Coronavirus updates October 2024

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Long COVID fatigue shows up as distinct changes in brain scans​

Published September 27, 2024 | Originally published on ScienceAlert Latest

Fatigue is one of the most frequent and debilitating symptoms of long COVID, and yet it is also one of the hardest to measure objectively.
A new study suggests the extreme mental and physical fatigue experienced by many long COVID patients is, in fact, observable in the central nervous system.
Scanning the brains of 127 long COVID patients, scientists found some parts of the brain were communicating with others in a slightly altered way.
These regions include the frontal lobe, the temporal lobe, and the cerebellum, and while it's not clear how long the changes might last, the pattern could be used to identify those battling ongoing fatigue.
"These findings suggest a role of central nervous system involvement in the pathophysiology of fatigue in post-COVID syndrome," writeresearchers at the Complutense University of Madrid in Spain.
"The existence of several brain characteristics associated with fatigue severity detected by magnetic resonance imaging could constitute a neuroimaging biomarker to objectively evaluate this symptom in clinical trials."
The frontal lobe is the part of the brain associated with higher executive functions, like planning, reasoning, and problem solving. Meanwhile, the temporal lobe is associated with memory and processing, and the cerebellum is linked to movement, posture, and balance.
All three areas have previously shown changes in connectivity among patients with chronic fatigue syndrome or myalgic encephalomyelitis(CFS/ME).
CFS/ME comes with many of the same symptoms as long COVID; however, it remains unclear how the two illnesses relate.
Recent findings suggest brain changes associated with long COVID mirror those of CFS/ME, but further research using larger and more diverse sample sizes is needed.
The new study on long COVID, led by neuropsychologist Maria Diez-Cirarda, does not consider CFS/ME, but it analyzes the brain scans of 127 people who had contracted SARS-CoV-2 at least three months before. Around 74 percent of participants were female, and most had only been sick with COVID-19 once.
Roughly 87 percent reported symptoms of global fatigue, including physical or mental fatigue, and 86 percent said they were suffering from cognitive complaints, like memory, attention, or processing issues.
Ultimately, those with global fatigue, physical fatigue, or cognitive complaints showed reduced connectivity between the frontal and occipital brain regions. They also showed increased connectivity between the cerebellar and temporal areas.
Mental fatigue, however, stood out. It was associated with distinct changes in the left prefrontal areas, the anterior cingulate, and the left insula – the central hubs of a known mental fatigue network.
Changes to white matter were also found in the brains of long COVID patients with lingering fatigue. White matter contains the nerve fibers that connect neurons, and these are covered in white sheaths, which protect and allow messages to be sent faster.
In long COVID patients, the recent study suggests that physical and mental fatigue is "partly related to several microstructural changes, including demyelination."
Demyelination is when the insulating sheath that protects neurons and transmits electrical signals is damaged, resulting in reduced functionality, such as muscle weakness, blurry vision, or slurred speech.
Interestingly, the current brain study found no changes in gray matter, which contains the bodies of neurons. Previous studies have shown reduced gray matter in COVID patients, but this shrinkage was recorded during or shortly after an infection, and it may not last over the longer term.
Given how malleable the brain can be, it's important that future studies investigate the changes of long COVID over greater lengths of time. Further research could also investigate how fatigue due to long COVID compares to other conditions, like ME/CFS or multiple sclerosis.
"The involvement of the central nervous system in the pathophysiology of fatigue in post-COVID syndrome paves the way for the use of non-invasive brain stimulation techniques to alleviate fatigue in these patients," the researchers conclude.
The study was published in Psychiatry Research.
This article was originally published on ScienceAlert Latest.

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[missy]

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Two studies find SARS-CoV-2 virus becoming resistant to antiviral drugs used to treat patients​

Published September 30, 2024 | Originally published on MedicalXpress Breaking News-and-Events

Two studies have found that the virus that causes COVID-19 is becoming resistant to two drugs used to treat patients with infections.
In the first study, a combined team from Cornell University and the National Institutes of Health studied the treatment outcomes for patients with compromised immune systems who were given the drug remdesivir. They have published their results in the journal Nature Communications.
In the second study, a team of researchers from the University of Pittsburgh, Brigham and Women's Hospital, Stanford University and Harvard University studied the outcomes for COVID-19 patients given antiviral drugs over the years 2021 to 2023. They published their results in the journal JAMA Network Open.
Zhuo Zhou and Peng Hong, with the Chinese Academy of Medical Sciences & Peking Union Medical College and VA New York Harbor Healthcare System, respectively, have published a Commentary piece in the same JAMA Network Open issue outlining the work by the second team.
In the years since the height of the COVID-19 pandemic, medical researchers have continued to study SARS-CoV-2, along with new vaccine options. They have also been working on developing new therapies for people who are infected by the virus but have not been immunized or who have compromised immune systems.
As part of that effort, two such therapies, named remdesivir and nirmatrelvir, have become the go-to drugs for patients with immune systems that are not capable of fighting off the virus. But because they are antivirals, they run the risk of obsolescence as the virus mutates.
In the first study, the researchers sequenced the DNA of the virus infecting 15 COVID patients and found that the virus had developed a reduced sensitivity to both remdesivir and nirmatrelvir. They also found that the mutated viruses could infect others in the vicinity. One positive note: The researchers found that giving both antivirals to patients cleared the virus.
In the second study, the research team studied the treatment of 156 COVID-19 patients over two years—as part of that effort, the researchers divided the patients into two groups: those who had received the antiviral drugs and those who had not. Viruses with antiviral-resistant mutations were more likely to be found in patients who had received antiviral drugs. The effect was more evident in the immunocompromised and those who had received nirmatrelvir.
This article was originally published on MedicalXpress Breaking News-and-Events.
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They're idiots. Why don't they trust us? ​

Shame doesn't work, but we keep using it.​

KRISTEN PANTHAGANI, MD, PHD OCT 2

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This is post 3 of 4 in this mini-series looking back at the public health communication around the COVID vaccines, why trust was lost, and where communication broke down. The goal is not to point fingers or assign blame, but to get a view from outside our bubble and understand how messages were perceived. Catch up on the first two posts: misinformation versus miscommunication and expectation management.

