Coronavirus & Monkeypox Tidbits #213 10/2/22

Announcements:

First, there is now a Resources Page here for the most commonly asked questions I'm getting.

Happy to continue to answer your questions/concerns as best I can, so don't be shy about that.

New posts:

Cracks In Promising Treatments For Monkeypox—TPOXX And Jynneos

https://www.forbes.com/sites/judystone/2022/09/21/cracks-in-promising-treatments-for-monkeypox-tpoxx-and-jynneos/?sh=5b15d4ad3122

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The Pandemic Is NOT Over

https://www.medscape.com/viewarticle/981321

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What Makes Some Infections Asymptomatic?

https://www.medscape.com/viewarticle/981679

News 

Covid:

Five things about covid we still don’t understand at our peril

https://wapo.st/3fAlzYB  FREE gift article  Good overview

Short-term increase in menstrual cycle length related to COVID-19 vaccination

A recent study found that women who received any type of COVID-19 vaccination had a short-term increase in menstrual cycle length, according to a press release from NIH.

This was the second NIH-funded study to investigate the relationship between menstrual cycle duration and COVID-19 vaccination.

https://www.healio.com/news/womens-health-ob-gyn/20220928/shortterm-increase-in-menstrual-cycle-length-related-to-covid19-vaccination

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As few as 1 in 5 COVID cases may have been counted worldwide, mathematical models suggest

https://medicalxpress.com/news/2022-09-covid-cases-worldwide-mathematical.html

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Big COVID-19 waves may be coming, new Omicron strains suggest

Emerging subvariants have hit on a combination of mutations that makes them more immune evasive than ever

Science BYGRETCHEN VOGEL 27 SEP 2022

Nearly 3 years into the pandemic, SARS-CoV-2 faces a formidable challenge: finding new ways around the immunity humans have built up through vaccines and countless infections. Worrisome new data show it is up to the challenge. Several new and highly immune-evasive strains of the virus have caught scientists’ attention in recent weeks; one or more may well cause big, new COVID-19 waves this fall and winter.

“We can say with certainty that something is coming. Probably multiple things are coming,” says Cornelius Roemer, who studies viral evolution at the University of Basel. Whether they will also lead to many hospitalizations and deaths is the big question.

“It’s not surprising that we’re seeing changes that yet again help the virus to evade immune responses,” says molecular epidemiologist Emma Hodcroft of the University of Bern, who notes that SARS-CoV-2 faces “the same challenge that things like the common cold and influenza face every year—how to make a comeback.”

The strains that look poised to drive the latest comeback are all subvariants of Omicron, which swept the globe over the past year. Several derived from BA.2, a strain that succeeded the initial BA.1 strain of Omicron but then was itself outcompeted in most places by BA.5, which has dominated in recent months. One of these, BA.2.75.2, seems to be spreading quickly in India, Singapore, and parts of Europe. Other new immune-evading strains have evolved from BA.5, including BQ.1.1, which has been spotted in multiple countries around the globe.

Despite their different origins, several of the new strains have chanced upon a similar combination of mutations to help scale the wall of immunity—a striking example of convergent evolution. They all have changes at half a dozen key points in the viral genome that influence how well neutralizing antibodies from vaccination or previous infection bind to the virus, says evolutionary biologist Jesse Bloom of the Fred Hutchinson Cancer Center.

https://www.science.org/content/article/big-covid-19-waves-may-be-coming-new-omicron-strains-suggest

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Kids with shortness of breath after COVID-19 may have airway obstruction

The authors said approximately 50 children have been seen at National Jewish Health over the course of the pandemic with shortness of breath as the primary symptom of long COVID. Almost all patients "report at least partial improvement of their dyspnea and improved exercise intolerance on initiation of inhaled corticosteroid therapy with, or without, long-acting β2-agonist," the authors said. Patients also benefit from an exercise regimen.

Sep 29 J Allergy Clin Immunol study

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Monkeypox:

Severe Manifestations of Monkeypox among People who are Immunocompromised Due to HIV or Other Conditions

Distributed via the CDC Health Alert Network

Summary

  1. People who are immunocompromised due to HIV or other conditions are at higher risk for severe manifestations of monkeypox than people who are immunocompetent.
  2. Because people with HIV-associated immunocompromise are at risk for severe manifestations of monkeypox, the HIV status of all sexually active adults and adolescents with suspected or confirmed monkeypox should be determined.
  3. There are diagnostic and clinical management strategies that may help address severe manifestations of monkeypox.

