies in the circulation, you just need memory cells that can then, in the case of B cells, make antibodies. That, usually, is plenty of time when you have a long incubation period to activate those cells, to get them to differentiate – in the case of B cells make antibodies – to prevent even mild disease.

So for that kind of disease, you can actually eliminate it from the face of the Earth. Smallpox is a long incubation period disease and so we've eliminated it. Polio, we're getting close to eliminating it -- another long incubation period disease. And measles, we eliminated measles from the United States in 2000. It's come back in large part because of falling immunization rates, but that's that.

For short incubation period diseases like SARS-CoV-2 or influenza or respiratory syncytial virus or rotavirus, there what you can do is when you immunize, you can induce antibodies, which will then protect you against mild disease for a while. You'll also induce these memory cells, which will protect you against severe disease because it takes a while to develop severe disease. But, you're not going to be protected against mild disease for long.



I was fortunate enough to be part of a team at Children's Hospital of Philadelphia that created the rotavirus vaccine. Rotaviruses don't really evolve away from protection induced by vaccination or natural infection. All viruses mutate, but they don't really evolve away from recognition by antibodies induced by vaccination or natural infection.

So what we've done with that disease is essentially we've eliminated hospitalizations in this country, but the virus still circulates. That virus doesn't create variants. It still circulates in the community, and it still causes mild disease, you probably have 95% immunization rates.

Even if 100% of people in the world were vaccinated against COVID and the virus didn't mutate or didn't evolve, you still would see that virus circulating because it's a short incubation period disease. You're going to get mild disease again and again and again. We never made that clear early in this pandemic.



Faust: In terms of this virus, I struggle with whether or not I should or we should be thinking about it as a garden variety coronavirus that just happens to be new and happens to be worse prior to immunity. Is that how you think about it? And if so, what's going on with the seasonality? Because clearly every year now we see a peak in the winter months, but unlike some of these other viruses -- as you say in the book -- it doesn't just go away in the summer.

Offit: Right. So there are four strains of circulating so-called human coronaviruses, and for the most part they're winter diseases. We'll see them in our hospital accounting for maybe 10% to 15% of children who are hospitalized with respiratory symptoms.

One of those viruses entered the human population in the late 1700s, another of those viruses entered the human population in the late 1800s. So I think it's fair to assume that this virus, SARS-CoV-2, will be with us for decades, if not longer.



Will it, as you argue, will it sort of settle into a seasonal pattern as these others did and become primarily a winter respiratory virus -- join the pantheon of winter respiratory viruses, like not only the human coronaviruses, but influenza, respiratory syncytial virus, human metapneumovirus, parainfluenza virus, etc? We'll see.

It hasn't clearly defined itself as a seasonality yet, but if you had to make a guess -- and you should never make a guess about this virus because you're always wrong -- I would say that it probably would settle into being a winter virus.

Faust: Alright. Let's talk a little bit about vaccine politics. The anti-vaccine movement has been with us for a long time, but it seems to me that in the past decade or two, it made a shift from primarily being a feature of the fringe left to actually going to the other side. For example, in terms of religious exemptions to other vaccines, only two states, I believe you said, had said no religious exemption, and it was Mississippi and West Virginia.



So in fact, I used to think of vaccine hesitancy and anti-vaxxing as from my original neck of the woods, the Bay Area, these crunchy liberals who believe in natural stuff. Now, it's sort of gone the other way. What happened there?

Offit: I think there's never been a politics to the anti-vaccine movement. I think on the left it was, as you note, this sort of all-natural "don't inject me with anything with a chemical name." And that outbreak of measles in Southern California in 2014-2015 that spread to 25 states, that was a phenomenon of the left, if you will. There has always been this sort of libertarian "government off my back; don't tell me what to do." But you're right -- it has swung wildly to the right.

The anti-vaccine movement has never been better funded. There was recently an article in the Washington Post talking about how much money has poured into the coffers of groups like RFK [Robert F. Kennedy] Jr.'s Children's Health Defense or Del Bigtree's Informed Consent Action Network. They are better funded than they've ever been. They're certainly far better funded than the people who are trying to communicate facts about vaccine safety and efficacy.