Shame doesn’t work, but has become widely adopted as a response to vaccine misinformation.
“Denormalizing”—the process of reinforcing a negative behavior as socially unacceptable, can be beneficial, and has proven successful in public health efforts such as campaigns to reduce smoking. However, it’s a double-edged sword—efforts to denormalize a behavior can lead to shame and stigma, which don’t help. We know from the literature around smoking and alcohol use that shame and stigma not only don’t work, but often backfire. One studyfound exposure to negative stereotypes about smoking actually increased the drive to smoke.
Denormalization can help, but shame can cause harm. Where is the line?
Renowned shame researcher Brené Brown draws a distinction between shame and guilt that helps clarify: guilt says I’ve done something bad, shame says I am bad. Guilt is helpful—it reveals when behaviors need to change. Shame, on the other hand, smothers us. It employs the ad hominem fallacy—instead of addressing an argument or behavior, it attacks the person themselves.
Guilt says: this was the wrong decision. Shame says: you are idiots.

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New Yorker
Shame has, unfortunately, been widely adopted as a strategy to combat vaccination misinformation. An analysis of TikTok videos about vaccines revealed that videos promoting vaccines overall used more negative language and more judgment, while “anti-vax” videos used more positive language and had higher levels of positive appreciation and emotion. In particular, they found pro-vaccine videos sometimes labeled “anti-vaxxers as weak, stupid, fragile, selfish, or crazy and their behaviour as insane or dumb.”
In my own experience, I’ve found this to be true—while I’ve had my fair share of awful comments from people opposing vaccines, I’ve found some of the pro-vaccine comments can also be extremely vicious. For example, I’ve had to delete comments off my Instagram posts from pro-vaccine advocates telling those who distrust vaccines to go kill themselves.
Of course, these extreme vicious comments are the minority, but the ad hominem sentiment that “anti-vaxxers are stupid” has become mainstream, featured in headlines and late-night talk show segments.

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Is this strategy working? No, it’s making things worse​

While often a well-intentioned effort to combat misinformation, shame-based or “mean” messaging backfires. This is intuitive: we generally don’t take advice from people who treat us with contempt and disgust, even if they have credentials. This is also backed up by data:

• In a study conducted during the COVID vaccine rollout, perceived ‘moral reproach’ (feeling morally judged for not being vaccinated against COVID) did not motivate people to get vaccinated, and instead did the opposite—it strongly predicted vaccine refusal.
• A study using natural language processing of Twitter conversations found that corrections to misinformation that used positive and polite language were more likely to be effective, whereas corrections that used negative language (calling someone an idiot) were more likely to backfire, further entrenching the recipient in their belief.

Rants get views, and it’s easy to confuse virality with effectiveness. Social media content bashing antivaxxers is often popular because people who already trust vaccines cheer it on. But is this helping reach the people who actually need to be reached? Probably not, and if they do see it, the data suggests it will make them more hesitant about vaccines, not less.

It’s less about facts and more about values​

Shame-based messaging ignores a critical dynamic in vaccine hesitancy: vaccine refusal isn’t just about intelligence or lack of understanding of facts and data. Often it has far more to do with people’s values and identity.
Katherine Hayhoe, internationally recognized climate scientist and science communicator, recommends when talking about climate change, the solution is not just showing people more and more data. Instead, she recommends connecting over values they already hold dear. This allows them to incorporate new information into their worldview instead of trying to change a core piece of who they are.
Shame-based messaging does the opposite: instead of connecting with a person’s identity and values, it attacks them.

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Messaging like this has the potential to do more harm than good, as it tells the audience that their values and beliefs don’t matter. Source

Why is it so tempting to shame?​

A lot of shame-based messaging is driven out of genuine, valid frustration. Just like those rejecting vaccines are not “bad” humans, those shaming them are not “bad” people either. (That would be shaming people for shaming people! Also not helpful.)
Where is this frustration coming from? There are the obvious answers—rejecting vaccines puts both the person and the community at higher risk of disease, leads to worse health outcomes, etc.
But early on in the pandemic, I realized for me (and probably many of you), it was more than that. It wasn’t just about the individual vaccines. It was fundamentally about believing that evidence-based medicine actually works—that systematically collecting data and analyzing it will give us a clearer picture of reality than anecdotes. That we don’t have to go back to the days of basing medical decisions on hunches, fears, and vibes. We have a better way of figuring out what’s real and true.
The rejection of carefully collected, peer-reviewed data in favor of rumors and memes is understandably infuriating. If universally adopted, this would make our society collapse. For people who have devoted their lives to science, medicine, and public health, it makes sense that this gets under our skin and infuriates us.
But in the irony of ironies, reacting out of anger to defend evidence-based medicine is, itself, very much not evidence-based. Unfortunately, it will only make things worse, furthering the very problem we are trying to fix.