Background
Since May 2022, more than 25,000 monkeypox cases have been identified in the United States. During the current outbreak in the United States, 38 percent of people diagnosed with monkeypox were coinfected with HIV1 and most reported cases of monkeypox with severe manifestations have been among people living with untreated HIV.... an increasing proportion of cases have been identified among Black and Hispanic/Latino people.  Black and Hispanic/Latino people are disproportionately affected by HIV.

Severe manifestations of monkeypox can occur in both immunocompetent and immunocompromised people; however, most people diagnosed with monkeypox have had mild-to-moderate clinical courses. Of the people with severe manifestations of monkeypox for whom CDC has been consulted, the majority have had HIV with CD4 counts <200 cells/ml, indicating substantial immunosuppression. Healthcare providers should recognize underlying risk factors for severe disease, optimize immune function, and when appropriate, initiate medical countermeasures (such as tecovirimat and vaccinia immunoglobulin) early to prevent or mitigate severe disease.

https://emergency.cdc.gov/han/2022/han00475.asp?

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US Jynneos vaccine eligibility expands

Yesterday during a White House press briefing, officials from the Centers for Disease Control and Prevention (CDC) said Americans who were at risk for contracting monkeypox could now get the Jynneos vaccine prophylactically.

Previously, the CDC recommended that only those with known or likely exposure be vaccinated.

The CDC yesterday reported 168 more monkeypox cases, raising the national total to 25,509 infections. To date, the United States has administered 800,000 doses of Jynneos vaccine.

https://www.cidrap.umn.edu/news-perspective/2022/09/first-monkeypox-case-uk-likely-seen-march

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Studies detail monkeypox transmission risks

A study of almost 400 samples taken from men with monkeypox reveals a high prevalence of the virus on skin, throat, and anus swabs compared to in blood or urine—with detections in semen in the midrange—and high viral loads in skin and anal swabs.

Two other new studies detail transmission risk in a tattoo parlor and in healthcare settings, and in US news, officials report a monkeypox-related death in Ohio.

Viral DNA found on skin swabs of 88% of men

The new analysis of 356 samples from 50 men in France infected with monkeypox shows that viral DNA detection via polymerase chain reaction (PCR) was more frequent from skin (88% of men), throat (77%), and anus (71%) swabs, than from semen (54%), blood (29%), or urine (22%).

The highest viral DNA loads were consistently found in skin and anus swabs, and lesions were common on the anus and genitals, which continues to suggest sexual contact as the main route of transmission. The study, published in The Lancet Infectious Diseases is one of several new studies that aim to describe real-world transmission risks of the poxvirus.

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Nurses infected after collecting samples

In another study highlighting transmission routes, practitioners writing in Emerging Infectious Diseases describe the infections of two Brazilian nurses 5 days after collecting samples from a monkeypox patient.

The authors say the virus was most likely transmitted via contact with contaminated objects. The nurses visited with the patient in his home and had no skin-to-skin contact with the patient, and they reported no sharps injuries. They wore N95 respirators and gloves, but did not sanitize clipboards and specimen-collection boxes.

"Our report provides evidence supporting the hypothesis that both [healthcare workers] infections observed in this study were transmitted through fomite exposure with surfaces in the patient's home, their own [personal protective equipment], or outer surfaces of the specimen transport box," the authors wrote.

High attack rate in tattoo-linked outbreak

Also published in the Lancet Infectious Diseases is a report on several monkeypox cases linked to a piercing and tattoo parlor in Cadiz, Spain. Of 54 exposed clients, 20 (37%) contracted the disease from Jul 19 to Aug 3.

In 90% of the cases, patients developed a rash at the piercing or tattoo site. Subsequent surface sampling showed extensively contaminated and unhygienic conditions, with detectable monkeypox viral DNA on work tables and chairs, and sharps and other work instruments.

"Together, these findings suggest that monkeypox virus can be transmitted through exposure to contaminated piercing or tattoo material and, potentially through contaminated hands, due to poor aseptic measures and handling of materials," the authors concluded.

https://www.cidrap.umn.edu/news-perspective/2022/09/studies-detail-monkeypox-transmission-risks

Ebola:

Uganda Ebola cases jump to 50, with 1 more death

The number of people infected in Uganda's Ebola Sudan outbreak jumped to 50 today, with 14 more cases added to the total, the World Health Organization (WHO) African region said today on Twitter.

One more person died, raising the fatality count to 24.

Of the 14 new cases, 13 are lab-confirmed and 1 is listed as probable, bringing the case numbers to 31 confirmed and 19 probable. The death occurred in someone who had a lab-confirmed case, raising the fatality count to 6 confirmed and 18 probable.