It's a tough time, and you're seeing a real pushback against the kind of weapons that are needed in public health, whether it's isolation or quarantine or vaccines or masking. In some ways, I think we may be less prepared for the next pandemic than we were for this one.

Faust: You also write about Dr. Ala Stanford, who is a really perfect embodiment of another thing that happened in the pandemic, which is that the Black population initially [had] a little bit of hesitancy around the vaccine, but due to efforts like Dr. Stanford's, actually the opposite happened: you have a huge interest in the Black community. There's a trust there that I think might be a win.

So do you think that that's what's happened here? That because this virus hit Black communities and other communities of color so hard, the vaccine was seen as something to be lauded and accepted, rather than a continuation of like prior suspicion about medical research and all of the earned baggage there?



Offit: I think she was one of the bright and shining lights that occurred during this pandemic. I have known Ala for a little while and just feel honored to know her. She's a hero to me.

So here's a woman, an African American surgeon at Temple University, who really took it upon herself to form something called the Black Doctors COVID Consortium with her own money. She then went into North Philadelphia, primarily a Black and brown community, and sat in people's living rooms and just tried to explain to them why it was important for them to get a vaccine. And if they said no, she would come back. And if she said they said no again, she would still come back. She got 50,000 people in that community to be vaccinated.

There should be a thousand Ala Stanfords, because I think if we're going to really combat this misinformation and disinformation, I think it has to occur at that level. I don't think it can really be at the federal level or the state level. I think it has to be at the local level, so you go into an ultra orthodox Jewish community in Brooklyn and explain why it's important to be vaccinated or a Somali American population in Hennepin County, Minnesota and explain why it's important to be vaccinated. But you have to find out who the people are that they trust, because I think there's been an enormous loss of trust during this pandemic.

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missy

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Flu Vaccines to Change After COVID Kills Off One Strain of Virus

Publish date: March 7, 2024
By
Ralph Ellis

https://www.linkedin.com/shareArtic...-vaccines-change-after-covid-kills-one-strain
An FDA advisory committee has recommended that the United States switch from a quadrivalent to trivalent influenza vaccine for the next flu season.

The flu vaccine currently in use targets two A strains and two B strains. But the Yamagata/B subtype, which was already in decline, has not been detected worldwide since March 2020, the FDA said. Social distancing and other precautions used to avoid COVID apparently finished it off.
In response to that change, the Vaccines and Related Biological Products Advisory Committee (VRBPAC) voted on March 5 to recommend the three-strain flu shot.
VRBPAC recommended the egg-based flu vaccines contain an A/Victoria/4897/2022 (H1N1)pdm09-like virus, an A/Thailand/8/2022 (H3N2)-like virus; and a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.
The committee recommended the cell- or recombinant-based flu vaccines contain an A/Wisconsin/67/2022 (H1N1)pdm09-like virus; an A/Massachusetts/18/2022 (H3N2)-like virus; and a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.
The move is no surprise. The World Health Organization and FDA experts had been recommending the change since last year.
Jerry Weir, MD, director of the FDA’s Division of Viral Products, said companies that make flu vaccines should have the trivalent shot ready for the 2024-2025 flu season.
“Each of the U.S. influenza vaccine manufacturers have submitted updated regulatory files related to a trivalent influenza vaccine, and approval of all the necessary regulatory submissions is on track for 2024-25,” he said during the advisory committee’s meeting, according to CNN.
“FDA anticipates that there will be an adequate and diverse supply of approved trivalent seasonal influenza vaccines for the United States in the coming season,” the agency said.
U.S. flu vaccine manufacturers will still make a four-strain vaccine for distribution to overseas markets, CNN said.

"
 

missy

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Why did we lose trust during the pandemic?

My conversation with Kelley Krohnert​




I am very concerned about declining trust in science and public health. Although there have been many polls and much talk at conferences, one big thing has been missing: listening to people whose trust we are losing.

Source: Pew; Annotations by YLE
This has been really hard for me to approach. I’ve been in the trenches for the past four years, so it’s personal, still very raw, and the bruises still feel fresh. When am I ready to listen? Who is genuinely interested in giving constructivefeedback without it turning into a finger pointing match?

