September 2023 Coronavirus updates

[missy]

Happy September all

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September 1, 2023​

By David Leonhardt

Whether over when​ ​

Covid cases have risen. Flu season is approaching. And new vaccines for the virus known as R.S.V. recently became available.​

This swirl of developments has left many people wondering which vaccine shots they should be getting and when. Today’s newsletter offers a guide.​

The main message that I heard from experts is that Americans should shift how they think about respiratory viruses. For the past few cold-weather seasons (which are also when viruses spread most), we obsessed over Covid. This year, we should take a broader approach. “It’s not only Covid you have to think about,” said Dr. Peter Hotez, a vaccine expert and the author of a forthcoming book, “The Deadly Rise of Anti-Science.”​

The good news is that there are vaccines and treatments that reduce risks from all major viruses likely to circulate this season, including Covid. “For the past couple of seasons, the notion was that Covid controlled us,” Dr. Nirav Shah, the C.D.C.’s principal deputy director, told me. “The tables have turned, not just for Covid but for the others.”​

1. R.S.V.​ ​

The most immediate step worth considering involves R.S.V., which stands for respiratory syncytial virus. It is a common winter virus that usually causes mild cold-like illness but can be dangerous for young children and older adults, as Emily Martin, an epidemiologist at the University of Michigan, has told The Times.​

This spring, the federal government approved the first R.S.V. vaccines, for people aged 60 and older. If you qualify, consider getting your R.S.V. vaccine shot now. Shah, the C.D.C. official, recently urged his mother to do so. Hotez, who’s 65, has received his own R.S.V. shot.​

Why now? R.S.V. tends to circulate somewhat earlier than the flu. If you’re 60 or over, “you don’t want to get into November without having an R.S.V. vaccine,” said Dr. Ashish Jha, the former White House Covid adviser and current dean of Brown University’s public health school.​

What about infants? Although there is no R.S.V. vaccine for them, children under 8 months (and some who are older) can receive an advance antibody treatment to prevent severe illness. Parents may want to ask their pediatrician about it. It’s sufficiently new that not all doctors have it yet.​

2. Influenza​ ​

The flu officially kills about 35,000 Americans in a typical year, and the true toll is probably higher. As Jha told me, the flu also weakens the body in ways that make heart attacks and strokes more common, especially among the elderly. “We underestimate the impact that respiratory viruses have on our population,” he said. “The flu can knock people out for weeks, even younger people.”​

Yet the flu’s toll would be lower if more people got a vaccine shot. In recent years, less than half of Americans have done so.​

This year’s flu vaccine shots are now available at drugstores, hospitals, doctor’s offices and elsewhere. You may want to wait until late September or October to get one, though. The heaviest parts of flu season tend to occur between December and February. If you wait, the shot’s protection against severe illness will still be near its strongest level during those months.​

3. Covid​ ​

The best defenses against Covid haven’t changed: vaccines and post-infection treatments. They are especially important for vulnerable people, like the elderly and the immunocompromised. “Overwhelmingly, those who are being hospitalized are unvaccinated or undervaccinated,” Hotez said.​

The federal government is on track to approve updated Covid vaccine shots, designed to combat recent variants, in mid-September. Once it does, all adults should consider getting a booster shot. Many Americans have now gone more than a year without one, and immunity has waned.​

Yes, severe Covid remains rare in people under 50, especially if they have received a vaccine shot or had the virus — and nearly all Americans fall into one or both categories. But Covid can still be nasty even if it doesn’t put you in the hospital. A booster shot will reduce its potency.​

Shah argues that children (over 6 months old) should also get a Covid shot this fall, even though their own Covid risk is very low. “We should be thinking bigger than just ourselves,” he told me. “Do you want to see your grandpa? Do you want to hang out with your grandma? Are you really sure you’re not going to give Covid to them?” Even some boosted older people get severe versions of Covid.​

A good strategy for many people may be to get their Covid booster and flu shot at the same time, in late September or October.​

And if you’re older and you get Covid, talk to a doctor about taking Paxlovid or a different treatment. It can make a big difference. “When I get Covid,” said Jha, who’s 52 and healthy, “I have every intention of taking Paxlovid.”​

The bottom line​ ​

I’ve offered specific advice here about the ideal time to get different vaccine shots. But don’t exaggerate the importance of timing. As Shah said, “What I care more about is that you get all three shots if you’re eligible rather than when you get all three.” "​

 

[missy]

"

Fake doctor peddling fraudulent COVID-19 ‘cure’ arrested after a three-year manhunt
By Lisa Marie Basile | Fact-checked by Davi Sherman |


In 2020, Gordon H. Pedersen posed as a fake doctor and sold a COVID-19 ‘cure’ made from structural alkaline silver. When the feds found out, he was requested to appear in court that August. Instead, Pedersen dodged authorities and sent them on a manhunt that lasted until this month when he was arrested.

Pedersen was charged with seven felonies, including mail, wire fraud, and selling misbranded drugs across state lines with the intent to defraud and mislead.

Pedersen also alleged that he was not a US citizen but rather a “living soul.” He told authorities that Bill Gates and Dr. Anthony Fauci created the COVID-19 virus as a “war exercise.”

A 63-year-old Utah resident, Gordon H. Pedersen, was arrested last week after running from federal law enforcement since August 2020. A Department of Justice (DOJ) press release from 2020 stated that Pedersen was originally indicted after posing as a medical doctor and fraudulently peddling ingestible silver-based products to treat COVID-19.[1][2]

Pedersen was charged with seven felonies, including mail fraud, wire fraud, and selling misbranded drugs across state lines with the intent to defraud and mislead.[3]

Court documents cited by Insider state that Pedersen failed to appear in court as ordered on August 25, 2020. Over the three years, authorities searched for him, he filed a dozen documents stating that he was a sovereign citizen, claiming that he was neither himself nor a US citizen but a "corporate entity" and "Living Soul." He also espoused the belief that Bill Gates and Anthony Fauci created COVID-19 as a “simulated war exercise.”[4]
Pedersen was only caught after being caught on a gas station surveillance camera on July 5 outside of Salt Lake City, according to court documents obtained by the New York Times. Pedersen was called to appear at a detention hearing in federal court in Salt Lake City on August 15, 2023.[5][6]

A fake cure

Pedersen claimed that the silver—sales of which earned him $2 million—“resonates, or vibrates, at a frequency that destroys the membrane of the virus, making the virus incapable of attaching to any healthy cell, or to infect you in [any way],” according to a 2023 press release from the DOJ. [5][6]

Pedersen sold the products through the company that he co-owned, My Doctor Suggests LLC. The company parted ways with him and pleaded guilty to peddling the products. Pedersen had been in the business of selling silver products since at least 2014 and told people that these products could treat arthritis, diabetes, and pneumonia, according to the New York Times. The My Doctor Suggests website is still live, and its products, including silver solution and silver mouthwash, are sold on Amazon.[5]

To convince patients that he was a licensed MD, Pedersen posted videos and photos of himself online donning a white lab coat and stethoscope. His LinkedIn profile, which lists doctorate degrees in pharmacy and natural medicine, is still live. While this may have legitimized him to potential buyers, it is believed that Pedersen does not hold these degrees— nor is he a board-certified medical doctor.[6]
Stamping out the sale of Pedersen’s fraudulent treatments was part of a larger Justice Department plan that involved issuing warnings to companies selling quack COVID-19 medications.[7]

According to the National Center for Complementary and Integrative Health (NCCIH), the US Food and Drug Administration (FDA) issued a warning stating that colloidal silver isn’t safe or effective for treating any disease or condition and that it has no known functions or benefits when taken orally.

The NCCIH also writes that colloidal silver can lead to argyria, a build-up of silver in the body’s tissues. This build-up can cause someone’s skin to appear bluish-gray, leading to poor absorption of certain medications and potential kidney, liver, or nervous system issues. The NCCIH clearly states that silver cannot prevent or treat COVID-19.[8]

Silver’s roots in medical history date back to the 1890s, when physicians used colloidal silver to sterilize wounds. However, the discovery of antibiotics quickly replaced silver, according to Antibiotics (Basel).

Heather Barbieri, JD, Founding Attorney at Barbieri Law Firm, says, “In 2021, the United States Attorney General established a COVID-19 Fraud Enforcement Task Force to handle situations exactly like this. The Department of Justice has also focused on community outreach initiatives to make the public aware of COVID-19-related scams.”

Barbieri says that Pedersen will be given the option of either pleading guilty or fighting the charges against him and going to trial. “The company that Pedersen co-owned, My Doctor Suggests, pleaded guilty to a misdemeanor charge and is cooperating with prosecutors, so it appears that the government has been looking at Pedersen as their main target for quite some time. That will undoubtedly be a factor in Pedersen’s ultimate decision,” Barbieri adds.
Barbieri says that federal courts generally follow federal sentencing guidelines when determining punishments for defendants convicted of federal crimes. When it comes to offenses like the charges Pedersen is facing, “there are specific factors that can affect the possible punishment range, such as the amount of financial loss involved; whether the offender knew that the victim was unusually vulnerable due to age or physical or mental condition; and whether the offender obstructed justice,” she adds.

According to James Jackson, Psy.D, Director of Long Term Outcomes at the ICU Recovery Center at Vanderbilt and the author of a new book on COVID-19 called “Clearing the Fog: From Surviving to Thriving with Long Covid—A Practical Guide,” people like Pedersen are straight-up dangerous: “They prey on the vulnerabilities of people who are appropriately afraid of getting COVID-19—often the elderly, the frail, the immunocompromised, and those desperate for protection because they have a lot to lose,” he says.

Jackson says that the fact that there’s even a market for fake ‘cures’ reveals how frightened people were—and are—about COVID-19. “[It] speaks to the terror that many had and continue to have related to this virus and speaks to how badly people want a level of protection,” he says.