How to do better going forward​

• Focus criticism on the data, not the person. It’s perfectly valid to criticize false beliefs and misleading data about vaccines. But when doing it, make sure your criticism focuses on the data and argument, not the person themselves.
• Rant privately. The need to vent your anger is real, do it. But not online—it might entertain those who already agree, but alienate those who we most need to reach.
• Kindness will get you further than anger. In defending the data, remember the data: kindness helps, insults do not.
• Connect over shared values. People will be far more open to what you have to say if you connect over values you both hold dear.

Bottom line​

We must use science to figure out how to regain trust in science. And the science is clear: shaming isn’t helpful. Kindness, empathy, and connecting over shared values are critical for restoring trust in vaccines and science. This might not make us go viral, but it will build bridges instead of destroying them.
Sincerely, KP

Kristen Panthagani, MD, PhD, is a resident physician and Yale Emergency Scholar, completing a combined Emergency Medicine residency and research fellowship focusing on health literacy and communication. In her free time, she is the creator of the medical blog You Can Know Things and author of YLE’s section on Health (Mis)communication. You can find her on Threads,Instagram, or subscribe to her website here. Views expressed belong to KP, not her employer.

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How Experts Predicts This COVID and Flu Season Will Unfold​

October 3, 2024|Infectious Disease

Kathleen Doheny

What’s the outlook for COVID-19 and flu this fall and winter? It’ll probably be a lot like last year, experts say.

“We currently expect this flu season to be comparable to last year’s season,” said Adrienne Keen, PhD, of the Centers for Disease Control and Prevention’s (CDC) Center for Forecasting and Outbreak Analytics. “We expect this year’s COVID-19 season peak to be similar to last year’s or lower.” The CDC is still analyzing COVID surveillance data from the summer and will update the forecast as more is learned.

For COVID, that means it won’t be as bad as the pandemic years, and for the flu, it’s a typical pre-pandemic season. But status quo does not mean great.
Between October 2023 and April 2024, as many as 75 million people got the flu in the United States, according to CDC estimates, resulting in up to 900,000 hospitalizations and between 17,000 and 100,000 deaths. In 2023, about 900,000 Americans were hospitalized with COVID and 75,000 died.

Other experts agreed with Dr. Keen’s prediction.

But unknowns — such as a COVID variant that takes off quickly or a surprise influenza strain — could knock that forecast flat. Getting vaccinated remains crucial, public health officials stressed.

Predicting COVID​

Two key predictors of how bad an upcoming COVID season will be are the cycling of new variants and the population’s immunity (protection from an infectious disease that happens when a population is immune through vaccination or previous infection).

When new variants go up and immunity goes down, “we tend to see the increase in cases,” said Michael T. Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy and a professor of public health at the University of Minnesota, Minneapolis. But if the number of variants goes down and immunity levels go up, the outlook is more favorable.

The new COVID variant called XEC has been found in at least 25 states. On September 27, the CDC added the variant to the COVID tracker. It now accounts for 6% of US cases. This was expected, as the variant has been circulating in Europe, said Amesh Adalja, MD, a senior scholar and infectious disease expert at the Center for Health Security at Johns Hopkins University, Baltimore, Maryland.

“There will always be a new variant appearing, and one falling,” he said. “So the fact that this is happening is not surprising.”

Meanwhile, the summer COVID surge has provided postinfection immunity for some people. “What’s likely is, we are going to see substantial protection of the population for several months based on previous infection and in some cases vaccination,” Dr. Osterholm said. That means protection from serious illness, hospitalizations, and deaths (but not necessarily infection). That protection could last through the year or into early 2025.

The timing of 2024’s winter surge will likely be a bit later than 2023’s, said Andrew Pekosz, PhD, a professor and vice chair of molecular microbiology and immunology at Johns Hopkins University, Baltimore, “peaking just after the Christmas/New Year holiday.”

During the 2023-2024 season, weekly COVID hospitalizations peaked the week of Dec. 30, said Justin Lessler, PhD, a professor of epidemiology at the University of North Carolina at Chapel Hill and a member of the COVID-19 Scenario Modeling Hub.

But variants are unpredictable. “There’s a chance that the XEC variant may take off and spread, or might not,” said Dr. Adalja. As of September 28, the Omicron variant KP.3.1.1 was leading, accounting for 58.7% of US cases, according to the CDC.

While Dr. Adalja agreed that 2024’s COVID season will probably be like 2023’s, “we have to be prepared for cases and hospitalizations going up,” he said, “but not to the point of a crisis.” A return to lockdowns and social distancing is unlikely.

Still, older adults and others at higher risk of getting very sick from COVID should consider masking during travel, said Rajendram Rajnarayanan, PhD, MSc, an associate professor at the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro.

Flu Forecasts​

Predicting flu season this early is hard, said Jeffrey Shaman, PhD, a professor of environmental health sciences and professor of climate at Colombia University, New York.

“You can look at the CDC forecast and use it as a very loose guide right now,” said Dr. Shaman, who won the CDC’s first “Predict the Influenza Season Challenge” in 2014. “Until there is actually flu, it’s like trying to predict the landfall of a hurricane.” Flu activity remained low as of September 14 (the most current data available), according to the CDC.