The number of affected districts remains at three: Mubende, Kassanda, and Kyegegwa. So far, no cases have been reported in the Kampala area.

So far, health officials have identified 414 contacts, up 191 from 3 days ago.

Possible vaccine trial in Uganda

In a related development, WHO officials have been meeting since last week to assess the possibility of an Ebola Sudan vaccine trial could be launched in Uganda's outbreak, Stat reported.

The Ebola Sudan vaccine furthest along in clinical trials and most likely to be tested in Uganda's outbreak is one developed by the Sabin Vaccine Institute. Stat said there are six candidate vaccines, but only three are in clinical trials.

The Sabin Vaccine Institute said its Ebola Sudan candidate, using GSK's ChAD3 platform and is given in one dose, has completed a phase 1B trial.

https://www.cidrap.umn.edu/news-perspective/2022/09/uganda-ebola-cases-jump-50-1-more-death

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https://twitter.com/Boghuma/status/1575813987761258496?s=20&t=4pLJmevlOisJgk_z0NQmSg

Diagnostics:

Blood test could predict who is likely to get long COVID

by University College London

A blood test taken at the time of COVID-19 infection could predict who is most likely to develop long COVID, suggests a new small-scale study led by UCL researchers.

The study, published in eBioMedicine, analyzed proteins in the blood of health care workers infected with SARS-CoV-2, comparing them to samples from health care workers who had not been infected.

Usually protein levels in the body are stable, but the researchers found a dramatic difference in levels of some of the proteins up to six weeks following infection, suggesting disruption to a number of important biological processes.

Using an artificial intelligence (AI) algorithm, they identified a "signature" in the abundance of different proteins that successfully predicted whether or not the person would go on to report persistent symptoms a year after infection.

The researchers say that if these findings are repeated in a larger, independent group of patients, a test that could predict people's likelihood of developing long COVID could potentially be offered alongside a polymerase chain reaction (PCR) test.

Lead author Dr. Gaby Captur (MRC Unit for Lifelong Health and Ageing at UCL) said, "Our study shows that even mild or asymptomatic COVID-19 disrupts the profile of proteins in our blood plasma. This means that even mild COVID-19 affects normal biological processes in a dramatic way, up to at least six weeks after infection.

https://medicalxpress.com/news/2022-09-blood-covid.html

Drugs and Vaccines:

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Intranasal COVID-19 Vaccine Prepares Commercialization in U.S., Europe and Japan

Washington University in St. Louis, MO, and Ocugen, Inc. announced yesterday that they entered into an exclusive license agreement for the rights to develop, manufacture, and commercialize its proprietary, intranasally delivered iNCOVACC COVID-19 vaccine in the United States, Europe, and Japan.

The iNCOVACC vaccine was authorized for emergency use in India on September 6, 2022.

“Because the vaccine can be delivered directly into the nose, it is specifically designed to block infection at the portal of virus entry. We believe it may help prevent transmission as well as protect against new COVID-19 variants.”...

 press release

https://www.precisionvaccinations.com/2022/09/29/intranasal-covid-19-vaccine-prepares-commercialization-us-europe-and-japan

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National study confirms that mRNA vaccines protect against serious COVID-19 during pregnancy

by Regenstrief Institute  SEPTEMBER 26, 2022

The first large, real-world study of the effectiveness of mRNA COVID-19 vaccines during pregnancy found these vaccines, especially two initial doses followed by a booster, are effective in protecting against serious disease in expectant mothers whether the shots are administered before or during pregnancy.

Pregnant women were excluded from COVID-19 mRNA vaccine clinical trials, so this new study fills a significant knowledge gap, providing strong evidence that vaccinating women who are or might become pregnant protects against hospitalization for the disease during pregnancy.

https://medicalxpress.com/news/2022-09-national-mrna-vaccines-covid-pregnancy.html

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Remdesivir-resistant version of COVID-19 detected in organ transplant recipients

Recent studies have shown that patients with weakened immune systems—which enables the virus that causes COVID-19 to remain longer in the body, copy itself, and continually change—may enable the development of new, slightly different versions of the virus (variants). These patients include those treated with drugs that suppress the immune system to keep it from rejecting a newly transplanted organ.

