Coronavirus Tidbits #224 12/18/22

Infectious diseases fellowships go unfilled for newly minted doctors:

44% of training programs are unfilled. Why do 2-3 more years training to get lower pay?

Unfolding disaster

https://www.npr.org/sections/health-shots/2022/12/12/1142250941/newest-doctors-shun-infectious-diseases-specialty

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Vaccine effectiveness:

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COVID-19: What we know about new omicron variant BF.7

Since the COVID variant omicron emerged in late 2021, it has rapidly evolved into multiple subvariants. One subvariant, BF.7, has recently been identified as the main variant spreading in Beijing, and is contributing to a wider surge of COVID infections in China.

https://medicalxpress.com/news/2022-12-covid-omicron-variant-bf7.html?

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Half of US adults say they had COVID-19, but only a fraction were officially diagnosed, new research shows

Half of U.S. adults report being sickened with COVID-19 at some point during the pandemic, with only a fraction saying they received an official medical diagnosis of the respiratory infection, according to a new survey by the COVID States Project, led by Northeastern researchers.

Also, A substantial majority of American adults have not gotten the bivalent booster shot, which protects against the present strain in circulation—the BA.5 omicron variant and only 28% of respondents said they have received their flu shot.

In 2022, just 9.2% said they were treated with leading antiviral medications Paxlovid or Molnupiravir.

https://medicalxpress.com/news/2022-12-adults-covid-fraction.html?

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Covid, Vaccines, and POTS

a small percentage of patients vaccinated against COVID-19 may develop postural orthostatic tachycardia syndrome, or POTS. The investigators also found that those diagnosed with COVID-19 are five times more likely to develop the same cardiac condition after infection than after vaccination, emphasizing the importance of the vaccine.

https://medicalxpress.com/news/2022-12-covid-infection-vaccination-linked-heart.html?

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Autopsies show COVID-19 virus in brain, elsewhere in body

An analysis of tissue samples from the autopsies of 44 people who died with COVID-19 shows that SAR-CoV-2 virus spread throughout the body—including into the brain—and that it lingered for almost 8 months. The study was published yesterday in Nature.

Scientists from the National Institutes of Health (NIH) tested samples from autopsies that were performed from April 2020 to March 2021. They conducted extensive sampling of the nervous system, including the brain, in 11 of the patients.

The researchers detected SARS-CoV-2 RNA and protein in the hypothalamus and cerebellum of one patient and in the spinal cord and basal ganglia of two other patients. But they found little damage to brain tissue, "despite substantial viral burden."

The investigators also isolated viable SARS-CoV-2 virus from diverse tissues in and outside the respiratory tract, including the brain, heart, lymph nodes, gastrointestinal tract, adrenal gland, and eye. They isolated virus from 25 of 55 specimens tested (45%).

Possible ramifications for 'long COVID'

Senior study author Daniel Chertow, MD, MPH, said in an NIH news release that, prior to the work, "the thinking in the field was that SARS-CoV-2 was predominantly a respiratory virus."

Finding viral presence throughout the body—and sharing those findings with colleagues a year ago—helped scientists explore a relationship between widely infected bodily tissues and "long COVID," or symptoms that persist for weeks and months after infection.

Part of an NIH-funded Paxlovid RECOVER trial that is expected to begin in 2023 includes an extension of the autopsy work highlighted in the Nature study, according to coauthor Stephen Hewitt, MD, PhD, who serves on a steering committee for the RECOVER project. Autopsies in the RECOVER trial include people who both were vaccinated and infected with variants of concern—data that weren't available in yesterday's study.

https://www.cidrap.umn.edu/covid-19/autopsies-show-covid-19-virus-brain-elsewhere-body

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Coronavirus May Spread From Corpses, Scientists Report.

While transmission from corpses is not likely to be a major factor in the #COVID19 pandemic, bereaved family members should exercise caution, experts said.

Several studies have found traces of infectious virus in corpses for as long as 17 days after death. Dr. Saitoh and his colleagues went further, showing that dead bodies may carry significant amounts of infectious virus,

https://www.nytimes.com/2022/12/15/health/covid-dead-bodies.html

[Interesting aside. People who have had Covid can be organ donors:

https://www.organdonor.gov/learn/process/covid-19-frequently-asked-questions

Their bodies are not accepted by anatomy boards (e.g., for med schools).

How does this make sense?]

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Waiting longer for surgery after Covid tied to fewer post-op problems

The timing of surgery after Covid infection can be critical, a new study in JAMA Network Open reports. In their analysis of nearly 4,000 patients, researchers estimated a 1% reduction in risk of postoperative problems for every 10 days after a positive Covid diagnosis. Those problems included deep vein thrombosis, pulmonary embolism, stroke, myocardial injury, acute kidney injury, and death within 30 days after surgery.

