Coronavirus Tidbits #247, May 28, 2023

May 27, 2023 /

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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.

New Post:

Infections From Medical Tourism And How To Protect Yourself

https://www.forbes.com/sites/judystone/2023/05/23/infections-from-medical-tourism-and-how-to-protect-yourself/

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My LTE on #Masking

Hospitals throughout Maryland have been lifting their mask mandates to varying degrees. UPMC announced that masking is now only “required in specic patient care areas where patients are particularly vulnerable to infection.”

The Women’s Action Coalition objects to this decision. Our group focuses on social justice issues affecting our community. We believe that protecting each other and looking out for our neighbors’ well-being, particularly for the most vulnerable among us, is crucial to improving health in our community.

The WHO, President Biden, and others have declared the pandemic emergency is over. This does not mean that COVID has stopped. There are still 88,330 new COVID cases (12,619/day), 1,402 new hospitalizations, and 1,052 (150/day) new deaths in the U.S. This rate is far better than Feb. 10, when the CDC reported more than 40,000 new infections daily.

The CDC has recommended masking when community levels are high, but there is no good way of knowing this. Most people test at home. The CDC no longer collects test data — only deaths. They stopped wastewater surveillance here last year. Now the CDC will stop tracking community levels of COVID. We are deliberately being kept in the dark.

Further, hospitals are not required to report COVID infections acquired within their facilities to anyone. We know that up to 50% of health care workers continue to work despite having symptomatic COVID. There are increasing numbers of hospital-acquired COVID which carry higher rates of death, too.

We understand that there are now fairly effective vaccines that keep most people from dying, even if they don’t prevent infection reliably. The antiviral Paxlovid also makes illnesses milder — until the virus becomes resistant to it. But even a mild COVID infection can result in long COVID.

Long hauling — continuing to experience (often debilitating) symptoms after no longer testing positive — is a key concern. COVID is not a simple “cold.” The CDC estimated that 20% of people infected with SARS-COV2 may develop long COVID. Recent data suggests that 6% — more than 12 million Americans — are suffering with long COVID.

Yes, individuals can mask if they are concerned. But we have ample evidence that one-way masking is less effective than all people masking.

A UPMC administrator told me that patients could request that staff mask. First, many people will likely be anxious and/or confused from their illness and forget to ask. Some may be too ill to ask. Others might not know to ask. Even if they do, many people already feel frightened and vulnerable when they are sick and go to the doctor and are unlikely to risk antagonizing their doctor or nurse by asking for staff to wear masks.

A number of chronically ill people on social media are saying that dropping mask mandates will translate to their not seeking medical care except in emergencies. They simply are unwilling to risk becoming more ill.

Hospitals and businesses could make spaces safer by improving ventilation and being transparent as to what they have done. For example, some restaurants and concert venues display CO2 levels to show attendees how well ventilated the space is. Some medical ofces have HEPA units in exam rooms. Such measures show people that their safety is of paramount importance.

The message from UPMC, state public health ofces, and other businesses is that the appearance of normalcy trumps caring for others. Elders, high-risk people, and the immunocompromised are being told that they are inconvenient and expendable collateral damage. What happened to “caring for the least of these?” All people have the right to safe health care. We urge UPMC and local medically related ofces to resume masking to protect all — especially the most vulnerable — in the community.

https://www.times-news.com/opinion/letters_to_the_editor/hospitals-and-medical-offices-should-continue-masking-for-patient-safety/article_259cabe8-f8bc-11ed-b26b-a3bd38d66a65.html

 

News 

Covid outbreak at CDC meeting

@TogetherWeMask
At the Epidemic Intelligence Service “mostly maskless” gathering, 181 out of 1,800 attendees got #Covid. Positivity is >10%. Yikes We agree with HeathOfficer Duchin’s response to CDC’s #SuperSpreadingEvent. We need the layered approach to stop transmission.
Acc. a survey participated by 80% of the attendees:
-- 99% vaccinated
-- ~70% didn’t mask
-- 52% of the infected caught it the first time
The risk of infection was 70 percent greater among those who attended three or more days compared with those attending two or fewer days.
The end of the public health emergency on May 11 also meant cases and positive test results stopped being reported to the CDC.
Gift article/ Free link:
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New XBB-driven #COVID wave in China

Bloomberg news predicts ~65 million infections/week by June. 40% cases are already **reinfections** and rising as immunity from previous illness wanes. China is focusing on XBB specific vaccines

bloomberg.com/news/articles/

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What happens to the brain ~ 1 year after mild to moderate #Covid?