"

 

[empliau]

There are those who believe ingesting colloidal silver will improve your health, or maybe cure what ails you. Not sure of their motivations. But what's fascinating to me is that if you take enough of that stuff, it can turn your skin bluish-gray, a condition called argyria.

Warning not to google image argyria. The discoloration of the skin is permanent.

 

[missy]

There are those who believe ingesting colloidal silver will improve your health, or maybe cure what ails you. Not sure of their motivations. But what's fascinating to me is that if you take enough of that stuff, it can turn your skin bluish-gray, a condition called argyria.

Warning not to google image argyria. The discoloration of the skin is permanent.

Yes, please don’t take it

 

[empliau]

I promise I won't. I have never wanted to be a Smurf.

 

[missy]

I promise I won't. I have never wanted to be a Smurf.

Lol



it isn’t easy being blue

 

[Austina]

@missy, are you planning on getting a booster this year?

 

[missy]

@missy, are you planning on getting a booster this year?

Yes I am. I also plan on getting the flu vaccination as we always do but we are getting them separately not together as suggested by some. I do not want to overwhelm our immune system so one vaccination at a time..

How about you @Austina? Are you and Colin planning on getting the booster?

 

[missy]

"

Q&A: What to Know About the New BA 2.86 COVID Variant​

Kara Grant





The CDC and the World Health Organization have dubbed the BA 2.86 variant of COVID-19 as a variant to watch.
So far, only 26 cases of "Pirola," as the new variant is being called, have been identified: 10 in Denmark, four each in Sweden and the United States, three in South Africa, two in Portugal, and one each the United Kingdom, Israel, and Canada. BA 2.86 is a subvariant of Omicron, but according to reports from the CDC, the strain has many more mutations than the ones that came before it.
With so many facts still unknown about this new variant, we asked experts what people need to be aware of as it continues to spread.
What is unique about the BA 2.86 variant?

"It is unique in that it has more than three mutations on the spike protein," said Purvi Parikh, MD, an infectious disease expert at New York University's Langone Health. The virus uses the spike proteins to enter our cells.




This "may mean it will be more transmissible, cause more severe disease, and/or our vaccines and treatments may not work as well, as compared to other variants," she said.
Good news ― hospital admissions with Covid plateaued last week, and at levels lower than recent troughs. none of this has anything to do with new variant BA.2.86 ("Pirola") which is a tiny tiny proportion of sequenced cases. "Eris" (EG.5.1) still not dominant either (~20-30%) pic.twitter.com/zsjFAf5nMe ― Prof. Christina Pagel (@chrischirp) August 24, 2023
What do we need to watch with BA 2.86 going forward?

"We don't know if this variant will be associated with a change in the disease severity. We currently see increased numbers of cases in general, even though we don't yet see the BA.2.86 in our system," said Heba Mostafa, PhD, director of the molecular virology laboratory at Johns Hopkins Hospital in Baltimore.
"It is important to monitor BA.2.86 (and other variants) and understand how its evolution impacts the number of cases and disease outcomes," she said. "We should all be aware of the current increase in cases, though, and try to get tested and be treated as soon as possible, as antivirals should be effective against the circulating variants."
What should doctors know?
Parikh said doctors should generally expect more COVID cases in their clinics and make sure to screen patients even if their symptoms are mild.

"We have tools that can be used – antivirals like Paxlovid are still efficacious with current dominant strains such as EG.5," she said. "And encourage your patients to get their boosters, mask, wash hands, and social distance."

How well can our vaccines fight BA 2.86?

"Vaccine coverage for the BA.2.86 is an area of uncertainty right now," said Mostafa.

In its report, the CDC says scientists are still figuring out how well the updated COVID vaccine works. It's expected to be available in the fall, and for now, they believe the new shot will still make infections less severe, new variants and all.

If you weren't already aware, BA.2.86 (Pirola) is in the US Midwest%u2014probably the first time a major variant has been seen in the Midwest before the major US coastal cities. What's more, the sequences in Michigan & Ohio come from separate branches of BA.2.86. That means... 1/2 https://t.co/cDgQLuzNHC ― Ryan Hisner (@LongDesertTrain) August 27, 2023


Prior vaccinations and infections have created antibodies in many people, and that will likely provide some protection, Mostafa said. "When we experienced the Omicron wave in December 2021, even though the variant was distant from what circulated before its emergence and was associated with a very large increase in the number of cases, vaccinations were still protective against severe disease."


What is the most important thing to keep track of when it comes to this variant?


According to Parikh, "it's most important to monitor how transmissible [BA 2.86] is, how severe it is, and if our current treatments and vaccines work."


Mostafa said how well the new variants escape existing antibody protection should also be studied and watched closely.




What does this stage of the virus mutation tell us about where we are in the pandemic?


The history of the coronavirus over the past few years shows that variants with many changes evolve and can spread very quickly, Mostafa said. "Now that the virus is endemic, it is essential to monitor, update vaccinations if necessary, diagnose, treat, and implement infection control measures when necessary."


With the limited data we have so far, experts seem to agree that while the the variant's makeup raises some red flags, it is too soon to jump to any conclusions about how easy it is to catch it and the ways it may change how the virus impacts those who contract it.

Sources​

CDC: "Risk Assessment Summary for SARS CoV-2 Sublineage BA.2.86."

Purvi Parikh, MD, assistant professor, NYU Langone Health, New York City.

Heba Mostafa, PhD, director, molecular virology laboratory, Johns Hopkins Hospital, Baltimore.

GISAID: "Tracking of hCoV-19 Variants."

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[missy]

"

This Is When You're Most at Risk for 'Leaky' COVID Immunity​

Lisa O'Mary




Close and prolonged contact with someone with COVID-19 can more than quadruple the risk of getting the virus, a new study confirms. A higher – but somewhat reduced – risk persists even among people who have been vaccinated, had a prior infection, or both.
Led by public health researchers from Yale University, the study was published this month in the journal Nature Communications. The authors studied the topic because, while vaccination and prior infection are known to provide some protection against infection, the virus has still been able to sometimes evade immunity. Scientists call this "leaky" protection.
The new findings support a long-held theory that infection is more likely based on how much of the virus a person is exposed to and for how long.
Designing a study to evaluate this is challenging, so the authors decided it was best to do theirs at 13 correctional facilities. The facilities were all in Connecticut, and they all regularly did COVID testing on residents with and without symptoms. Researchers analyzed the risk of whether someone caught the virus based on where they lived in relation to an infected person, such as in the same cell or in the same cellblock.

The likelihood of becoming infected was also higher based on whether a person was vaccinated, had a prior infection, or both. The study took place from June 2021 to May 2022, when the Delta and Omicron virus variants were widespread. During that time, about 15,000 people spent at least 1 night housed in a facility, 48% of people had completed the primary vaccine series, and 27% were boosted.




The researchers found that during the Omicron period, people who shared a cell with an infected person had a nearly five times the risk of also becoming infected, and people who lived in the same cellblock had nearly four times the risk of infection. Having a prior infection, being vaccinated, or both did reduce a person's risk of getting COVID-19, but people who shared a cell with an infected person still faced a significantly increased risk.
The authors wrote that the findings provide a case for continued contact tracing, particularly in places where people live close together, like prisons or nursing homes. They said such tracing should include not just people who share a room, but also people who were together during recreation times or meals. The findings also suggest the continued benefits of social distancing, quarantine and isolation, masking, and improved ventilation and airflow, they wrote.
Akiko Iwasaki, PhD, an immunobiologist at Yale who was not part of the study, told Nature that the outcome of the study "just makes intuitive sense. But now there's evidence that these [measures] are probably going to be important to help the vaccine-mediated immunity work for you."

Sources​

Nature Communications: "Evidence of leaky protection following COVID-19 vaccination and SARS-CoV-2 infection in an incarcerated population."
Nature: "COVID infection risk rises the longer you are exposed – even for vaccinated people."

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[missy]

"

Cancer Patients More Likely to Die During COVID Pandemic​

— Omicron wave was especially deadly, and those with blood cancers at increased risk​

by Mike Bassett, Staff Writer, MedPage Today September 1, 2023

Cancer patients experienced significantly higher rates of COVID-19-related deaths compared with the general public, according to two retrospective studies from the U.S. and Canada.
In a cross-sectional study published in JAMA Oncologyopens in a new tab or window, researchers found that the winter Omicron surge of 2021-2022 was particularly deadly, as the number of deaths among U.S. cancer patients increased by 18% compared with the winter surge of the wild-type variant (December 2020-February 2021), reported Chi-Fu Jeffrey Yang, MD, of Massachusetts General Hospital in Boston, and colleagues.

In contrast, there were 21% fewer COVID deaths in the general population during the winter Omicron surge compared with the previous winter's surge.
These findings "suggest that patients with cancer had a disparate burden of COVID-19 mortality during the winter Omicron wave compared with the general U.S. population," Yang and colleagues wrote. "With the emergence of new, immune-evasive SARS-CoV-2 variants, many of which are anticipated to be resistant to monoclonal antibody treatments, strategies to prevent COVID-19 transmission should remain a high priority."
Findings on COVID mortality across all cancer sites evaluated were consistent, with the exception of brain, thyroid, and bladder cancers.
COVID mortality increased the most among patients with lymphoma (mortality ratio 1.38, 95% CI 1.31-1.45) during the winter Omicron wave compared with the wild-type period.
Yang's group suggested that the greater mortality burden experienced by cancer patients was likely due to the increased transmissibility of the Omicron variant, a relaxation in policies geared to prevent COVID transmission, reduced effectiveness of vaccines in patients with cancer, and a greater risk of severe disease in those individuals.