Well, I didn’t have to look around to find the answer. Kelley Krohnert reached out to me. I was familiar with her, as she was a strong voice on social media throughout the pandemic. Although we have a lot in common (both moms, in the South at the time, both data-driven), we disagreed loudly. It took me a few days to decide whether I was ready to respond. But I eventually accepted her invitation, and we met on Zoom. Much to my surprise, it was a constructive, respectful discussion. Some of it was hard to hear. Some of it I wasn’t surprised to hear. And, we still disagree on a lot, but I am genuinely glad we had this discussion.

We didn’t record the conversation, but I asked if she could summarize her points below. Why did we lose trust during the pandemic?

Take it away, Kelley…

Everything sounds like a sales pitch

From Paxlovid to vaccines to masks to ventilation. Public health sounded (and still sounds like) a used car salesman for many different reasons:

  1. Data seems crafted to feed the pitch rather than the pitch crafted by data. Overly optimistic claims weren’t well-supported by data, risks of Covid were communicated uniformly which meant the risks to young people were exaggerated, and potential vaccine harms were dismissed. Later, when it was time to pitch boosters, public health pivoted on a dime to tell us vaccine protection wanes quickly. How did we get here?
  2. Data mistakes. For example, when CDC claimed Covid was a top 5 leading cause of death in children based on flawed data. How can people give public health the benefit of the doubt when such obvious data mistakes were made?
  3. Messaging inaccuracies. Messaging was so poorly worded that it caused people to misunderstand and start their conspiracies. For example, recommendations to get the bivalent booster 2 months after your last dose led many people to think that boosters were being recommended every 2 months.
  4. Mixing advocacy with scientific communication. Many people pretend to be unbiased scientists or journalists, but instead only share studies that support their claims and attack any other perspectives that don’t meet their interpretations or values. The latest example was a long Covid discussion at a recent congressional hearing, and one of the top long Covid doctors saying, “The burden of disease from long Covid is on par with the burden of cancer and heart disease.” There was also a flyer handed out with some statistics taken out of context. (Other scientists have since refuted it.) It’s sometimes hard for people to know who is a straight shooter and who is an activist.

Information that would have been helpful was never provided

I could never find a basic guide for people about how to take care of themselves, their children, or their parents with a mild/moderate case of Covid. Practical, helpful, and simple recommendations like: Does staying hydrated help? Should I use over-the-counter fever reducers as needed? What are signs to watch out for? NPIs and vaccines were pushed to prevent Covid, but that didn’t help already sick people stay out of the hospital.

I also expected more investigation into children and young people who experienced severe Covid-19. Covid-19 has a huge age gradient, with kids least affected—but some kids were affected, and parents never heard what specific risk factors were the biggest concerns. Instead, all risk factors were treated equally, which meant that people at high risk didn’t realize it, and those at lower risk were overly fearful.

Everything is misinformation, so nothing is misinformation

Many opinions were treated as undeniable facts, and anything that went against that was dubbed misinformation, when they were often just a different reading of the evidence or a different value judgment based on the evidence. Many things were not as black and white as claimed. People sharing legitimate harms of school closures or post-vax myocarditis risks were all deemed to be promoting “misinformation.” Like the boy who cried wolf, this makes it hard for public health to be trusted when countering verifiably false claims.

A disconnect between what I experienced on the ground and the narrative I was hearing

While some people did get very sick from Covid, and many doctors were indeed traumatized by this, many people knew few, if any, people who were hospitalized or died from Covid. While hospitals were dealing with the worst cases, a lot of the Americans weren’t affected in the same way. People were sick for a week or two and recovered, and subsequent infections were typically uneventful. Messaging from CDC like the recent tweet claiming “your next infection could be your worst” just isn’t credible for people who experienced a fairly ordinary illness from Covid.

Some things are improving

I have started seeing some change, which is why I reached out to Katelyn in the first place:

  • For example, the CDC now has a blog with more plain language and is responsive to the conversations on the ground. The latest entries are refreshing to read. For example, this one where they properly contextualized the burden of Covid this past winter.
  • Also, the updated guidance on Covid isolation catches up to where much of the world has been for a while now.

Bottom line

From Kelley: I’m glad Katelyn was willing to speak with me. I’ve been trying to reach out to those who I often butted heads with about Covid, and try to build bridges, because I think it’s important to help public health understand the perspective of many of us who lost trust during Covid. We don’t have to agree on everything to have a respectful conversation.

