Coronavirus updates September 2022

[missy]

Oops, kept adding to the August thread and completely forgot we are in September. My apologies.

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Who isn’t getting a rebound?​

I recently returned from vacation with Covid and, though my symptoms were mild, my doctor prescribed Paxlovid as a precautionary measure. I quickly improved, but not for long. I became one more person stuck at home with a post-Paxlovid Covid rebound. At least I’m in good company. Back in February, VA Boston Healthcare System Chief of Staff Michael Charness experienced a rebound after he took Paxlovid. He explored his illness the way a good physician-scientist does, storing his samples next to the yogurt in the family fridge and getting them analyzed. He even tweeted for the first time in his life to spread the word. His and others’ findings are officially out now in the New England Journal of Medicine, joining a stream of recent research that has been turning what was once a collection of anecdotes into published data. A spokersperson for Pfizer, the maker of Paxlovid, describes rebounds as “uncommon and not uniquely associated with any specific treatment.” The resarchers’ findings, though, suggest a different story: Infectious disease specialists say the rebounds aren’t uncommon, and patients should watch for them. They should also feel reassured that symptoms are almost always mild when a rebound occurs. Because a rebounder can become contagious again, the Centers for Disease and Control and Prevention urges people to re-isolate and mask if symptoms recur and rapid tests turn positive again. Specialists emphasize that though rebounds are an inconvenience, Paxlovid remains the treatment of choice for people at high risk of severe Covid. “For patients with more serious risk for disease progression, Paxlovid can be life-saving,” says Charness. “The potential inconvenience of rebound is a small price to pay.” It’s not usual for a respiratory virus to kick back up after antiviral treatment. In the case of Paxlovid, Columbia University virologist David Ho, who co-authored the New England Journal paper, has been studying the rebounds and found evidence that they stem from a lingering intermediate form of the virus that gets reactivated when the medicine fades. Some specialists speculate that a longer course of the pills may reduce rebound cases, and Pfizer says it's looking into whether some patients need re-treatment -- such as a second five-day course of pills. That’s the tactic soon-to-step-down White House health adviser Anthony Fauci chose when he relapsed. — Carey Goldberg :

 

[missy]

Long COVID Risk Factors May Include Loneliness, Depression, Stress​

— Psychological distress prior to infection linked with higher risk for post-COVID conditions​

by Michael DePeau-Wilson, Enterprise & Investigative Writer, MedPage Today September 7, 2022

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High levels of pre-existing psychological distress prior to a COVID-19 infection were associated with an increased risk for developing long COVID symptoms, according to a prospective cohort study.

Participants who self-reported psychological distress -- including probable depression or anxiety, being very worried about COVID-19, and feeling lonely some of the time or often -- had an increased risk of developing post-COVID conditions:

• Depression: risk ratio (RR) 1.32 (95% CI 1.12-1.55)
• Anxiety: RR 1.42 (95% CI 1.23-1.65)
• Worry about COVID: RR 1.37 (95% CI 1.17-1.61)
• Loneliness: RR 1.32 (95% CI 1.08-1.61)

And those in the highest quartile of perceived stress had a 46% higher risk for post-COVID conditions compared to those in the lowest quartile (RR 1.46, 95% CI 1.18-1.81), reported Siwen Wang, MD, of Harvard T.H. Chan School of Public Health in Boston, and colleagues in JAMA Psychiatry.

"We found that psychological distress is even more strongly associated with long COVID compared to ... established risk factors, including obesity, diabetes, and hypertension," Wang told MedPage Today.

Additionally, the researchers noted that patients who had two or more types of distress prior to infection had a nearly 50% increased risk for long COVID symptoms (RR 1.49, 95% CI 1.23-1.80).

Wang and co-authors emphasized that the results should not be misinterpreted to suggest that long COVID is psychosomatic. For example, 40% of participants who developed long COVID symptoms experienced no distress at baseline, and long COVID symptoms differ substantially from symptoms of mental illness.



Studies have shown that more than half of patients with long COVID report relapses triggered by physical activity, which is considered protective against relapses of mental illnesses, Wang and co-authors said.

At least one previous study on risk factors for long COVID found an association with anxiety disorder, but the new study is one of the first with data from early in the pandemic to focus on the risks of a wider variety of psychological variables, Wang said.

"We understand that mental health conditions [are] so prevalent in the United States, and it has all been linked to those kinds of chronic inflammation, immune dysregulation, which are proposed mechanisms for long COVID," she said. "So we hypothesized that if there is the link, we should probably look at it."

To gather the data, the researchers drew from participants from three ongoing longitudinal studies: the Nurses' Health Study II, the Nurses' Health Study 3, and the Growing Up Today Study.



The analysis included 54,960 participants -- 38% of whom were active healthcare workers -- who completed a questionnaire from April to September 2020 and were followed through November 2021. Mean age was 57.5 years. A positive SARS-CoV-2 test result was reported by 6% during the follow-up period.

While the participants' psychological symptoms and COVID-19 infection were self-reported, Wang said the team is confident in the unique study population for these purposes: "This is predominantly a group of healthcare workers, so self-report should be very accurate, and there are a lot of validation studies in this cohort to validate their self-report on health conditions," she said.

Wang also noted that while the study population aided in some aspects of the analysis, it was also a limitation, in that participants were predominantly white (96.5%) and female (96.6%) and worked in healthcare, so the results might not be generalizable to a wider population.

The findings, however, could help identify new areas of focus for studies into the mechanism of COVID-19 infection and long COVID symptoms, Wang said. "In consideration of how high the prevalence of depression [and] anxiety are in the United States and worldwide, future research might want to look at whether treatment or better management of psychological distress might mitigate symptoms of long COVID or prevent the development of long COVID."

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  Michael DePeau-Wilson is a reporter on MedPage Today’s enterprise & investigative team.
  
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[missy]

Posted the other day in the August thread. I am adding it here where it belongs.

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One shot per year? We really need to step up our game then ​

Katelyn Jetelina Sep 7

Yesterday, the White House announced a new plan: one COVID-19 shot per year. The idea is this will decrease public confusion and increase booster uptake by aligning with the flu vaccine campaign. Reading between the lines, I think this is also a political signal to shift out of the SARS-CoV-2 emergency phase.
Will an annual shot plan work? Maybe. But there’s a lot that needs to align beforehand. And I certainly hope this doesn’t mean we are accepting our current state of affairs with vaccines.

Stars need to align​

The annual COVID-19 plan largely follows our flu model: evaluate circulating strains and update the vaccine before the flu season. This model works for the flu for three main reasons:

1. Flu is clearly seasonal. The predictability of the flu allows us to time vaccine recommendations so that vaccine companies can manufacturer and distribute by winter. A 6-month flu season also means that we really only need our flu to cover the winter months. In other words, the vaccine can wane, particularly among older populations.
2. Flu mutations have direction. As I have written before, the flu mutates in a ladder-like pattern. This allows us to “predict” the direction the flu may be mutating.
3. Flu has been around for decades, which has allowed us to develop and refine global surveillance systems to identify emerging strains.

SARS-CoV-2 is mutating 4 times faster than the flu. It’s not seasonal nor annual. It’s not mutating in a ladder like form. And we do not have global surveillance systems in place. We expect and hope that COVID-19 will eventually be like the flu but to assume that has already happened is premature. I also think it is a gamble, as the virus continues to surprise us. To pivot the public—again—is risky.
The fall bivalent vaccine is also our first attempt to apply the flu model to SARS-CoV-2. This is our pilot. And we really need to see how the pilot works in the “real world” before making sweeping declarations, like an annual shot. We need the data, the time, and the humility to tell. Let’s first get through winter.

Up our vaccine game​

The annual COVID-19 booster plan also means the White House has one goal: prevent severe disease and death. And our first generation vaccines can do this well. In fact, the first generation vaccines saved an estimated 20 million lives across the globe in one year.
However, we can and should do better. This does not mean boosting our way out of the pandemic, but it means leveraging innovation and science to develop next generation vaccines that last longer and/or prevent infection/transmission. This would have immense, positive ripple effects. It would slow transmission. It would slow viral mutations. It would slow morbidity (long COVID-19). It could sunset the pandemic.
Next generation vaccines include:

• Mucosal vaccines. Nasal and/or oral vaccines would provide more protection against infection and transmission (i.e., sterilizing immunity). Thirteen nasal vaccines are currently in development. These work very differently from our current vaccines, as they target “mucosal” immunity. Mucosal tissue is all over our body, including our nose and throats. In fact, it’s the largest component of our immune system and is one of the first defenses with the elements in the real world. By providing immunity there (instead of deep within our circulatory system) we can prevent infection in the first place. Clinical trial data is incredibly promising, especially when used as a booster (opposed to the primary series). This week, China approved the world’s first inhaled booster against COVID-19 called Convidecia Air.
• Pancoronavirus vaccines. The next best thing to sterilizing immunity would be a variant-proof vaccine that lasts longer. As I’ve written before, there are several in development, but the one winning the race is from the Walter Reed Army Institute of Research using “nanoparticle vaccine technology.” The vaccine presents a protein that looks like a soccer ball with many different faces. Each face presents instructions for a different part or version of a virus. We can include faces on it not just for SARS-CoV-2, but for other coronaviruses, too.
• Flu and COVID-19 combo vaccines. At the very least we need one vaccine that contains both the flu and COVID-19 vaccine formula. Earlier this year, Novavax released data on the Phase 1/2 clinical trial of its COVID-Influenza Combination Vaccine. Animal data showed this vaccine worked well, and currently 642 people aged 50-70 years old are in the Phase 1/2 clinical trial. If all goes well, a combo vaccine may be available by 2023 flu season. We need more options in case this one doesn’t make it through clinical trials.

These next generation vaccines are obtainable. We are well on our way, but this cannot be accomplished without investment from Congress. It costs an estimated $1 billion to develop and test a drug or vaccine from start to finish. And it takes risk, as not every vaccine makes it through clinical trials. Money will move mountains in science and research. But we need a push from the public, and a push from the administration. We need an Operation Warp Speed 2.0.

Bottom line​

The White House plans to have only one booster per year. This plan may (or may not) be a good one, as the stars would need to align for it to be effective. Regardless, next generation vaccines need to be a part of this conversation, as they are a critical solution for better health. We just need to fight for it.


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[missy]

"

He Stood His Ground': California State Senator Will Leave Office as Champion of Tough Vaccine Laws​

Angela Hart
September 06, 2022

SACRAMENTO, Calif. — A California lawmaker who rose to national prominence by muscling through some of the country's strongest vaccination laws is leaving the state legislature later this year after a momentous tenure that made him a top target of the boisterous and burgeoning movement against vaccination mandates.
State Sen. Richard Pan, a bespectacled and unassuming pediatrician who continued treating low-income children during his 12 years in the state Senate and Assembly, has been physically assaulted and verbally attacked for working to tighten childhood vaccine requirements — even as Time magazine hailed him as a "hero." Threats against him intensified in 2019, becoming so violent that he needed a restraining order and personal security detail.
"It got really vicious, and the tenor of these protests inside the Capitol building didn't make you feel safe, yet he stood his ground," said Karen Smith, director of the California Department of Public Health from 2015 to 2019. "Dr. Pan is unusual because he has the knowledge and belief in science, but also the conviction to act on it."
"That takes courage," she added. "He's had a tremendous impact in California, and there's going to be a hole in the legislature when he's gone."