In another study published in JAMA Network Openopens in a new tab or window, researchers found that patients with hematologic malignancies were at increased risk of COVID infection from January 2020 through November 2021 compared with the general Canadian population (adjusted HR 1.19, 95% CI 1.13-1.25), while those with solid tumors were at a lower risk (aHR 0.93, 95% CI 0.91-0.95).
Notably, both groups of cancer patients had increased risks of 14-day hospitalization and 28-day mortality, reported Kelvin K.W. Chan, MD, PhD, of the Odette Cancer Centre at Sunnybrook Health Sciences Centre in Toronto, and colleagues:

• Hematologic malignancies: aHR 1.75 (95% CI 1.57-1.96) and aHR 2.03 (95% CI 1.74-2.3, respectively
• Solid tumors: aHR 1.11 (95% CI 1.05-1.1 and aHR 1.31 (95% CI 1.19-1.44)

Following hospitalization, the 28-day mortality rate after COVID infection was 50.7% in patients with hematologic malignancies and 45.8% in those with solid tumors.
However, the risk of 21-day intensive care unit (ICU) admission in patients with hematologic malignancies (aHR 1.14, 95% CI 0.93-1.40) or solid tumors (aHR 0.93, 95% CI 0.82-1.05) was not significantly different from the risks among people without cancer.

"These findings highlight the importance of prioritization strategies regarding ICU access to reduce the mortality risk in increased-risk populations, such as patients with cancer," Chan and team wrote.
Chan and colleagues also noted that COVID risk decreased stepwise with increasing numbers of COVID vaccine doses received (one dose: aHR 0.63, 95% CI 0.62-0.63; two doses: aHR 0.16, 95% CI 0.16-0.16; three doses: aHR 0.05, 95% CI 0.04-0.06).
Study Details
In their study, Yang and colleagues used data from the CDC's Wide-Ranging Online Data for Epidemiologic Research (WONDER) database to identify 34,350 patients (57.8% men) with cancer and 628,156 members of the general public (55.9% men) who died from COVID-19 during the wild-type variant wave (December 2020-February 2021), the Delta wave (July 2021-November 2021), and the winter Omicron wave (December 2021-February 2022).
The authors noted that the number of patients with cancer who died from COVID in the WONDER database was likely underestimated, since patients with a remote history of cancer may not have had cancer recorded in their death certificate and may not have been included in the study cohort. In addition, the database does not include data on vaccination status or cancer staging.

For the Canadian cohort study, Chan and team used data from the Ontario Cancer Registry on 11,732,108 community-dwelling adults from January 2020 through November 2021.
Of these adults, 279,287 had cancer (57.2% women, mean age 65.9) and 11,452,821 people did not have cancer (45.7% women, mean age 65.9). Overall, 4.1% developed COVID.
The cumulative incidence of COVID infection was 2.9% among those with solid tumors, 3.5% among those with hematologic malignancies, and 4.0% in the non-cancer population.
Study limitations included the fact that the authors did not have access to data on patients admitted to hospice or patients' preferences for hospitalization or ICU admission at the individual level.

• 
  
  Mike Bassett is a staff writer focusing on oncology and hematology. He is based in Massachusetts.

Disclosures
Yang had no disclosures.
One of his co-authors reported relationships with Bioverativ, Merck, Janssen, Edwards Life Sciences, Amgen, Eisai, Otsuka, Vertex Pharmaceuticals, Sage Therapeutics, Precision Health Economics, Analysis Group, Harry Walker Agency, All American Entertainment, Freakonomics M.D., and Doubleday Books.
The Canadian study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-term Care. This work was also supported by the Ontario Health Data Platform, a Province of Ontario initiative to support Ontario's ongoing response to COVID-19 and its related impact.
Chan and co-authors had no disclosures.
Primary Source
JAMA Oncology
Source Reference: opens in a new tab or windowPotter AL, et al "Deaths due to COVID-19 in patients with cancer during different waves of the pandemic in the US" JAMA Oncol 2023; DOI: 10.1001/jamaoncol.2023.3066.
Secondary Source
JAMA Network Open
Source Reference: opens in a new tab or windowHosseini-Moghaddam SM, et al "SARS-CoV-2 infection, hospitalization, and mortality in adults with and without cancer" JAMA Netw Open 2023; DOI: 10.1001/jamanetworkopen.2023.31617.

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[missy]

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Number of People With Long COVID Could Be Vastly Underestimated​

Megan Brooks




It's been estimated that up to one third of people who survive acute SARS-CoV-2 infection will suffer a post-viral syndrome with lingering neurologic and other symptoms — now known as long COVID or neurological postacute sequelae of SARS-CoV-2 infection (Neuro-PASC).
However, new research suggests that may be an underestimate and that far more people may be suffering from long COVID without ever having tested positive for the virus. Researchers found a significant proportion of patients in their small study who had never tested positive for COVID-19 but who were having symptoms of long COVID nevertheless showed evidence of immune responses consistent with previous exposure.
"We estimate that millions of people got COVID in the US during the first year of the pandemic and then developed long COVID, yet they did not get a positive COVID diagnosis because of testing limitations," Igor J. Koralnik, MD, of Northwestern Medicine Comprehensive COVID-19 Center in Chicago, Illinois, told Medscape Medical News.
He noted that many post-COVID-19 clinics in the US don't accept people with long COVID symptoms who do not have a positive test result.

Patients with long COVID symptoms but without laboratory evidence of prior infection, "who have often been rejected and stigmatized, should feel vindicated by the results of our study," Koralnik said.




"We think that those patients deserve the same clinical care as those with a positive test, as well as inclusion in research studies. This is what we are doing at Northwestern Medicine's Comprehensive COVID[-19] Center," Koralnik added.
The study was published online August 23 in the journal Neurology: Neuroimmunology & Neuroinflammation.

Delayed Care​

The researchers measured SARS-CoV-2-specific humoral and cell-mediated immune responses against nucleocapsid protein and spike proteins, which indicate a prior COVID-19 infection, in 29 patients with post-viral syndrome after suspected COVID-19, including neurologic symptoms such as cognitive impairment, headache, and fatigue, but who did not have a confirmed positive COVID-19 test.

They did the same in 32 age- and sex-matched people with long COVID with confirmed Neuro-PASC and 18 healthy controls with none of the symptoms of long COVID and no known exposure to SARS-CoV-2 or positive test result.
They found that 12 of the 29 patients (41%) with post-viral syndrome (but no positive COVID-19 test) had detectable humoral and cellular immune responses consistent with prior exposure to SARS-CoV-2. Three-quarters harbored antinucleocapsid and 50% harbored antispike responses.
"Our data suggest that at least 4 million people with post-viral syndrome similar to long COVID may indeed have detectable immune responses to support a COVID diagnosis," Koralnik said in a news release.
The 12 patients with post-viral syndrome but without a confirmed COVID-19 test had similar neurologic symptoms as those with confirmed Neuro-PASC.

However, lack of a confirmed COVID-19 diagnosis likely contributed to the 5-month delay in the median time from symptom onset to clinic visit, the researchers said. They were evaluated at a median of 10.7 months vs 5.4 months for Neuro-PASC patients.

Koralnik told Medscape Medical News the "most important take-home message" of the study is that patients with post-viral syndrome often present with similar clinical manifestations as confirmed patients with Neuro-PASC, suggesting that a positive result by commercially available SARS-CoV-2 diagnostic test should not be a prerequisite for accessing care.

Patients with post-viral syndrome may benefit from the same clinical care as confirmed patients with Neuro-PASC, and the absence of a positive SARS-CoV-2 test should not preclude or delay treatment, he added.

The study had no specific funding. The authors report no relevant financial relationships.

Neurol Neuroimmunol Neuroinflammation. Published online August 23, 2023. Full text.



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[Austina]

I think we probably will @missy, and like you, on separate occasions, not together. As we’re away for Christmas, I think we’ll plan it for nearer the time.

 

[Daisys and Diamonds]

There are those who believe ingesting colloidal silver will improve your health, or maybe cure what ails you. Not sure of their motivations. But what's fascinating to me is that if you take enough of that stuff, it can turn your skin bluish-gray, a condition called argyria.

Warning not to google image argyria. The discoloration of the skin is permanent.

i have a friend who has a little machine to make her own
she swears by it
she puts a wee drop in her drinking water (she is normal coloured)
but not as a cure for covid mind you
but silver was used before antibioditcs were imvented throught out history, even durring WW1

 

[empliau]

Absolutely. Silver can kill bacteria, and as you point out has been used for it. The problem is that a safe dose for oral consumption is complicated. And of course there are always those (I don't speak of your friend) who say if some is good, more must be better -- that way madness lies. Or, in this case, argyria.

As Paracelsus is said to to have said: dosis sola venenum facit. Only the dose makes the poison.

(I don't think this applies to thallium, though.)

 

[missy]

"

China's CanSino Seeks More Vaccine Contracts After AstraZeneca Deal​

By Brenda Goh and Miyoung Kim
September 01, 2023

SHANGHAI (Reuters) - China's CanSino Biologics, which recently announced a contract manufacturing deal to support AstraZeneca's messenger RNA (mRNA) technology vaccine programme, is in talks with more firms on similar deals, its CEO said, as it seeks new revenue streams to make up for plummeting COVID vaccine demand.
CanSino begun researching mRNA technology in 2018 and has built a facility in Shanghai that can produce up to 200 million doses a year, giving it the capacity to provide similar services to other companies, CanSino's CEO and co-founder Xuefeng Yu told Reuters in an interview.
"This is the first step," he said, describing the AstraZeneca deal announced earlier this month as "a business model."
"We do have discussions with not just the multinational giants, we also discuss with partners in Malaysia, Indonesia and Mexico, Argentina, any market that may need our technology and product."

AstraZeneca said the deal would support investigational mRNA vaccines early in its pipeline, but the companies have declined to provide any further details.