From Katelyn: I was toying with whether I should insert my opinions throughout this post, but in the end, I wanted to listen. I admit—I made some of the mistakes above and her points reflect some of the lessons I’ve learned. But I also know that public health poured their heart and soul into the emergency. I hope we can bring the lessons learned forward— both positive and negative. In fact, I would argue, we have no other choice.



"
 

missy

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Five Keys to Helping Long-COVID Patients Recover
Hallie Levine
March 14, 2024

About 7% of US adults report having or having had symptoms of long COVID such as fatigue, heart palpitations and/or dizziness. These are three of the 12 symptoms identified as part of the National Institute of Health's RECOVER initiative that can be reliably used to classify someone as having long COVID.

While there is no standard federally approved treatment for long COVID, physicians can recommend several strategies to their patients to help them recover.

The good news is that many people experience improvements in their symptoms over time by adopting these strategies, said Andrew Schamess, MD, an internal medicine physician at the Ohio State University Wexner Medical Center and director of its Post-COVID Recovery Program.


1. Pace yourself.

Fatigue and postexertional malaise are two of the 12 symptoms used to classify someone as having long COVID.

"There's mental, or cognitive, fatigue, where people become exhausted after any span of time trying to do complicated cognitive tasks," said Schamess. "There's also general fatigue, or sleepiness, where after a few hours you feel like you could go right back to sleep."

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The third category, he added, is postexertional malaise, where patients are exhausted by exercise, either immediately or up to 24-48 hours later.


That's where a technique known as "pacing" can help. Pacing is an energy-conservation technique often used among people with other disabling conditions, such as chronic fatigue syndrome, said Ravindra Ganesh, MD, an internal medicine physician at the Mayo Clinic in Minnesota who specializes in long COVID.

"I tell patients that they have to figure out what their energy envelope is, which is the fixed amount of energy that they can use every day without crashing," he said.

You may be able to handle a daily 30-minute walk, for example, but if you pair it with something cognitively difficult, such as doing your taxes, your fatigue symptoms may flare up.


"It's hard advice for my patients to follow, as most are real go-getters," he said. "But I point out to them that if they aim to minimize crashes, it will help them make slow progress."

Over time, he said, their energy levels should gradually rise so that they can engage in more and more activity.

2. Follow a plant-based, anti-inflammatory diet.

There's no research to suggest that following a certain eating pattern will help to reverse long COVID, said Ganesh. But in general, he said his patients anecdotally report that they feel better when they limit refined sugar and follow a plant-based diet that can help to lower inflammation in the body.

"It makes sense, because it prevents dramatic blood glucose changes that can cause their body to crash," he said. He generally recommends an anti-inflammatory diet like the Mediterranean diet, which is rich in fruits, vegetables, whole grains, and monounsaturated fat.

Many people with long COVID take an array of supplements, Ganesh said, although there's little research to suggest that they may help. He does encourage patients to take about 2 g of an omega-3 supplement, such as fish oil, as it may help to reduce inflammation associated with long COVID.

He also recommends fisetin, a dietary flavonoid found in fruits like strawberries and kiwis. Preliminary research suggests that it may help to combat some of the neurologic damage associated with long COVID.

"It appears to maintain mitochondrial function and has anti-inflammatory activities," said Ganesh.

3. Modify exercise.

Most of the time, exercise boosts health and reduces risk for certain diseases. But this strategy may not work for people who have certain symptoms from long COVID, such as postexertional malaise or postural orthostatic tachycardia syndrome (POTS), a condition that causes symptoms such as a fast heart rate, dizziness, and fatigue when transitioning from lying down to standing up.

"With long-COVID patients, it often has to be symptom-titrated exercise," said Schamess. This means physical activity needs to be constantly monitored and adjusted on the basis of a patient's symptoms. "We need to figure out what they can do that doesn't provoke their symptoms," he explained.


Schamess often recommends that patients with long COVID, at least initially, focus on exercises in which they are sitting (such as cycling) or prone.

"The key thing is most people with long COVID can do a lot more exercise in a sitting or lying position than a standing position," he said. "It's baffling to them that they can't walk two blocks but can bike 10 miles."