The Democrat from Sacramento is leaving the Capitol because of legislative term limits that restrict state lawmakers to 12 years of service. He has overseen state budget decisions on health care and since 2018 has chaired the Senate Health Committee, a powerful position that has allowed him to shape health care coverage for millions of Californians.




Pan, 56, helped lead the charge to restore vision, dental, and other benefits to California's Medicaid program, called Medi-Cal, after they were slashed during the Great Recession. Since then, he has pushed to expand social services to some of the most vulnerable enrollees.
He was instrumental in implementing the Affordable Care Act in California, and when Republicans attacked the law after Donald Trump was elected president, Pan spearheaded measures to cement its provisions in state law. After the Republican-controlled Congress axed the federal coverage mandate in 2017, he led the effort to create the state penalty for not having health insurance. And he negotiated with the governor to expand health insurance subsidies for low- and middle-income Californians.
In 2020, Pan authored legislation that will put California in the generic drug-making business, starting with insulin.

"What drives me is my commitment to health and healthy communities," Pan told KHN.

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• But he hasn't always succeeded. Some of his bills — including those to expand benefits and improve the quality of care for Medi-Cal enrollees — were stalled by the influential health insurance industry or opposition from his own party. And this year, Pan retreated on his contentious proposal to require schoolchildren to get vaccinated against covid-19.
  Pan has also faced criticism that he's too closely aligned with the health care industry, including the California Medical Association, or CMA, a deep-pocketed group that lobbies in Sacramento on behalf of doctors. On contentious policy fights, such as those dealing with provider pay or physician authority, Pan has often sided with his fellow doctors.
  For instance, he rallied with the doctor association against a long-sought attempt to give nurse practitioners the ability to practice without physician supervision — a bill that was one of the association's top legislative targets but one that ultimately passed despite its vehement opposition. And two key bills that sought to rein in health care costs died in his committee after clearing the state Assembly — one in 2019 to limit surprise medical bills for emergency room visits and another this year to give the state attorney general authority over some hospital and health system mergers.
  
  "He's inseparable from the doctors' lobby, and obviously he carries water for the CMA," said Jamie Court, president of the advocacy group Consumer Watchdog, arguing that Pan has stood in the way of progressive health care bills such as a proposal to create a government-run, single-payer health care system.
  
  Pan rejected claims that he's too close to the industry. "I'm proud to be a member of the CMA, but I don't just blindly follow CMA," he said. When it came to the nurse practitioner legislation, he said, his concerns "came from my knowledge about professional medical education and how that influences patient outcomes."
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  Pan isn't running for anything this year but isn't ruling out the possibility of doing so in the future. For now, he said, he's focusing on his work in Sacramento until his term ends Nov. 30. After that, he plans to practice medicine full time.
  
  Pan said the public hasn't heard the last of him when it comes to improving Medi-Cal. The state must do more to ensure high-quality care and equitable access for the 14.5 million Californians enrolled in the low-income health program, he said.
  
  Pan said he entered politics to improve community health. He left his job as a faculty member and head of the pediatric residency program at the University of California-Davis to run for state Assembly in 2010. He served two terms before being elected to the state Senate in 2014.
  
  Early on, he found himself at the forefront of California's wars over vaccination mandates.
  
  In 2012, he authored a law making it more difficult for parents to obtain personal belief exemptions for vaccines that are required for children entering public and private schools and that prevent communicable diseases such as measles and polio. In 2015, he succeeded in banning personal belief exemptions for schoolchildren altogether.
  
  In 2019, when lawmakers were voting on Pan's bill that cracked down on bogus medical exemptions for required school immunizations, a protester hurled menstrual blood at them on the Senate floor. Pan also clashed with Gov. Gavin Newsom, who watered down the bill by demanding amendments that allowed doctors to retain significant authority over the exemptions. Newsom ultimately signed the measure.
  
  "I didn't run for the legislature because I was planning to do vaccine legislation, but I care about children and that's what I've devoted my life to," said Pan, who got his medical degree from the University of Pittsburgh and a master's degree in public health from Harvard University. "We had a whooping cough outbreak, and 10 infants died. And I was very concerned about the fact that we could prevent these diseases, yet we were failing."
  
  
  This year, Pan introduced legislation to require covid vaccinations for school-age kids but pulled it in April, saying it would be difficult for California officials to enforce. At the time, the covid vaccination rate for schoolchildren "was too low — around 30%," Pan said. He concluded the state should redouble its efforts to increase vaccination rates before instituting a mandate.
  
  
  Pan also noted that covid-19 was mutating fast and that emerging research indicated that the vaccines weren't very good at combating new variants. "The vaccine is very effective protecting against death, but its ability to slow down transmission seemed to decrease," Pan said. "Unfortunately, it has also been so politicized, so we have more work to do."
  
  
  As chair of California's Asian & Pacific Islander Legislative Caucus, Pan in 2021 helped secure a $157 million investment to combat violence and hate crimes against Asian Americans and was a powerful force advocating for more money for the state's beleaguered public health system — a fight Democrats finally won last year when Newsom approved $300 million in ongoing funding.
  
  
  State Sen. Scott Wiener (D-San Francisco) said that Pan inspired his interest in introducing tough vaccination and public health bills and that he regularly asks Pan's advice before unveiling legislative proposals. "I'd randomly call him all the time," Wiener said. "There's really no one in the Senate with the experience and knowledge he has."
  
  
  Brainy and studious, Pan regularly delves deep into scientific evidence during legislative floor debates. Interviews with reporters often result in lengthy discourses about the history of the U.S. health care system — like the time a question about hospital financing led to a lesson in how hospitals are both profit-earning enterprises and institutions that provide charity care.
  
  
  
  
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[AprilBaby]

Well after being Covid free for 2.5 years I got Covid last night from my 1 yr old grandson. The headache is terrrible, my head is stuffed and I can’t breathe, I have a low grade fever and chills, puking and the other end too. All my joints hurt and I can’t sleep.

 

[missy]

Well after being Covid free for 2.5 years I got Covid last night from my 1 yr old grandson. The headache is terrrible, my head is stuffed and I can’t breathe, I have a low grade fever and chills, puking and the other end too. All my joints hurt and I can’t sleep.

Sending you bucketloads of healing vibes. May you make a speedy and full recovery.
How is your grandson doing?

 

[missy]

"

There’s a new way to get your Covid booster​

The mere idea of vaccination conjures up image of a needle pushing into someone’s arm, a sickening vision for some. But China and India just approved a simpler way to get a Covid booster -- one that you can just breathe in. The products are a first, and were developed by local manufacturers. China’s CanSino Biologics Inc. says it’s hoping to expand beyond its home market soon. Here’s how the Chinese vaccine works: a machine that looks a little like an espresso maker turns the vaccine liquid into a pale odorless cloud that’s funneled into a plastic sipping cup. The patient is asked to exhale thoroughly, inhale the mist from the cup through their mouth and hold their breath for at least five seconds. The other one consists of nasal drops. India’s Bharat Biotech International says it pursued the approach despite a lack of demand for Covid vaccines at the moment because it “promises to become an important tool in mass vaccinations during pandemics.” The idea isn’t just to spare the squeamish another injection. The nose and mouth are where the virus first enters the body, so the antibodies elicited by the vaccine go right where they’re most needed, giving patients a better immediate defense when they encounter the virus -- and maybe even reducing the risk of contagion. “The prospect that mucosal vaccines bring is not only an opportunity to reduce the severity of infection but also to reduce onward transmission,” says Michael Ryan, the World Health Organization’s executive director for health emergencies. That’s the logic at least, and CanSino and Bharat aren’t the only drugmakers to buy in. California’s Meissa Vaccines Inc. and the University of Oxford, which developed one of the first pandemic shots with AstraZeneca Plc, are also pushing ahead with nasal sprays. The CanSino inhaled vaccine roused higher levels of protective antibodies against the original Covid strain and omicron than another local shot made by Sinovac Biotech Ltd in clinical trials. But there is no evidence on how well it can prevent infections in the real world. So sit tight for more data, especially from China, where a new tool to blunt transmission could be a real shot in the arm. — Dong Lyu :

 

[missy]

"

Unvaccinated Over 10 Times More Likely to be Hospitalized During Omicron​

— But hospitalizations among the vaccinated are on the rise​

by Ingrid Hein, Staff Writer, MedPage Today September 8, 2022



Unvaccinated adults were over 10 times more likely to be hospitalized for COVID-19 during the Omicron wave compared with those who were vaccinated and boosted, a U.S. population-based cross-sectional study showed.
Among nearly 200,000 hospitalizations recorded in the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), monthly hospitalization rates from January 2021 through April 2022 were 3.5 to 17.7 times higher in unvaccinated people versus those who were vaccinated, irrespective of booster dose status, reported Fiona Havers, MD, MHS, of the CDC, and colleagues.

Compared with individuals who were both vaccinated and had received a booster dose during the January to April Omicron wave, hospitalization rates were 10.5 times higher in those who were unvaccinated and 2.5 times higher in those who were fully vaccinated but had not received a booster, they noted in JAMA Internal Medicine.
"The study results suggest that clinicians and public health practitioners should continue to promote vaccination with all recommended doses for eligible persons," Havers and colleagues concluded.
Not surprisingly, vaccinated hospitalized patients were older than those who were unvaccinated (median age 70 vs 5, more likely to have three or more comorbidities (77.8% vs 51.6%), and had a higher likelihood of being immunosuppressed (23.3% vs 10.8%; all P<0.001).
"Persons with underlying conditions are more likely to be vaccinated, and those who were hospitalized despite vaccination may be more vulnerable to severe infection at baseline than those who are unvaccinated," the authors noted.

Although vaccination normally attenuates severe disease, "the current study found that conditional on being hospitalized, vaccinated persons were still at a high risk of severe outcomes," they added.
When looking at vaccinated hospitalized cases per month, there was a steep upward trend month-over-month, with an increase from two (<0.1%) cases documented in January 2021 to 2,239 (67%) in April 2022, with 75% of cases being 65 and older in that month.
The proportion of vaccinated people in the COVID-NET catchment area increased from 0.9% to 79.3% during this time period, reaching 89.7% in those ages 65 and older.
This is predictive of what's to come, Havers and team noted. "The proportion of hospitalized cases who are vaccinated, including those who are boosted, is expected to increase as population vaccination coverage and receipt of booster doses increases."
The increase in hospitalizations despite vaccination and boosters was also noted in recent CDC data that showed a hospitalization rate of 44.1% in patients ages 65 and older during the Omicron BA.2 wave (March-May), despite high vaccination rates. Still, the report noted that hospitalization rates among unvaccinated adults were approximately triple those of vaccinated adults.