The cardiovascular outcomes make sense, the authors say: Covid-19 is a respiratory disease, but it also causes vascular inflammation and sweeping changes in clotting that lead to serious damage. The infection ramps up inflammation, raising the risk of death in surgical patients with more inflammatory activation as a result of their operations. “Understanding the potential benefits associated with delaying surgery provides a key step in clinicians’ ability to optimize surgical timing for the increasing population of patients who have been infected with Covid-19,” they write.

https://mailchi.mp/statnews/tk-tncyc6de8v-621884?e=5c09ee46b1

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A paper in @Nature describes MERS-CoV-related viruses that use ACE2 as an entry receptor, underscoring a promiscuity of receptor use and a potential zoonotic threat. https://t.co/iSkVMygltx pic.twitter.com/9LemXhx8B5

— Nature Portfolio (@NaturePortfolio) December 11, 2022

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Monkeypox:

Report describes mpox infections tied to tattoo parlor

Piercing or tattooing appears to be the vehicle that left 21 people infected with mpox virus (MPXV) after visiting the same tattoo parlor in Cadiz, Spain, during 2 weeks in July, according to a report yesterday in the New England Journal of Medicine.

From July 6 to July 19, the parlor served 58 customers, and 21 of them (36%) became infected with the virus. Of the mpox patients, 14 (67%) were female, and 9 (43%) were children. The median patient age was 26.

https://www.cidrap.umn.edu/mpox/report-describes-mpox-infections-tied-tattoo-parlor

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Other:

Group A strep infections climbing in Europe

At least five countries in Europe are reporting an increase in invasive group A Streptococcus (iGAS) disease and scarlet fever, according to a disease outbreak update today from the World Health Organization (WHO).

The WHO said that as of Dec 8, France, Ireland, the Netherlands, Sweden, and the United Kingdom have been observing an increase in iGAS cases stretching back to the spring in the Netherlands and summer months in the United Kingdom. Many of the cases have been in children under 10 years of age, and some have been fatal, with 13 deaths reported in England within 7 days of diagnosis.

Group A Streptococcus is most known for causing acute pharyngitis, also known as strep throat, but can also cause scarlet fever and other, more serious and life-threatening invasive infections. Transmission occurs through close contact with an infected person and is passed on through coughs, sneezes, or contact with a wound.

In all five countries, the number of iGAS cases reported in recent months has been higher than that observed during the same period in previous years.

Scarlet fever spikes in UK

Only France and the United Kingdom have reported scarlet fever cases, with the latter reporting 4,622 scarlet fever notifications from weeks 37 to 46 of the current season—more than three times the average number reported for the previous 5 years. UK health officials say several outbreaks have occurred in nurseries and schools.

The WHO says the increase could reflect an early group A Strep season coinciding with an increase in the circulation of other respiratory viruses. In response, enhanced surveillance has been implemented in the countries reporting iGAS increases, along with public health messages for the public and clinicians.

The WHO currently assesses the risk for the general population as low, with no observed increases in antibiotic resistance but says it will continue to closely monitor the epidemiologic situation throughout the European region.

https://www.cidrap.umn.edu/antimicrobial-stewardship/group-strep-infections-climbing-europe

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RSV wave hammers hospitals — but vaccines and treatments are coming

As the respiratory illness helps to fuel a ‘tripledemic’, Pfizer and GSK race to get jabs approved.

Nature  Rachel Fairbank  15 December 2022

In the past few months, the respiratory syncytial virus (RSV) has been sending children under the age of 5 to hospital at alarming rates in the United States and Europe. As paediatric units fill beyond capacity, and physicians contend with a ‘tripledemic’ of RSV, influenza and COVID-19, some have been calling for a state of emergency to be declared.

RSV, which inflames the smallest airways of the lungs, is the only one of the three respiratory illnesses for which there are not yet any approved vaccines — but that could soon change. Last week, the pharmaceutical company Pfizer announced that the US Food and Drug Administration (FDA) had agreed to review its RSV vaccine, to be administered to adults over the age of 60, as a priority. If approved — which might happen as soon as May — it could be the first sanctioned jab for RSV. The same vaccine has also shown positive results against RSV in a clinical trial in pregnant people, and Pfizer has said it will seek approval for this group by the end of the year.

Nature looks back at how vaccines for RSV emerged, and ahead to how they are about to change the public-health landscape.

https://www.nature.com/articles/d41586-022-04434-5

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Camel virus  in Qatar?

[Unclear what is going around--3 players ill so far w viral syndrome, but no deaths]. Experts feel MERS is highly unlikely...but large gatherings like this, or hajj, are a risk for MERS, especially simultaneously "hosting a camel beauty pageant, poses an enhanced risk of transmission and globalisation of MERS-CoV." https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00543-5/fulltext#%20:

@PeterHotez  Dec 16

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Influenza:

con't to rise: Globally, of respiratory specimens that tested positive for flu at national flu labs during the latter part of November, 97.9% were influenza A. Of the subtyped influenza A samples, 85.6% were H3N2.

https://www.cidrap.umn.edu/influenza-general/flu-rises-continue-several-northern-hemisphere-countries

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Antibiotic resistance: