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. In addition, I would like to update you on other infectious disease information as well as other new non-infectious medical information that has come to light. New information will be in BOLD.
COVID-19
General Information
I know many of you have asked me whether the side effects associated with the COVID-19 vaccines have implications for the vaccine efficacy: in other words: do side effects predict how effective the vaccines will be? Well, an article published in JAMA Network Open found that people who have more symptoms tend to create more antibodies to the virus....of course that doesn't necessarily mean these people will get sick less often, but it is interesting!
You all have heard me write about the new bivalent booster, that incorporates viral particles of the omicron and delta variants, not just the original SARS-Cov-2. Like flu shots, that are updated yearly, these updated boosters will hopefully be more effective in preventing COVID-19. Indeed, recent studies done on both the Moderna and the Pfizer/ BioNTech boosters DO show a significantly increased antibody responses compared to prior boosters. This again makes us hopeful that the new bivalent boosters will be more effective in preventing infection and severe disease.
A new study (New England Journal of Medicine) has found that the protection of the COVID-19 vaccine for kids under 12 wanes more rapidly than in older kids or adults. This rapid dissipation of efficacy may be related to the lower doses of vaccine administered to kids.
COVID-19 hospitalization are rising in babies under the age of 6 months. We know that if pregnant mothers are vaccinated for the virus, the baby will be protected also. For this reason, more efforts are being made to vaccinated pregnant women.
The federal administration is very worried that tens of thousands of Americans will die this winter of COVID-19, deaths that could be prevented with vaccination and early treatment. As a consequence, the administration is working together with Walgreens, DoorDash, and Uber to provide free delivery of the anti-viral medications and better access to the vaccines.
Actually, we are seeing a "triple epidemic" throughout our country now, with infections due to influenza, COVID-19, and RSV (respiratory syncytial virus) rising rapidly (see below).
There are ever more SARS-Cov-2 subvariants popping up: luckily, they don't seem to be more aggressive than previous variants, though they do seem to be less immune to prior vaccinations or COVID-19 infection. Currently, the most common subvariants in the United States are BQ.1 and BQ.1.1 and currently account for a quarter of new infections.
A new study (Nature Medicine) is a bit worrisome, I'm afraid: each time a person becomes infected and gets COVID-19, they can have significant health complications - not just the first time. Such people are more likely to end up in the hospital. People with repeated infections are also more likely to get long COVID. This applies to people regardless of their vaccination or booster status.
The current isolation recommendations of the CDC are as follows:
people with mild to moderate symptoms should be considered contagious for 10 days since onset of symptoms. They can then leave isolation if they are feeling better and haven't had a fever for 24 hours
people without symptoms but with a positive test should be considered contagious for 10 days after the first positive test.
people who have moderately or severely compromised immune systems need to isolate for 10 days (as above) AND also have two negative tests, at least 48 hours apart
Symptoms and Risk Factors:
Long COVID:
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.
A new study (JAMA Network Open) found that about 10% of people have ongoing symptoms one year after symptomatic infection with COVID-19.
People with gout (especially women) may be more prone to COVID-19 and more likely to require hospitalization (Arthritis & Rheumatology).
Incidence/ Prevalence:
Nationwide, the number of people ill with COVID-19 as well as the associated hospitalizations are on the rise. This increase is most noteworthy in Arizona, Colorado, Nevada, and New Mexico, states that have seen an increase in COVID-19 hospitalizations of 30% in the last two weeks. Luckily, the deaths associated with the virus are decreasing and have actually dropped 9% in the last two weeks.
Over 800 people on a cruise ship (more the 20% of the people on board!) tested positive for COVID-19 on 11/12/22....and they only tested those people with symptoms, so that the count could be even higher....
A study just published in JAMA found that "all cause mortality" in the U.S. from 2021 to early 2022 was up by 150,000 to 470,000. These extra deaths are thought to be related directly or indirectly to COVID-19. The states with the highest vaccination rates had the fewest "excess deaths."
Treatment
Vaccines:
A study published in the British Journal of Sports Medicine found that the COVID-19 vaccination were most effective in preventing disease in people who exercised regularly - these people were 25% less likely to be hospitalized than the couch potatoes. One more reason to get active!
Pfizer/ BioNTech:
An article (Journal of the American College of Cardiology) found that people who got the Pfizer/ BioNTech booster had a slightly lower incidence of heart inflammation compared to those who got the Moderna booster.