"The high proportion of hospitalized patients who were vaccinated suggests not only a need for all people to stay up to date with vaccination, including additional booster doses for eligible persons, but also for increased use of early outpatient antiviral treatment for patients at high risk of severe COVID-19 regardless of vaccination status and the use of pre-exposure prophylaxis, such as tixagevimab-cilgavimab [Evusheld], in patients with an immunocompromising condition that may result in an inadequate immune response to COVID-19 vaccination," the authors wrote.
For this study, Havers and colleagues used data from 250 hospitals in the population-based COVID-NET, including 192,509 laboratory-confirmed COVID-19-associated hospitalized cases. Of these cases, 146,937 (76%) had vaccination data available: 98,243 (69.2%) were unvaccinated, 39,353 (24.5%) received primary vaccination, and 8,796 (22%) had also received a booster.
Among 11,127 patients whose reason for hospitalization was likely associated with COVID-19, median age was 61, 48.3% were women, 51.4% were white, 24.9% were Black, and 12.6% were Hispanic.
Havers and colleagues noted that though COVID-NET covers about 10% of the U.S. population, their findings may not be generalizable to the whole country. Furthermore, some COVID-related hospitalizations may have been missed.

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[missy]

"

Infectious Disease>Long COVID

Inflammation a Culprit in Long COVID Heart Problems​

— Prospective study illuminates mechanisms of lingering heart issues after mild COVID-19​

by Crystal Phend, Contributing Editor, MedPage Today September 8, 2022

While long COVID holds many mysteries, researchers found clues to the heart symptoms common in these patients, which pointed to ongoing inflammation as the mediator.
In a cohort of 346 previously healthy patients with initially mild COVID-19, most seen for lingering symptoms a median of around 4 months later, structural heart disease and elevated biomarkers for cardiac injury or dysfunction were rare.
But there were plenty of signs of subclinical heart issues, reported Valentina O. Puntmann, MD, PhD, of University Hospital Frankfurt in Germany, and colleagues in Nature Medicine.

Compared with uninfected controls, the COVID patients had significantly higher diastolic blood pressure and more non-ischemic myocardial scar by late gadolinium enhancement, detectable pericardial effusion with no hemodynamic relevance, and pericardial enhancement by gadolinium contrast uptake in the pericardial layers (all P<0.001).
In addition, the 73% of COVID patients studied who had cardiac symptoms had higher mapping values denoting diffuse myocardial inflammation and more pericardial contrast agent accumulation on cardiac MR (CMR) imaging than asymptomatic individuals.
"What we see is relatively mild," Puntmann told MedPage Today. "These are patients that were previously normal."
The findings provided a window into a different group than often considered for cardiac problems from COVID-19, as patients with pre-existing heart problems were more likely to land in the hospital and to have severe disease and sequelae from that.
Puntmann's group has been studying people without prior heart issues to try to home in on the impact of COVID-19 itself, using research-level CMR imaging on patients recruited to their clinic via promotional materials disseminated through family practitioners, health authority centers, patient online groups, and websites.

While it's a select patient group that might not be representative of mild COVID-19 cases overall, these patients who seek out answers for their symptoms aren't that uncommon either, Puntmann noted.
Federal survey data suggest that 19% of U.S. adults who had COVID have had symptoms that lasted 3 or more months after infection. In the current study, follow-up scans at a median of around 11 months after COVID-19 diagnosis showed ongoing cardiac symptoms in 57% of the participants. Those persistently symptomatic patients had more pronounced diffuse myocardial edema than those who recovered or never had symptoms (native T2 37.9 vs 37.4 and 37.5 ms, P=0.04).
"Cardiac involvement is an important part of the long COVID presentation -- so the shortness in breath, the effort intolerance, tachycardia," Puntmann said in an interview.
Her group concluded that the cardiac symptoms they saw "were related to subclinical inflammatory cardiac involvement, which may, at least in part, explain the pathophysiological background of persistent cardiac symptoms. Notably, profound myocardial injury or structural heart disease is not prerequisite for the presence of symptoms defying the classical definitions of viral myocarditis."

One important clinical implication was pointed out by cardiologist and long COVID patient Alice A. Perlowski, MD, who tweeted: "This study illustrates how traditional biomarkers (in this case CRP, troponin, NT-proBNP) are likely NOT telling the whole story in #LongCovid. I hope all clinicians seeing these patients in their practices can take this key point away."
Among the 346 adults with COVID-19 (mean age 43.3, 52% women) assessed at a single center from April 2020 to October 2021 a median of 109 days after infection, the most common cardiac symptoms were exertional dyspnea (62%), palpitations (28%), atypical chest pain (27%), and syncope (3%).
"It is a problem understanding what is going on with a routine cardiac investigation, because it is very difficult to capture that is very abnormal," Puntmann said. "This is partially because of the pathophysiology behind it. ... Even if their function is impaired, it is not going to be so dramatic because they compensate for this through tachycardia and also very excited heart function. So we don't yet see them in the stage of decompensation."

The group plans to continue following these patients longer term to see what the potential clinical consequences might be, with concern as noted on the center's website that it "may herald a considerable burden of heart failure in a few years from now." The group is also initiating the placebo-controlled MYOFLAME-19 trial to test anti-inflammatory and renin-angiotensin system-targeted medications for this population.
Their study included only patients without previously known cardiac conditions, comorbidities, or abnormal lung function tests at the baseline assessment and who had not been hospitalized for acute COVID-19 at any point.
Another 95 of the clinics' patients with no prior COVID-19 and no known heart disease or comorbidities were used as a control group. While the researchers acknowledged that there may have been unrecognized differences compared with the COVID patients, they noted the similar distribution for age, sex, and cardiovascular risk factors.
Of the COVID patients with symptoms, these were mild or moderate for most (38% and 33%, respectively), and only nine (3%) had severe symptoms that limited the activities of daily life.

Factors that independently predicted cardiac symptoms that persisted from the baseline scan to the repeat scan at least 4 months later (median 329 days post diagnosis) were female gender and diffuse myocardial involvement on baseline imaging.
"Notably, as our study focused on a selected population of individuals with prior COVID illness, it does not inform on the prevalence of cardiac symptoms after COVID," Puntmann's group wrote. "However, it provides important insights into their spectrum and subsequent evolution."

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[missy]

"

The latest​

The pandemic has killed more than 6.5 million people worldwide, leaving more than 10.5 million children without one or both parents, or primary caretakers. "Children in countries with lower vaccination rates and higher fertility rates were more likely to be affected," my colleague, Ariana Eunjung Cha, reports. Southeast Asia and Africa were hardest hit — one out of every 50 children lost a parent or caretaker. Only two countries, Peru and the United States, have committed to addressing “covid-associated orphanhood.” The researchers urged a more robust response for these children in the form of economic, educational and mental health support.

The coronavirus vaccine could become an annual shot much like the seasonal flu vaccine, my colleague, Lena H. Sun, reports. On Tuesday, the White House covid-19 response coordinator, Ashish Jha, said that moving to an annual coronavirus shot should provide a "high degree of protection against serious illness all year." Unlike the current booster shots, which were recommended for high-risk Americans every few months, an annual schedule would minimize the frequency of administration. Whether such a plan would provide long-lasting protection remains an open question, however.

Some experts, meanwhile, question the efficacy of the newly reformulated micron-targeted vaccines, authorized for use earlier this month and available around the country this week. But Anthony S. Fauci, chief medical adviser to President Biden, said that if the current subvariant of omicron, BA.5, remains the dominant strain, or even if it undergoes minor changes, the new booster “will very like hold a substantial degree of protection.”

Sun also cites a Centers for Disease Control projections estimate that "100,000 hospitalizations and 9,000 deaths could be prevented" if the public embraces coronavirus boosters at similar rates as flu vaccines – possibly an optimistic projection given that more than half of Americans eligible for previous boosters have yet to receive one.

Other important news​

Chengdu, China has extended its coronavirus lockdown. To reach “zero covid,” the province, which has a population of 21 million, has been on a strict covid lockdown since April.

Experts don’t expect the coronavirus to surge this season as it has in previous years. One wild card that could change these predictions is a new variant, but officials hope the new omicron boosters will minimize a potential outbreak.

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[missy]

"

Health System Warns Exemptions to COVID Vaccines May Expire With New Options​

— Holdouts who used religious exemptions to avoid vaccination can get Novavax now​

by Sophie Putka, Enterprise & Investigative Writer, MedPage Today September 9, 2022



The Froedtert Health network in Wisconsin has sent a clear message to employees claiming religious exemptions from COVID-19 vaccination: with an alternative to mRNA vaccines now available, get vaccinated or resign.
In an email to a Froedtert staff member obtained by WTMJ-TV, the health network's COVID-19 Vaccine Religious Exemption Review Committee wrote, "Your original exemption submission and additional documentation you provided do not meet the criteria of explaining your sincerely held religious belief that conflicts with receiving the COVID-19 vaccine, including the new Novavax vaccine."

The religious exemption will not be upheld, despite additional comments provided that "related to opinions or non-factual information," the committee added. If the staff member does not get a first dose by September 21, they will be "considered voluntarily resigned."
The move by Froedtert, which is affiliated with the Medical College of Wisconsin in Milwaukee, signals a blow to vaccine holdouts in the workplace, including healthcare providers, who have argued their religion prevents them from getting vaccinated.
While the Pfizer and Moderna vaccines are mRNA-based, Novavax is protein-based. Those who requested religious exemptions to their work or school policies have often cited the use of fetal material in mRNA vaccines or in their development, though neither Novavax nor the Pfizer and Moderna vaccines contain fetal tissue or DNA. However, it has been reported that laboratory-replicated fetal cell lines, some originating from abortions decades ago, have been used in the testing of mRNA vaccines.

Dorit Reiss, PhD, a professor at the University of California Hastings College of the Law in San Francisco, who has researched religious exemptions from vaccines, told MedPage Today it was only a matter of time before some employers, including hospitals, started to enforce vaccination policies after Novavax was authorized for use in August.
"I've said publicly before that I think Novavax does change the situation in relation to arguments about cell lines," she said. "This is the first I've heard of an employer actually moving on it."
An emailed statement from Froedtert to MedPage Today said, in part, "This protein-based vaccination option eliminates conflicts for those staff with religious or medical exemptions caused by mRNA-based vaccines and other concerns. Since those staff are now eligible for a vaccination that does not conflict with their religious beliefs or medical situation, their exemption will expire."
The health network said that the rule will affect less than 1% of their staff, and that "impacted employees" were given a chance to apply for another exemption before previous ones expired, noting they will uphold "valid medical exemptions and sincerely held religious exemptions."

Reiss said of the many claims to back up religious exemptions she's come across, the fetal cell line argument was perhaps the most common, partially because it might curry favor from pro-life judges. "If they can piggyback on the abortion debate, they're more likely to win" in a dispute, she said. But other reasons, like the claim that some religions require blood to be free of contamination, have also been used.
Some vocal opponents of vaccine requirements may have anticipated the post-Novavax repercussions, and urged their followers to use other reasons to back up their religious objections, Reiss said.
For example, Cait Corrigan, a Boston University theology student behind a group called Students Against Mandates, posted an online outline to the group's website with tips for "successful" religious exemption letters, writing, "Note you can write about aborted fetal tissue ... but this is not enough! (You must talk about the issue of Blood in the vaccines, being made in the Image of God, etc.)" (MedPage Today could not confirm whether Corrigan is still a student at Boston University.)

