Coronavirus Tidbits #197 6/19/22

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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.

Recent posts:

Surgery During a Pandemic? COVID Vax Status Matters – or Not

An online survey captured mixed information about people’s willingness to undergo surgery during a viral pandemic in relation to the vaccine status of the patient and staff. https://www.medscape.com/viewarticle/975477 ~ ~ ~

Dengue Vaccine Candidate Works Without Big Safety Risks

Drugmaker Takeda announced Thursday that its dengue vaccine candidate, TAK-003, prevented 84% of hospitalized dengue cases and 61% of symptomatic cases in 4.5 years of follow-up during its phase 3 TIDES trial. https://www.medscape.com/viewarticle/975354

News 

FDA advisers OK COVID-19 vaccines for youngest kids

In a step eagerly anticipated by families who want an extra tool to protect babies and young children, the Food and Drug Administration (FDA) vaccine advisory group today unanimously approved emergency use of Moderna and Pfizer-BioNTech vaccines for babies and young children.

The CDC’s Advisory Committee on Immunization Practices (ACIP) has meetings scheduled on Jun 17 and Jun 18 to discuss recommendations in young children, as well as to discuss one for Moderna in kids ages 6 to 17. If federal officials approve and sign off on the recommendations, the White House has projected that immunization of the youngest children will begin in earnest as soon as Jun 21.

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COVID vaccine hesitancy threatens flu vaccine uptake

Polarized views and worries about COVID-19 vaccination had spillover effects on flu vaccination in adults, according to researchers who examined data over two pandemic years on both vaccines by state.

The authors of the study say the findings are a warning of declining trust in public heath, which comes at a vulnerable time as eased COVID-19 measures put populations at risk for the return of disease threats such as flu. Late-season flu activity is still under way in some parts of the United States, and health officials are closely watching Australia, where an early-season surge is already worse than some of the country’s pre-COVID pandemic flu seasons.

The group, based at University of California-Los Angeles Health Services, published its findings yesterday in a letter to the New England Journal of Medicine.

https://www.cidrap.umn.edu/news-perspective/2022/06/covid-vaccine-hesitancy-threatens-flu-vaccine-uptake

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CLUES TO LONG COVID

A version of this story appeared in Science, Vol 376, Issue 6599.Download PDF

They span three continents, but a trio of researchers who’ve never met share a singular focus made vital by the still-raging pandemic: deciphering the causes of Long Covid and figuring out how to treat it.

Almost 2 years ago in Italy, pediatric infectious disease doctor Danilo Buonsenso, who works at Gemelli University Hospital, started to see children who, months after mild infections with SARS-CoV-2, were still short of breath and had crushing fatigue and other symptoms. He now suspects that, in some of them, the cells and tissues that control blood flow are damaged and the blood’s tendency to clot is amplified. Minute blood clots, leftover from the viral assault or fueled by its aftermath, might be gumming up the body’s circulation, to disastrous effect from the brain to joints. “In some patients we have specific areas where no blood flow comes in” or the flow is reduced, Buonsenso says. Is that driving their lingering symptoms? “I can’t say this is the truth, of course. But this makes sense.”

Meanwhile, in the United States, microbiologist Amy Proal can’t stop thinking about a second leading Long Covid theory: that the coronavirus keeps hurting people by stubbornly enduring in the body, even after acute infection passes. Studies have shown “the virus is capable of persistence in a wide range of body sites,” especially nerves and other tissues, says Proal, who works at the PolyBio Research Foundation, a nonprofit in Washington state. She recently caught COVID-19 for the third time.

Down under in Australia, immunologist Chansavath Phetsouphanh of the University of New South Wales, Sydney, is chasing a third lead, motivated by what the blood of Long Covid patients has divulged: an immune system gone haywire even 8 months after they’d first tested positive. He had assumed that immune cells galvanized to fight off infection would have calmed down over that time span. So, “It was a surprise that these cells did not recover,” says Phetsouphanh, who is working to set up an international Long Covid collaboration.

