Updates on New Infectious Disease Threats: What You Need to Know
Information about COVID-19 as well as other infectious diseases is constantly evolving. I am hoping to summarize some of that in these newsletters. New information will be in BOLD.
COVID-19
General Information
A recent article (JAMA) found that deaths caused by COVID-19 in the United States in 2021 and 2022 exceeded the death rate in 20 peer countries. The per capita death rate was higher than abroad even in those U.S. states with the highest vaccination rates.
People who died of COVID-19 in 2021 tended to be younger then those who died earlier (Annals of Internal Medicine).
I know many of us wonder (or at least: I wondered) if all the money the government was spending in paying for free COVID-19 vaccinations was worth it: well, a recent analysis (JAMA Network Open) looked at the example of New York City in this regard: for every $1 the city invested in their vaccination campaign, there were $10.19 in cost savings from lower hospitalizations, doctors visits, and lost productivity.
I don't think you want to hear this, but listen up anyway: as I've noted in the past, the U.S. is facing a "triple epidemic" this winter of flu, RSV infections (see below), and COVID-19. The CDC therefore is urging the use of face masks in indoor public places to help prevent spread. Rates of RSV are plateauing in the Bay Area, though cases of flu and COVID-19 are going up.
Symptoms and Risk Factors:
Long COVID:
A new study (JAMA Network Open) found that about 10% of people have ongoing symptoms one year after symptomatic infection with COVID-19.
Based on an analysis of the CDC, long Covid has been associated with at least 3,500 deaths in the U.S.
Incidence/ Prevalence:
Across the county, COVID-19 cases and hospitalizations are rising. In fact, hospitalizations for COVID-19 are up 25% in the last few weeks. This surge is not as severe as in previous years, though the number of states involved is bigger. Luckily, we have NOT seen an increase in deaths due to COVID-19 with the current surge, at least not yet!
Treatment
Vaccines:
The new Moderna and Pfizer/ BioNTech vaccines (that target the newer SARS-Cov-2 variants) were found to be only 43% effective in preventing mild disease in people younger than 50. Nonetheless, they are more effective than earlier COVID-19 vaccines. People who received the newer bivalent shots were more protected than those who did not receive them.
The first human studies looking at new vaccines that are administered intranasally did not produce a strong immune response in the body....back to the drawing board...
Pfizer/ BioNTech:
On December 9, U.S. regulators authorized the new bivalent COVID-19 booster for kids under the age of 5 - not just as a booster, but as part of the initial series. The bivalent booster would take the place of the third shot in the initial vaccination series.
Moderna:
On December 8, U.S. regulators authorized the new bivalent COVID-19 booster for kids under the age of 5 - not just as a booster, but as part of the initial series. The bivalent booster would take the place of the third shot in the initial vaccination series.
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.
A recent study (JAMA Network Open) gave paxlovid to 47 pregnant women with COVID-19: the women did well and kept the disease from becoming severe. Moreover, the drug did not seem to interfere with the pregnancy in any significant way.
Testing
Roche is working together with Pfizer in boosting COVID-19 testing as well as treatment: the test (made by Roche) will include a QR code that sends folks to a website on COVID-19, including testing and treatment information.
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%.
Monkeypox is also known as MPX. Also, the WHO also just renamed the disease "mpox." Many people believed that "monkeypox" called to mind racists slurs and stigmatized patients in general.
So far, there have been about 30,000 cases and 14 deaths in the United States.
The federal administration is planning to end the public health emergency for mpox due to stark declines in disease incidence. At this time, the United States is seeing less than 10 cases daily, down for 450 daily cases at the onset. The public health emergency went into effect in August, 2022
INFLUENZA:
Flu-like illnesses (caused by COVID-19, influenza, RSV, as well as various other viruses) have made up 7.5% of all outpatient medical visits in the last week! The rising trend of infections took a turn for the (even) worse after the Thanksgiving break, when we were all gathering together indoors. Likewise, hospitalizations due to influenza are higher now than they have been in a decade.
There have been at least 8.7 million influenza illnesses, 78,000 hospitalizations and 4.500 deaths this season so far (including 14 children who have died of the disease!). Normally, influenza doesn't peak until December or January. 44 of our 50 states have reported higher or very high flu activity in the last week.
As mentioned previously, this year's flu vaccine seems to be a good match for the circulating flu variants.
RSV:
RSV is a virus that leads to symptoms much like the flu. It is seen most often in kids and older adults.
There are some indications that RSV rates have peaked and are now declining.
Pfizer has developed an RSV vaccine, which is being reviewed by the FDA now. This vaccine would be aimed at adults older than 60. A decision by the FDA is expected by May, 2023.
EBOLA:
There has been an outbreak of Ebola in Uganda in recent months.
Symptoms of Ebola include fever, headache, muscle pain, vomiting and diarrhea.
As of November 28, 141 cases of Ebola have been identified in Uganda. No cases have been described outside of Uganda.
On December 2, Uganda discharged its last hospitalized patient with Ebola.
Though the number of new infections is declining, all districts in Uganda need to be Ebola free for 42 days in order to the outbreak to be declared over.
A new vaccine co-produced by J&J and Merck seems to elicit antibodies to the disease in both kids and adults (New England Journal of Medicine).
OTHER MEDICAL NEWS:
There is another medication ("lecanemab") being tested in the treatment of early stage Alzheimer's Disease. In a study looking at 1,700 people, scientists found that the medication delayed the worsening of symptoms by about 5 months (New England Journal of Medicine). However, more than 25% of patients had side effects on the mediation. These trials are still in their early phases and lecanemab is NOT available to the public at large yet.
We have all learned about mRNA vaccines with the advent of the COVID-19 pandemic. Now the technology of mRNA vaccines has been used to fight against melanoma, a deadly kind of skin cancer. This experimental medication, made by Moderna, and combined with a immunotherapy medication from Merck, has shown promise in early trials, cutting the risk of recurrence almost in half!
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.
Peninsula hospital is getting very full! this is largely due to increased cases of influenza and COVID-19.
About Dr. Sujansky's Life in These Times
Well, the Holidays are upon us yet again!
Last weekend, I met up with two of my college roommates and we spent the morning baking Christmas cookies, a tradition we have kept up for about 25 years now. See the picture below for a sampling of our wares
My younger son comes home from college this coming weekend and then my older son will be back shortly thereafter. I am beyond excited and have made a trip to Costco to stock up, knowing how incredibly much two young men can eat! Now I have to go de-clutter their rooms, as their rooms *might* have been used as storage for our things while the boys were gone...
I wish all of you a happy and healthy holiday season and more of the same in 2023. I am truly blessed to know all of you and look forward to what the future will bring us!
Next newsletter in 2023!
Take care!