But neither these types of arguments nor religious beliefs are likely to hold up in most courts, according to Reiss and other experts. "The standard for vaccine mandates in the workplace is, you can refuse an exemption if it's an undue burden, like the burden of not having vaccinated employees at a hospital," she said.
And though objections to vaccination itself may be sincere, "for most of them, I think it's about safety concerns, many of them created by misinformation," Reiss noted. "For most of them, the religion is a cover for that concern."

Sophie Putka is an enterprise and investigative writer for MedPage Today. Her work has appeared in the Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire, and more

"

 

[missy]

Could Covid exposure boost my immune system?​

My husband had Covid at the end of April. I was clearly exposed for a number of days before he tested positive. I never developed symptoms or tested positive myself. Would this exposure ramp up my immune system in a way similar to a booster shot? Barbara, Boulder, Colorado Who gets sick and who doesn’t when exposed to Covid is a perpetual source of fascination. I know this personally. Just a few months ago I traveled with a friend, spending days together in close contact. Turns out my friend had Covid the whole time. But I stayed virus free, leading me to believe I was special. I was among the so-called super immune. Of course, a few weeks later, my grandiose self-image was shattered when I tested positive for Covid. I asked Katrine Wallace, an epidemiologist at the University of Illinois at Chicago, whether the virus alone might give the immune system any benefit at all. “Probably not,” she says. Her explanation: “When a person is exposed to enough virus to develop an infection, the immune system starts to build its response. It's that immune response that gives the ‘boost’ or additional immunity.” Since Barbara never tested positive—she shared that she took two rapid tests and one PCR test—that’s a good indication that her immune system was never challenged during her time of exposure. Even a virus like Covid, which is highly contagious, can miss repeated opportunities to infiltrate our bodies. At a certain point, it comes down to randomness and chance. “It's a good question, though,” says Wallace. “For some viruses, where there is better mucosal immunity in the nose (via past infection or vaccines), people can fight off pathogens and develop an immune response without ever feeling ‘sick.’” In other words, for certain infections, your immune system might get revved up by recognizing a virus, and then swiftly fight it off. “However, Covid-19 is not a virus that we have developed lasting mucosal immunity for, either through vaccines or via previous infections,” says Wallace. This is the whole rationale for the development of the new Covid shots that are inhaled instead of injected, she says. The nose and mouth are where Covid first enters the body, so the vaccine antibodies elicited by those types of vaccines give people a more immediate line of defense. — Kristen V. Brown

 

[missy]

Can I combine my booster and flu shots?​

How long is it recommended to wait between getting the 2022 flu shot and the updated Covid booster that just became available? Can I get them together? I’ve been hearing different answers from different sources. Susan, East Hampton, New York Last weekend I was at my local Brooklyn pharmacy awaiting my booster shot. I overheard three people in a row ask the pharmacist this very question. We’re all more aware of the role vaccines play in stopping the spread of disease and how they protect not just ourselves, but the most vulnerable members of our society. However, getting vaccinated takes time out of our busy lives. So why not double up? For an answer on whether that’s safe, I turned to Monica Gandhi, an infectious disease expert at the University of California at San Francisco. In short, it’s probably fine, though she couldn’t be 100% sure there are no drawbacks. “We don’t have data on the simultaneous administration of the influenza vaccine and the new Covid-19 boosters,” Gandhi says. But, she says, one UK study looked at administering older versions of Covid vaccines and the seasonal flu shot at once. Researchers sought to determine whether doubling up would to any adverse effects and if it would impact antibody responses. The study included both the AstraZeneca shot and the old formulation of the Pfizer mRNA vaccine. There wasn’t an increase in adverse effects in the cases they looked at, and no obvious impact on how effective the shots were, Gandhi says. (She notes, however, that the study didn’t measure all the ways efficacy could have been impacted.) “This UK study does give us some reassurance that, if easier for you logistically, you can go ahead and get the flu shot and the new Covid-19 booster at the same time,” she says. — Kristen V. Brown

 

[missy]

Unvaccinated Over 10 Times More Likely to Be Hospitalized During Omicron​

— But hospitalizations among the vaccinated are on the rise​

by Ingrid Hein, Staff Writer, MedPage Today



Unvaccinated adults were over 10 times more likely to be hospitalized for COVID-19 during the Omicron wave compared with those who were vaccinated and boosted, a U.S. population-based cross-sectional study showed.
Among nearly 200,000 hospitalizations recorded in the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), monthly hospitalization rates from January 2021 through April 2022 were 3.5 to 17.7 times higher in unvaccinated people versus those who were vaccinated, irrespective of booster dose status, reported Fiona Havers, MD, MHS, of the CDC, and colleagues.

Compared with individuals who were both vaccinated and had received a booster dose during the January to April Omicron wave, hospitalization rates were 10.5 times higher in those who were unvaccinated and 2.5 times higher in those who were fully vaccinated but had not received a booster, they noted in JAMA Internal Medicine.
"The study results suggest that clinicians and public health practitioners should continue to promote vaccination with all recommended doses for eligible persons," Havers and colleagues concluded.
Not surprisingly, vaccinated hospitalized patients were older than those who were unvaccinated (median age 70 vs 5, more likely to have three or more comorbidities (77.8% vs 51.6%), and had a higher likelihood of being immunosuppressed (23.3% vs 10.8%; all P<0.001).
"Persons with underlying conditions are more likely to be vaccinated, and those who were hospitalized despite vaccination may be more vulnerable to severe infection at baseline than those who are unvaccinated," the authors noted.

Although vaccination normally attenuates severe disease, "the current study found that conditional on being hospitalized, vaccinated persons were still at a high risk of severe outcomes," they added.
When looking at vaccinated hospitalized cases per month, there was a steep upward trend month-over-month, with an increase from two (<0.1%) cases documented in January 2021 to 2,239 (67%) in April 2022, with 75% of cases being 65 and older in that month.
The proportion of vaccinated people in the COVID-NET catchment area increased from 0.9% to 79.3% during this time period, reaching 89.7% in those ages 65 and older.
This is predictive of what's to come, Havers and team noted. "The proportion of hospitalized cases who are vaccinated, including those who are boosted, is expected to increase as population vaccination coverage and receipt of booster doses increases."
The increase in hospitalizations despite vaccination and boosters was also noted in recent CDC data that showed a hospitalization rate of 44.1% in patients ages 65 and older during the Omicron BA.2 wave (March-May), despite high vaccination rates. Still, the report noted that hospitalization rates among unvaccinated adults were approximately triple those of vaccinated adults.

"The high proportion of hospitalized patients who were vaccinated suggests not only a need for all people to stay up to date with vaccination, including additional booster doses for eligible persons, but also for increased use of early outpatient antiviral treatment for patients at high risk of severe COVID-19 regardless of vaccination status and the use of pre-exposure prophylaxis, such as tixagevimab-cilgavimab [Evusheld], in patients with an immunocompromising condition that may result in an inadequate immune response to COVID-19 vaccination," the authors wrote.
For this study, Havers and colleagues used data from 250 hospitals in the population-based COVID-NET, including 192,509 laboratory-confirmed COVID-19-associated hospitalized cases. Of these cases, 146,937 (76%) had vaccination data available: 98,243 (69.2%) were unvaccinated, 39,353 (24.5%) received primary vaccination, and 8,796 (22%) had also received a booster.
Among 11,127 patients whose reason for hospitalization was likely associated with COVID-19, median age was 61, 48.3% were women, 51.4% were white, 24.9% were Black, and 12.6% were Hispanic.
Havers and colleagues noted that though COVID-NET covers about 10% of the U.S. population, their findings may not be generalizable to the whole country. Furthermore, some COVID-related hospitalizations may have been missed.

• 
  
  Ingrid Hein is a staff writer for MedPage Today covering infectious disease. She has been a medical reporter for more than a decade

 

[missy]

Health System Warns Exemptions to COVID Vaccines May Expire With New Options​

— Holdouts who used religious exemptions to avoid vaccination can get Novavax now​

by Sophie Putka, Enterprise & Investigative Writer, MedPage Today

The Froedtert Health network in Wisconsin has sent a clear message to employees claiming religious exemptions from COVID-19 vaccination: with an alternative to mRNA vaccines now available, get vaccinated or resign.
In an email to a Froedtert staff member obtained by WTMJ-TV, the health network's COVID-19 Vaccine Religious Exemption Review Committee wrote, "Your original exemption submission and additional documentation you provided do not meet the criteria of explaining your sincerely held religious belief that conflicts with receiving the COVID-19 vaccine, including the new Novavax vaccine."

The religious exemption will not be upheld, despite additional comments provided that "related to opinions or non-factual information," the committee added. If the staff member does not get a first dose by September 21, they will be "considered voluntarily resigned."
The move by Froedtert, which is affiliated with the Medical College of Wisconsin in Milwaukee, signals a blow to vaccine holdouts in the workplace, including healthcare providers, who have argued their religion prevents them from getting vaccinated.
While the Pfizer and Moderna vaccines are mRNA-based, Novavax is protein-based. Those who requested religious exemptions to their work or school policies have often cited the use of fetal material in mRNA vaccines or in their development, though neither Novavax nor the Pfizer and Moderna vaccines contain fetal tissue or DNA. However, it has been reported that laboratory-replicated fetal cell lines, some originating from abortions decades ago, have been used in the testing of mRNA vaccines.

Dorit Reiss, PhD, a professor at the University of California Hastings College of the Law in San Francisco, who has researched religious exemptions from vaccines, told MedPage Today it was only a matter of time before some employers, including hospitals, started to enforce vaccination policies after Novavax was authorized for use in August.
"I've said publicly before that I think Novavax does change the situation in relation to arguments about cell lines," she said. "This is the first I've heard of an employer actually moving on it."
An emailed statement from Froedtert to MedPage Today said, in part, "This protein-based vaccination option eliminates conflicts for those staff with religious or medical exemptions caused by mRNA-based vaccines and other concerns. Since those staff are now eligible for a vaccination that does not conflict with their religious beliefs or medical situation, their exemption will expire."
The health network said that the rule will affect less than 1% of their staff, and that "impacted employees" were given a chance to apply for another exemption before previous ones expired, noting they will uphold "valid medical exemptions and sincerely held religious exemptions."

Reiss said of the many claims to back up religious exemptions she's come across, the fetal cell line argument was perhaps the most common, partially because it might curry favor from pro-life judges. "If they can piggyback on the abortion debate, they're more likely to win" in a dispute, she said. But other reasons, like the claim that some religions require blood to be free of contamination, have also been used.
Some vocal opponents of vaccine requirements may have anticipated the post-Novavax repercussions, and urged their followers to use other reasons to back up their religious objections, Reiss said.
For example, Cait Corrigan, a Boston University theology student behind a group called Students Against Mandates, posted an online outline to the group's website with tips for "successful" religious exemption letters, writing, "Note you can write about aborted fetal tissue ... but this is not enough! (You must talk about the issue of Blood in the vaccines, being made in the Image of God, etc.)" (MedPage Today could not confirm whether Corrigan is still a student at Boston University.)