When flu activity picks up, typically in mid-October or November, experts look at the dominant strain, exposure to similar strains in previous years, and how well-matched the current flu vaccine is to that dominant strain, Dr. Shaman said. Vaccine makers must make an educated guess months in advance regarding which strain to target, to allow time for production.
The vaccination rate plays a role, too, but that tends to remain constant, Dr. Shaman said. According to the CDC, less than half of adults age 18 and up got a flu vaccination last year.

Experts also consider flu patterns in the Southern Hemisphere, where 2024 flu activity has mostly involved two subtypes of influenza A — H1N1 and H3N2 — and some influenza B, the CDC found.

How Well Do This Year’s Vaccines and Viruses Match Up?​

The FDA has authorized three updated COVID vaccines for this fall. Novavax targets the JN.1 strain of SARS-CoV-2, the virus that causes COVID-19. Both mRNA vaccines, Moderna and Pfizer, target KP.2, a descendant of JN.1. All three target current predominant variants, and any one of them is recommended by the CDC.

The vaccines are a good “though not perfect match to virtually all the circulating variants of SARS-CoV-2,” said Dr. Pekosz.

Experts said that the shots will protect against the XEC variant.

“XEC and its sublineages are expected to be the dominant fall/winter variant group,” said Dr. Rajnarayanan.

This year’s flu vaccines, all trivalent (protecting against three viruses), will target the three strains expected to circulate — H1N1, H3N2, and influenza B (Victoria), according to the CDC.

People should still get vaccinated, Dr. Adalja said, and use home tests for flu and COVID and take antivirals promptly when needed. The goal should not be status quo but rather fewer COVID and flu hospitalizations and deaths.

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COVID Levels Start to Dip, New Variant Emerges​

October 4, 2024|Infectious Disease

Lisa O’Mary

A new COVID-19 variant called XEC is on the rise, and it has experts who track variants on alert.

Each time a new variant makes a grand entrance onto tracker lists, health officials take notice because it may mean there’s an important change in behavior of SARS-CoV-2, the virus that causes COVID.

Countries reporting rising detections of XEC include Germany, the United Kingdom, and the Netherlands, Australian data scientist Mike Honey posted on the platform X this past week.
XEC’s “characteristic mutations” have been detected in at least 25 states, CBS News reported, with New Jersey, California, and Virginia labs reporting 10 or more cases each. New Jersey detections at least in part stem from the CDC’s testing program for international travelers at Newark Liberty International Airport.

Still, XEC hasn’t gained enough traction in Europe, the United States, or any other part of the world for it to be listed as a standalone variant on official watchlists maintained by the CDC, European Union, or World Health Organization.

However, Eric Topol, MD, executive vice president of Scripps Research and editor-at-large for Medscape, believes XEC is the next variant “to get legs.”

The rate at which a new variant takes the stage doesn’t always predict how severe it will be. Around this time last year, health officials sounded alarms about another Omicron variant called BA.2.86, dubbed Pirola, that ultimately didn’t make major waves.

“CDC is not aware of any specific symptoms associated with XEC or any other co-circulating SARS-CoV-2 lineage,” a CDC spokesperson said in a statement to CBS News.

The current dominant variant in the U.S. is called KP.3.1.1, accounting for an estimated 53% of U.S. COVID cases. Its parent lineages are KP.2 and KP.3, and all of these belong to the Omicron family. The SARS-CoV-2 virus mutates over time, and scientists use the names and labels to identify groups of viral variants based on their similarities and on which strains a mutated descendant came from.

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The people who willingly caught Covid, and lost IQ points

Human test subjects ​

In early 2020, it was assumed that most people who contracted Covid would fully recover in two to three weeks. Months later, we learned that a significant proportion of survivors are plagued by lingering symptoms that we now recognize as long Covid. In 2021, analyses of electronic health record data showed how Covid patients, especially those treated in hospitals, were at higher risk of a constellation of problems — from diabetes and depression to heart attacks and strokes — months later. The research, though, was based on observational data that linked or associated a SARS-CoV-2 infection with subsequent health effects. To test if the coronavirus actually causes a new health problem requires experimentally infecting people and comparing them with uninfected “controls.” After a rigorous review of the ethics, UK researchers did precisely that in early 2021. Their so-called human challenge study was the first — and likely only — research to involve inoculating healthy, young, unvaccinated adult volunteers with the original coronavirus strain. The research yielded unique and important insights into why some people manage to avoid infection and why others can spread it widely. But the latest finding might be the most eye-opening. Each participant, aged 18 to 30 years old, completed 11 tasks on an iPad during two consecutive days before they were all inoculated nasally with the SARS-CoV-2 virus. That exposure led to a mild infection in roughly half of them. While none of the participants noticed any lasting cognitive effects after their inoculation, the results of further testing showed otherwise. Five rounds of cognitive testing after the participants left quarantine found the infected group had measurable reductions in memory and executive function compared with those who weren’t infected. The differences were small, but persistent, with the changes still evident a year after the experiment. The effect size equated roughly to a difference of 6 IQ points, said Adam Hampshire, one of the study’s senior authors. The finding broadly aligned with his earlier research — involving more than 81,000 participants — during the UK’s first pandemic wave in 2020, he added. “I would say that these are small decrements that are comparable in scale to the fluctuations that we see day-by-day in a person’s cognitive abilities,” Hampshire told me. “It is likely a person would not perceive a difference of this scale over the longer term.” Time will tell whether the deficit eventually disappears or whether the volunteers will be left with a slight, but permanent reduction in cognition. The results can’t be extrapolated across the broader population since our immune defenses have been strengthened by vaccinations and previous infections and newer virus variants may carry a lower risk of neurological complications. Still, they corroborate a growing body of evidence showing that the SARS-CoV-2 virus — and its indirect social and economic effects — have taken a toll on people’s minds and bodies. —Jason Gale "

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Long COVID Rates in Kids Revised Upward: What to Know​

Sara Novak

October 02, 2024



Gabrielle Jospa, 15, was diagnosed with long COVID after a serious bout with acute COVID-19 that left her hospitalized in 2021. Since then, the Long Island, New York, teen has had crippling headaches, postural orthostatic tachycardia syndrome (POTS), fatigue, joint pain, anxiety, and problems at school.

But perhaps the worst part for Jospa is that she says she's often treated like she's not telling the truth. Teachers and doctors shrug off her symptoms as those of an overly dramatic teenager.

"Doctors would constantly say that tests showed I was fine, but I wasn 't fine. It just leaves you thinking you 're going crazy," she said.


That's why her recent participation in the National Institutes of Health 's Researching COVID to Enhance Recovery (RECOVER) study has been so validating. Jospa said that for the first time, she's being treated by doctors who listen to her complaints and understand that her symptoms are caused by long COVID.

Teens like Jospa have become an increasing focus of researchers who have also begun to outline how, and how many, kids and adolescents are affected by the disorder and how the symptoms vary within each age group. Their findings are helping detail what doctors, pediatricians, and parents need to know about the long-term impacts of long COVID on kids and teens — an issue some public health experts say has not received enough attention.





Experts contend that pediatricians need to be on the lookout for common long COVID symptoms in kids and teens, like complaints of daytime tiredness and general low energy, muscle or joint pain, stomach pain, new or worsening headaches, and trouble with memory or focusing.

Kids and Long COVID: What the Numbers Show

In the most expansive study of its kind, researchers have for the first time shown serious and prevalent symptoms of long COVID in kids and teens. The August study, published in the Journal of the American Medical Association, is among the first large comprehensive studies of the disorder in this age group. The study, which followed 5367 children, found that 20% of kids (ages 6-11) and 14% of teens met researchers' threshold for long COVID.

Until now, research has been lacking because children were thought to be less susceptible to both acute COVID-19 and long COVID, experts say. But by some estimates, up to 5.8 million kids and teens have the disorder.

Study author Rachel Gross, MD, an associate professor in the departments of pediatrics and population health at NYU Langone, is in line with the percentage of adults diagnosed with long COVID.

The new research found that long COVID affected nearly every organ system in kids and teens. And experts contend that pediatricians need to be on the lookout for gastrointestinal complaints in kids as well as complaints of extreme fatigue and cognitive deficits or perceived changes in mental acuity in teenagers.

By enrolling children who had been infected with acute COVID-19, as well as those who had not, researchers were able to isolate long-COVID symptoms in kids and teens.

"It allowed us to separate symptoms related to long COVID with those that may have resulted from changes in a child's environment during the pandemic," said Gross — for example, learning loss and mental health changes that were caused by the pandemic vs those that were caused by prolonged symptoms associated with long COVID.

Common Long-COVID Symptoms

Symptoms were also different for kids and teens in different age groups. While younger children had a distinct cluster of symptoms that included attention problems, gastrointestinal issues, and sleep issues, teens were more likely to experience a loss of taste and smell as well as brain fog and extreme fatigue.

Small children are less likely to be able to describe cognitive and mental health issues compared with teens, said Grace McComsey, MD, who leads one of the 15 nationwide long-COVID centers funded by the federal RECOVER Initiative, in Cleveland. For the study, parents helped younger children fill out the survey, but they were able to notice things like attention deficits or a lack of focus in their children, she said.

"Age still impacted which long-COVID symptoms patients were more likely to present," said McComsey, even considering the ability to communicate within each age group.


Kids and teens also face higher risks for reinfection because they attend school and are constantly exposed to the virus. This, according to experts, means that their symptoms may worsen before they get better. An August 2023 study published in the International Journal of Molecular Sciences highlighted the increased risk for long COVID after acute COVID reinfection, even in vaccinated individuals.

Long-Term Impacts on Child Development

Researchers are also learning that these impacts are having profound and long-term repercussions on kids and teens who are too sick to engage in the activities that they previously enjoyed.

Postexertional malaise, a worsening of fatigue that occurs after even minimal exertion, often precludes kids from being able to participate in sports or after-school activities. This may take them away from the things that they enjoyed as well as their friend group, said Lael M. Yonker, MD, an associate professor of pediatrics at Harvard Medical School.

"Not only are kids not able to play the sports they once did, a lot of them have had to take weeks, months, or even whole years off from school. Other kids have had to switch to homeschooling," said Yonker. "There's also been an impact on their social engagements because things like playdates present too much exertion and can set them way back."

A study recently published in the journal eClinicalMedicine showed that the symptoms of long COVID in children significantly interfered with their lives, specifically their education and social interactions, which may lead to long-term developmental challenges down the line.

Acknowledging that kids and teens are suffering is one thing, but we're still not doing nearly enough to help them, and the repercussions could be staggering, said study author Danilo Buonsenso, a researcher focused on long COVID in kids at Gemelli University Hospital in Rome. "We're past the point of doing observational research; now it's time to study effective treatments," he said.

For now, Jospa is feeling better due to a mix of new medications like atogepant for her migraines as well as beta-blockers, compression socks to improve blood flow, and regular visits to a psychiatrist.

Her mother, Amy Jospa, deserves much of the credit. She's made her daughter's treatment regimen a full-time job for the past 4 years. It's tiring and time-consuming but, said Amy, at least her daughter is back in school, a junior now, and is settling back into the new school year. Still, she has good days and bad.

"Sometimes it's a vicious cycle. When I get sick, I get anxious; and when I get anxious, I can't seem to feel better," said Jospa.
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COVID-19 human challenge study highlights small changes to memory and cognition​

Published October 4, 2024 | Originally published on MedicalXpress Breaking News-and-Events
A new analysis from Imperial's human challenge study of COVID-19 has revealed subtle differences in the memory and cognition scores of healthy volunteers infected with SARS-CoV-2, which lasted up to a year after infection.
The researchers say all scores fell within expected normal ranges for healthy individuals and no one reported experiencing any lasting cognitive symptoms such as brain fog.
The findings, published in the journal eClinicalMedicine, show a small but measurable difference following highly intensive cognitive testing of 18 healthy young people with infection compared to those who did not become infected, monitored under controlled clinical conditions.
The team explains that incorporating such sensitive cognitive testing into future studies could help reveal more detailed insights into how infections may alter brain function and could help to find ways to reduce these processes when they cause symptoms.
Senior author Professor Adam Hampshire, from the Department of Brain Sciences at Imperial College London and now based at King's College London, explained, "We know that COVID-19 can have lasting impacts on our memory and ability to carry out common cognitive tasks. However, much of the scientific evidence we have comes from large studies based on self-testing and reporting, or where there's a range of variables that could increase or reduce these effects.
"Our work shows that these cognitive effects are replicated even under carefully controlled conditions in healthy individuals—including infection with a comparable dose of virus—and further highlights how respiratory infections can impact specific aspects of brain function.
"We were only able to detect some of these effects because of the trial design, which used very sensitive tests and controlled conditions, with participant performance compared to their own pre-inoculation baselines. This enabled us to pick up on subtle changes of which the participants themselves appear not to have been aware."

COVID-19 and cognition​

Previous studies that included patients with a wide range of severities have shown COVID-19 can have a lasting impact on people's brain function. One such study, led by Imperial and involving more than 140,000 people, found small deficits in the performance of cognitive and memory tasks in people who had recovered from COVID-19, with differences evident a year or more after infection.
In the latest study, researchers analyzed findings from a small group of healthy volunteers who were part of the world's first human challenge study for COVID-19 in 2021. The findings reveal subtle differences in how they performed on the same tests, which lasted up to 12 months although later testing could have been affected by other and later factors.
During the trial, 36 healthy, young participants with no previous immunity to the virus were infected with SARS-CoV-2 and monitored under controlled clinical conditions. They were carefully monitored and remained at the facility until they were no longer infectious. From the group, 18 participants became infected and developed mild illness, one without symptoms.
Participants also performed sets of tasks to measure multiple distinct aspects of their brain function, including memory, planning, language and problem solving, using the Cognitron platform. Participants took the tests before exposure to the virus, during the two weeks they spent in the clinical facility, and then at multiple points for up to a year.
Analysis showed that those who became infected with SARS-CoV-2 had statistically lower cognitive scores than uninfected volunteers—compared to baseline scores—during their infection as well as during the follow-up period. The main differences in scores were seen in memory and executive function tasks (including working memory, attention and problem solving).
Differences in scores between groups were seen up to one year after infection, with the uninfected group performing slightly better on tasks overall.
The researchers note that the observed differences were small and that none of the volunteers reported prolonged cognitive symptoms. They also highlight limitations of the study, including the small sample size and that the majority of participants were white males, and so caution is needed in extrapolating the findings to the general population.
They explain that future research could examine the biological links between respiratory infection and cognition in COVID-19, and even show how this impact compares with other conditions, such as Respiratory syncytial virus (RSV) or influenza.
Co-author Professor Christopher Chiu, from the Department of Infectious Disease at Imperial College London, who led the COVID-19 human challenge study, said, "These latest findings from our study add more fine detail to the picture we have of COVID-19 and other respiratory infectious diseases.
"Challenge studies can offer a tool to help us better understand how infections disrupt a range of biological functions. Here, by showing biological effects that fall below what could be considered symptoms or disease, we were able to identify the smallest changes in these pathways.
"This could ultimately help us to develop new treatments to reduce or even block some of these effects, which we know on other settings can have lasting impacts on people's lives."
This article was originally published on MedicalXpress Breaking News-and-Events.
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[missy]

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Six Tips on Coronavirus Testing for Doctors and Patients​

Michael van den Heuvel

October 04, 2024



In Germany, the activity of acute respiratory diseases is at a higher level than usual for this time of year because of rhinoviruses and SARS-CoV-2, according to the Robert Koch Institute, Germany. If a patient has a fever and cough and feels exhausted, it could be COVID-19. What significance do rapid tests have? And when should doctors advise their patients about them?

When to Test​

People at a higher risk for severe COVID-19 benefit from tests. This population includes the following groups:

• Older patients
• Immunocompromised patients
• Patients with respiratory diseases
• Patients with cardiovascular diseases
• Patients with liver and kidney diseases
• Patients with neurological diseases
• Patients with obesity

If doctors detect SARS-CoV-2 infection early, they can prescribe Paxlovid, for example, to reduce morbidity and mortality risks. Conversely, people without specific risks should test themselves if they plan to visit vulnerable individuals.