For each of these researchers-and many others exploring the causes of Long Covid-untangling the complex syndrome, with a still-evolving definition, is a laborious, step-wise process. First, they must show that a possible contributor-such as minuscule clots, lingering virus, or immune abnormalities-crops up disproportionately in people with Long Covid. Then comes the hard part: proving that each of these traits, alone or in combination, explains why the coronavirus has rendered millions of people shadows of their former selves.

https://www.science.org/content/article/what-causes-long-covid-three-leading-theories

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Long Covid less likely after Omicron than Delta

The odds of developing long Covid were 24% to 50% lower after infection with the Omicron than the Delta strain, depending on age and time since vaccination, a new analysis reports. But because so many more people fell sick with Omicron, the absolute numbers are concerningly high. The U.K. study in the Lancet drew data from a smartphone app through which people report symptoms such as fatigue, shortness of breath, brain fog, and joint pain four weeks after infection.

Their strain was assumed by the time period: Omicron for 56,003 patients from December 2021 to March 2022 and Delta for 41,361 from June to November 2021. The results: 4.4% of Omicron cases were followed by long Covid, compared to 10.8% of Delta cases. U.K. long Covid cases hit 2 million as of May 1, a figure expected to rise.

https://mailchi.mp/statnews/tk-tncyc6de8v-616916?e=5c09ee46b1

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Brain fog after COVID-19 has similarities to ‘chemo brain,’ Stanford-led study finds

…something doctors often refer to as “chemo brain.” In both cases, excessive inflammation damages the same brain cells and processes, according to research led by Stanford University School of Medicine.

The discovery, described in a paper that published online June 12 in Cell, relied on studies of mice with mild SARS-CoV-2 infection and postmortem human brain tissue collected early in the pandemic. The findings may help guide treatments for cognitive effects of COVID-19, the scientists said.

https://med.stanford.edu/news/all-news/2022/06/brain-fog-covid-chemo-brain.html

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Hepatitis in kiddies:

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Avian flu:

After 40 million dead birds, hot weather may be killing off the bird flu virus

https://www.foodsafetynews.com/2022/06/after-40-million-dead-birds-hot-weather-may-be-killing-off-the-bird-flu-virus/

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800-year-old graves pinpoint where the Black Death began

Ancient DNA from cemeteries in today’s Kyrgyzstan reveal earliest known victims of 14th century plague

The Syriac engraving on the medieval tombstone was tantalizing: “This is the tomb of the believer Sanmaq. [He] died of pestilence.” Sanmaq, who was buried in 1338 near Lake Issyk Kul in what is now northern Kyrgyzstan, was one of many victims of the unnamed plague. By scrutinizing field notes and more photos from the Russian team that had excavated the graves in the 1880s, historian Philip Slavin found that at least 118 people from Sanmaq’s Central Asian trading community died in the epidemic.

Slavin was on the trail of the origin of the Black Death, which devastated Europe a decade after the Kyrgyzstan burials. But he knew the medieval diagnosis of “pestilence” encompassed many horrific diseases. “I was almost 100% certain it was the beginning of the Black Death,” says Slavin, a medieval historian at the University of Stirling. “But there was no way to prove it without DNA.”

Now, Slavin is senior author of a new study of ancient DNA from the “pestilence” victims showing they were indeed infected with the bacterium, Yersinia pestis, that caused the Black Death. The strain that killed them was ancestral to all the strains that rampaged across Europe a decade later and continued to kill for the next 500 years.

https://www.science.org/content/article/800-year-old-graves-pinpoint-where-black-death-began

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AMA declares climate change a public health crisis

The American Medical Association (AMA) this week adopted policy during the annual House of Delegates meeting declaring climate change a public health crisis that threatens the health and well-being of all people. The AMA took a stand on climate change with new policies because of the widely expected impacts on public health. Some of these effects have already been seen with increasing numbers of wildfires, the resulting poor air quality, heat related deaths and hospitalizations, extended draughts, and climate changes that foster the spread of mosquito and other insect vector diseases.