But neither these types of arguments nor religious beliefs are likely to hold up in most courts, according to Reiss and other experts. "The standard for vaccine mandates in the workplace is, you can refuse an exemption if it's an undue burden, like the burden of not having vaccinated employees at a hospital," she said.
And though objections to vaccination itself may be sincere, "for most of them, I think it's about safety concerns, many of them created by misinformation," Reiss noted. "For most of them, the religion is a cover for that concern."

• 
  
  Sophie Putka is an enterprise and investigative writer for MedPage Today. Her work has appeared in the Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire, and more. She joined MedPage Today in August of 2021.

 

[missy]

Long COVID Was a Preventable Tragedy. Some of Us Saw It Coming​

Brian Vastag



"

Note: Brian Vastag is a former science reporter for The Washington Post who has been disabled by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) since 2012.


It should have been the start of new insight into a debilitating illness. In May 2017, I was patient No. 4 in a group of 20 taking part in a deep and intense study at the National Institutes of Health aimed at getting to the root causes of myalgic encephalomyelitis/chronic fatigue syndrome, a disease that causes extreme exhaustion, sleep issues, and pain, among other symptoms.
What the researchers found as they took our blood, harvested our stem cells, ran tests to check our brain function, put us through magnetic resonance imaging (MRI), strapped us to tilt tables, ran tests on our heart and lungs, and more could have helped prepare doctors everywhere for the avalanche of long COVID cases that's come alongside the pandemic.
Instead, we are all still waiting for answers.

In 2012, I was hit by a sudden fever and dizziness. The fever got better, but over the next 6 months, my health declined, and by December I was almost completely bedbound. The many symptoms were overwhelming: muscle weakness, almost paralyzing fatigue, and brain dysfunction so severe, I had trouble remembering a four-digit PIN for 10 seconds. Electric shock-like sensations ran up and down my legs. At one point, as I tried to work, letters on my computer monitor began swirling around, a terrifying experience that only years later I learned was called oscillopsia. My heart rate soared when I stood, making it difficult to remain upright.




I learned I had post-infectious myalgic encephalomyelitis, also given the unfortunate name chronic fatigue syndrome by the CDC (now commonly known as ME/CFS). The illness ended my career as a newspaper science and medical reporter and left me 95% bedbound for more than 2 years. As I readabout ME/CFS, I discovered a history of an illness not only neglected, but also denied. It left me in despair.
In 2015, I wrote to then-NIH director Francis Collins, MD, and asked him to reverse decades of inattention from the National Institutes of Health. To his credit, he did. He moved responsibility for ME/CFS from the small Office of Women's Health to the National Institute of Neurological Disorders and Stroke, and asked that institute's head of clinical neurology, neurovirologist Avindra Nath, MD, to design a study exploring the biology of the disorder.
But the coronavirus pandemic interrupted the study, and Nath gave his energy to autopsies and other investigations of COVID-19. While he is devoted and empathetic, the reality is that the NIH's investment in ME/CFS is tiny. Nath divides his time among many projects. In August, he said he hoped to submit the study's main paper for publication "within a few months."

In the spring of 2020, I and other patient advocates warned that a wave of disability would follow the novel coronavirus. The National Academy of Medicine estimates that between 800,000 and 2.5 million Americans had ME/CFS before the pandemic. Now, with billions of people worldwide having been infected by SARS-CoV-2, the virus that causes COVD-19, the ranks of people whose lives have been upended by post-viral illness has swelled into nearly uncountable millions.

Back in July 2020, National Institute of Allergy and Infectious Diseases Director Anthony Fauci, MD, said that long COVID is "strikingly similar" to ME/CFS.

It was, and is, a preventable tragedy.

Along with many other patient advocates, I've watched in despair as friend after friend, person after person on social media, describe the symptoms of ME/CFS after COVID-19: "I got mildly sick"; "I thought I was fine – then came overwhelming bouts of fatigue and muscle pain"; "my extremities tingle"; "my vision is blurry"; "I feel like a have a never-ending hangover"; "my brain stopped working"; "I can't make decisions or complete daily tasks"; "I had to stop exercising after short sessions flattened me."


What's more, many doctors deny long COVID exists, just as many have denied ME/CFS exists.





And it is true that some, or maybe even many, people with brain fog and fatigue after a mild case of COVID will recover. This happens after many infections; it's called post-viral fatigue syndrome. But patients and a growing number of doctors now understand that many long COVID patients could and should be diagnosed with ME/CFS, which is lifelong and incurable. Growing evidence shows their immune systems are haywire; their nervous systems dysfunctional. They fit all of the published criteria for ME, which require 6 months of nonstop symptoms, most notably post-exertional malaise (PEM), the name for getting sicker after doing something, almost anything. Exercise is not advised for people with PEM, and increasingly, research shows many people who have long COVID also cannot tolerate exercise.


Several studies show that around half of all long COVID patients qualify for a diagnosis of ME/CFS. Half of a large number is a large number.


A researcher at the Brookings Institution estimated in a report published in August that 2 million to 4 million Americans can no longer work due to long COVID. That's up to 2% of the nation's workforce, a tsunami of disability. Many others work reduced hours. By letting a pandemic virus run free, we've created a sicker, less able society. We need better data, but the numbers that we have show that ME/CFS after COVID-19 is a large, and growing, problem. Each infection and re-infection represent a dice roll that a person may become terribly sick and disabled for months, years, a lifetime. Vaccines reduce the risk of long COVID, but it's not entirely clear how well they do so.


We'll never know if the NIH study I took part in could have helped prevent this pandemic-within-a-pandemic. And until they publish, we won't know if the NIH has identified promising leads for treatments. Nath's team is now using a protocol very similar to the ME/CFS study I took part in to investigate long COVID; they've already brought in seven patients.


There are no FDA-approved medicines for the core features of ME/CFS. And because ME/CFS is rarely taught to medical students, few frontline doctors understand that the best advice to give suspected patients is to stop, rest, and pace – meaning to slow down when symptoms get worse, to aggressively rest, and to do less than you feel you can.

Over and over, we hear that long COVID is mysterious. But much of it isn't. It's a continuation of a long history of virally triggered illnesses. Properly identifying conditions related to long COVID removes a lot of the mystery. While patients will be taken aback to be diagnosed with a lifelong disorder, proper diagnosis can also be empowering, connecting patients to a large, active community. It also removes uncertainty and helps them understand what to expect.


One thing that's given me and other ME/CFS patients hope is watching how long COVID patients have organized and become vocal advocates for better research and care. More and more researchers are finally listening, understanding that not only is there so much human suffering to tackle, but the opportunity to unravel a thorny but fascinating biological and scientific problem. Their findings in long COVID are replicating earlier findings in ME/CFS.


Research on post-viral illness, as a category, is moving faster. And we must hope answers and treatments will soon follow.

"

​

 

[missy]

"

State of Affairs (Sept 19): COVID19, MPX, Polio, and... Flu​

Katelyn Jetelina Sep 19

COVID-19​

Globally, deaths from COVID-19 are on the decline, again. During a media briefing last week, WHO Director General Tedros provided a reaction: “We have never been in a better position to end the pandemic. We are not there yet, but the end is in sight. (But)… a marathon runner does not stop when the finish line comes into view. She runs harder, with all the energy she has left… Now is the worst time to stop running.”

No one knows where this finish line is exactly. In the U.S., whispers suggest the end of the public health emergency will be in mid-2023, with signals that we are moving to privatize tests, treatments, and vaccines. Yesterday, Biden suggested on 60 Minutes that the “pandemic is [already] over”. This is hard to believe given an average of 400 Americans are dying each day. But, as I’ve written before, the “end of a pandemic” isn’t purely epidemiological, but also physiological, cultural, political, and moral. Essentially we’re collectively deciding where we place SARS-CoV-2 in our repertoire of threats. To me, this winter will be a true test as to whether we are still in an “emergency” phase, at least if we define this by deaths, hospitalizations, and healthcare capacity (opposed to infection or long COVID).

Currently, the Omicron subvariant BA.4.6 is taking hold in the U.S., and we are getting the first signs that it can outcompete BA.5. Wastewater levelshave begun to rise in the Northeast where BA.4.6 is most prevalent. Also, for the first time last week, cases of BA.4.6 started rising while BA.5 cases started falling. We don’t think BA.4.6 will cause a big wave, as it doesn’t have mutations on the spike protein to escape our immunity, but coupled with behavior change and weather change, I guess anything is possible.

​

Wastewater trends in past 6 months. Yellow=Northeast; Pink= South; Green= West; Purple=Midwest. Source: Biobot Analytics
SARS-CoV-2 continues to mutate, and there are a few Omicron variants, like BA.2.3 and BJ.1, on the horizon with potentially concerning combinations of mutations. But evidence thus far is extremely limited. Most eyes are on BA.2.75.2, which is a second generation subvariant and has three additional spike protein mutations. Two preprints have shown substantial immune escape, even compared to BA.5. This means it has the potential to cause future waves. The number of BA.2.75.2 cases is still very small across the globe, but counts are doubling every week. If this growth rate continues, BA.2.75.2 may be one that causes the much anticipated winter wave.

Monkeypox​

Monkeypox (MPX) is getting under control as global cases continue to decline. Even in places like U.S., Peru, and Brazil, case growth has plateaued and even decelerated. This. is. fantastic. news. And we have to applaud the gay community for working tirelessly in communication, outreach, and vaccination. But we still have a long way to go. MPX is a very different virus than COVID19, so our goal needs to be containment and nothing less. We can do it.

There have been 24 MPX global deaths, and last week we confirmed the first American death among a severely immunocompromised person in Los Angeles.

​

In the U.S., the CDC has started releasing rapid data summaries and technical reports. They have been fast, clean, and data driven. This shift in science communication is nothing short of fantastic and I hope a reflection of CDC’s new direction. The reports provide the best picture we have of MPX on a national level.

While we have a national decline in MPX cases, this comes with substantial variation by state. States like OR, VA, and MA are seeing a fast incline in cases, while the original case leaders, like NY and CA, continue to decline in MPX cases.

​

MPX growth rates by state (Source: CDC Technical Report)
Unfortunately, this also comes with substantial variation by race and ethnicity, as we continue to see immense inequities in cases, testing, and vaccinations. For example, in New York City, cases among Hispanic people continue to rise while cases among non-Hispanic White people are clearly on the decline.

​

(Lala Tanmoy Das)
North Carolina’s last equity report showed a clear vaccine allocation imbalance: 70% of cases were among Black men and Black residents only received 24% of vaccinations. This calls for more culturally nuanced vaccine education, outreach, and behavioral communication. I’m excited to hear what CDC’s new initiative, the MPX Vaccine Equity Pilot, will offer.