For symptoms like fatigue or postexertional malaise, Schamess often refers patients to physical therapy to develop an individualized exercise program. A 2022 study published in Scandinavian Journal of Medicine & Science in Sports found that when long-COVID patients completed an 8-week program of three exercise sessions per week, they experienced significant improvements in quality of life, fatigue, muscle strength, and overall fitness compared with a control group.


"It's important to make sure that workouts are supervised, so that they can be modified as necessary" said Schamess.

4. Take steps to improve sleep quality.

A 2023 study published in the Journal of General Internal Medicine found that about 40% of people with long COVID report sleep issues such as insomnia or not feeling refreshed in the morning.

"Sleep may become challenging, which can be frustrating for a patient with long COVID who desperately needs rest," said Lawrence Purpura, MD, an infectious disease specialist and director of the long COVID clinic at Columbia University Medical Center in New York City.


Some of the simplest ways to improve sleep are common sense; however, these issues never affected the person pre-COVID, so they have to become new habits.

"A lot of my patients with long COVID find that they are more sensitive to caffeine, so they really can't have it anymore later in the day," he said. "The same goes for bright screens" such as those on cell phones, tablets, and e-book readers, he said. "They may find that it's harder for them to fall and stay asleep if they're on their iPhone right before bed. These are all things that may not have been issues before they were diagnosed with long COVID."

Purpura also said that he encourages his patients to practice mindfulness or relaxation exercises before bed, such as deep breathing. One technique he recommends is called box breathing, where the patient inhales for 4 seconds, holds his or her breath for 4 seconds, exhales for 4 seconds, then holds his or her breath again for 4 seconds. Some research suggests that this paced breathing technique, when done for 20 minutes before bed, helps to improve symptoms of insomnia.

While sleep medications such as zolpidem (Ambien) are often used as short-term relief for insomnia, Schamess said he has not found them particularly helpful for sleep issues that stem from long COVID.

"They help patients fall asleep but not necessarily stay asleep, which can be an issue for people with long COVID," he said.

5. Consider medications.

No standard drugs or treatments have yet been approved to treat long COVID (although some, like Paxlovid, are in clinical trials). But some medications may help to relieve symptoms, said Ganesh. These include:


Blood pressure drugs such as beta-blockers now used to treat POTS symptoms
Nerve-pain medications such as gabapentin or pregabalin. "These can also help with sleep, since patients don't have pain to distract them," said Ganesh.
Low-dose naltrexone to help with fatigue
"There's not a one-size-fits-all approach to treat long-COVID symptoms," said Ganesh. "You really need to work with the patient and possibly even cycle through several different medications before you find one that helps."

"
 

missy

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Opinion: COVID, 4 Years on​

Eric J. Topol, MD
March 14, 2024

As we recently hit — March 11, 2020 — the 4-year anniversary of when WHO finally declared COVID a global pandemic, and today, March 13th, when the US declared it a national emergency, we're still learning every day about SARS-CoV-2's impact, its evolution, protection from vaccination, and more. Here's a quick summary of what I think is worth reviewing:
Impact
The global excess mortality has reached about 30 million lost lives attributable to COVID, and the Global Burden of Disease published a major paper this week in The Lancet on the toll it has taken for reducing life expectancy in 204 countries summarized as "The COVID-19 pandemic caused the most severe drops in life expectancy seen in 50+ years." The study did not address disability among survivors, with multiple concurrent studies reinforcing the prevalence of long COVID in tens of millions of people.

Here in the United States, it is striking to review the updated data on partisan gap death rates, as reflected by counties who voted Republican in the 2020 election. According to Ashley Wu, graphics editor at the New York Times, the curves are continuing to diverge, both weekly and cumulatively. There was no divergence when vaccines were first administered but since that time the death rates continue to worsen in counties with 70%+ Republican voters compared with <30%.
Multiple state level data, such as Washington's, indicate the protection from death with a booster, almost halving the rate in people age 65 and older.
Evolution of the Virus
The JN.1 variant took over globally and a number of subvariants (JN.1.11.1, JN.1.18, JN.1.13, JN.1.18) are showing up with added spike mutations such as R346T and F456L, but without signs of wastewater levels on the rise or other concerning metrics.