https://healthexec.com/topics/healthcare-management/healthcare-policy/ama-declares-climate-change-public-health-crisis

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One-third of top hospitals’ websites sent patient data to Facebook, investigation finds

To even the most jaundiced viewer of patient privacy, this is jaw-dropping. An investigation by the nonprofit newsroom The Markup, co-published with STAT, documents finding Meta Pixel, a snippet of code that tracks users, installed inside the password-protected patient portals of seven health systems. That means when a patient clicked the “Schedule Online” button on a doctor’s page, Facebook got the text of the button, the doctor’s name, and the search term patients used: “pregnancy termination” in one case and “Alzheimer’s” in another that allowed The Markup to find them.

The patients volunteered to participate in the Pixel Hunt project, a collaboration between The Markup and Mozilla to understand how Facebook gathers information about its users. “Almost any patient would be shocked,” said Glenn Cohen of Harvard Law School. Facebook’s parent company, Meta, did not respond to questions. Read more.

https://mailchi.mp/statnews/tk-tncyc6de8v-616912?e=5c09ee46b1

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Monkeypox:

Updated Case-finding Guidance: Monkeypox Outbreak-United States, 2022

Summary
Since May 2022, monkeypox cases, which have historically been rare in the United States, have been identified in 18 states and territories among both persons returning from international travel and their close contacts domestically. Globally, more than 1,600 cases have been reported from more than 30 countries; the case count continues to rise daily. In the United States, evidence of person-to-person disease transmission in multiple states and reports of clinical cases with some uncharacteristic features have raised concern that some cases are not being recognized and tested.

This Health Alert Network (HAN) Health Update serves to alert clinicians to clinical presentations of monkeypox seen so far in the United States and to provide updated and expanded case definitions intended to encourage testing for monkeypox among persons presenting for care with relevant history, signs, and symptoms. In addition, this Health Update provides an update to a HAN Health Advisory that the Centers for Disease Control and Prevention (CDC) issued May 20, 2022 titled Monkeypox Virus Infection in the United States and Other Non-endemic Countries-2022. In people with epidemiologic risk factors, rashes initially considered characteristic of more common infections (e.g., varicella zoster, herpes, syphilis) should be carefully evaluated for concurrent characteristic monkeypox rash (see images and links to below) and considered for testing.

Background
The current identification of West African monkeypox cases in many countries that do not have endemic disease and involving patients with no direct travel history to an area with endemic monkeypox, suggests person-to-person community spread. The first case of monkeypox in the United States was diagnosed in a traveler who returned to Massachusetts from Canada on May 17, 2022. Since then, 65 cases have been identified in 18 states and territories and more than 1,600 have been identified in 35 countries and territories that do not have endemic disease. The case fatality rate of monkeypox associated with the West African clade of monkeypox virus is 1%, and possibly is higher in immunocompromised individuals; no deaths have been reported globally from the current outbreak. Any person, irrespective of gender identity or sexual orientation, can acquire and spread monkeypox. In this outbreak, however, many of the reported cases in the United States are among gay, bisexual, or other men who have sex with men (MSM). Close contact, sustained skin-to-skin contact including sexual contact, with a person with monkeypox or contact with contaminated fomites (e.g., shared linens) are the most significant risk factors associated with human-to-human transmission of Monkeypox virus.

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WHO discourages mass vaccination for monkeypox outbreak

With more than 3,100 confirmed and suspected cases of monkeypox in 32 non-endemic and 7 endemic countries, the World Health Organization (WHO) today said it does not recommend mass vaccination campaigns at this time to limit the outbreaks, and instead emphasized contact tracing and isolation to limit the further spread of the poxvirus.