Global signs continue to point to an MPX outbreak among men who have sex with men (MSM), with WHO data showing 95% of cases as MSM. In the latest U.S. technical report, cases among men who have not had sex with men are increasing. Interestingly, female cases are not also increasing. This unusual pattern is probably due to the y-axis—the number of cases among MSM are decreasing so other categories are increasing. But only detailed contact tracing data can help us understand whether MPX is infiltrating other social networks.

​

Proportion of cases with known data on sexual history and gender reporting recent man-to-man sexual contact (MMSC) (Source: CDC Technical Report)

Polio​

According to the Global Polio Eradication Initiative, the paralytic case in New York last month is genetically linked to two cases in Israel and one case in London. This suggests a large, international, and silent outbreak.

New York recently declared a state of emergency following the detection of polio virus in a fourth county’s wastewater. Unfortunately, this means there’s enough circulating polio virus with enough genetic mutations that the WHO added the U.S. to a list of countries with active circulating polio. This is a list that no country wants to be on. It’s both a remarkable and an incredibly disturbing moment in public health.

Certain workers in NY can now get a polio booster, even if they’ve previously been fully vaccinated for polio.

Flu​

Finally, flu. The flu season in Australia wrapped up, and it wasn’t pretty. This is notable because, historically, Southern hemisphere patterns predict what is to come in the Northern hemisphere.

​

(Dr. Ian MacKay)
U.S. flu activity remains low, as is typical this time of year, but flu season is just around the corner. Given the Southern hemisphere’s warnings, we predict that this activity will change. However, right now, the only predictable thing about viral behavior is that it is unpredictable.

​

(CDC)

Bottom line​

The dynamics of all these viruses continue to change. Stay healthy by getting up-to-date on your vaccines, which now includes a COVID-19 bivalent and flu shot. If you’re eligible, get your polio and monkeypox shot, too. Our immune systems could use all the help we can get going into the winter season.

"

 

[missy]

"

​

Booster roulette​

When the new, omicron-specific boosters arrived on the scene, I jumped at the chance to roll up my sleeve. I scheduled my shot for a Sunday morning, then planned to go about my business, showing a pal from San Francisco around town. I’d had no reaction to my third shot, so I assumed my fourth would be similar. That was a mistake. Within an hour, I was feeling lethargic. Halfway through dinner at my favorite neighborhood Italian restaurant, I felt an extreme need to lay down. For the next 48 hours, I experienced what I can only describe as an entire course of Covid, compressed. I ran a high fever, slept for an entire day and even after my symptoms subsided found myself out of breath just making a cup of tea. After three doses of Moderna and a round of the virus, I was shocked that a few micrograms of vaccine could still knock me out. It turns out that I’m far from the only person who experienced a terrible reaction to shot No. 4. As I apologetically canceled work appointments to sleep, people commiserated, sharing their own booster woes. And some also shared another detail that I found a bit alarming: Their unpleasant vaccine reactions made them unlikely to get boosted again. One person, for example, said that after bad reactions to shots three and four, she just wasn’t sure she could do it again. When I tweeted my experience, another person responded that a flu-like reaction to previous shots had led them to assume they were protected enough that they didn’t even need a fourth at all. Whether such sentiment is widespread is hard to say, but what’s for certain is that US booster uptake is nowhere near where it should be. While nearly 80% of American adults have had their first two shots, only about 50% of those folks have had their first booster shot, according to the Centers for Disease Control and Prevention. I was curious whether there was anything to be gleaned from reading the tea leaves of my own booster reaction. Could my 48 hours of illness tell me anything useful about how well-equipped my immune system is to fight off Covid? I posed this question to Katrine Wallace, an epidemiologist at the University of Illinois at Chicago. (Wallace shared on Twitter that she, too, had slept for 24 hours after her most recent booster shot.) “Vaccine side effects should not be taken as a proxy for effectiveness of someone’s vaccination,” she says. Because experiences like mine are merely anecdotal, she says the best way to understand the meaning of vaccine reactions is to look at data from clinical trials and then compare those results to real world data. In trials for both the Moderna and Pfizer vaccines, she says, pain at the injection site was the most common reaction. About 20% of vaccine recipients had none, she says, and it was less common in patients over 55. Other common reactions included fatigue, headache and muscle pain. After dose one, about 45% of people experienced no systemic reactions to the Moderna shot. Only about 20% of people escaped dose two with no systemic side effects. Pfizer’s data was similar. In other words, a lot of people reacted in some way to the shots. “Comparing these trials to real world data, it’s extremely consistent,” Wallace says. And, she said, whether they experienced side effects didn’t appear to impact their immunity to the virus. The new omicron-specific boosters didn’t go through human clinical trialssince they are closely related to the original shots, so we don’t have data on reactions to those specifically. (In clinical trials for the BA.1 booster that the US didn’t end up using, though, vaccine reactions weren’t different from the earlier trials.) But, Wallace says, the data we do have highlights a point that surely also applies to the new shots: “Everyone’s immune system is unique.” So whether your booster kept you bed-ridden or you got off without so much as a sore arm, the end result is the same. The best way to make sure you’re protected from contracting Covid—and spreading it to others—is to get vaccinated and boosted. But when you do get boosted, it’s not a bad idea to make sure you can take the next day off. — Kristen V. Brown

• Pharmacy chains are reporting Moderna’s latest vaccines are in short supply just as people once again come in for their booster shots.

Society may be moving on, but Covid is still killing hundreds of people every day, The Los Angeles Times reports.
"

 

[missy]

"​

Sound Sick? New AI Technology Might Tell If It's COVID​

Bill Stieg
September 19, 2022


Imagine this: You think you might have COVID. You speak a couple of sentences into your phone. Then an app gives you reliable results in under a minute.
"You sound sick" is what we humans might tell a friend. Artificial intelligence, or AI, could take that to new frontiers by analyzing your voice to detect a COVID infection.
An inexpensive and simple app could be used in low-income countries or to screen crowds at concerts and other large gatherings, researchers say.

It's just the latest example in a rising trend exploring voice as a diagnostic tool to detect or predict diseases.




Over the past decade, AI speech analysis has been shown to help detect Parkinson's disease, posttraumatic stress disorder, dementia, and heart disease. Research has been so promising that the National Institutes of Health just launched a new initiative to develop AI to use voice to diagnose a wide array of conditions. These range from such respiratory maladies as pneumonia and COPD to laryngeal cancer and even stroke, ALS, and psychiatric disorders like depression and schizophrenia. Software can detect nuances that the human ear can't, researchers say.
At least half a dozen studies have taken this approach to COVID detection. In the most recent advancement, researchers from Maastricht University in the Netherlands are reporting their AI model was accurate 89% of the time, compared with an average of 56% for various lateral flow tests. The voice test also was more accurate at detecting infection in people not showing symptoms.
One hitch: Lateral flow tests show false positives less than 1% of the time, compared with 17% for the voice test. Still, since the test is "virtually free," it would still be practical to just have those who test positive take further tests, said researcher Wafaa Aljbawi, who presented the preliminary findings at the European Respiratory Society's International Congress in Barcelona, Spain.

"I am personally excited for the possible medical implications," says Visara Urovi, PhD, a researcher on the project and an associate professor at the Institute of Data Science at Maastricht University. "If we better understand how voice changes with different conditions, we could potentially know when we are about to get sick or when to seek more tests and/or treatment."

Developing the AI​

A COVID infection can change your voice. It affects the respiratory tract, "resulting in a lack of speech energy and a loss of voice due to shortness of breath and upper airway congestion," says the preprint paper, which hasn't been peer reviewed yet. A COVID patient's typical dry cough also causes changes in the vocal cords. And previous research found that lung and larynx dysfunction from COVID changes a voice's acoustic characteristics.
Part of what makes the latest research notable is the size of the dataset. The researchers used a crowd-sourced database from the University of Cambridge that contained 893 audio samples from 4,352 people, of whom 308 tested positive for COVID.

You can contribute to this database – it's all anonymous -- via Cambridge's COVID-19 Sounds App, which asks you to cough three times, breathe deeply through the mouth three to five times, and read a short sentence three times.

For their study, Maastricht University researchers "only focused on the spoken sentences," explains Urovi. The "signal parameters" of the audio "provide some information on the energy of speech," she says. "It is those numbers that are used in the algorithm to make a decision."

Audiophiles may find it interesting that the researchers used mel spectrogram analysis to identify characteristics of the sound wave (or timbre). Artificial intelligence enthusiasts will note that the study found that long short-term memory (LSTM) was the type of AI model that worked best. It's based on neural networks that mimic the human brain and is especially good at modeling signals collected over time.




For laypeople, it's enough to know that advancements in the field may lead to "reliable, efficient, affordable, convenient, and simple-to-use" technologies for detection and prediction of disease, the paper said.

What's Next?​

Building this research into a meaningful app will require a successful validation phase, says Urovi. Such "external validation" -- testing how the model works with another dataset of sounds -- can be a slow process.

"A validation phase can take years before the app can be made available to the broader public," Urovi says.

Urovi stresses that even with the large Cambridge dataset, "it is hard to predict how well this model might work in the general population." If speech testing is shown to work better than a rapid antigen test, "people might prefer the cheap non-invasive option."

"But more research is needed exploring which voice features are most useful in picking out COVID cases, and to make sure models can tell the difference between COVID and other respiratory conditions," the paper says.

So are pre-concert app tests in our future? That'll depend on cost-benefit analyses and many other considerations, Urovi says.

Nevertheless, "It may still bring benefits if the test is used in support or in addition to other well-established screening tools such as a PCR test."

Source​

Visara Urovi, PhD, associate professor, Institute of Data Science, Maastricht University.

"

 

[missy]

FLU Vaccine info

Can I get a flu booster?​

If you get a flu shot in early September, can you get a second one later in the season? Joan, Port Chester, New York This inclination makes total sense to me. After reaching the fourth dose of Covid vaccines, we’re all hyper-aware that their potency can eventually wane. And the flu is terrible. No one wants the flu! So why not get your flu shot early in the season, and then top it off a bit later? While there’s no danger in getting two flu shots, it’s probably unnecessary, according to Katrine Wallace, an epidemiologist at the University of Illinois at Chicago. “For adults whose immune systems have encountered both the flu vaccine and the flu virus, studies have not shown a benefit to receiving a second flu shot, even in elderly people with less robust immune systems,” Wallace says. “One influenza vaccination per year is enough for the majority of the population.” (The rules are different for kids, she says. The Centers for Disease Control and Prevention recommends that kids under 9 who have never had a flu shot get two shots for their first vaccination.) The efficacy of the flu shot, however, does fade. The flu virus mutates rapidly — much more rapidly than Covid — making the shot you got last year less effective against this season’s version. Both of these factors mean it’s important to boost your immune system with a new dose of the flu shot each year. Though there is one thing you can do to boost the power of your flu shot: game your timing. “The recommended time to get an influenza vaccine is by the end of October,” says Wallace. “It is before the winter flu season.” Getting vaccinated in August or September isn’t really recommended, she says. There are a few exceptions, such as pregnant people in their third trimester. They might want to get vaccinated in the months leading up to flu season to provide protection to the baby, who will be too young to get the shot right after birth. So, to sum it up, time your shot right and don’t worry about doubling up. — Kristen V. Brown

 

[missy]

NYT

Why Omicron Might Stick Around​

Omicron, the 13th named variant of the coronavirus, seems to have a remarkable capacity to evolve new tricks.