But BA.2.87.1, is the major "Omicron-like" event out there that has been the subject of five recent papers/preprints (here, here, here, here and here). That, in itself, should tell you it's a variant of interest. It's chock full of new mutations compared with the variants that came long previously, and many of these are deletions.
In itself, it is not a threat as there's no sign it is more immunoevasive or transmissible. In fact, the consensus is that it's less evasive of our immune response, the current booster works to achieve good levels of neutralizing antibodies, and some of the monoclonal antibodies that were previously found to be resistant to earlier variants may be effective again. That's great news. But as Yunlong Cao and his team appropriately warned us, "BA.2.87.1 may not become widespread until it acquires multiple [receptor binding domain] RBD mutations to achieve sufficient immune evasion comparable to that of JN.1."
It's much too early to know whether (and when) this will take place, but after 4 years if there's anything to predict, it is that the virus will find its way (through selection) to infect more hosts and repeat human hosts.
Protection from Vaccines
A big study was reported yesterday that addressed the question of protection from COVID shots against blood clots—deep vein thrombosis and pulmonary embolism, heart attacks, strokes, and heart failure. The data are from three countries—UK, Spain and Estonia, from electronic health records of over 20 million people. All these outcomes were reduced by prior COVID vaccination compared with no vaccination, especially in the first 30 days after an infection, but many showed durable protection out to 1 year follow-up (stroke, TIA, heart failure, DVT, PE).

This is different from the 40-50% protection of vaccinations vs long COVID symptoms. It's specifically addressing major cardiovascular outcome protection from being vaccinated. Major welcome news!
One More Thing
I remain very disappointed and surprised by the recent change (1 March) of CDC policy towards isolation, without regard to using rapid antigen tests. Their own data shows that at least 1 in 3 people will still be infectious at 5 days after symptom onset! That's by culturable virus, the gold standard, which tracks very closely with the rapid tests. To reduce infecting others, especially high risk vulnerable individuals, no less adding to the toll of long COVID, rapid tests should be used before people circulate.

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missy

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Virus Research Roundup

A dude gets 217 Covid-19 vaccines, more on long Covid, and Sweden opinions.​


Several new (and fascinating) scientific developments have peppered the public health stratosphere in the last few weeks. Some of this might be useful to you.

Major cardiovascular benefits of getting Covid-19 vaccine

What we knew: Previous studies have tangled the relationship between SARS-CoV-2 infection, Covid-19 vaccines, and cardiac complications. Moreover, studies are scarce during the latest Omicron period.

New info? A new study found risk of all adverse heart events (heart attack, strokes, etc., including myocarditis) was significantly lower after infection among vaccinated people, compared to unvaccinated people. This lasted for up to 12 months for most heart outcomes. While this is not a randomized control trial, it’s an impressive study—they compared 10 million vaccinated to 10 million unvaccinated people with some nice, clean analyses. I was disappointed, though, that they didn’t assess differences in this relationship by age.

Figure Source: Heart; Annotations by YLE
Why does this matter? Staying up-to-date on vaccinations has an added benefit: preserving heart health. This is likely explained by vaccines preventing infection and severe disease.

Iron and long Covid: A potential path for treatment?

What we knew: One of the immune system’s tricks for dealing with infections is hiding the body’s iron supply so that germs can’t use the nutrient to thrive. However, if this goes on too long, it can cause anemia (insufficient red blood cells to get oxygen to your tissues).

New info? A new study found that a person’s iron status after COVID-19 infection can predict the severity of illness and long COVID. People who do not develop long COVID tend to have a normal iron status over the weeks following infection.

Why does this matter? Iron may account for some of the consequences of long COVID-19. This opens up the door to trying therapeutics. However, whether the change in iron status causes or is caused by long COVID-19 is unclear.

Dude got 217 COVID-19 vaccines

What we knew: The benefit-risk profile of COVID-19 vaccines has always been favorable, especially for older adults. Still, how many vaccines are too many?Theoretically, repeat vaccination could teach the immune system to tolerate vaccines and stop working, just as weekly allergy shots teach the immune system to tolerate allergens.