In new interim guidance on vaccine use against monkeypox, the WHO said contacts of cases should be offered post-exposure prophylaxis (PEP) with a vaccine within four days of first exposure to prevent onset of disease.

Pre-exposure prophylaxis (PrEP) is recommended at this time only for health workers at risk, laboratory personnel working with orthopoxviruses, clinical laboratory staff performing diagnostic testing for monkeypox, and others who may be at risk as per national policy, the WHO said…

Monkeypox DNA found in semen

Researchers in Italy have detected monkeypox DNA in semen samples from patients, offering more evidence that sexual transmission may be at play in the current outbreak.

Current thinking suggests close contact, including intimate contact, is driving transmission…Subsequent testing showed that the virus found in semen samples was capable of being infectious and replicating in another person.

US total grows to 65

The United States now has 65 cases from 18 states and Washington, DC.

The Chicago Department of Public Health (CDPH) says a few monkeypox cases have been linked to a BDSM conference (the International Mr. Leather event) held in the city.

https://www.cidrap.umn.edu/news-perspective/2022/06/who-discourages-mass-vaccination-monkeypox-outbreak

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(Note: I do not at all support EFD and am rare to cite him, as he is a publicity seeking sensationalist. However, this was shocking, even by CDC standards..:)

Diagnostics:

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Reminder: a Positive Rapid Test is likely “real” and you are infectious

A negative test may well be a false negative. If you are sick, assume you have COVID

Drugs and Vaccines:

Pfizer’s Paxlovid study fails to answer key questions over benefit for broader populations

Pfizer said Tuesday that a much-watched study of its antiviral Paxlovid in patients who have Covid but don’t have risk factors for severe disease failed to show a benefit in speeding alleviation of Covid symptoms, but did seem to prevent doctor’s visits and hospitalizations.

Additionally, because of the small number of hospitalizations overall in the study, it failed to produce a statistically significant finding on whether patients who had previously been vaccinated against Covid were hospitalized less often if they received Paxlovid.

The data in no way invalidate earlier results that show that Paxlovid prevents hospitalizations and saves lives in patients at high risk of severe Covid.

https://www.statnews.com/2022/06/14/pfizers-paxlovid-study-fails-to-answer-key-questions-over-benefit-for-broader-populations/

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Long Covid is a ‘national crisis.’ So why are grants taking so long to get?

$1.2 billion NIH effort lacks urgency and transparency, critics charge

David Putrino, a neurophysiologist at the Icahn School of Medicine at Mount Sinai, labored through his holiday last Christmas to write a grant application for urgently needed Long Covid research. With colleagues, he hoped to tap into $1.15 billion in funding that Congress granted the National Institutes of Health (NIH) in 2020, as Long Covid emerged as a major public health problem. NIH had solicited grant applications in December 2021, just weeks before their January due date. The agency said it planned to issue decisions by late March.

But as of today, Putrino was still waiting to hear whether NIH will fund his effort to discover whether microclots might be a meaningful diagnostic biomarker for many types of Long Covid. “Maybe they should hire people who are dedicated to accelerating these programs,” says Putrino, who specializes in rehabilitation medicine. “[Long Covid] is a national crisis. This does not deserve to be somebody’s second or third job. What we need from the NIH right now is their full attention.”

Putrino’s is not the lone complaint about NIH’s management of Long Covid research-an initiative dubbed RECOVER, for Researching COVID to Enhance Recovery. RECOVER’s flagship, an observational study of up to 40,000 people, has come under fire from patient advocates and some scientists who say it lacks transparency and is moving far too slowly-a ponderous battleship when a fleet of hydroplanes are what’s needed. As of 6 June, the study had signed up 3712 adults, or 21% of its adult enrollment target of 17,680. Among children, numbers are even lower: Ninety-eight children are participants in a study aiming to enroll 19,500 of them.

https://www.science.org/content/article/long-covid-national-crisis-so-why-are-grants-taking-so-long-get

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New COVID drugs face delays as trials grow more difficult

Fewer people are eligible for the massive studies needed to test treatments for severe COVID-19.