A new study, led by researchers at NYU Grossman School of Medicine and NYU Long Island School of Medicine, shows that two kidney transplant patients treated with immunosuppressive drugs, and who later had a lengthy COVID-19 infection, developed a version of the virus with a genetic change (mutation) that made it resistant to the antiviral therapy remdesivir.

https://medicalxpress.com/news/2022-09-remdesivir-resistant-version-covid-transplant-recipients.html

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Monkeypox

Monkeypox vaccine 79% effective, according to Israeli preprint study

Sep 26 Research Square Israeli preprint study
Sep 26 CDC update
Sep 26 CDC Tpoxx update
Sep 26 CDC Jynneos update
Sep 26 Siga press release
Sep 25 NBC News story

https://www.cidrap.umn.edu/news-perspective/2022/09/news-scan-sep-26-2022

Devices:

Useful thread:

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Masks:

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Epidemiology/Infection control:

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European countries see early signs of autumn COVID-19 rise

Health officials in the United Kingdom and the European region as a whole are seeing early signs of rising COVID activity, patterns that US experts closely watch as a harbinger of how the next months might unfold.

Disease modeling experts have warned of a rise in infections in Northern Hemisphere countries as cooler weather brings more people indoors, as schools resume, and as vaccine protection wanes.

https://www.cidrap.umn.edu/news-perspective/2022/09/european-countries-see-early-signs-autumn-covid-19-rise

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New study finds that SARS-CoV-2 infects fat tissue and creates inflammatory storm cloud

Is SARS-CoV-2 hiding in your fat cells?

A study by Stanford Medicine investigators shows that SARS-CoV-2 can infect human fat tissue. This phenomenon was seen in laboratory experiments conducted on fat tissue excised from patients undergoing bariatric and cardiac surgeries, and later infected in a laboratory dish with SARS-CoV-2. It was further confirmed in autopsy samples from deceased COVID-19 patients.

Obesity is an established, independent risk factor for SARS-CoV-2 infection as well as for the patients' progression, once infected, to severe disease and death. Reasons offered for this increased vulnerability range from impaired breathing resulting from the pressure of extra weight, to altered immune responsiveness in obese people.

But the new study provides a more direct reason: SARS-CoV-2, the virus that causes COVID-19, can directly infect adipose tissue (which most of us refer to as just plain "fat"). That, in turn, cooks up a cycle of viral replication within resident fat cells, or adipocytes, and causes pronounced inflammation in immune cells that hang out in fat tissue. The inflammation converts even uninfected "bystander" cells within the tissue into an inflammatory state.

https://medicalxpress.com/news/2022-09-sars-cov-infects-fat-tissue-inflammatory.html

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Covid in neonates:

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Six countries report new polio cases this week

According to the latest update from the Global Polio Eradication Initiative (GPEI), six countries have new polio cases this week.

Afghanistan, Pakistan, and Mozambique all have new wild poliovirus type 1 cases. This is Afghanistan's second case in 2022; last year the country reported 4 cases. In Pakistan, 2 polio cases were recorded, bringing the 2022 total to 19. In Mozambique, intensified surveillance has tracked 1 new polio case, bringing the yearly total to 6 in that country.

Benin and the Democratic Republic of the Congo reported cases of circulating vaccine-derived poliovirus type 2 (cVDPV2). Benin has 2 cases, with 6 total reported this year. The DRC has 1 case, but its 2022 total is 111, up from 28 cases in 2021.

Malawi has two circulating vaccine-derived poliovirus type 1 (cVDPV1) cases. These are the first reported in the country; last year one wild-type case was reported.
Sep 21 GPEI update

https://www.cidrap.umn.edu/news-perspective/2022/09/news-scan-sep-23-2022

Tips, general reading for public:

Ventilate.

Mask.

Vax.

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Tips/thread for anyone in hospital:

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New book (I have not seen it):

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Politics:

Covid:

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TFG:

SCOTUS:

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GOP:

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Veterans:

49 Republicans Who Voted Against Food Security Help for Veterans democraticunderground.com/10142975961

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Guns/Mental health:

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Race:

Banks:

Gas companies:

The Chevron ad is also on YouTube: https://youtu.be/S2XTGteritE

Bannon/Hilton

Abortion/elections:

https://twitter.com/stevesgirl56/status/1573772087415685121?s=20&t=4pLJmevlOisJgk_z0NQmSg

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Entire email text at https://t.co/82585p0p90

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Books:

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Cannabis:

Climate change/Environment:

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LGBT:

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Churches:

Immigrants/Asylum seekers:

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Student loans:

Arizona:

California:

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Florida/DeSantis:

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Pennsylvania:

Texas:

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Utah:

Italy:

Iran:

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Feel good du jour:

Neat thread

Bookstores mentioned in the thread are mapped at https://t.co/WZe27pS80s

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Comic relief:

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https://twitter.com/buitengebieden/status/1574075372857364480?s=20&t=4pLJmevlOisJgk_z0NQmSg

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Perspective/Poem

Bits of beauty:


 

 

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