Updates on New Infectious Disease Threats: What You Need to Know
Information about the spread and about the safety concerns of the novel coronavirus (aka "SARS-Cov-2"), and the disease it causes, COVID-19, is constantly evolving. However, I am now officially broadening the scope of this newsletter, as COVID-19 information dies down and other diseases pop up. I will try to concentrate on infections, but include other medical concerns as I see relevant. New information will be in BOLD.
COVID-19
General Information
The CDC also now recommends that people actually infected with COVID-19 need to be isolated for 5 days; After 24 hours without a fever and if they are feeling better, they can leave their homes as long as they wear a mask around others for the next 5 days. People can test themselves for COVID-19 on day #6 of their infection and stop wearing a mask if they have two consecutive negative tests. People with severe disease need to isolate for a full 10 days. And people who start feeling poorly again need to restart isolation for another 5 days....Clear as mud?
The above notwithstanding, a recent article in JAMA Network Open looked at student athletes infected with SARS-Cov-2 and found that 27% of them still tested positive 7 days after getting infected. This study suggests that a longer isolation period than 5 days is appropriate in some.
The CDC has updated its masking guidelines for health care facilities: universal masking is no longer mandatory, unless the health care facilities are in areas of high COVID-19 transmission.
A new study (Journal of Infectious Diseases) shows that babies born to mothers who have had COVID-19 but also got vaccinated, have higher antibody levels to the virus and are likely to be more protected from the disease.
In 2020 and 2021, COVID-19 contributed to one quarter of the maternal deaths (U.S. Government Accountability Office).
80% of children under the age of 18 have antibodies to SARS-Cov-2 that indicated a past infection - and hopefully also provide a degree of immunity.
The Sars-Cov-2 virus continues to mutate, but luckily, the new variants seem to be less dangerous than older variants.
The Federal Administration has again extended the public health emergency associated with COVID-19 until January 11, 2023, given concerns for increasing cases in the colder winter months.
At the same time, the administration is advising physicians to get ready for the end of the COVID-19 public health emergency, making some of us doctors' heads spin.
There are new omicron subvariants ("BQ.1" and "BQ1.1") that are becoming more common in the United States. They are not as common as the BA.5 and BA.4.6 subvariants, but are gaining ground.
Symptoms and Risk Factors:
Long COVID:
More recent studies suggest that ongoing inflammation (especially of the heart) may explain the long COVID syndrome.
A recent study published in JAMA again looked at the proportion of people with symptomatic COVID-19 in 2020 and 2021 and asked the question how many still had symptoms (ongoing fatigue, breathing issues, body pain, foggy brain, mood swings) 3 months after the infection: 6.2% continued to have some of these...which is lower than some of the previous studies suggested.
We have reported previously that COVID-19 infection is associated with an increased risk of blood clots. A new study (Circulation) used the health records of over 48 million adults in the United Kingdom and found that this increased risk of blood clots persists for at least one year after the infection.
A new article (Immunology) shows how SARS-Cov-2 damages the DNA of a patient's heart - thereby affecting the body in a way very different than the influenza virus, for example. So the COVID-19 heart damage goes beyond mere inflammation. More studies to understand this phenomenon are ongoing.
Incidence/ Prevalence:
The incidence of new COVID-19 infections is still decreasing, as are the hospitalizations and deaths. A worrisome sign, however, is that numbers are increasing in Europe. Some experts are concerned that this could predict an increase in cases in the United States soon also.
More than 95,000 Californians have died of COVID-19 since the onset of the pandemic.
Treatment
Vaccines:
An analysis conducted by the Commonwealth Fund found that COVID vaccinations could save about 90,000 lives, 936,000 hospitalizations, and $56 billion in medical costs in this winter alone. SO GET YOUR BOOSTER, IF YOU HAVEN'T ALREADY, PLEASE.
A nasally administered vaccine made by AstraZenica did NOT do well in recent trials, with only a small number of people developing an immune response (eBioMedicine).
Both the Moderna and the Pfizer/ BioNTech booster shots (in smaller doses!) are now authorized for children (Pfizer for kids aged 5-11, Moderna for kids aged 6-17).
Recent studies have found that the new booster shots are safe and significantly increase the amount of antibodies to the BA4 and BA5 subvariants
Pfizer/ BioNTech:
Moderna:
Johnson & Johnson:
The FDA has restricted the use of this vaccine to those people who can't get an mRNA vaccine OR specifically request the J&J vaccine.
Novavax:
This vaccines is protein-based, and therefore employs a different technology than was used with either the J&J or the mRNA vaccines. In fact, the technology has been used for decades.
On October 18, the FDA granted emergency use authorization to Novavax for use of a booster shot for the coronavirus vaccine. The Novavax booster is for people older than 17 who can't or won't get the booster made by Moderna or Pfizer/ BioNTech.
Other treatments:
We have discussed the medication Paxlovid for the treatment of COVID-19 in people over 50 or in people with immune compromise in the past. I have also mentioned that some few people seem to rebound with the disease after they finish their course. Well, a recent study published in the New England Journal of Medicine showed that only 2.3% of people who take Paxlovid actually rebound. Unfortunately, this study only included people who had the Delta variant of the SARS-Cov-2 virus, so it's now clear how people with the Omicron variant will fare...