A comprehensive MRI study of >200 unvaccinated individuals with matched controls indicates a "prolonged neuroinflammatory response" w/o cognitive decline pnas.org/doi/10.1073/pn
     @EricTopol  
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COVID-19 during pregnancy may predict worse birth outcomes

COVID-19 infection during pregnancy predicted worse birth outcomes, including preterm delivery, low birthweight and longer hospital stay, researchers reported at the ACOG Annual Clinical & Scientific Meeting.

“We found that COVID-19 infection during pregnancy predicted poor birth outcomes — it decreased birthweight by almost half a pound and increased the risk of an extended delivery hospitalization almost threefold. These effects were largely driven by earlier delivery, as those who had COVID-19 during pregnancy had a fourfold increased risk of preterm delivery,”

...“Severity of COVID-19 infection during pregnancy matters,” Elsayed told Healio. “In our study, severe infection ... was a strong predictor of poor outcomes with the worse outcomes among those with the most severe infections during pregnancy.”

https://www.healio.com/news/womens-health-ob-gyn/20230522/covid19-during-pregnancy-may-predict-worse-birth-outcomes

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Post-Covid Diabetes in Children

@skepticalraptor   
New research shows that there is a greatly increased risk of Type 1 diabetes in children who have had a COVID diagnosis. More reason to make sure your kids have been vaccinated. buff.ly/431UQry
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Paxlovid gets full FDA approval

Pfizer's Covid antiviral Paxlovid has gained full US approval. The pill previously had been granted emergency use authorization. Full approval clears the way for the drugmaker to sell it at "market rates" once US government's supplies dwindle.
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Hospital-acquired Covid

again accounts for 31% of Covid admissions in England. The proportion of hospital acquired cases has been at this high level consistently for many months now and is likely to remain at this level but will not be reported.
    @AdeleGroyer
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Vitamin D and Long Covid:

People with low vitamin D after being hospitalized for COVID-19 are more likely to develop long COVID compared to people without a vitamin D deficiency, a new study finds.

But long COVID affects 50% to 70% of people who’ve been hospitalized with COVID-19, according to a new study that explores a link between vitamin D deficiency and long COVID.

https://www.medicalnewstoday.com/articles/vitamin-d-deficiency-linked-to-increased-risk-of-developing-long-covid#Getting-enough-vitamin-D

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Reproductive health and Long Covid

@patientled  May 24

1/ New @patientledpaper alert! Reproductive health issues after COVID are well known among #LongCovid patients but are not adequately studied. For

@FrontRehSci, we reviewed studies on repro health impacts of Long COVID & associated conditions in women:
Long thread...
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Clotting and MI:

@CatchTheBaby   
Patients with COVID-19 at time of heart attack have more clotting buff.ly/3MOx1h8
Clots were seen in multiple arteries in close to 30% of patients with #COVID at the time of their heart attack, but in less than 5% of heart-attack patients who did not have COVID.
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RECOVER #LongCovid

@ahandvanish   
First: The overall prevalence of #LongCovid is 10% at 6 months! The prevalence for those who got Omicron (or later) AND were vaccinated is also 10%! This was a cohort enrolled in the acute phase, before they knew if they had LC - these are extremely reliable numbers.
Second, a huge datapoint: Reinfections had significantly higher levels of #LongCovid. Even in those who had Omicron (or later) as their first infection, 9.7% with those infected once, but 20% (!!) of those who were reinfected had Long Covid AT 6 MONTHS AFTER INFECTION.
Reinfections also increased the severity of #LongCovid. 27% of first infections were in cluster 4 (worst) vs 31% of reinfections.
Third, we have an understanding of most common #LongCovid symptoms, and which symptoms are more useful to identifying LC. Overall, most common symptoms: Post-exertional malaise Fatigue Brain fog Dizziness GI issues Palpitations Hearing issues
It also explores the most *specific* symptoms - those less likely to show up in uninfected controls - to help us identify #LongCovid. These include PEM, fatigue, brain fog, dizziness, GI ussues, heart palpitations, changes to (NOT just loss of) smell/taste, & others. 6/
graph with frequency of most specific symptoms
Crucially, anxiety and depression a) did not show up as within the most common symptoms and especially b) were nowhere near sensitive enough to be used in the #LongCovid definition.

 

Bird Flu outbreaks:

The Pan American Health Organization (PAHO) recently stated the detection of bird flu outbreaks in Latin America and the Caribbean is a situation never recorded before.

The identified influenza type A Highly Pathogenic Avian Influenza (HAPI) outbreaks are mainly located in areas of the Pacific flyway.

 

https://www.precisionvaccinations.com/2023/05/24/bird-flu-outbreaks-situation-never-recorded

Diagnostics:

still an incredible, negligent last of testing.

Drugs and vaccines:

Project Next Gen

The WhiteHouse is supporting next generation—nasal and variant-proof Covid vaccines —and therapies with a $5 billion program washingtonpost.com/health/2023/04 by @ddiamond

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COVID-19 vaccines may undergo major overhaul this fall

As Omicron persists, consensus grows for abandoning the ancestral coronavirus strain to improve immune responses

Science BY JENNIFER COUZIN-FRANKEL  23 MAY 2023

Earlier this year, U.S. regulators settled on a new strategy for COVID-19 vaccines. Like the annual flu shot, the vaccines will be updated each year based on the virus’ evolution, then rolled out in the fall. Accordingly, on 15 June, advisers to the U.S. Food and Drug Administration will weigh which strain or strains of SARS-CoV-2 should make up the next iteration of vaccine, so that the agency can greenlight a version for companies to mass-produce.

Regulators may well jettison the original SARS-CoV-2 strain that emerged in China and is long extinct—but which people are still being vaccinated against today. Many scientists favor eliminating it. The ancestral strain “should go out of the formulation,” says William Messer, an infectious disease specialist and viral immunologist at Oregon Health & Science University. Last week, the World Health Organization (WHO) agreed. But other questions loom, including whether to bundle multiple virus strains into the vaccine or just one.

To date, COVID-19 vaccines have been modified only once, when a bivalent version based on both the original strain and the BA.5 Omicron variant was introduced in September 2022. Uptake was disappointing: Only 17% of people in the United States have rolled up their sleeves. (By comparison, about 50% get an annual flu shot.) Furthermore, many researchers say the bivalent vaccine packed less of a punch than it could have. The decision to preserve the ancestral strain sprang from worries that if an entirely new variant emerged, an Omicron-only vaccine might falter against it.

This hedging proved unwarranted: All major new variants have flowed from Omicron, which was first detected in South Africa in November 2021. And evidence increasingly shows that a vaccine split between a current strain and one that’s extinct makes it harder for people to mount a strong immune response to the virus.

https://www.science.org/content/article/covid-19-vaccines-may-undergo-major-overhaul-fall

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World Health Organization recommends that new #Covid shots should target XBB variants.

Vaccines should aim to prompt antibody responses against XBB.1.5 or XBB.1.16, a WHO advisory panel says. Panel advised against original SARS2 strain in future shots.

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@EricTopol  
It's the apple-shaped, abdominal obesity, that appears to be the driver of obesity as a risk factor for severe Covid and cytokine storm
pnas.org/doi/10.1073/pn
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Vaccine hesitancy persists among parents

The majority of U.S. parents accept the recommended vaccine schedule for their children. But a new review of published research from the University of Georgia suggests vaccine hesitancy among a small but significant percentage of Americans doesn't appear to be going away any time soon.

https://medicalxpress.com/news/2023-05-vaccine-hesitancy-persists-parents.html?

Devices:

Epidemiology/Infection control:

Recover Trial

@loscharlos   May 25
1st  @NIH RECOVER adult cohort results are out today: “Among participants with a first infection during the Omicron era, #LongCovid frequency was higher among those with recurrent infections, corroborating EHR–based studies”
“Though studies on the effect of vaccination are conflicting, these findings of modest reduction in #LongCovid frequency among fully vaccinated participants align with recent systematic reviews.”
“10% of participants first infected on or after December 1, 2021, and enrolled within 30 days of infection were classified as PASC positive at 6 months after infection.” #LongCovid
“Among participants with #LongCovid, the most common symptoms were PEM (87%), fatigue (85%), brain fog (64%), dizziness (62%), GI (59%), and palpitations (57%)”
“The proportion of infected participants with #LongCovid in the acute Omicron subcohort was 10% (224/2231).. It was greater in the postacute pre-Omicron (1320/3732) 35%.”

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Could Alzheimer's be Caused by an Infection?

@PGeldsetzer1   
Biggest thing to ever come out of my little group. Pls help spread this finding! We found clean, CAUSAL evidence that the shingles vaccine prevents a good chunk of dementia cases. So, could a virus cause Alzheimer’s->YES! Hear me out & see preprint: bit.ly/3MVqXU9
There’s recently been increased interest in the possibility that a virus may be involved in the causal pathways of dementia. Most attention has been on herpesviruses, incl the VZV that causes chickenpox and shingles, partly because of their lifelong latency (bit.ly/3nibvYk).
In Wales starting in Sept 2013, the shingles vaccine was rolled out using an exact DOB cutoff. Those born on or after Sept 2 1933 were eligible, while those born earlier weren’t and remained ineligible for life. We analyzed EHR data for all of Wales with DOB exact to the week.
We first show that just a one-week difference in age causes a massive (47 %-point) difference in the probability of ever getting the vaccine. This is paradise for getting at CAUSATION rather than correlation!
Image
After all, there’s no reason why those born one week before Sept 2 1933 should differ in anything from those born just one week later, EXCEPT for this diff in vacc receipt. This is just like a clinical trial: two exchangeable groups with only one getting the intervention.
So, no need for the usual heroic assumption of perfect info on all confounders that make those who get the vacc different from those who don’t. This is crucial, and why our study is fundamentally different to other (all correlational) analyses in this area. What did we find?
We first tried to replicate the vaccine’s known effect from clinical trials that it prevents shingles and PHN. It does – no surprise here but nice proof of concept. Now we test our real hypothesis: does getting vaccinated decrease your chance of a dementia diagnosis years later?
Image
It does! We estimate that over a 7-year follow-up period, getting vaccinated averts one in five new dementia diagnoses. In the paper, we demonstrate through extensive robustness checks that it is essentially impossible that this finding is due to confounding.
Given how robust this finding is across a large variety of specifications and series of robustness checks, it’s also extremely unlikely to be due to pure chance.
We then show that the vaccine has no effect on any other common causes of morbidity or mortality. This is unlike correlational analyses that usually suffer from bias because healthier/more health motivated folk with better healthcare access are more likely to get vaccinated.
Shingles is more common in women + increased recognition that the causes of Alzheimer’s may differ by sex (bit.ly/3HqGh8k). We find strong protective effects of the vaccine for women but none for men, and that this diff is driven by Alzheimer’s (not vascular) dementia.
What’s needed next? 1) Randomized trials w/ precise cognition measures to determine exact effect size + optimal pop groups & time interval for vacc.

Tips, general reading for public:

Ventilate.

Mask.

Vax.

 

Politics:

Covid, CDC:

@mehdirhasan   May 26
Don't let DeSantis gaslight you on Covid. Florida has a higher per capita death rate than CA; has had a majority of its deaths since vaccines unlike CA & NYC; & a higher per capita death rate than other states with elderly populations. I brought receipts:
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Florida under DeSantis also had the highest number of Covid deaths of any state in the country for three straight months last summer.
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@ahandvanish   
I just learned that the CDC no longer recommends routine testing for the STD herpesviruses (HSV-1 and HSV-2), which is pretty mind boggling given everything we’ve learned about herpesviruses in the past few years.
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Congress/GOP/Budget:
Pretty cool how we have an $800 billion defense budget and the first thing Congress is going to cut is food stamps.
     --@kenklippenstein   May 25
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Permanently extending parts of the 2017 Trump-GOP tax law—as Republican leaders have promised to do—would add at least $3.5 TRILLION to the national debt over the next decade. All of their budget cuts would be canceled out by lost revenue from their tax giveaways.
     --@4TaxFairness   May 17
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All House Republicans (and two Democrats) just voted to overturn President Biden's student debt forgiveness plan.  May 24
GOP/TFG
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Greed:
@60Minutes   May 22
The Pentagon announced in March its largest-ever budget: $842 billion. Almost half will go to defense contractors. A six-month 60 Minutes investigation found that contractors are overcharging the Pentagon on almost everything. cbsn.ws/45kcicq
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@Cigna CEO David Cordani made over $21 million dollars last year.
In the meanwhile:
Hey @Cigna I have a patient in the ICU who needs an urgent heart transplant and we are being told that not only is our hospital out of network for transplant but so is the only other transplant center in the state.
     --@annievanb, Advanced Heart Failure and Transplant Cardiologist at Emory University   May 16  She continues:
@Cigna you apparently would like us to transfer to another ICU in a hospital out of state and hundreds of miles away where the patient has no family, no resources and no support. Are you also then going to cover housing and transportation costs indefinitely post transplant?
Or do you suggest the patient have their family which includes young children pack up and move to a different state where there is a hospital that is in your network for an urgent heart transplant? Will you be paying for that?
since you seem to know what the best way treat patients is I would genuinely like to hear how you suggest we best care for this patient.
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Abortion/Reproduction
"Right to Life" group met at local high school here to plan opposition to the Women's Health Center that is opening here in Cumberland next week.
Includes Mike McKay, state senator for our district
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Antisemitism:
Biden Unveils a National Plan to Fight Antisemitism - Jews account for 2.4 percent of the U.S. population, but are the targets of 63 percent of reported religious hate crimes-
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LGBTQ
@Esqueer_   May 25
Republicans think 12 years old is too young to learn about LGBTQ people but old enough to work in bars and slaughterhouses, get married, and be forced to give birth to their rapists baby. The party of "protecting children."
apnews.com/article/child-
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Florida
DeSantis formally enters Prez race
Image
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@jemelehill   May 23
This is the one parent who successfully got Amanda Gorman’s poem banned. Will the Miami-Dade school district reverse this decision now that it’s surfaced that parent as ties to a white supremacist organization? Or does the comfort of a white supremacist matter more? :
Yesterday the @MiamiHerald published an article on Miami Lakes parent Daily Salinas who challenged several books such as The ABCs of Black History. But what they didn’t report & we will reveal is Salinas’ ties to far-right groups like M4L & open support of the Proud Boys.--from Miami Against Fascism
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@radleybalko  May 24
A heart transplant recipient was arrested after a dispute with a neighbor over WiFi. Jail officials refused to let him take his transplant medication for two days. He’d waited 12 years for a heart. His body rejected the heart, and he died.
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Indiana

Indiana doctor reprimanded and fined for talking publicly about Ohio 10-year-old's abortion

An Indiana board has decided to reprimand an Indianapolis doctor after finding that she violated patient privacy laws by talking publicly about providing an abortion to a 10-year-old rape victim from neighboring Ohio. The state Medical Licensing Board voted that Dr. Caitlin Bernard didn’t abide by privacy laws when she told a newspaper reporter about the girl’s treatment in a case that became a flashpoint in the national abortion debate days after the U.S. Supreme Court overturned Roe v. Wade last summer. Board members chose to fine Bernard $3,000 for the violations, turning down a request from the attorney general’s office to suspend Bernard’s license. - AP

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Tennessee
@jbcarmody   May 23
Last week, Tennessee passed legislation to allow international medical graduates to obtain licensure and practice independently *without* completing a U.S. residency program. This is BIG news. So you know what that means. Time to break it down, Winners & Losers style.
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@JuddLegum   May 25
1. Laurie Cardoza-Moore has promoted conspiracy theories about 9/11 She defended to plot to kidnap the Governor of Michigan Now Tennessee House Speaker @CSexton25 has appointed her to a board charged with creating the state's social studies standards
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Texas:
We're watching a bad election bill currently up in the #txlege House seeking state takeover of local elections: SB1933 would allow partisan state actors to manipulate local elections in any county by imposing "administrative oversight"
It would effectively allow @GovAbbott through his appointed Secretary of State, to exercise direct control over county election systems and manipulate them for his own partisan gain.
     --@TXCivilRights  

Feel good du jour:

also nytimes.com/2023/05/24/sci

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@JL_Braden
Two things are missing from the obituaries about #TinaTurner: her commitment to Buddhism, which she credited with saving her life, and this story of true abiding love:
Image

Comic relief:

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https://twitter.com/MsPackyetti/status/1657378634703749122?s=20

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https://twitter.com/buitengebieden/status/1662405532915847172?s=20

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Perspective/Poem

Bits of beauty:

Freeland Bog Trail, Canaan Valley

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