New info? Outside the context of research, for his own reasons, and against recommendations, a German man received 217 Covid-19 vaccines over 29 months. (More than half of the vaccinations were verified.) When scientists asked to study his immune system, they found it didn’t learn to tolerate the vaccine—he had modestly higher antibody levels than people with three doses. Also, his immunity to other things seemed unaffected, and he’s never had a COVID-19 infection (as far as we can tell).

Figure from The Lancet; Annotations from YLE
Why does this matter? This study made many headlines. But be careful with generalizations, given this is one person in an extreme scenario. It provides insights for scientists, though, into how the immune system works and opens the door to understanding how to reproduce the positive effects with much smaller doses.

RSV monoclonal antibodies are effective

What we knew: Clinical trials showed that RSV monoclonal antibodies (a drug) for infants were highly effective. However, we didn't have real-world data.

New info? Scientists in Spain found the RSV drug protected against hospitalization by at least 70%. Some regions had upwards of 97% effectiveness. CDC also published a similar study boasting a 90% effectiveness against RSV hospitalization.

Why does this matter? Only 40% of babies got protection this last season. Low rates were in large part due to access issues, but some was due to hesitancy. I hope this increases confidence for next season.

Trial for RSV vaccine in pregnancy stopped: Now we know why

What we knew: Pfizer has a safe and effective RSV vaccine for pregnant women, and many took it this last fall. GSK was also working on an RSV vaccine but had to stop the clinical trial early, and it was not made available.

New info? The data underlying the decision to stop the GSK clinical trial was just published:

  • Preterm births were higher in vaccine group vs. placebo (6.8% vs. 4.9%)
  • Of the preterm births, 5.5% of those in the vaccine group were very (<32 weeks) or extremely (<28 weeks) preterm, compared with 2.3% of the placebo group.
  • There was a higher risk of neonatal death in the vaccine group because of the extreme prematurity.
Why does this matter? It doesn’t really, as clinical trials fail all the time. However, scientists need to understand why this particular vaccine has this problem so that future vaccines can avoid it.

Bottom line

Scientific evidence continues to flow in, providing a few reassuring puzzle pieces and some remaining mysteries.



"
 

missy

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missy

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New Monoclonal Authorized to Prevent COVID in Immunocompromised People​

— No such option has been available since FDA revoked the authorization of Evusheld last year​

by Ian Ingram, Managing Editor, MedPage Today March 22, 2024

FDA EUA pemivibart (Pemgarda) over a computer rendering of antibodies attacking COVID viruses.

The FDA issued an emergency use authorization (EUA) for pemivibart (Pemgarda)opens in a new tab or window as COVID-19 pre-exposure prophylaxis in immunocompromised individuals who are unlikely to mount a sufficient immune response following vaccination, the agency announced on Friday.
A long-acting monoclonal antibody, pemivibart is specifically authorized for people ages 12 years and older (and weighing 40 kg or more) with moderate-to-severe immune compromise either because of a medical condition or due to immunosuppressant medications. Pemivibart is given as a single intravenous infusion and is not for use as post-exposure prophylaxis or in people currently infected with SARS-CoV-2.

The EUA was based on immunobridging data involving other human monoclonal antibodies against SARS-CoV-2 demonstrating that pemivibart may be effective for COVID prevention.
"Serum neutralizing antibody titers of Pemgarda were consistent with the titer levels associated with efficacy in prior clinical trials of adintrevimab and certain other monoclonal antibody products," the FDA stated.
According to the EUA, individuals who would qualify for the antibody include those undergoing active treatment for cancer (including those receiving CAR T-cell therapy or stem cell transplant); patients with hematologic malignancies associated with poor responses to COVID vaccines regardless of their treatment status; solid-organ transplant recipients; those with moderate-or-severe primary immunodeficiency; people with advanced or untreated HIV; and those on high-dose corticosteroids, B-cell depleting agents, and other immunosuppressants.
No long-acting monoclonal antibody has been available for preventing COVID infection in individuals with moderate-to-severe immune compromise since the agency pulled the EUAopens in a new tab or window for tixagevimab-cilgavimab (Evusheld) in January 2023 -- the move followed data showing the combination was unlikely to be sufficiently active against circulating SARS-CoV-2 variants. At the time, the CDC recommendedopens in a new tab or window that immunocompromised individuals receive the latest COVID booster (if they had not already), wear a well-fitting high-quality mask in public, maintain distance in crowded areas, and improve indoor ventilation.