A recent study looked at just 6 people who had rebound symptoms after taking paxlovid. They were actually found to have a more robust immune system (higher antibody levels) compared to those who did not have rebound symptoms...a surprising finding. But this would argue that taking longer courses of paxlovid is not the answer. Of those six that did rebound, four had milder symptoms, one had same symptoms, and one had worse symptoms with the rebound.
Testing
The U.S. plans on ordering over 100 million at-home COVID tests to be prepared for a possible surge in coming cold-and-flu season.
A study in the Annals of Internal Medicine found that the over-the-counter quick tests for COVID-19 were just as effective at detecting the Omicron variant as they were in detecting the previous Delta variants.
MONKEYPOX/ MPX
Symptoms of the current outbreak include initial chills and fever as well as a severe headache and muscle aches. However, 33% of people have no fevers or achiness. A few days later, people develop a rash consisting of blister-like firm lesions that then scab over. Lesions are usually painful and tender. Often times, the initial skin lesions are in the genital and rectal area. The mortality rate of monkeypox is 0.02%.
The incidence of monkeypox is declining now. Nonetheless, some health officials do not believe the diseases will go away, as too many people have been infected and exposed already. Transmission among gay and bisexual communities could go on for a long time.
72, 558 people have come down with MPX in non-endemic countries; most cases are in the U.S. 37%). California has 5,010 cases. Only 28 died of the disease.
The CDC has published a study showing that Americans who get a single MPX vaccine were much less likely to get infected by the virus.
Pharmacists are now permitted to administer the Jynneos MPX vaccine.
Since their peak in August, cases of MPX have dropped by more than 85%! The reason is thought to be related to vaccination as well as more careful behavior in the communities that were most effected (gay and bisexual men).
According to the CDC, the following people are eligible for the Monkeypox vaccine:
People who have been in direct physical contact with a person with monkeypox in the last 14 days.
High risk individuals
transgender or men who have sex with men and
have multiple sexual partners.
People who have occupational exposure to monkeypox (lab workers, certain healthcare and public health workers).
People who anticipate engaging in high risk activities in the next 14 days.
POLIO
Another infectious disease has recently been in the news: polio! On July 21, a young adult in New York (who was not vaccinated against polio) contracted the disease and became paralyzed. Even though only one person has fallen ill with paralysis, the state has declared a disaster emergency. This is due to a larger percentage of people not being fully vaccinated AND many people likely being infected, but not having any symptoms or only mild symptoms.
Here are some important things to know about the disease:
Polio causes symptoms only 25% of the time, and then the symptoms usually feel like you have a flu. However, 1 in 200 to 1 in 2000 will become paralyzed with the virus, and a small percentage of these can die. So even though we have heard only of one case of a paralyzed individual, there may be more people who have become infected and just not had significant disease. This is bad, as they can spread the disease to others...
Polio is caused by a virus for which there is currently no treatment. Luckily, vaccination is VERY effective in preventing polio. The CDC recommends one lifetime booster in people who
travel to an area where polio is common
work as lab techs in polio labs
health care workers who treat patients with polio
Polio vaccines have been around for over 50 years.
In the United States, only about 79% of 2-year-olds are fully vaccinated
INFLUENZA:
Cases of influenza are on the rise! Cases across the country are higher than "normal" for this time of year.
Flu cases are still low in California. Higher levels of influenza are being reported in southeast and south-central U.S.
And, it's time again for the annual flu shot! Health experts have warned the nation that this flu season could be particularly severe, as we have been isolating in the last few years and not built up much immunity to the flu virus...Our office has gotten our supplies in our office already and you are welcome to come in to get yours. No appointment is needed, but please call ahead of time to let us know you are coming. As mentioned in previous newsletters, flu shots do more than protect against influenza: people who get the flu shot are also less likely to get COVID-19. They are also at lower risk for heart attacks and strokes (see the journal Neurology)!
EBOLA:
There has been an outbreak of Ebola in Uganda in recent weeks. The strain causing diseases there is called the "Sudan Strain," for which there are no known treatments or medications.
Symptoms of ebola include fever, headache, muscle pain, vomiting and diarrhea.
There have not been any cases reported in the United States, but people traveling to the U.S. from Uganda will now be redirected to airports where they can be screened for the disease.
Screening will include checking for fever or symptoms of Ebola and collecting contact information in case someone comes down with the virus.
OTHER MEDICAL NEWS:
The Food and Drug Administration is implementing new rules on food labeling. Manufacturers can now state on the food label that it is "healthy" if the food contains a significant amount of one of the major food groups (think fruits, vegetables, daily) AND limits certain nutrients (like saturated fats, sodium, added sugars). I hope that this well help clarify which foods should be minimized in our diets...
As mentioned in a previous newsletter, pharmacies and other big-box stores are now allowed to sell hearings aids over-the-counter. This could be a good thing, as hearing aids are not covered by Medicare or most insurance plans. This new regulation will make the devices more easily accessible and (likely) more affordable. However, this could also be a bad thing, as the devices will be largely unregulated. This could lead to devices of poor quality being marketed to the public.
Our Community and Beyond:
Gov. Gavin Newsome has announced that California's COVID-19 state of emergency will end at the end of February, 2023. This state of emergency had allowed the state government to mandate stay-at-home orders as well as masking guidelines.
About Dr. Sujansky's Life in These Times
I recently attended an event at Filoli Gardens in Woodside. It was so beautiful! I was again reminded in what a marvelous place we live and that we need to visit such resources more often. I urge all of you to do the same!
Happy Halloween, everyone!
I hope that the good witches and adorable goblins knock at your door!