CanSino, whose one-dose COVID shot is approved for sale in countries including China and Mexico, saw its revenues soar in 2021 at the height of the pandemic, but like many of its peers its sales have since tumbled as demand waned.
CanSino heavily relies on COVID vaccines and meningococcal vaccines for revenue. On Wednesday, it reported a gross loss of 776.5 million yuan ($106.5 million) in the first half, mainly due to reduced COVID vaccine sales and write-downs of unsold COVID vaccines.
Yu expected no further significant writedowns involving unsold COVID vaccines.

The company has paused its clinical trials for mRNA COVID vaccine candidates, and will explore using the technology for other diseases. It is also looking at other uses for its factory in Tianjin which makes its COVID shot, Yu added.
"That facility shares the same platform technology with other vaccines, it could easily be used for other vaccine production," Yu said. CanSino's pipeline includes vaccines aimed at infections and diseases such as tetanus and polio.
The company made headlines last year when its inhalable version of COVID vaccine was approved for use in China. It is now developing an inhalable vaccine against the zoster virus, as the inhalable COVID vaccine stimulated strong mucosal immunization and a robust immune response, Yu said.
China's healthcare industry has in the past month come under pressure from Chinese regulators who launched an anti-corruption campaign targeting rampant graft and bribery in sales practices.

Yu said it would be difficult for him to comment on the campaign's impact, adding that CanSino was complying with the rules and had an audit and compliance team that reported directly to him.

"I hope the system can go on to the right track and they can encourage the right practices," he added.



(Reporting by Brenda Goh and Miyoung Kim; editing by Miral Fahmy)


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COVID-19 Hospitalizations and Deaths on the Rise​

Jay Croft
September 01, 2023




COVID-19 hospitalizations rose by 19% last week and COVID deaths by 21%, according to figures from the CDC. More than half the states, 26, had a "substantial increase" in hospital admissions.
Only Alaska, New Hampshire, and North Dakota saw drops in admissions, the CDC said. Rates for the other states went up or remained stable. South Dakota had the biggest jump in hospitalizations at 127%.
The CDC says a jump is "substantial" when admissions go up by at least 20% in a week.
"Overall, I would expect cases and hospitalizations to increase – then decrease again before they rise in the late fall and early winter," Peter Chin-Hong, MD, an infectious disease expert at the University of California San Francisco, told NEXSTAR news service.

"This has been the pattern for the past three years and may be where COVID may settle to: a smaller swell in the summer and a larger increase in cases in the late fall and winter," he said.




The FDA and CDC should provide details soon about the availability of a new booster shot, NEXSTAR reported. A new booster shot to fight a recent strain of the Omicron variant could be approved by the end of September.

Sources​

NEXSTAR: "26 states see 'substantial' spike in COVID hospitalizations, CDC says."

CDC: "United States COVID-19 Hospitalizations, Deaths, Emergency Department (ED) Visits, and Test Positivity by Geographic Area."

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5 Questions for COVID Experts: How Concerned Should We Be?​

Damian McNamara, MA


COVID-19 hospitalizations have been on the rise for weeks as summer nears its end, but how concerned should you be? SARS-CoV-2, the virus behind COVID, continues to evolve and surprise us. So COVID transmission, hospitalization, and death rates can be difficult to predict.

WebMD turned to the experts for their take on the current circulating virus, asking them to predict if we'll be masking up again anytime soon, and what this fall and winter might look like, especially now that testing and vaccinations are no longer free of charge.

Question 1: Are you expecting an end-of-summer COVID wave to be substantial?​

Eric Topol, MD: "This wave won't likely be substantial and could be more of a 'wavelet.' I'm not thinking that physicians are too concerned," said Topol, founder and director of Scripps Research Translational Institute in La Jolla, CA, and editor-in-chief of Medscape Medical News, our sister news site for healthcare professionals.



Thomas Gut, DO: "It's always impossible to predict the severity of COVID waves. Although the virus has generally mutated in ways that favor easier transmission and milder illness, there have been a handful of surprising mutations that were more dangerous and deadly then the preceding strain," said Gut, associate chair of medicine at Staten Island University Hospital/Northwell Health in New York City.



Robert Atmar, MD: "I'll start with the caveat that prognosticating for SARS-CoV-2 is a bit hazardous as we remain in unknown territory for some aspects of its epidemiology and evolution," said Atmar, a professor of infectious diseases at Baylor College of Medicine in Houston. "It depends on your definition of substantial. We, at least in Houston, are already in the midst of a substantial surge in the burden of infection, at least as monitored through wastewater surveillance. The amount of virus in the wastewater already exceeds the peak level we saw last winter. That said, the increased infection burden has not translated into large increases in hospitalizations for COVID-19. Most persons hospitalized in our hospital are admitted with infection, not for the consequences of infection."

Stuart Campbell Ray, MD: "It looks like there is a rise in infections, but the proportional rise in hospitalizations from severe cases is lower than in the past, suggesting that folks are protected by the immunity we've gained over the past few years through vaccination and prior infections. Of course, we should be thinking about how that applies to each of us — how recently we had a vaccine or COVID-19, and whether we might see more severe infections as immunity wanes," said Ray, who is a professor of medicine in the Division of Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore.

Question 2: Is a return to masks or mask mandates coming this fall or winter?​

Topol: "Mandating masks doesn't work very well, but we may see wide use again if a descendant of [variant] BA.2.86 takes off."


Gut: "It's difficult to predict if there are any mask mandates returning at any point. Ever since the Omicron strains emerged, COVID has been relatively mild, compared to previous strains, so there probably won't be any plan to start masking in public unless a more deadly strain appears."


Atmar : "I do not think we will see a return to mask mandates this fall or winter for a variety of reasons. The primary one is that I don't think the public will accept mask mandates. However, I think masking can continue to be an adjunctive measure to enhance protection from infection, along with booster vaccination."

Ray: "Some people will choose to wear masks during a surge, particularly in situations like commuting where they don't interfere with what they're doing. They will wear masks particularly if they want to avoid infection due to concerns about others they care about, disruption of work or travel plans, or concerns about long-term consequences of repeated COVID-19."

Question 3: Now that COVID testing and vaccinations are no longer free of charge, how might that affect their use?​

Topol: "It was already low, and this will undoubtedly further compromise their uptake."

Gut: "I do expect that testing will become less common now that tests are no longer free. I'm sure there will be a lower amount of detection in patients with milder or asymptomatic disease compared to what we had previously."

Atmar: "If there are out-of-pocket costs for the SARS-CoV-2 vaccine, or if the administrative paperwork attached to getting a vaccine is increased, the uptake of SARS-CoV-2 vaccines will likely decrease. It will be important to communicate to the populations targeted for vaccination the potential benefits of such vaccination."

Ray: "A challenge with COVID-19, all along, has been disparities in access to care, and this will be worse without public support for prevention and testing. This applies to everyone but is especially burdensome for those who are often marginalized in our healthcare system and society in general. I hope that we'll find ways to ensure that people who need tests and vaccinations are able to access them, as good health is in everyone's interest."

Question 4: Will the new vaccines against COVID work for the currently circulating variants?​

Topol: "The XBB.1.5 boosters will be out Sept. 14. They should help versus EG.5.1 and FL.1.5.1. The FL.1.5.1 variant is gaining now."

Gut: "In the next several weeks, we expect the newer monovalent XBB-based vaccines to be offered that offer good protection against current circulating COVID variants along with the new Eris variant."
Atmar: "The vaccines are expected to induce immune responses to the currently circulating variants, most of which are strains that evolved from the vaccine strain. The vaccine is expected to be most effective in preventing severe illness and will likely be less effective in preventing infection and mild illness."

Ray: "Yes, the updated vaccine design has a spike antigen (XBB.1.5) nearly identical to the current dominant variant (EG.5). Even as variants change, the boosters stimulate B cells and T cells to help protect in a way that is safer than getting COVID-19 infection."

Question 5: Is there anything we should watch out for regarding the BA.2.86 variant in particular?​

Topol: "The scenario could change if there are new functional mutations added to it."



Gut: "BA.2.86 is still fairly uncommon and does not have much data to directly make any informed guesses. However, in general, people that have been exposed to more recent mutations of the COVID virus have been shown to have more protection from newer upcoming mutations. It's fair to guess that people that have not had recent infection from COVID, or have not had a recent booster, are at higher risk for being infected by any XBB- or BA.2-based strains."

Atmar: "BA.2.86 has been designated as a variant under monitoring. We will want to see whether it becomes more common and if there are any unexpected characteristics associated with infection by this variant."

Ray: "It's still rare, but it's been seen in geographically dispersed places, so it's got legs. The question is how effectively it will bypass some of the immunity we've gained. T cells are likely to remain protective, because they target so many parts of the virus that change more slowly, but antibodies from B cells to spike protein may have more trouble recognizing BA.2.86, whether those antibodies were made to a vaccine or a prior variant."

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One in Five Doctors With Long COVID Can No Longer Work: Survey​

Claire Sibonney


Crippling symptoms, lost careers, and eroded incomes: This is the harsh reality for doctors suffering with long COVID, according to the first major survey of physicians with the condition.
The survey, conducted by the British Medical Association (BMA) and the Long COVID Doctors for Action support group, sheds light on the lingering effects of long COVID on more than 600 chronically ill and disabled doctors with the condition. It also spotlights what they describe as a lack of medical and financial support from their government and employers at the National Health Service (NHS).
"We feel betrayed and abandoned," said Kelly Fearnley, MBChB, chair and co-founder of Long COVID Doctors for Action. "At a time of national crisis, when healthcare workers were asked to step up, we did. When the nation needed us, we stepped up. We put our lives on the line. We put our families' lives on the line. And now that we are injured after knowingly being unprotected and deliberately and repeatedly exposed to a level-three biohazard, we now find ourselves in this position."

