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
On January 30, The Biden Administration informed Congress that the national health emergency of COVID-19 will end on May 11. After this time, funding for free testing and medications will end and/ or be restructured to include greater reliance on health insurance coverage.
A new review has found that COVID-19 infection during pregnancy increases the risk of maternal death and disease as well as abnormalities to the fetus (BMJ). If you compared pregnant women who did not get COVID-19 to those who did, those with COVID-19 were 4-times more likely to be admitted to an intensive care unit and 7-times more likely to die; infants born to women who had had COVID-19 during the pregnancy were twice as likely to end up in the intensive care unit.
On January 23, the FDA suggested that Americans get a COVID shot annually, much as they get (or should get) an annual flu shot. Like the flu shot, the annual COVID booster would be targeted to the circulating SARS-Cov-2 strains each year. Some experts are a bit wary of this new recommendation, requesting hard data (like scientific studies) that show that annual COVID boosters are needed or -even- that more frequent boosters may not be better. The FDA is still meeting with its advisers and are trying to hash this all out.
The FDA also asked its advisors to weigh in on the question if the new bivalent COVID booster shots should replace the original vaccination series in unvaccinated individuals.
COVID-19 was the 8th most common cause of death in children (JAMA Network Open) in the period from August 2021 to July 2022.
According to two separate studies (Lancet Infectious Disease and Lancet Diabetes & Endocrinology) infection with COVID-19 could lead to an 14% elevation of cholesterol levels for up to 12 months after infection.
Symptoms and Risk Factors:
Long COVID: a recap:
Long COVID refers to COVID-19 patients who continue to have symptoms 3 months after onset of the disease.
The symptoms associated with Long COVID tend to resolve after about one year (BMJ).
Results of a recent population-based survey of about 3,000 adults suggests that about 19 million American adults may have long COVID (Clinical Infectious Diseases).
Incidence/ Prevalence:
Luckily, it seems like the dreaded annual winter surge of COVID-19 is not so bad this year! The number of hospitalizations has gone up only mildly. We continue to see lots of new infections, but most of these are relatively mild. We think the reason for this lies mainly in our community now having quite a bit of immunity against this nasty virus, an immunity obtained from vaccinations/ boosters as well as past infections.
COVID-19 incidence is finally going down! And, flu and RSV are declining as well; hospitalizations are down 30% for these diseases compared to one month ago.
Treatment
Vaccines:
The currently available bivalent booster is proving effective against the currently circulating strains (Omicron variants XBB, XBB.1.5), according to the CDC.
Pfizer/ BioNTech:
There were some concerns that the new bivalent booster made by Pfizer/ BioNTech (NOT Modera) could increase the risk of stroke for people over the age of 65. This increased risk was noted only in the 3 weeks after the vaccination. However, further intense review of this concern has NOT shown any increased risk of strokes. More investigations are ongoing.
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:
Other treatments:
A year or two ago, we thought that the anti-depressant "fluvoxamine" could help treat COVID-19...then some studies cast that assumption in doubt. A recent article published in JAMA looked at this question again and found that fluvoxamine does NOT help mitigate symptoms or duration of COVID-19.
Another treatment that has fallen into and out of favor in the treatment of COVID-19 is transfusion of blood plasma from people who had suffered from COVID-19 in the past. Now an article in JAMA Network Open has found that such convalescent plasma DOES help recovery, but only in people who have a compromised immune system.
Testing
Nothing new here, folks....
INFLUENZA:
Influenza incidence continues to decline. In some past seasons, however, there have been two peaks in one winter, so experts are not ready to call victory yet.
RSV:
RSV is a virus that leads to symptoms much like the flu. It is seen most often in kids and older adults.
RSV cases continue to decline.
Moderna is developing a vaccine against RSV. A recent trial found that it was 82% effective in preventing severe RSV in people older than 60. Moderna plans on submitting the vaccine to the FDA for approval in the next few months.
HIV:
J&J was developing a vaccine to prevent HIV infection. Unfortunately, the trials did not show that this vaccine was effective and so J&J has now halted this trial and is going back to the drawing board...
OTHER MEDICAL NEWS:
There is new 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 medication. Doctors are still debating the safety of this medication, especially as the benefits are still not clear. This medication was approved by the FDA on 1/6/2023 for the treatment of MCI (mild cognitive impairment) and early dementia. The list price for lecanemab is $26,500/ year. It is not currently covered by Medicare.
Meanwhile, a different medication "donanemab" has been developed by the pharmaceutical firm Eli Lilly. This too shows some initial promise, though larger safety trials are still pending. At this time, the FDA does not want to grant accelerated approval to donanemab until we know more about its safety.
Based on a report by the American Cancer Society, our likelihood of dying of cancer has dropped by 33% in the last 30 years. But not all cancers are declining: in particular: prostate cancer is rising, while cervical cancer deaths have plummeted. The improvements have been attributed to a decline in smoking, improved early detection, and improved cancer treatment.
Our Community and Beyond:
California will be closing dozens of state-run COVID-19 testing and treatment sites. Sites that are running on only 50% capacity will close by the end of January, 2023.
About Dr. Sujansky's Life in These Times
Some of you have asked you to publish my recipe for my vegetable soup...something I often have for lunch at the office and a healthy easy option for many people. I make the soup on the weekend and use it for lunches throughout the week. I warn you that I am NOT a gourmet cook, and this is not my invention, but here we go!
Heat 2 Tbsp of canola or olive oil in a large pot
Add one cut-up onion, 2-3 stalks of celery, and 3-4 carrots and sauté until soft (about 5 minutes).
Add whatever vegetable you have bought (like a head of broccoli, 5 squash, cauliflower) and any other vegetables that are sitting in your refrigerator going limp.
Add enough water (or chicken broth) to cover the vegetables by about 150% and bring to a low boil.
Add protein in the form of almond butter or tofu or cashews.
After about 45 minutes, the vegetables should be quite mushy. Use an immersion blender to puree the mixture until smooth and creamy. If you don't have an immersion blender, then buy one (it's one of my favorite kitchen utensils) or put the soup in a blender (at 50% capacity) and puree.
Use salt, pepper, and whatever spices appeal to you (curry powder is good, or perhaps paprika?) to add more flavor to the mixture.
Bon Appetit!
It's hard to mess this one up!
We went skiing last weekend in Tahoe (Kirkwood) and it was amazing. See the picture of snow as we try to leave by the front door! We entered and left via the garage...
Happy Valentine's to my favorite patients! I wish you a year full of love!