After two years of breakneck research, scientists have amassed a collection of therapies to treat people with COVID-19. But now, researchers fear that development of new treatments could falter as the clinical trials needed to test them become increasingly difficult.

Vaccinations in many places have led to a decline in severe disease, shrinking the pool of potential study participants. Hesitance to enrol in trials is rising, and the existence of potent treatments is making statistical analysis more difficult, too.

“It was definitely easier to do research in the past. Now you’ve got to design a study that meets the standards of care, doctors want to do, and patients want to do. And it’s a lot harder,” says Elizabeth Hohmann, an infectious-disease expert at Massachusetts General Hospital in Boston.

Doctors treating people with COVID-19 can choose from roughly half a dozen types of therapy that have been recommended by the World Health Organization, or by national authorities such as the US Food and Drug Administration. Among them are steroids, synthetic antibodies and antiviral tablets. Some cut the risk of death for those already in hospital. Others lower the odds of having to be hospitalized at all. Death rates are dropping in some countries that are fortunate enough to have access to these treatments, and modelling1 suggests that widespread antiviral treatment could prevent the majority of COVID-19 deaths.

https://www.nature.com/articles/d41586-022-01602-5

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Devices:

Epidemiology/Infection control:

Study spotlights Omicron’s impact on unvaccinated, rural Americans

Though it causes less severe disease than the Delta variant, the highly transmissible Omicron SARS-CoV-2 variant has been twice as deadly in unvaccinated people and has therefore hit rural Americans harder than those living in cities, a study today in Frontiers in Medicine finds.

Because low-vaccination parts of the country are mostly rural, those living in less densely populated areas continue to bear the highest COVID-19 burden, according to the study authors, who hail from universities in four US states and Zimbabwe. They worry that rural America will face a disproportionate long-term impact from lingering symptoms known as long COVID.

“We’re talking about an extra burden that rural counties face. They face a higher probability of developing chronic illness from long COVID,” said co-author Claudia Moreno, PhD, assistant professor of physiology and biophysics at the University of Washington, in a University of Cincinnati news release.

https://www.cidrap.umn.edu/news-perspective/2022/06/study-spotlights-omicrons-impact-unvaccinated-rural-americans

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Spike found in 60% of 37 #LongCovid patients’ plasma, at some point 2-12 months post-Covid, and not in any of 26 patients recovered from Covid without PASC.

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Tips, general reading for public:

Ventilate.

Mask.

Vax.

Politics:

Covid:

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SCOTUS:

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Jan 6th:

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Pardons:

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GOP:

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Abortion:

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Healthcare:

Comparison of status quo with universal health care suggests 330,000 in US died needlessly during pandemic

A team of researchers at the Yale School of Public Health, working with colleagues from the University of Massachusetts Amherst, the University of California, San Francisco and the University of Florida, has found evidence that suggests hundreds of thousands of lives could have been saved during the pandemic if people in the U.S. had been covered by a universal health care system. In their paper published in Proceedings of the National Academy of Sciences, the group outlines their estimates of deaths that could have been prevented during the pandemic and the possible cost savings if the U.S. had a universal health care system.

https://medicalxpress.com/news/2022-06-comparison-status-quo-universal-health.html

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HIPAA and Facebook:

Guns:

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Race:

LGBTQ vs Catholics:

Texas:

Florida:

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Nazis in America:

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Ukraine/Russia:

In normal times, Ukraine is a leading exporter of foodstuffs. A Russian naval blockade now prevents Ukraine from exporting grain. 2/16

If the Russian blockade continues, tens of millions of tons of food will rot in silos, and tens of millions of people in Africa and Asia will starve. 3/16

remainder of thread here: https://threadreaderapp.com/thread/1535617894045868033.html

 

Feel good du jour:

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Comic relief:

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Perspective/Poem

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Bits of beauty:

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