Coronavirus Tidbits #224 12/18/22
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.
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?
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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.
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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.
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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.
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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.
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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,
[Interesting aside. People who have had Covid can be organ donors:
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.
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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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Thread on LongCovid from
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.
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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.
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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.
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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:
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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.
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The first mass screening system for COVID cases has been developed with a sensitivity of 97%
Washing your hands with hydroalcoholic gel, smelling it and using a QR code to answer a short questionnaire. These very simple actions make up the world's first patented mass screening system for COVID cases.
Drugs and Vaccines:
Nasal vaccines promise to stop the COVID-19 virus before it gets to the lungs—an immunologist explains how they work
The Pfizer-BioNTech and Moderna mRNA vaccines have played a large role in preventing deaths and severe infections from COVID-19. But researchers are still in the process of developing alternative approaches to vaccines to improve their effectiveness, including how they're administered. Immunologist and microbiologist Michael W. Russell of the University at Buffalo explains how nasal vaccines work, and where they are in the development pipeline.
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Nasal COVID-19 vaccine approved for use as booster in India
A nasal COVID-19 vaccine based on technology licensed from Washington University in St. Louis has been approved for emergency use in India as a booster for people who have already received two doses of other COVID-19 vaccines. The approval follows the Indian government's emergency use authorization in September of the vaccine as a primary series of two doses, and makes the intranasal vaccine the world's first to receive approval as both a primary vaccine for COVID-19 and a booster.
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Large, real-world study finds COVID-19 vaccination more effective than natural immunity
In one of the first large, real-world studies comparing the effectiveness of COVID-19 vaccines versus natural immunity in protecting against death, hospitalizations and emergency department (ED) visits for any cause, including COVID, research-scientists from Regenstrief Institute, Indiana University School of Medicine and Vanderbilt University Medical Center report that people of all age groups benefited significantly more from vaccination than natural immunity acquired from a previous COVID infection. The lower death rate of vaccinated individuals was especially impressive for adults ages 60 years or older.
Significantly, the all-cause death and hospital admission rates for vaccinated individuals were 37 percent lower than the rates for those with natural immunity acquired from previous COVID infection. The rate of ED visits for all causes was 24 percent lower for vaccinated individuals than for the previously infected.
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Benefits of Vax estimated:
From December 2020 through November 2022, we estimate that the COVID-19 vaccination program in the U.S. prevented more than 18.5 million additional hospitalizations and 3.2 million additional deaths. Without vaccination, there would have been nearly 120 million more COVID-19 infections. The vaccination program also saved the U.S. $1.15 trillion (Credible Interval: $1.10 trillion–$1.19 trillion) (data not shown) in medical costs that would otherwise have been incurred.
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Paxlovid in early Covid:
In the EPIC-HR (Evaluation of Protease Inhibition for Covid-19 in High-Risk Patients) trial, nirmatrelvir plus ritonavir led to an 89% reduction in hospitalization or death among unvaccinated outpatients with early COVID-19. The clinical impact of nirmatrelvir plus ritonavir among vaccinated populations is uncertain.
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Paxlovid Has Been Free So Far. Next Year, Sticker Shock Awaits.
"Nearly 9 in 10 people dying from the virus now are 65 or older. Yet federal law restricts Medicare Part D — the prescription drug program that covers nearly 50 million seniors — from covering the covid treatment pills."
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More serious antibiotic/drug shortages:
CAVI | Community Access to Ventilation Information
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Smartphone-connected device uses light to detect malaria – in 10 seconds
"The infrared light can penetrate thru the skin to the bloodstream, and the light that is reflected back is an indicator of what is present in the bloodstream. Malaria infects red cells, causing both structural & chemical changes”
Pandemic's two-year global death toll may be close to 15 million
Almost 15 million people likely died as a result of the COVID-19 pandemic in 2020 and 2021, nearly three times more than previously reported, a new World Health Organization study estimates.
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COVID-19 has erased two decades of life expectancy growth in the US. Yet, leaders are still trying to gaslight us into believing that the US had one of the best responses to the pandemic. https://t.co/7KBlB1Dv8g pic.twitter.com/TXtTcW9tSJ— Dr. Lucky Tran (@luckytran) December 12, 2022
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Long COVID a factor in more than 3,500 American deaths
Long COVID is a collection of symptoms—brain fog, chronic fatigue, shortness of breath, stomach pain—that can torment people for months and even years on end.