Detecting New Variants​

A comprehensive study from the fall of 2022 provides evidence that antigen tests targeting the nucleocapsid (N) protein of SARS-CoV-2 also detect new variants.

The researchers built a library of various versions of the SARS-CoV-2 N protein. Their collection included nearly 8000 individual amino acid substitutions, representing more than 99.5% of all statistically possible mutations of the N protein.





They then examined how these N proteins interacted with 17 antibodies used in 11 commercially available antigen rapid tests.


All antibodies were able to recognize altered N proteins. Since the researchers successfully investigated diagnostic antibodies against nearly all possible N-protein mutations, rapid tests should be able to detect future virus variants. However, sensitivity and specificity may still change.

Test Timing​

Uncertainty about what time of day to test can be mitigated by performing multiple COVID-19 rapid tests over time. The US Food and Drug Administration (FDA) and similar organizations make this recommendation. Studies of symptomatic individuals show that serial tests increase accuracy.

In the early stages of infection, swabs may contain too little virus material because of widespread immunity against SARS-CoV-2. That is, they may contain inadequate levels of the relevant antigen. Especially in asymptomatic individuals or patients in the incubation phase, a single test may therefore yield a false negative result. Therefore, the FDA recommends conducting at least two additional tests 48 hours apart in case of a negative test result.

Costs of Rapid Tests​

The days of free tests are long gone. In Germany, the distribution of free preventive coronavirus tests was discontinued on March 1, 2023.

Test kits are still available in pharmacies or drugstores. In packages with 5-10 tests, the individual test costs between €0.90 and €1.50, depending on the provider. If a patient still has old rapid coronavirus tests in his or her medicine cabinet, are they still suitable?

Expired Tests​

Properly stored tests that have not passed their expiration dates can still be used. But microbiologist and pathologist Dr Daniel Rhoads from the Cleveland Clinic in Ohio warns against expired rapid tests.

The chemicals may have decomposed, the solvent may have evaporated, or antibodies may have lost their effectiveness, thus making false negative results more likely. "These are proteins that can decompose over time," said Rhoads.

Ordering PCR Tests​

The polymerase chain reaction (PCR) test remains the gold standard for diagnosing COVID-19. It is still available within statutory health insurance coverage. As Germany's National Association of Statutory Health Insurance Physicians observes, form Muster 10 is used to order the test in that country.

The fee for the swab is included in the insured patient's basic flat rate. Laboratories bill the PCR test using fee schedule position (GOP) 32816, according to the Uniform Value Scale (EBM).

There is no possibility for billing rapid tests for SARS-CoV-2 in medical practices within the EBM. A laboratory-based SARS-CoV-2 antigen detection test (GOP 32779) can be requested via the Muster 10 form.

This story was translated from the Medscape German edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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[missy]

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COVID-19 linked to type 2 diabetes onset in children​

[COLOR=rgba(32, 37, 41, 0.7)]Published October 18, 2024 | Originally published on MedicalXpress Breaking News-and-Events[/COLOR]
Pediatric patients aged 10 to 19 years old diagnosed with COVID-19 have a higher risk of new-onset type 2 diabetes within six months compared to those diagnosed with other respiratory infections, according to researchers at Case Western Reserve University School of Medicine.

The research is a follow-up of meta-data analysis showing an increased risk of type 2 diabetes in adults. The meta-analysis revealed a 66% higher average risk of new-onset diabetes after SARS-CoV-2 infection in adults. In the current retrospective study, "SARS-CoV-2 Infection and New-Onset Type 2 Diabetes Among Pediatric Patients, 2020 to 2022," published in JAMA Network Open, researchers looked to see if a similar pattern existed in children.

The study analyzed a cohort of 613,602 pediatric patients aged 10 to 19 years. After propensity score matching, this cohort was divided equally into two groups: 306,801 patients diagnosed with COVID-19 and 306,801 patients diagnosed with other respiratory infections (ORI).

A subset of the cohort with obesity and COVID or ORI was also analyzed, with two groupings of 16,469 patients.

The research compared the incidence of new type 2 diabetes diagnoses at one, three, and six months after the initial respiratory infection. The risk ratios (RR) for developing type 2 diabetes after COVID-19 were found to be significantly higher than for those with ORI.

Specifically, the RR was 1.55 (95% CI, 1.28–1.89) at one month, 1.48 (95% CI, 1.24–1.76) at three months, and 1.58 (95% CI, 1.35–1.85) at six months post-infection.

The smaller subgroup analyses revealed even greater elevated risks among children classified as overweight, with RRs of 2.07 at one month, 2.00 at three months, and 2.27 at six months. Hospitalized patients also showed increased risks, with RRs of 3.10 at one month, 2.74 at three months, and 2.62 at six months after COVID-19 diagnosis.

The study concluded that SARS-CoV-2 infection is associated with a higher incidence of type 2 diabetes diagnoses in children than those with other respiratory infections. Further research is necessary to determine whether the diabetes persists or is a recoverable condition that reverses later in life.

While COVID-19 may seem an unintuitive cause of type 2 diabetes, we currently do not understand what initiates the condition. It is often linked to being overweight, being less active, eating processed foods or having a family history of type 2 diabetes, indicating both an environmental and a possible genetic basis.

Insulin resistance is what type 2 diabetes essentially does within the body. Insulin is a hormone made in the pancreas that is essential for removing glucose from the blood by binding it to receptor sites of cells, where the glucose is absorbed and used as energy to power the cell.