Fearnley fell ill while working in a hospital's COVID ward in November 2020. He is one of an estimated two million people in the UK — including thousands of NHS employees — with long COVID. She hasn't been able to return to work in nearly 3 years.
SUGGESTED FOR YOU



Long COVID affects more than 65 million people worldwide. It is estimated that 1 in 10 people infected with the virus develop long-term symptoms. In the UK, healthcare and social care workers are seven times more likely to have had severe COVID-19 than other types of employees.
Doctors responding to the BMA survey reported a wide range of long COVID symptoms, including fatigue, headaches, muscular pain, nerve damage, joint pain, and respiratory problems.
Among the survey's key findings, 60% of doctors said long COVID has affected their ability to carry out day-to-day tasks on a regular basis. Almost 1 in 5 (18%) said they were no longer able to work, while fewer than 1 in 3 (31%) were working full time. This compares to more than half (57%) of respondents working full time before the onset of their COVID illness — a decline of 46%.

Nearly half (48%) of respondents said they have experienced some form of loss of earnings as a result of long COVID, and almost half of the doctors were never referred to an NHS long COVID clinic. The survey included the following first-person accounts from doctors living with the condition.

• One doctor said: "I nearly lost my life, my home, my partner and my career. I have received little support to help keep these. The impact on my mental health nearly cost [me] my life again."
• A senior consulting physician commented: "Life is absolutely miserable. Every day is a struggle. I wake up exhausted, the insomnia and night terrors are horrendous as I live through my worst fears every night. Any activity such as eating meals, washing etc will mean I have to go to bed for a few hours. I am unable to look after myself or my child, exercise or maintain social relationships. I have no financial security. Long COVID has totally destroyed my life."
• A salaried general practitioner said: "I can no longer work, finances are ruined. I didn't have employment protection so am now unemployed and penniless."

Calls for action from the BMA include the following:

• Financial support for doctors and healthcare staff with long COVID;
• The recognition of long COVID as an occupational disease among healthcare workers, along with a definition of the condition that covers all of the debilitating disease's symptoms;
• Improved access to physical and mental health services to help comprehensive assessment, investigations, and treatment;
• Greater workplace protection for healthcare staff who risk their lives for others;
• Better support for long COVID sufferers to return to work safely if they can, including a flexible approach to the use of workplace adjustments.

"One would think, given the circumstances under which we fell ill and current workforce shortages, NHS employers would be eager to do everything to facilitate the return to work of people with long COVID," said Fearnley. "However, NHS employers are legally required to implement only 'reasonable adjustments,' and so things such as extended phased return or adjustments to shift patterns are not always being facilitated. Instead, an increasing number of employers are choosing to terminate contracts."

Raymond Agius, the BMA's occupational medicine committee co-chair, also put the blame on inadequate safety measures for doctors. Those inadequte measures persist to this day, inasmuch as UK hospitals have dropped masking requirements.

"During the COVID-19 pandemic, doctors were left exposed and unprotected at work," he said in a BMA press release. "They often did not have access to the right PPE.... Too many risk assessments of workplaces and especially of vulnerable doctors were not undertaken."




A small minority of doctors who were surveyed said they had access to respiratory protective equipment (RPE) about the time they contracted COVID-19. Only 11% had access to an FFP2 respirator (the equivalent of an N95 mask); 16% had an FFP3 respirator (the equivalent of an N99 mask).


To date, the British government hasn't issued much of a response to the survey, saying only that it has invested more than ₤50 million to better understand long COVID.

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Three Shots for Fall: What You Need to Know

The F.D.A. approved a new shot to protect infants from a deadly respiratory virus. And here’s what we know about who should get the flu, Covid and R.S.V. vaccines, and when.

www.nytimes.com

Three Shots for Fall: What You Need to Know

​

The F.D.A. approved a new shot to protect infants from a deadly respiratory virus. And here’s what we know about who should get the flu, Covid and R.S.V. vaccines, and when.


This fall, in addition to the flu and Covid vaccines, older Americans will be able to get a shot for respiratory syncytial virus.Credit...Frederic J. Brown/Agence France-Presse

By Apoorva Mandavilli

Most Americans have had one or more shots of the flu and Covid vaccines. New this year are the first shots to protect older adults and infants from respiratory syncytial virus, a lesser-known threat whose toll in hospitalizations and deaths may rival that of flu.
Federal health officials are hoping that widespread adoption of these immunizations will head off another “ of respiratory illnesses, like the one seen last winter. For people with insurance, all of the vaccines should be available for free.
]“This is an embarrassment of riches,” said Dr. Ofer Levy, director of the precision vaccines program at Boston Children’s Hospital and an adviser to the Food and Drug Administration.
Here’s what he and other experts say about who should receive which immunizations, and when.

What respiratory illnesses are coming our way?​

The coronavirus, flu and R.S.V. are all likely to resurge this fall, but exactly when and how much damage they will do are unknown. That’s in part because the restrictions in place during the pandemic altered the seasonal patterns of the viruses.
This past winter, the flu peaked in December instead of in February, when it typically does. The virus may have caused as many as 58,000 deaths, a higher number than usual. Covid kept up a steady number of infections and deaths most of the season, with a peak in January.
Compared with its pattern before the pandemic, R.S.V. peaked several weeks earlier last year, and it circulated for longer than usual.
R.S.V. is increasingly recognized as a major respiratory threat, particularly to older adults, immunocompromised people and young children. “R.S.V. has a burden of disease similar to flu in older adults — it can make you very, very sick,” said Dr. Helen Chu, a physician and immunologist at the University of Washington.
Scientists expect respiratory viruses to return to their prepandemic patterns eventually, but “it’s going to be unpredictable for the next two years,” Dr. Chu said.

Which vaccines should I seek out?​

Everyone should have at least the flu and Covid shots this fall, experts said.
The annual flu vaccine is recommended for everyone 6 months and older, but it is most important for adults ages 65 and older, children under 5 and people with weak immune systems.

​

Updated Covid shots are expected this fall from Pfizer, Moderna and Novavax, and all are designed to target XBB.1.5, the Omicron variant that currently accounts for roughly 12 percent of cases. The full recommendations will not be available until the F.D.A. authorizes the shots and the Centers for Disease Control and Prevention reviews new data.


Federal health officials aren’t talking about a primary series of shots followed by boosters. (Officials aren’t even calling the shots “boosters” anymore.) Instead, they are trying to steer Americans toward the idea of a single annual immunization with the latest version of the vaccine.

“Like a seatbelt in a car, it’s a good idea to keep using it,” Dr. Camille Kotton, a physician at Massachusetts General Hospital and an adviser to the C.D.C., said of the Covid vaccine.

R.S.V. is a frequent cause of respiratory illness among young children and seniors, particularly those 75 and older who have other conditions, such as cardiovascular disease, chronic lung disease or diabetes.

The C.D.C. in August recommended a new shot against R.S.V. — Beyfortus, a monoclonal antibody — to protect infants less than 8 months old and infants 8 months to 19 months if they are at risk for severe illness.

On Aug. 21, the F.D.A. did approve the use of Pfizer’s vaccine, Abrysvo, for pregnant women as a way to protect infants from the virus. The vaccine, to be given in the last weeks of pregnancy, would provide maternal antibodies that travel through the placenta and is expected to prevent severe respiratory illness in infants up to 6 months.

Abrysvo and another R.S.V. vaccine, Arexvy, are not yet approved for most Americans younger than 60. The C.D.C. now recommends that people ages 60 and older get immunized after consulting with their doctors.

While it’s true that risks posed by any of the three viruses increase with age, remember that “65 is not a magical cutoff point,” Dr. Chu said.

“Even those with no pre-existing conditions can become quite sick with all three of these viruses,” she said.

When should I get the vaccines?​

No one knows when these viruses will re-emerge, so you should get the shots early enough in the fall to build immunity against the pathogens. Most people will not want or be able to make multiple trips to a clinic or pharmacy to space the shots apart.

That probably means September or October. Most Americans may want to consider receiving the flu and Covid shots at the same time, so they are prepared to face either virus. Older adults who are in poor health — who have heart or lung disease, for example, or are on home oxygen — should get all three shots simultaneously, some experts said.

They should “get them as quickly as possible and definitely before the season, and do it all at once,” Dr. Chu said.

Adults 50 and older should also get the vaccine for shingles, if they haven’t already, and those 65 and older should sign up for the pneumococcal vaccine. But those vaccines don’t need to be given in the fall and can be scheduled for a different time, Dr. Chu said.

Is it safe to get these vaccines at once?​

The flu and Covid shots were often given together last fall and seemed to work well. Because the R.S.V. vaccine is new, however, there is little information on how it might interact with the other two vaccines.

“The available data pertaining to the administration of influenza and Covid-19 vaccines at the same time do not indicate safety concerns,” the Department of Health and Human Services said in a statement to The New York Times.

“F.D.A. and C.D.C. systems monitor vaccine safety year round and will remain in place,” the department said. “If any new potential safety signals are identified, the F.D.A. and C.D.C. will conduct further assessment and inform the public.”

Some research suggests that the R.S.V. and flu vaccines produce lower levels of antibodies when given together than when delivered one at a time. But those levels are probably still high enough to protect people from the viruses, experts said.

There is also limited data on the safety of the two R.S.V. vaccines. Clinical trials recorded six cases of neurological problems, including Guillain-Barré syndrome, compared with none in the placebo groups.

But the numbers were too small to determine whether the cases were a result of the inoculations. More clarity will come from surveillance while the vaccines are administered on a large scale, Dr. Chu said.

The C.D.C. is expected to make recommendations on administration of the vaccines together in the coming weeks.

Christina Jewett contributed reportng.

Apoorva Mandavilli is a reporter focused on science and global health. She was a part of the team that won the 2021 Pulitzer Prize for Public Service for coverage of the pandemic. More about Apoorva Mandavilli



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BA.2.86 update​

KATELYN JETELINA SEP 5

Since the last BA.2.86 update, lab and epidemiological data have trickled in. Many of us took a big sigh of relief after seeing specific results over the weekend.

Here is your update.

Lab data​

Three labs have already tested BA.2.86 in a petri dish. (The speed of scientific discovery for SARS-CoV-2 still amazes me). They found three main things:

1. Escapes immunity. As suspected, BA.2.86 can escape our neutralizing antibodies— our immune system’s first line of defense. We thought BA.2.86 would escape our antibodies ~10 times more than XBB (the most recent Omicron subvariant to sweep the U.S.), but it’s only escaping 2-3 fold. In other words, we can expect BA.2.86 to cause infections, but not as much as anticipated.
   

   ​

   Source here
2. Infectivity. BA.2.86 has a more challenging time infecting our cells than XBB. The more difficult time it has getting into our cells, the better. (When a virus evolves, there are typically tradeoffs—it gets better at one thing but at the expense of another. It seems that BA.2.86 traded infectivity for antibody escape.)

​

1. Previous XBB infection helps protect against BA.2.86. This news is very reassuring for our fall vaccines, as the updated formula includes XBB.

All good news. But, of course, what happens in a well-controlled lab doesn’t always reflect what happens in the real world. So, it’s essential to look at epidemiological data, too.

Epidemiological data​

We continue to find cases of BA.2.86. The latest count is 39 samples in 10 countries. Wastewater systems have also detected BA.2.86 in the U.S., Switzerland, Thailand, and Spain. This means BA.2.86 isn’t a random blip on our radar and is spreading.

Our biggest question is around “growth advantage”: How quickly is it spreading? Especially in the current landscape of high immunity? This will give us an idea of the timing and height of a BA.2.86 wave. Unfortunately, determining this is incredibly challenging today because we need enough cases in the same country, but our surveillance is down 90%.

But three brave souls have given it a shot:

• Weekly growth rate: 41% to 86% by Alex Selby
• Weekly growth rate: 35% by Nick Rose
• Daily growth rate: 21% by Oliver Johnson

These initial estimates suggest that BA.2.86 isn’t spreading as fast as the original Omicron (which had a weekly growth rate of 400%) but faster than XBB. In other words, we won’t have a tsunami, but a BA.2.86 wave is possible.

This can change. These estimations have a ton of limitations and we just don’t have a lot of data points to go off of. And like we’ve seen before, a variant can gain or lose speed over time. Delta, for example, started really slowly in the beginning before taking off.

​

Number of Delta cases over time. Figure Source: Marc Johnson

Other questions​

We’ve started getting answers about how well our tools work against BA.2.86, too:

• Paxlovid: Works
• Antigen tests: Works
• Monoclonal antibodies: Don’t work (but they also don’t work against XBB)

We still have unanswered questions:

• Where did it emerge?
• How did it emerge?
• Does it spread faster in some places but not others?
• Does it cause more severe disease? We don’t think so, but it would be nice to see data.

Bottom line​

BA.2.86 has a ton of mutations, but the initial puzzle pieces look reassuring. We are at the mercy of time to see how this unfolds.

None of this changes the bigger story arc, though: SARS-CoV-2 continues to mutate and continues to cause illness and death. In fact, we are currently in a wave right now from Omicron subvariants. Regardless of what BA.2.86 does, our work for the fall/winter is already cut out. At the very least, get a COVID-19 vaccine this fall.




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How to Help Patients Navigate a Newly Complex Vaccine Season​

— The primary message should focus on the importance of the flu, RSV, and COVID vaccines​

by Judith A. O’Donnell, MD September 5, 2023

O’Donnell is an infectious diseases physician and a hospital epidemiologist.
In years past, once the calendar moved into September, there were straightforward recommendations across healthcare settings being provided to all adult patients about the benefits of receiving the annual influenza vaccine. Healthcare providers and patients are no longer in such a simple landscape for fall 2023. Along with the already-available influenza vaccines, two recently approved vaccinesopens in a new tab or window to prevent respiratory syncytial virus (RSV)opens in a new tab or window are now available for older individuals, and the new updated COVID-19 boosters are expected to arrive toward the middle or end of September.

The Advisory Committee on Immunization Practices (ACIP) has clear guidance on influenza vaccines and those recommendations have not changed -- everyone is recommended to get a flu shot. ACIP has also released formal guidanceopens in a new tab or window around RSV vaccinations in adults 60 and older, but has yet to provide recommendations on use of one of the RSV vaccines, Abrysvo, which has also been approved for use in pregnant womenopens in a new tab or window to prevent RSV disease in infants. Guidance on who should receive the upcoming COVID-19 boosters, which will target an XBB strainopens in a new tab or window, is not yet available from ACIP or CDC. Additionally, there are questions about timing of each of these vaccines, and whether they can be administered together or should be separated over time.
So, what are healthcare providers to do when trying to determine who will gain the most benefits from these three vaccines to prevent respiratory infections?
Flu Vaccines

Everyone 6 months of age and older should receive an influenza vaccine. Influenza vaccination not only prevents infection, it also significantly decreases the risk of severe disease, need for hospitalization, and death in those who are vaccinated and then get infected with influenza. People who are ages 65 and older should receive the high-dose influenza vaccine preparations. New this year, people with egg allergies can be vaccinated withoutopens in a new tab or window special additional safety measures needed. They can receive any influenza vaccine (egg-based or non-egg-basedopens in a new tab or window) that is otherwise appropriate for their age.
It is not possible to predict when seasonal influenza will arrive, but it typically peaks in December-January. Getting vaccinated in September or October will still provide protection even if the flu season arrives in February or March.
RSV Vaccines
RSV may cause severe lower respiratory tract infections (LRTIs) in older adults and infants. Two RSV vaccines were approved by the FDA in May for the prevention of LRTIs in adults ages 60 and older. In June, the ACIP formally recommended that people ages 60 and above may receive a single dose of an RSV vaccine, using shared clinical decision-making. This means that the decision to proceed with RSV vaccination should be made between the patient and their healthcare provider after a discussion of the patient's underlying health conditions, their risk of severe RSV-associated LRTI, and the potential benefits, risks, and limitations of vaccination. Patients 60 and over with chronic lung diseases, asthma, congestive heart failure, coronary artery disease, diabetes, chronic kidney or liver diseases, and moderate or severe immunosuppression are among those most likely to benefit from RSV vaccination.

For eligible patients who decide they want to receive an RSV vaccine, the time to get vaccinated is now. Note that RSV vaccination should be offered without regard to seasonality to any unvaccinated adult who is in the target population (based on age and chronic conditions). With respect to severe side effects after an RSV vaccination, a small number of patients in the original vaccine trails did experience serious neurologic conditions including Guillain-Barré syndrome. However, these occurred rarely and it was not clear whether the vaccine caused the events. As part of any shared decision-making discussions, patients should be provided the CDC's RSV Vaccine Information Statement found hereopens in a new tab or window to help drive the conversation and decisions.
As noted above, one of the two approved RSV vaccines (Abrysvo, manufactured by Pfizer) was also approved in late August for use in women who are 32 to 36 weeks pregnant, as a tool to protect RSV in infants from birth to age 6 months. The vaccine was generally well tolerated with minimal side effects. There was a slightly increased incidence of preterm birth in the group who received the RSV vaccine, although a causal relationship has not been determined. The ACIP has yet to weigh in on guidance for use of the RSV vaccine in pregnancy, though it is under review and expected in the near future. When the time comes, this information should be provided to pregnant women considering RSV vaccination.

Updated COVID-19 Vaccines
The updated COVID-19 vaccines are expected in late September. They will target the XBB.1.5 strainopens in a new tab or window of Omicron, which has circulated widely throughout the U.S. for much of 2023. These vaccines have not yet been evaluated by the FDA, and CDC and ACIP have not yet provided guidance. However, it is widely expected that once approved, the updated COVID-19 vaccines will be recommended for all adults 65 and older, for adults of any age with chronic medical conditions that make the risk of severe COVID more likely, for anyone with moderate or severe immunocompromising conditions, and for those who are pregnant.
The big questions will be focused on other populations such as healthy adults 50-65, adults under age 50 with chronic conditions, and teens and older children. Shared decision-making will probably be recommended for these groups. Patients who have had a recent COVID-19 infection should wait at least 3 months before getting a fall 2023-updated COVID vaccine. The same goes for patients who received a dose of the current bivalent vaccines any time since July 2023. Patients with severe immunocompromising conditions should discuss timing with their healthcare providers.

With COVID-19 rates on the rise nationally, there have been renewed questions about boosting those who are eligible now. Given that the updated COVID-19 vaccines are expected this month, most experts are advising patients to wait for the updated vaccine.
In terms of timing for getting vaccinated with the upcoming updated COVID-19 vaccines, individuals not in the higher risk groups may also want to consider when they want the highest level of protection, since we know that protective immunity begins to wane after about 2 to 3 months. For example, if someone is planning to spend the winter holidays traveling or with extended families in large indoor gatherings, then they may want to time their updated COVID-19 vaccine for late October or early November.
Timing and Co-Administration of Respiratory Virus Vaccines
Patients can receive an influenza vaccine simultaneously with either the RSV vaccine or the updated COVID-19 vaccines. Whenever multiple vaccines are administered at the same time, the injection sites should be spaced appropriately from one another, or in opposite arms. There are no data around co-administration of the RSV vaccines and COVID-19 vaccines. Most experts are recommending a 2-week period between receiving an RSV vaccine and the updated COVID-19 vaccine, but there are no data to guide these decisions, and patients should be encouraged to do what works best for them and their schedules. Some patients may be unable to make three separate trips to their provider's office or local pharmacy for the injections, and we don't want that to be a barrier to getting immunized. Although the landscape around fall vaccines is more complex this year, the overarching message healthcare providers should be sharing with their patients is how important these immunizations are to staying healthy during winter respiratory virus season.
Judith A. O'Donnell, MD,opens in a new tab or window is chief of infectious diseases, director of infection prevention, and hospital epidemiologist at Penn Presbyterian Medical Center. She is also professor of clinical medicine at the University of Pennsylvania Perelman School of Medicine in Philadelphia.