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Tips, general reading for public:
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Free Covid tests by mail again available:
The Biden administration plans to reopen its popular program with the U.S. Postal Service to mail free at-home Covid-19 tests to households that request them ahead of a potential winter surge. Ordering will open Tuesday. w/ @adamcancryn: politico.com/news/2022/12/1
can order them here, same as before 4 per household: special.usps.com/testkits
Can also get from health dept, library, and some pharmacies.
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Disturbingly plausible thread on likely wave re auto loans:
Two Doctors Known for COVID Misinfo Now Reinstated on Twitter -- Robert Malone and Peter A. McCullough https://t.co/P2MOH3LcGp
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Morgue data reveal Africa's high #COVID19 death toll --90% were infected w COVID, but only 10% tested positive while alive. medicalxpress.com/news/2022-12-m
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Healthcare workers in China are reportedly getting sick with COVID-19 and being asked to keep working amid an abrupt loosening of strict pandemic rules in the country. (Reuters)
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The UK and other western countries are proudly and openly culling their populations. This is sick. https://t.co/riRNJPVFNE— Laura Miers (@LauraMiers) December 16, 2022
States that restrict #abortions have more maternal death rate that was 62% higher than states with easier abortion access. medicalxpress.com/news/2022-12-s via @medical_xpress
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This is so dangerous for public health. You are not only putting Dr. Fauci at risk, but deterring generations from public health leadership. This isn’t free speech, it’s absolute cowardice. pic.twitter.com/LCkEFO8R2l— Andrew Baback Boozary MD (@drandrewb) December 11, 2022
December 16, 2022
NYC public libraries say proposed budget cuts may 'push us over the edge'
New York City's public libraries may have to cut staff, hours, branches and programming as they face potential multi-million-dollar budget cuts in Mayor Eric Adams’ plan to curtail city spending.
Omnipresence of police in subways with a $10.4 million budget yet crime isn't going down. Police don't solve hardly any crimes. If anyone else was this bad at their job, the whole team would be fired.
Frank James took a mini tour of NYC on the subway after the shooting. NYPD couldn't find him with a $10.4 billion budget & omnipresence & unlimited surveillance. He was at a Chelsea hostel, ate at Dimes, & ate at Katz's Deli hours after firing 33 shots. He called 911 HIMSELF!
$10.4 BILLION on omnipresent cops who don't solve crime or prevent crime. Yet the MTA is spending $1M per month on private security guards — who are posted at subway station turnstiles to deter fare evasion despite 3,500 transit cops.
"Library leaders argue that their institutions provide vital services – free books, Wi-Fi, computer access, online content and educational programs, among others – in 200 neighborhoods across the city, including in underserved communities."
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There is a simple, outright cure for hepatitis C. But state prisons across the country are failing to save hundreds of people who die each year from the virus and related complications.
1,013 people died of hepatitis C-related complications in state prisons nationwide in the six years after the first cure. They did not have to die. Worst states: Florida, Arizona, Oklahoma, N Carolina, Texas, Tenn...
Will Congress really send 80,000 Afghans back to the Taliban?
Failure by Republicans and Democrats to pass the Afghan Adjustment Act this year means that Afghans admitted here after Kabul fell will lose their temporary U.S. parole status next year.
Feel good du jour:
After noticing that Ken slept with a photo of his late wife every night, one of the carers at Thistleton Lodge presented him with this incredible gift... pic.twitter.com/sszmWjZ5ZK— Tansu YEĞEN (@TansuYegen) December 14, 2022
Inuk child in her first parka. pic.twitter.com/PRWtiVKujY— Lakota Man (@LakotaMan1) December 14, 2022
They think it's a baby cow🐄😅— Tansu YEĞEN (@TansuYegen) December 15, 2022
🎥:David Minish pic.twitter.com/rZGGhARwxg
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It doesn’t matter how badass you are, sometimes you just need your pooh bear.. pic.twitter.com/mgTSy5CL5m— Buitengebieden (@buitengebieden) December 12, 2022