Insulin resistance on a physiological level usually means that the cells have down-regulated binding site availability. This resistance can come about if cells have encountered too much insulin. The downregulation of binding sites leaves more unbound glucose in the bloodstream, which the brain interprets as needing the pancreas to produce more insulin. This negative feedback loop often progresses the disease.

The current retrospective analysis can only see past correlations between COVID-19 and the study cohort and cannot identify causation. Future research will be needed to determine if COVID-19 is interfering directly with any of the systems related to glucose sensing and insulin regulation by the brain, insulin production in the pancreas or the binding ability of cells

This article was originally published on MedicalXpress Breaking News-and-Events.

 

[missy]

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Adults 65+: Expect a Covid-19 shot this spring ​

The CDC external advisory committee—called ACIP—met this week to discuss various vaccines. Members unanimously voted to recommend Covid-19 shots for seniors this spring.
They had two main reasons:

1. Waning protection against Covid-19 hospitalization and critical illness for those over 65. Last fall, there was zero additional protection against hospitalization 6 months after vaccination. (Note: This is additional protection compared to all the immunity already out there.)

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Source: CDC

1. 2 shots a year vs. 1. CDC presented data we have been desperately waiting for: Seniors who get two shots per year have ~20% additional protection against hospitalization than those who get one shot per year. Importantly, though, our confidence is low because few people get two shots a year. So, mathematical models show this percentage can range from 0% to 40%. In other words, scientists think two shots are better but don’t know for sure.

Seniors should get their Covid-19 shot this fall. Another one will be available in spring. I think it’s the right policy and will encourage my grandparents to get two a year.

Multistate E. coli outbreak tied to McDonald's Quarter Pounders​

This week, we got another food warning: E. coli in McDonald’s Quarter Pounder hamburgers. The epidemiological investigation is starting to point to slivered onions as the culprit, so McDonald's has stopped selling Quarter Pounders in a number of locations.

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Source: CDC
E. coli is a bacteria that can make people very sick, particularly kids, older adults, pregnant women, and immunocompromised people. This specific E. coli strain is dangerous because it can create a toxin that causes hemolytic uremic syndrome, a serious condition that can cause kidney failure. Antibiotics are not recommended because they can make a person sicker.
Below is an “epi curve”—this shows the number of people getting sick over time. While it looks like this outbreak has peaked, it certainly could continue growing, as it takes 3 to 4 weeks to determine if a sick person is part of an outbreak.

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(Source: CDC) Note: The true number of sick people in this outbreak is likely much higher than the number reported
In news that will shock no one, the timing of this outbreak has led to a viral conspiracy theory: E. coli was planted by public health to tarnish Trump’s campaign stop a visit to a McDonald’s in Pennsylvania over the weekend. This is simply not true, given that illnesses started September 27—far before any campaign stop.
Nonetheless, McDonald’s Inc. stock plummeted on Tuesday after the news of the foodborne illness broke. This highlights the pivotal lesson that good health is, in fact, linked to good business.

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McDonald’s Corp Stock Prices, past month
Does it seem like we’re getting more foodborne illnesses lately? It sure feelslike it from headlines, so some have pointed to a decrease in food regulations under Trump, and others have pointed to more complex supply chains or more sensitive testing. But, the number of multi-state investigations of foodborne illnesses this year is no different than pre-pandemic years. I think the feeling is due to a pandemic silver lining: More people are paying attention to public health-related topics.

Infant mortality rate increased since Dobbs​

A new study compared infant mortality rates for the 18 months following the Dobbs decision against historical trends. Scientists found:

• Infant death rates were higher than usual after the Dobbs decision
• Of the infant deaths, 80% were attributed to birth defects and anomalies.

This means that more women have to carry these gestations and give birth, knowing their child is likely going to die shortly after birth.
This finding is consistent with two other studies that came out earlier this year:

1. In Texas, infant mortality rose almost 13% after the state enacted a total abortion ban—with a 23% increase in deaths due to congenital anomalies.
2. In 2023, nearly a quarter of people seeking an abortion in the United States were unable to get one. A report (not peer-reviewed) found this increased the number of births in states with abortion bans—about 32,000 more births than expected.

Abortion is on the ballot in 10 states. These studies are a good reminder that your vote is linked to yours and others’ health and wellbeing.

Reader question grab bag​

For RSV for infants, I’m wondering if we are seeing any difference between the vaccine during pregnancy vs monoclonal antibodies once born - is one better than the other? And why not do both?
Unfortunately, no head-to-head study has been conducted yet. Given so many people have horror stories about trying to find RSV vaccines and/or monoclonal antibodies, I would get whichever one you can find.
If I’m being totally transparent, I think monoclonal is better: It maintains protective levels for over a year, and the protection is higher than reported for the vaccine (even though we can’t really compare because they were different clinical trials trials). But 98% effectiveness (for monoclonal antibodies) is basically unheard of.
Getting both won’t hurt. In other words, it will not “overwhelm” the baby’s immune system. However, it also won’t provide additional protection, it’s expensive, and supplies are limited. There are a few exceptions:

• If the pregnant woman has to deliver early, she won’t transfer enough antibodies depending on when she got vaccinated.
• If the pregnant woman is immunocompromised, she may not make a lot of antibodies that will transfer to the baby.
• If the infant is high-risk, like born premature with serious congenital heart defects.

Bottom line​

You’re now caught up on public health nuggets for the week! Have a great weekend.
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