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[missy]

"

Cancer Patients More Likely to Die During COVID Pandemic​

— Omicron wave was especially deadly, and those with blood cancers at increased risk​

by Mike Bassett, Staff Writer, MedPage Today September 1, 2023

Cancer patients experienced significantly higher rates of COVID-19-related deaths compared with the general public, according to two retrospective studies from the U.S. and Canada.
In a cross-sectional study published in JAMA Oncologyopens in a new tab or window, researchers found that the winter Omicron surge of 2021-2022 was particularly deadly, as the number of deaths among U.S. cancer patients increased by 18% compared with the winter surge of the wild-type variant (December 2020-February 2021), reported Chi-Fu Jeffrey Yang, MD, of Massachusetts General Hospital in Boston, and colleagues.

In contrast, there were 21% fewer COVID deaths in the general population during the winter Omicron surge compared with the previous winter's surge.
These findings "suggest that patients with cancer had a disparate burden of COVID-19 mortality during the winter Omicron wave compared with the general U.S. population," Yang and colleagues wrote. "With the emergence of new, immune-evasive SARS-CoV-2 variants, many of which are anticipated to be resistant to monoclonal antibody treatments, strategies to prevent COVID-19 transmission should remain a high priority."
Findings on COVID mortality across all cancer sites evaluated were consistent, with the exception of brain, thyroid, and bladder cancers.
COVID mortality increased the most among patients with lymphoma (mortality ratio 1.38, 95% CI 1.31-1.45) during the winter Omicron wave compared with the wild-type period.
Yang's group suggested that the greater mortality burden experienced by cancer patients was likely due to the increased transmissibility of the Omicron variant, a relaxation in policies geared to prevent COVID transmission, reduced effectiveness of vaccines in patients with cancer, and a greater risk of severe disease in those individuals.

In another study published in JAMA Network Openopens in a new tab or window, researchers found that patients with hematologic malignancies were at increased risk of COVID infection from January 2020 through November 2021 compared with the general Canadian population (adjusted HR 1.19, 95% CI 1.13-1.25), while those with solid tumors were at a lower risk (aHR 0.93, 95% CI 0.91-0.95).
Notably, both groups of cancer patients had increased risks of 14-day hospitalization and 28-day mortality, reported Kelvin K.W. Chan, MD, PhD, of the Odette Cancer Centre at Sunnybrook Health Sciences Centre in Toronto, and colleagues:

• Hematologic malignancies: aHR 1.75 (95% CI 1.57-1.96) and aHR 2.03 (95% CI 1.74-2.3, respectively
• Solid tumors: aHR 1.11 (95% CI 1.05-1.1 and aHR 1.31 (95% CI 1.19-1.44)

Following hospitalization, the 28-day mortality rate after COVID infection was 50.7% in patients with hematologic malignancies and 45.8% in those with solid tumors.
However, the risk of 21-day intensive care unit (ICU) admission in patients with hematologic malignancies (aHR 1.14, 95% CI 0.93-1.40) or solid tumors (aHR 0.93, 95% CI 0.82-1.05) was not significantly different from the risks among people without cancer.

"These findings highlight the importance of prioritization strategies regarding ICU access to reduce the mortality risk in increased-risk populations, such as patients with cancer," Chan and team wrote.
Chan and colleagues also noted that COVID risk decreased stepwise with increasing numbers of COVID vaccine doses received (one dose: aHR 0.63, 95% CI 0.62-0.63; two doses: aHR 0.16, 95% CI 0.16-0.16; three doses: aHR 0.05, 95% CI 0.04-0.06).
Study Details
In their study, Yang and colleagues used data from the CDC's Wide-Ranging Online Data for Epidemiologic Research (WONDER) database to identify 34,350 patients (57.8% men) with cancer and 628,156 members of the general public (55.9% men) who died from COVID-19 during the wild-type variant wave (December 2020-February 2021), the Delta wave (July 2021-November 2021), and the winter Omicron wave (December 2021-February 2022).
The authors noted that the number of patients with cancer who died from COVID in the WONDER database was likely underestimated, since patients with a remote history of cancer may not have had cancer recorded in their death certificate and may not have been included in the study cohort. In addition, the database does not include data on vaccination status or cancer staging.

For the Canadian cohort study, Chan and team used data from the Ontario Cancer Registry on 11,732,108 community-dwelling adults from January 2020 through November 2021.
Of these adults, 279,287 had cancer (57.2% women, mean age 65.9) and 11,452,821 people did not have cancer (45.7% women, mean age 65.9). Overall, 4.1% developed COVID.
The cumulative incidence of COVID infection was 2.9% among those with solid tumors, 3.5% among those with hematologic malignancies, and 4.0% in the non-cancer population.
Study limitations included the fact that the authors did not have access to data on patients admitted to hospice or patients' preferences for hospitalization or ICU admission at the individual level.





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[missy]

"
Perspective

Mass Masking without Mandates — The Role of Gender in Mask Use in China​

List of authors.

• Meng Zhang, Ph.D.

During the Covid-19 pandemic, government public health mandates in China and many parts of the world made wearing a mask a social norm for people of all genders. But when people have been allowed to decide for themselves about masking, gender norms have sometimes become an important factor. Research based on current public health surveys might give us some insight into gender-based trends, but a historical perspective provides a complex picture. In China, for instance, there have been moments in history when both public health authorities and the general public considered masking during epidemics to be a personal matter rather than the domain of the regulatory state.
During the Great Manchurian Plague of 1910 and 1911, draconian government measures left little room for laypeople to choose whether to wear a mask: they faced inspection by the armed sanitary police, who could impose quarantines. But after the less-regulated experiences during the Spanish influenza pandemic of 1918, the second Manchurian plague of 1920 and 1921, and other severe epidemics, members of the Chinese medical elite became aware that promoting compulsory masking among untrained laypeople would be very difficult.

During Nationalist Party control of the Nanjing government from 1928 to 1937, antigovernment strikes and uprisings were common, and central public health officials hesitated to promote compulsory hygienic measures — including mass masking, quarantines, and other regulations — for fear of triggering rebellions. Possibly for this reason, even as it sought to prevent meningitis (an emerging airborne disease) from spreading in big cities in 1929, the central government did not issue any strict mandates. Instead, it simply announced a national recommendation that masks be worn.1 It was against this background that gender began to influence the popularity of masks.
Figure 1.

Newspaper Cartoon Showing That Masks Were Popular in Peiping (Beijing) in 1929.
We lack the data to determine the exact percentages of people in each city who wore masks during the meningitis season, but contemporary popular media reveal that masks were a hot topic and that men were more likely to follow the authorities’ recommendations than women. Dr. Tang Yunzhong noted that in Shanghai, many Chinese people were wearing masks.2 And a popular magazine based in Beijing (Peiping) documented the mask fashion among men in a cartoon depicting policemen, academics, and businessmen all wearing masks on the street (Figure 1), with a caption saying gauze masks were probably not good enough for filtering contagious meningitis and should be replaced by gas masks.3
Figure 2.

A Young Woman Refuses to Wear a Mask Offered by Her Father.
But whereas many men adopted masks, women seldom did. In the 1930s, there were reports in the popular press of female celebrities, young women from eminent families, wives of prominent men, and prostitutes all shying away from mask wearing. Many newspapers run by male followers of science responded to this reluctance by publishing cartoons ridiculing young women’s unwillingness to wear masks. One cartoon even told the story of a young, modern-looking Chinese woman who refused to wear a mask offered by her father because she thought it was ugly…and then died of a contagious disease, leaving her parents filled with regret over not having forced the issue (Figure 2).4 Of course, most editors and authors were men at that time — when, according to historian and gender studies scholar Eugenia Lean, “men were obsessively writing about the plight of women in Chinese society and promoting models of new womanhood.” The popular discourse about women’s ignorance regarding mask wearing may have suited some Chinese men’s image of women as uneducated, weak, and silly.


Concerned about this gendering of mask wearing, some male scholars called for aesthetic enhancement of masks to make them appealing to female customers. Businesses found a new market in the 1930s by introducing disinfected handkerchiefs as a suitable and appealing replacement for masks — at the time, upper-class women saw it as an elegant gesture to use a handkerchief to cover their mouth when they grinned. “Masks are not convenient to wear and affect your appearance,” read a pharmacy advertisement in Shenbao, a Shanghai newspaper. “Our pharmacy invited renowned physicians to invent an anti-plague handkerchief; using it to cover your face will be much more elegant than wearing an ugly mask.” Before being shipped, the handkerchiefs were soaked in germicide solution that purportedly enabled them to kill pathogens. Promoting a beautiful disinfected handkerchief instead of monochromatic and visually unappealing masks was seen as an ideal method for enticing women to cover their noses and mouths to combat contagious diseases while maintaining their fashionable appearance.


After the Chinese Communist Party (CCP) established the People’s Republic of China in 1949, the rapid development of the textile industry enabled masks to be made available for the first time to the vast general population in China. As masks became a commodity for everyone, especially during the difficult years of the Cultural Revolution (1966–1976), they seem to have lost their association with masculinity. Indeed, in some places more women than men wore masks during epidemics. Liu Huangtian, a Chinese scholar who immigrated to the United States in the 1980s, recalled that when meningitis again broke out in South China in 1967, women in his hometown in Guangdong Province chose to wear masks, whereas men did not. In that tumultuous period, the official ideology of the CCP deemed individuality and sexuality to be harmful to the socialist project, and plain white masks could not only prevent diseases but also theoretically eliminate the problem of women’s sexual attractiveness. Yet ironically, Liu claimed that he and his peers found a strong feminine charm in female mask wearers.5 In a sense, a men’s public health device of the 1930s had become an item of women’s clothing by the 1960s.