By Carl Zimmer
Sept. 22, 2022


"
Where is Pi?
Last year, the World Health Organization began assigning Greek letters to worrying new variants of the coronavirus. The organization started with Alpha and swiftly worked its way through the Greek alphabet in the months that followed. When Omicron arrived in November, it was the 13th named variant in less than a year.
But 10 months have passed since Omicron’s debut, and the next letter in line, Pi, has yet to arrive.
That does not mean SARS-CoV-2, the coronavirus that causes Covid-19, has stopped evolving. But it may have entered a new stage. Last year, more than a dozen ordinary viruses independently transformed into major new public health threats. But now, all of the virus’s most significant variations are descending from a single lineage: Omicron.

“Based on what’s being detected at the moment, it’s looking like future SARS-CoV-2 will evolve from Omicron,” said David Robertson, a virologist at the University of Glasgow.



It’s also looking like Omicron has a remarkable capacity for more evolution. One of the newest subvariants, called BA.2.75.2, can evade immune responses better than all earlier forms of Omicron.
For now, BA.2.75.2 is extremely rare, making up just .05 percent of the coronaviruses that have been sequenced worldwide in the past three months. But that was once true of other Omicron subvariants that later came to dominate the world. If BA.2.75.2 becomes widespread this winter, it may blunt the effectiveness of the newly authorized boostersfrom Moderna and Pfizer.


Every time SARS-CoV-2 replicates inside of a cell, it might mutate. On rare occasions, a mutation might help SARS-CoV-2 replicate faster. Or it might help the virus evade antibodies from previous bouts of Covid.
Such a beneficial mutation might become more common in a single country before fading away. Or it might take over the world.

At first, SARS-CoV-2 followed the slow and steady course that scientists had expected based on other coronaviruses. Its evolutionary tree gradually split into branches, each gaining a few mutations. Evolutionary biologists kept track of them with codes that were useful but obscure. No one else paid much attention to the codes, because they made little difference to how sick the viruses made people.



But then one lineage, initially known as B.1.1.7, defied expectations. When British scientists discovered it, in December 2020, they were surprised to find it bore a unique sequence of 23 mutations. Those mutations allowed it to spread much faster than other versions of the virus.



Boosters that protect against the BA.5 subvariant are available, but experts worry BA.5’s dominance may be supplanted by another subvariant.Credit...Pfizer, via Associated Press


Within a few months, several other worrying variants came to light around the world — each with its own combination of mutations, each with the potential to spread quickly and cause a surge of deaths. To make it easier to communicate about them, the W.H.O. came up with its Greek system. B.1.1.7 became Alpha.
Different variants experienced varying levels of success. Alpha came to dominate the world, whereas Beta took over only in South Africa and a few other countries before petering out.

Read More on the Coronavirus Pandemic​

• A Persistent Variant: Ten months have passed since Omicron’s debut. Since then it has displayed a remarkable capacity to evolve new tricks.
• A Blunted Response: Major data gaps, the result of decades of underinvestment in public health, have undercut the U.S. government’s response to Covid — and now to monkeypox.
• Biden’s Comments: In an interview that aired on CBS’s “60 Minutes,” President Biden said that “the pandemic is over.” But 400 to 500 Americans are still dying every day of Covid-19.
• Updated Boosters: As masks have fallen away and quarantines have diminished, the new vaccines are one of the last remaining weapons in America’s arsenal against the coronavirus. So far, the rollout is methodical, but muted.

What made the variants even more puzzling was that they arose independently. Beta did not descend from Alpha. Instead, it arose with its own set of new mutations from a different branch of the SARS-CoV-2 tree. The same held true for all the Greek-named variants, up to Omicron.
It’s likely that most of these variants got their mutations by going into hiding. Instead of jumping from one host to another, they created chronic infections in people with weakened immune systems.

​

Unable to mount a strong attack, these victims harbored the virus for months, allowing it to accumulate mutations. When it eventually emerged from its host, the virus had a startling range of new abilities — finding new ways to invade cells, weaken the immune system and evade antibodies.



“When it gets out, it’s like an invasive species,” said Ben Murrell, a computational biologist at the Karolinska Institute in Stockholm.
Omicron did particularly well in this genetic lottery, gaining more than 50 new mutations that helped it find new routes into cells and to infect people who had been vaccinated or previously infected. As it spread around the world and caused an unprecedented spike in cases, it drove most other variants to extinction.
“The genetic innovations seen in Omicron were far more profound, as if it was a new species rather than just a new strain,” said Darren Martin, a virologist at the University of Cape Town.
But it soon became clear that the name “Omicron” hid a complex reality. After the original Omicron virus evolved in the fall of 2021, its descendants split into at least five branches, known as BA.1 through BA.5.
Over the next few months, the subvariants took turns rising to dominance. BA.1 went first, but it was soon outcompeted by BA.2. Each one was distinct enough from the others to evade some of the immunity of its predecessors. By this summer, BA.5 was on the rise.


Getting a Covid test at an Esperanza Health Center in Chicago.Credit...Jamie Kelter Davis for The New York Times

The U.S. Food and Drug Administration responded by inviting vaccine makers to produce booster shots that included a BA.5 protein along with one from the original version of the virus. Those boosters are now rolling out to the public, at a time when BA.5 is causing 85 percent of all Covid cases in the United States.



But BA.5 could be fading in the rearview mirror by winter, scientists said. Omicron has continued to evolve — likely by sometimes jumping among hosts, and sometimes hiding for months in one of them.
Since these new lineages belong to Omicron, they haven’t gotten a Greek letter of their own. But that doesn’t mean they’re just a slight twist on the original. Antibodies that could latch onto earlier forms of Omicron fare poorly against the newer ones.
“They could arguably have been given different Greek letters,” Dr. Robertson said.
BA.2.75.2 is among the newest of Omicron’s grandchildren, identified just last month. It’s also the most evasive Omicron yet, according to Dr. Murrell. In lab experiments, he and his colleagues tested BA.2.75.2 against 13 monoclonal antibodies that are either in clinical use or in development. It evaded all but one of them, bebtelovimab, made by Eli Lilly.
They also tested the antibodies from recent blood donors in Sweden. BA.2.75.2 did substantially better at escaping those defenses than other Omicron subvariants did.
The researchers posted their study online on Friday. Researchers at Peking University reached similar conclusions in a study posted the same day. Both have yet to be published in a scientific journal.
Dr. Murrell cautioned that scientists have yet to run experiments that will show the effectiveness of BA.5 booster shots against BA.2.75.2. He suspected that getting a big supply of BA.5 antibodies would provide some protection, especially against severe disease.

“It’s still important, but we’ll have to wait for the data to come out to see exactly what the magnitude of the boosting effect is,” Dr. Murrell said.



There’s no reason to expect that BA.2.75.2 will be the end of the evolutionary line. As immunity builds to previous versions of Omicron, new versions will be able to evolve that can evade it.
“I don’t think it’s going to hit a wall in the mutational space,” said Daniel Sheward, a postdoctoral researcher at the Karolinska Institute and co-author on the new study.
Lorenzo Subissi, an infectious disease expert with the W.H.O., said that the organization was not giving Greek letters to lineages like BA.2.75.2 because they are much like the original Omicron viruses. For example, it appears that all Omicron lineages use a distinctive route to get into cells. As a result, it is less likely to lead to severe infections but possibly better able to spread than previous variants.
“W.H.O. only names a variant when it is concerned that additional risks are being created that require new public health action,” Dr. Subissi said. But he did not rule out a Pi in our future.
“This virus still remains largely unpredictable,” he said.
Correction:
Sept. 22, 2022
An earlier version of this article misstated the year that the original Omicron variant emerged. It was 2021, not 2022.


"

 

[missy]

Long-Term Neurologic Problems Rise by 7% After SARS-CoV-2 Infection​

— Movement disorders, memory problems, strokes, and seizures emerge, regardless of age​

by Judy George, Deputy Managing Editor, MedPage Today September 25, 2022

Risk of movement disorders, memory problems, strokes, and seizures rose 1 year after acute SARS-CoV-2 infection, an analysis of millions of U.S. veterans' records showed.
Former COVID patients had a 42% increased risk of neurologic problems 12 months after testing positive (HR 1.42, 95% CI 1.38-1.47), reported Ziyad Al-Aly, MD, of Washington University in St. Louis and Veterans Affairs St. Louis Health Care System, and colleagues.
The burden was roughly a 7% increase in long-term neurologic problems (70.69 per 1,000 persons, 95% CI 63.54-78.01), the researchers wrote in Nature Medicine. Risks and burdens were elevated even in people who did not require hospitalization during acute COVID-19.
"COVID can lead to long-term neurologic consequences," Al-Aly told MedPage Today. "The virus is not always as benign as some people think it is."
"It is not only brain fog," he emphasized. "There is clearly an increased risk of strokes, headaches, seizures, peripheral neuropathy, and more."
Using Veterans Affairs national healthcare databases, Al-Aly and co-authors built cohorts that included 154,068 individuals diagnosed with COVID-19 from March 2020 to January 2021, 5,638,795 contemporary controls who were not infected, and 5,859,621 historical controls from 2017.
The mean age of the COVID cohort was 61, and 89% were men. The researchers used inverse probability weighting to balance the cohorts. In the COVID group, they evaluated incident occurrences of 44 brain and other neurologic disorders about 1 year after acute SARS-CoV-2 infection. Both hospitalized and non-hospitalized COVID patients were included.
Compared with controls, COVID patients were 80% more likely to have a new occurrence of epilepsy or seizures, 43% more likely to develop mental health disorders such as anxiety or depression, 42% more likely to be diagnosed with movement disorders, and 35% more likely to have mild to severe headaches at 1 year. They also were 50% more likely to have an ischemic stroke.
People with COVID had a 77% higher risk of memory problems as those in the control groups. In some patients, post-COVID memory problems have resolved over time, Al-Aly noted.
COVID patients also had an increased risk of an Alzheimer's disease diagnosis compared with their counterparts who weren't infected (HR 2.03, 95% CI 1.79-2.31).
"It's unlikely that someone who has had COVID-19 will just get Alzheimer's out of the blue," Al-Aly said in a statement. "Alzheimer's takes years to manifest."
"But what we suspect is happening is that people who have a predisposition to Alzheimer's may be pushed over the edge by COVID, meaning they're on a faster track to develop the disease," he added. "It's rare, but concerning."
Analyses by age as a continuous variable revealed two key findings, the researchers noted. "Regardless of age and across the age spectrum, people with COVID-19 had a higher risk of all the neurologic outcomes examined in this analysis," they observed.
In addition, "our interaction analyses suggest that the effect of COVID-19 on risk of memory and cognitive disorders, sensory disorders and other neurologic disorders (including Guillain-Barré syndrome and encephalitis or encephalopathy) is stronger in younger adults," they pointed out. "The effects of these disorders on younger lives are profound and cannot be overstated; urgent attention is needed to better understand these long-term effects and the means to mitigate them."
Limitations to the study included a cohort of mostly white males. Few people were vaccinated for COVID because vaccines were not widely available during the study period. Other research led by Al-Aly has shown that vaccines reduce but do not eliminate the risk of neurologic complications from COVID-19.
The study also predated Delta and Omicron variants.

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more.

 

[missy]

"

Japanese Prime Minister Fumio Kishida announced last week that the country will abolish a slew of Covid border controls, reinstate visa waivers and allow individual visitors to enter starting Oct. 11. There’s real excitement that cities will be full of hustle and bustle as travelers hop on planes to new venues, especially after disappointments from previous, cautious reopening efforts.

There’s massive pent-up demand, both among potential visitors and the businesses that are desperate to have them back. I know people who already placed their bets, booking hotels long ago for skiing holidays. Others raced to get flights and accommodations as soon as the announcement was made. For Americans, it seems like a bargain to visit right now as the weak yen makes everything cheap.

But I have concerns. Unlike in the US and Europe, Covid rules linger everywhere in Japan even as locals flock to tourism hotspots. It’s really hard to get past them.

Visitors at the Dazaifu Tenmangu shrine. Photographer: Shoko Takayasu/Bloomberg
Almost everyone wears masks indoors and in outdoor public venues, despite the government relaxing its recommendations. Temperatures are taken as you enter buildings. There are plastic partitions at dining tables in restaurants. Hotels ask patrons to wear plastic gloves to serve themselves from buffet trays. Locals follow these new customs willingly, thanks to peer pressure. None of the guidelines are imposed.

My question is: will tourists adjust to Japan’s unwritten Covid rules? If not, will they create confusion, confrontation and chaos?

The government has spent time and money to ease foreign tourists into the Japanese method of Covid containment, primarily to make sure locals aren’t put off by the visitors. They were first welcomed in May as part of chaperoned group tours that allocated little free time and came with warnings that they would be kicked out if they didn’t follow social distancing rules.

The expectations don’t necessary hold outside the country. I was curious whether Japan’s emperor and empress, who traveled to the UK to attend Queen’s Elizabeth’s funeral last week, were going to wear masks at the ceremony and the reception. They didn’t. The decision was made based on the local circumstances, according to a media report that cited an official at the Imperial Household Agency.

That got me thinking. Maybe Japan needs to find common ground with the broader world, rather than insisting on its own way. Tourism has been a rare bright spot in the economy as the number of foreign visitors expanded five-hold between 2011-2019. Now Japan needs that growth back. Given the soaring demand for flights, tourists want to come.

Now they just have to be welcomed. A full reopening is the next thing pending. — Kanoko Matsuyama

"

 

[missy]

The latest​

On Saturday, Pfizer CEO Albert Bourla tweeted that he had tested positive for the coronavirus. “I'm feeling well & symptom free,” he said. Bourla, who previously tested positive in mid-August, added that he hasn't received one of the new bivalent boosters yet because he “was following CDC guidelines to wait 3 months since my previous COVID case.”

According to Centers for Disease Control and Prevention recommendations, people should wait at least three months after their last coronavirus infection before getting the new bivalent booster.

The omicron-specific boosters were released last month, but there has been a slow uptake. Only 4.4 million people in the United States have received the shot, and while scientists don't fear a fall and winter surge such as the one in late 2021, they worry that a new variant could throw a wrench in generally declining case numbers.

Pfizer and its German partner, BioNTech, submitted an applicationMonday to the Food and Drug Administration for emergency use authorization for a bivalent vaccine booster for children aged 5 to 11. In August, the company applied for the same authorization for people 12 and older, which was granted a week later.

This booster targets the highly transmissible but milder version of the coronavirus, which first appeared in November 2021. The shot is called bivalent because it contains components targeting the original version of the coronavirus and the omicron variant. “We are facing a virus with an exceptionally high mutation rate, and real-world evidence reinforces the urgent need for updated vaccines targeted to the Omicron sublineages, like the bivalent boosters,” Pfizer said to The Washington Post in an email.

The original Pfizer booster, which is also available for children 5 to 11, has been given to 14.8 percent of that age group.

In its news release, Pfizer also stated it was conducting clinical trials on bivalent boosters for children 6 months to 11 years.

Other important news​

Wellness editor Tara Parker-Pope shares 10 tips for living with the coronavirus.

On Friday, Hong Kong said it would abolish mandatory quarantine for travelers.

 

[flowing_serenity]

These are helpful to know. Thank you so much for sharing these updates!!

 

[missy]

These are helpful to know. Thank you so much for sharing these updates!!

Thank you!

 

[missy]

COVID-19 Vaccines Can Make Periods Longer, Study Says

Menstrual cycles do tend to get longer after COVID-19 vaccination—though the change is minimal and temporary

time.com

“
COVID-19 Vaccines Can Make Periods Longer, Study Says


BY ALICE PARK

SEPTEMBER 27, 2022 11:00 AM EDT
Side effects from vaccines are not unusual, and in fact are expected. But when the COVID-19 shots were first authorized in the U.S., the effect these vaccines might have on the reproductive system weren’t known.

In a study published Sept. 27 in BMJ Medicine, researchers provide more information on this question, documenting how COVID-19 vaccines can affect menstrual cycles, as well as how long the impact lasts.


Dr. Alison Edelman, professor of obstetrics and gynecology at Oregon Health & Science University, and her team conducted the largest analysis to date on the effect that the vaccines have on menstruation. It included nearly 20,000 vaccinated and nearly 5,000 unvaccinated people around the world. The work is an extension of their first study into the issue, which was focused on data from the U.S.

In the latest study, Edelman found that any COVID-19 vaccine can extend the menstrual cycle—the time between periods—by less than a day on average, although it didn’t have much effect on how long bleeding lasts. The team also found that this change tended to only last for one cycle after vaccination, resolving by the next period.




Edelman began looking into the issue after people began reporting changes in their cycles after vaccination to U.S. government databases that track vaccine side effects. Surveys also documented changes in cycles. “Before, there was no data around this,” she says. “Now we have information to know that the vaccine does change the menstrual cycle, at least on a population level. It looks like a brief change, and it goes back to normal pretty quickly. But it’s important information to have.”

The latest data add to the existing data gathered from the U.S. because they include a larger number of people as well as a broader variety of COVID-19 vaccines. While three shots (from Moderna, Pfizer-BioNTech, and Johnson & Johnson-Janssen) have been approved or authorized in the U.S., other vaccines that use different technologies (like AstraZeneca’s) are also available around the world. Edelman and her team found that the effect on menstrual cycle length was similar with all of the COVID-19 vaccines. That means that the newer mRNA-based shots don’t seem to be associated with any menstrual changes than the other vaccines, which should allay concerns about the novel technology.

Exactly how the vaccines can prompt changes in periods isn’t clear, but previous studies have hinted that the effect is likely related to cross-talk between the immune system—which is activated after vaccination—and the reproductive system. Temporary inflammatory reactions after immunization, similar to those generated after getting natural infections, could affect processes like ovulation, and the extent of the effect could depend on when during the cycle people get vaccinated. “At this point we don’t know the exact mechanism, but there are a lot of hypotheses based on established research that has come before,” says Edelman. “We need more studies to understand this.”


COVID-19 may provide a good opportunity to launch such research. Edelman and her team are also continuing to mine the data to answer other questions about how the COVID-19 vaccines might affect menstruation, including whether vaccination affects menses itself. They are also exploring how getting infected with COVID-19 might affect periods, since infections of any kind are known to affect menstruation. Data from U.S. and global populations collected in studies so far were gathered in the first year after the vaccines were authorized, from late 2020 to late 2021, when fewer people were infected compared to 2022, when widely circulating and highly contagious Omicron variants have circulated.

The studies also do not account for the potential effect of booster shots, which were not authorized in the U.S. until fall of 2021, so the scientists are also investigating whether additional vaccine doses affect cycles in the same way.

While a cycle-length increase of less than a day may seem small, Edelman says that it’s important to acknowledge that vaccines can have an effect on periods. Building scientific knowledge around the topic can help people better track their fertility or know what to expect after getting vaccinated. “Hopefully this will create a foundation for information about menstrual cycles and future vaccines as well,” she says. “Menstrual cycles have been woefully understudied for so long, and we didn’t recognize the need for foundational information. Whether the cycles change or not is incredibly important to know for reassuring people and building trust in something like vaccines.”

“

 

[mrs-b]

Useful info - thanks @missy.

As you know, my DH and I have both come down with covid over the last few days and it sucks just as much as everyone says it does. I feel as tho every second person has come down with it recently and I ran that theory past my PCP doing a telemedicine visit today. She said she's seeing as many people for covid infection as she has ever seen - and many of them are repeat offenders - 2, 3 or more infections.

And that's how it feels - as tho we're going through a strong uptick at the moment. I really agree with the reporter from one of the articles above who said we need to up our game: vaccinations once a year just won't cut it.

ETA. Both DH and I are now on paxlovid. @AprilBaby - how are you doing?

ETA x 2 And just to add - the smell of food is utterly nauseating to me right now. The smell of meat makes me want to heave. Actually, all food is pretty disgusting right now. Yesterday all I ate was an avocado. I tried to eat more normally today, but now all I want to do is throw up. I'm thinking I might stay off the food for a bit.

 

[missy]

I am so sorry you and Tim are going through this @mrs-b

And yes. We do need to up our game. I agree completely. People (not you) have become complacent and pandemic fatigued. And cases are rising.

General thoughts for anyone reading.
Get vaccinated. Wear masks. Physically distance from those you don’t live with. This is not the time to forget those safety measures. Measures that work. But we all have to comply so we don’t get infected and we don’t infect others.

Glad you were finally able to get Paxlovid @mrs-b.
Bucketloads of healing vibes to you both.
And everyone who needs it.

 

[mrs-b]

I am so sorry you and Tim are going through this @mrs-b

And yes. We do need to up our game. I agree completely. People (not you) have become complacent and pandemic fatigued. And cases are rising.

General thoughts for anyone reading.
Get vaccinated. Wear masks. Physically distance from those you don’t live with. This is not the time to forget those safety measures. Measures that work. But we all have to comply so we don’t get infected and we don’t infect others.

Glad you were finally able to get Paxlovid @mrs-b.
Bucketloads of healing vibes to you both.
And everyone who needs it.

@missy - I'm really grateful that DH and I didn't get it till now, when the variant we caught wasn't as toxic as the original strain, and only after we've both had multiple vaccinations. We've been *incredibly* careful - but once DH caught it, given how much day to day help I need from him due to my back, there was just no way I could stay right away from him. And down we both went.....

He caught it at a conference where he was hosting dinners for clients. I suspect the whole conference (some hundreds of people) ended up being a super spreader event. Why people think we've reached a point where we don't need masks is utterly beyond me. I'm still sanitizing my hands/arms/face multiple times a day, for Pete's sake....