Pemivibart is administered at a dose of 4,500 mg over a 60-minute infusion, with repeat dosing every 3 months recommended if ongoing protection is needed.
FDA cautioned that anaphylaxis occurred in 0.6% of clinical trial participants who received pemivibart. Therefore, patients should be monitored for 2 hours after the infusion is finished, and pemivibart should be administered in settings where health providers have immediate access to medications to reverse severe allergic reactions and can alert EMS if necessary.
Other potential side effects noted in the labelingopens in a new tab or window include infusion-related reactions, fatigue, nausea, and headache.
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missy

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missy

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missy

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New Data: Long COVID Cases Surge
Tinker Ready
March 28, 2024

Experts worry a recent rise in long COVID cases — fueled by a spike in winter holiday infections and a decline in masking and other measures — could continue into this year.

A sudden rise in long COVID in January has persisted into a second month. About 17.6% of those surveyed by the Census Bureau in January said they have experienced long COVID. The number for February was 17.4.

Compare these new numbers to October 2023 and earlier, when long COVID numbers hovered between 14% and 15% of the US adult population as far back as June 2022.


The Census Bureau and the Centers for Disease Control and Prevention (CDC) regularly query about 70,000 people as part of its ongoing Pulse Survey.

It's Not Just the Federal Numbers

Independently, advocates, researchers, and clinicians also reported seeing an increase in the number of people who have developed long COVID after a second or third infection.

John Baratta, MD, who runs the COVID Recovery Clinic at the University of North Carolina, said the increase is related to a higher rate of acute cases in the fall and winter of 2023.


In January, the percentage of North Carolinians reporting ever having had long COVD jumped from 12.5% to 20.2% in January and fell to 16.8% in February.

At the same time, many cases are either undetected or unreported by people who tested positive for COVID-19 at home or are not aware they have had it.

Hannah Davis, a member of the Patient-Led Research Collaborative, also linked the increase in long COVID to the wave of new infections at the end of 2023 and the start of 2024.


"It's absolutely real," she said via email. "There have been many new cases in the past few months, and we see those new folks in our communities as well."

Wastewater Remains the Best Indicator

"This results in many cases of COVID flying under the radar," Baratta said. "However, we do know from the wastewater monitoring that there was a pretty substantial rise."

Testing wastewater for COVID levels is becoming one of the most reliable measures of estimating infection, he said. Nationally, viral measure of wastewater followed a similar path: The viral rate started creeping up in October and peaked on December 30, according to CDC measures.

RNA extracted from concentrated wastewater samples offer a good measure of SARS-CoV-2 in the community. In North Carolina and elsewhere, the state measures the virus by calculating gene copies in wastewater per capita — how many for each resident. For most of 2023, North Carolina reported fewer than 10 million viral gene copies per state resident. In late July, that number shot up to 25 million and reached 71 million per capita in March 2023 before starting to go down.

Repeat Infections, Vaccine Apathy Driving Numbers

Baratta said COVID remains a problem in rural areas. In Maine, wastewater virus counts have been much higher than the national average. There, the percentage of people who reported currently experiencing long COVID rose from 5.7% in October to 9.2% in January. The percentage reporting ever experiencing long COVID rose from 13.8% to 21% in that period.

Other factors play a role. Baratta said he is seeing patients with long COVID who have refused the vaccine or developed long COVID after a second or third infection.

He said he thinks that attitudes toward the pandemic have resulted in relaxed protection and prevention efforts.

"There is low booster vaccination rate and additional masking is utilized less that before," he said. About 20% of the population has received the latest vaccine booster, according to the Kaiser Family Foundation.

The increase in long COVID has many causes including "infection, reinfection (eg, people getting COVID after a second, third, or fourth infection), low vaccination rates, waning immunity, and decline in the use of antivirals (such as Paxlovid)," said Ziyad Al-Aly, MD, chief of research at Veterans Affairs St. Louis Health Care and clinical epidemiologist at Washington University in St. Louis, St. Louis, Missouri.

"All of these could contribute to the rise in burden of long COVID," he said.


Not all states reported an increase. Massachusetts and Hawaii saw long COVD rates drop slightly, according to the CDC

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