More recently, during the Covid-19 pandemic, universal mask wearing took hold in many parts of the world, but there were occasional reports of people avoiding wearing masks in public spaces even in East Asian countries where mass masking had been common before Covid. Given the gender gap in mask use and mask resistance, perhaps physicians and public health officials should consider the role of gender norms and their cultural associations in influencing people’s behaviors and acceptance of public health recommendations. For example, in societies that retain a more rigid gender hierarchy, health workers might be able to persuade men to wear masks by appealing to their patriarchal responsibilities to protect their families and communities; similarly, in cultures that increasingly value communitarianism, public health messages could focus on weighing others’ health more heavily than individualism. And perhaps by the next time we need to implement universal masking, there will be fewer gender-influenced hurdles to clear.


Disclosure forms provided by the author are available at NEJM.org.
This article was published on September 2, 2023, at NEJM.org.

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[missy]

"

What to Know About Eris and the Updated COVID-19 Vaccines

An infectious disease expert explains the evolving nature of COVID-19 and what to know about the updated vaccines coming this fall.

healthmatters.nyp.org

What to Know About Eris and the Plan for Updated COVID-19 Vaccines​

An infectious disease expert explains the evolving nature of COVID-19 and shares information about the updated vaccine that will be available this fall.​

COVID-19 NEWS• Story By Amanda Torres

EG.5 — a new COVID-19 variant also referred to as Eris — has spread quickly in the United States and currently accounts for about 20% of COVID-19 cases. But while Eris has become the dominant strain in the U.S. and beyond — leading to an uptick in COVID-19 cases — the World Health Organization (WHO) recently said in a statementthat it poses a low risk to public health.
“While the uptick in infections and hospitalizations is concerning, we have not experienced a major wave at this time, and we are still at lower levels than before,” says Dr. Magdalena Sobieszczyk, chief of the Division of Infectious Diseases at NewYork-Presbyterian/Columbia University Irving Medical Center. “Symptoms are like those from other Omicron strains, such as fatigue, a sore throat, and runny nose, and because so many people have had natural infection, have been vaccinated, or both, if they get sick, a majority will have mild symptoms.”

Dr. Magdalena Sobieszczyk
Eris descends from XBB.1.9.2, one of the lineages from the Omicron variant. As COVID-19 continues to evolve, Pfizer, Moderna, and Novavax — manufacturers of COVID-19 shots — are updating the vaccine formulation to a monovalent version targeting an XBB.1.5 lineage of Omicron, as advised in June by the U.S. Food and Drug Administration (FDA).
“The new vaccines from each manufacturer will be available in the early fall, and the FDA and the Centers for Disease Control and Prevention (CDC) are expected to issue their approval and recommendations soon,” says Dr. Sobieszczyk, who is also a professor of infectious diseases in medicine at Columbia University Vagelos College of Physicians and Surgeons.
Health Matters spoke with Dr. Sobieszczyk to better understand Eris and to learn about the new vaccines coming this fall and ways people can continue to protect themselves.
What makes Eris a variant of interest?
Eris has shown rapid prevalence and growth globally as well as genetic characteristics that help it escape the protection of our immune system, whether that’s acquired immunity from a natural COVID-19 infection or immunity from vaccines. For these reasons, Eris has caused a rise in case incidence and has become dominant in some countries or even globally.
With variants of interest like Eris, the WHO takes several actions, including monitoring and tracking the variants as they spread and assessing their characteristics and public health risks over time.
Why is it important to have a new COVID-19 vaccine?
Until the new vaccines become available in early fall, we currently have the bivalent booster, which targets the BA.4 and BA.5 lineages of the Omicron variant plus the original coronavirus strain. But these strains are not circulating widely anymore.
A new vaccine can improve protection by creating an immune response that targets these new variants. Based on evidence, in their recommendation to manufacturers, the FDA had a preference for the XBB.1.5 subvariant, which started to circulate widely last winter and is genetically similar to EG.5. Compared to last year’s formulation, the new shot is expected to better protect people against EG.5; it is a better match to the currently circulating variants.
In light of the increase in cases, should people get boosted with the current bivalent vaccine or wait for the new shot?
People who are in good health and had the bivalent booster vaccine for COVID-19 in the past few months should be fine to wait until the new one becomes available in the fall, but they should still follow protective measures like handwashing and wearing a mask.
Older adults or people who are immunocompromised, or who have never had COVID-19, and whose last booster was a long time ago, should speak with their healthcare providers, who may make different recommendations, such as getting another bivalent booster, depending on the person’s health and situation. The current booster, even though it is not well matched to the most commonly circulating strains, is still doing a good job of protecting people against severe disease.
Staying up to date with vaccines is important because it benefits not only the individual but also the community around them. While the vaccine does not eliminate the risk of getting COVID-19, it makes the virus mild and lowers the risk of transmitting it to others.
Besides other health and hygiene practices like handwashing, a few preventive measures include wearing a mask and improving ventilation, if possible, such as by opening windows. Additionally, if you have been exposed to COVID-19, follow recommendations, such as getting tested immediately if you have symptoms. If you have been exposed but do not have symptoms, you should test five full days after exposure. If test results come back positive, you should stay home and away from others for at least five days, wear a mask indoors if around others, and seek treatment.
Can testing and treatments detect and treat symptoms of new variants? Is there free testing?
We know that the tests, such as the PCR, are still accurate and can pick up the virus and its new strains. And an at-home rapid test is still effective for the new variants. But it should be done at the right time. For example, if someone takes a test early on, they may have little virus present, and the test could be a false negative. That is why it is important to test again around two or three days later. Testing multiple times over a few days if you have symptoms improves the accuracy of at-home tests to over 90%.
The FDA has extended the expiration dates of some at-home rapid tests, so it’s a good idea to check with the FDA or manufacturer’s website if you have any of these tests at home. The CDC can help people who are uninsured find no-cost COVID-19 testing near them. If a person tests positive, there are medications like Paxlovid — an FDA-approved antiviral pill that reduces the amount of COVID-19 virus in the body and prevents symptoms from getting worse.
Will the COVID-19 vaccine be updated every year?
The FDA is anticipating that they will need to meet on an annual basis to see how the virus is changing, review data on circulating strains, and advise manufacturers on which strains should be selected for the vaccine.
It is what happens with the flu vaccine. There is an updated or tweaked version every year. Updating the COVID-19 vaccine composition might be a continuous process given that the virus is mutating a lot.
What should the public keep in mind as COVID-19 continues to evolve?
It is endemic now, meaning that it will remain present in circulation and can be transmitted among people. With an endemic disease, we will see spikes, like we do now. Cases will go up and down, but COVID-19 itself will not disappear.
With certain respiratory viruses, such as the flu and RSV, there is seasonality. But COVID-19 seems to be present year-round.
One question that comes up is whether an endemic disease can get worse, and the answer is yes, which is why it is important to follow protective measures. There is always a risk that the infections can spike and have outbreaks leading to epidemics or pandemics, which can happen if there is a new variant that can spread more efficiently, or if there is low vaccine uptake in the community and if natural immunity from past infections wanes. If there is a new variant circulating, for example, then mini epidemics could happen in communities, underscoring the importance of staying up to date with updated vaccines.
Magdalena Sobieszczyk, M.D., is the chief of the Division of Infectious Diseases at NewYork-Presbyterian/Columbia University Irving Medical Center and is the Harold Neu professor of infectious diseases in medicine at Columbia University Vagelos College of Physicians and Surgeons. Dr. Sobieszczyk is also a clinical virologist and the principal investigator of the Columbia Collaborative Clinical Trials Unit, funded by the National Institutes of Health, which has been advancing the science of infections like SARS-CoV-2 and HIV.

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[pearlsngems]

I posted this elsewhere but am repeating here: CVS doesn't have the new bivalent booster yet.

We made appointments online and were confirmed, showed up and checked in, and only after waiting a bit were we told that CVS actually doesn't have the vaccine yet and they don't know when they will. It was recommended that we call first before making another appointment.

 

[Austina]

We asked at the pharmacy this week, and they’ve said the new booster will not be available until the end of the month (that’s what they’ve been told).

 

[missy]

I posted this elsewhere but am repeating here: CVS doesn't have the new bivalent booster yet.

We made appointments online and were confirmed, showed up and checked in, and only after waiting a bit were we told that CVS actually doesn't have the vaccine yet and they don't know when they will. It was recommended that we call first before making another appointment.

We asked at the pharmacy this week, and they’ve said the new booster will not be available until the end of the month (that’s what they’ve been told).

Yes I don’t think they’re available yet. Sometime this month. Possibly next week but likely before the end of the month if not next week

COVID-19 booster shots expected as early as next week

The upcoming COVID-19 booster is expected as early as next week.

abcnews.go.com

 

[Brigid]

Great article;

Why scientist Eddie Holmes changed his mind on the origins of COVID-19

The renowned Australian virologist considered the possibility the virus leaked from a Wuhan lab, before changing his mind. He never expected his considerations to be at the centre of an international debate.

www.smh.com.au

Might be deemed too political for some!

 

[Gloria27]

Great article;

Why scientist Eddie Holmes changed his mind on the origins of COVID-19

The renowned Australian virologist considered the possibility the virus leaked from a Wuhan lab, before changing his mind. He never expected his considerations to be at the centre of an international debate.

www.smh.com.au

Might be deemed too political for some!

It's all over the news and they realised how stupid they look now. The truth always comes out.

Too political? Have you seen the Roe vs Wade topic? I mean if that is tolerated, this should be too, it's about having rights over our own bodies, isn't it?