An article published in Jama Network Open found that kids younger than 5 years of age tolerated the Pfizer/ BioNTech vaccine well: they were just as likely to have side effects with the COVID-19 vaccines as they had with other routine childhood vaccinations.
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.
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.
A study in JAMA Network Open found that COVID-19 rebound symptoms can occur in people who never took paxlovid - suggesting that the rebounds we see are not unique to paxlovid but can occur regardless.
Evusheld is an infusion that we have been giving every 6 months to people at very high risk of COVID-19, to help prevent severe illness. Unfortunately, Evusheld doesn't seem to work with the newer variants, which make up about 50% of new cases at this time.
The FDA has given emergency use authorization for a new injection (anakinra) that can be used for adults hospitalized with COVID-19 that need supplemental oxygen. This is a medication that has been used for diseases like rheumatoid arthritis in the past.
Testing
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. The mortality rate of monkeypox is 0.02%.
The incidence of MPX is declining now. At this time, there is less than one new case daily in San Francisco.
Almost 29,000 cases of MPX have been diagnosed in the United States - California has the highest incidence of any state.
People with untreated HIV infection are particularly likely to do poorly with MPX Infection (like losing the function of their lungs, spinal cords and brains!) (MMWR); of the 57 hospitalized patients studied in the MMWR report, 82% had HIV.
San Francisco will end the State of Emergency for MPX on 10/31/22.
Over 27,000 SF residents have now been vaccinated for MPX.
The above notwithstanding, the WHO has stated that MPX continues to represent a "global health emergency," which is the highest level of alert for the agency. Similarly, HHS has renewed the national public health emergency for the disease, allowing for vaccine effectiveness studies to continue and for information exchange across states to be facilitated.
A new study (BMJ) has found that people with MPX can transmit the disease in the four days prior to symptoms starting. Indeed, it seems that 52% of transmissions occur prior to people even knowing they are infected!
INFLUENZA:
We are seeing an early and severe influenza season right now, with the highest rates of hospitalization for flu since 2010. 50% more people are hospitalized with the flu compared to last week!
Influenza rates are increasing significantly in large parts of the U.S (especially in the south and southeast). Santa Rosa has seen a recent surge in cases also.
Hospitalizations are the highest in over a decade for this point in the season: there have been over 880,000 lab-confirmed influenza cases, 7,000 hospitalizations, and over 360 deaths due to flu this season already.
Australia, whose flu season often predicts what is in store for us, has had its worst flu season in 10 years!
Similarly, Chile has had epidemic levels of influenza this year, with infections occurring early and frequently. (Morbidity and Mortality Weekly Report).
For unclear reasons, Europe, Central America, and the Caribbean has reported little influenza activity.
This year's flu symptoms are quite typical: rapid onset of severe headache, fever, and fatigue.
RSV:
RSV is a virus that leads to symptoms much like the flu. It is seen most often in kids and older adults.
Rates of RSV are currently very high in California as well as the rest of the U.S. ICU beds for kids are almost full due to RSV infection.
There are two new RSV vaccines that are undergoing review right now. One is made by GSK, the other by Pfizer. We are expecting an application for emergency use of both vaccines by the end of 2022. There are currently no FDA approved vaccines for RSV in the U.S.
EBOLA:
There has been an outbreak of Ebola in Uganda in recent weeks.
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.
A new vaccine developed by Merck seems to be effective. Vaccine doses are being donated to Uganda now.
As of November 12, 139 cases of Ebola have been identified in Uganda. No cases have been described outside of Uganda.
Vaccines to Ebola are due to arrive in Uganda next week.
OTHER MEDICAL NEWS:
Now for some good news: the incidence of dementia in the U.S. has dropped 30% from 2016 to 2020! This information comes from the Health and Retirement Study published in PNAS. It is thought that this decline reflects society-wide improved education as well as other larger socioeconomic changes and improved prevention of cardiovascular diseases and stroke.
Our Community and Beyond:
Note that COVID-19 cases in the Bay Area are on the rise also and hospitalization rates are going up also.
About Dr. Sujansky's Life in These Times
I have lived in the Bay Area for over 30 years now, but I don't think I have ever seen the fall colors as beautiful as they are this year! I was actually stopped at a stop sign last week and was so awed by the beautiful colored trees of the adjacent house, that I got out and took a picture....I hope the owners don't think I was a stalker!