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
COVID-19 call centers and testing cites all over the country are closing, as the pandemic is entering a new stage and states of emergency are ending.
In 2020 and 2021, more than 80% of the people who died of COVID-19 were older than 60 (Morbidity and Mortality Weekly).
The FDA has not come out with any recommendations on when/ if we need another COVID booster shot... though other countries have started recommending them for high risk individuals. However, it seems likely that they will soon recommend another round of boosters for "high-risk" individuals (age more than 65 or other problems with the immune system). Currently, it seems like the boosters are very good at preventing severe COVID-19 (and death), but less good at preventing low-grade infection. Stay tuned!
There have been yet more recent reports on the possible origins of the COVID-19 pandemic. More specifically, we are still trying to figure out if the novel coronavirus was the natural result of viral mutations in wild animals, or the consequence of a rogue Chinese lab experiment that went out of control. Most recently, the U.S. Department of Energy cites new "low level" evidence that supports the rogue-lab-experiment-getting-out-of-control theory. Other government agencies have not yet had a chance to see this new evidence, so have not weighed in on this yet. The WHO still confirms that the origin of the virus is still unclear and they have not taken a firm stance. Also, a pre-print article from China was just released: right after COVID-19 hit in early 2020, the Chinese collected over 1,300 environmental and animal samples (many from the Wuhan wild animal market) and tested them for the SARS-Cov-2 virus: 73 of these samples came back positive; also, some DNA from raccoon dogs was found together with the specimens containing the SARS-Cov-2 virus, suggesting that they could have been animal that introduced the virus to humans. This strongly suggests (though doesn't prove) that the SARS-Cov-2 virus was widely circulating in the animal market at the onset of the pandemic...
On March 20, the president signed a law that allows declassification of certain information about the origin of the coronavirus (SARS-Cov-2). This move will hopefully shed some light on whether the virus was the product of a lab experiment gone wrong or due to natural viral evolution in animal hosts.
There are new recommendations on isolation requirements for people with COVID-19: infected people may now leave isolation after 5 days if
they feel well
their symptoms are improving
they have not had a fever for the last 24 hours
they no longer need to have a negative covid test!
Symptoms and Risk Factors:
Long COVID:
A recent study (Nature Communications) showed that people who had recovered from COVID one year ago were much more likely to have gastrointestinal symptoms (reflux, diarrhea, pain) than uninfected people.
A study presented at the European Congress of Clinical Microbiology and infectious Disease compared the likelihood of developing Long COVID in people infected with original SARS Cov-2 virus (in 2000) versus those infected with the Omicron variant: the patients infected with the earlier COVID variants were 67% more likely to develop long-COVID symptoms (compared with people who were not infected with the virus). However, people infected with Omicron did not develop any more Long-COVID compared to uninfected people.
A study published in JAMA Internal Medicine showed that paxlovid therapy may decrease the incidence of Long Covid as well as death
Incidence/ Prevalence:
COVID-19 hospitalizations continue to drop weekly!
Unfortunately, examination of wastewater in the Bay Area suggests that COVID-19 incidence may be rising again.
Treatment
Vaccines:
Worldwide, 59% of people have received the initial vaccination series. For people older than 60, this number is at 76% (WHO).
Two doses of vaccine administered to mothers during pregnancy were 97% effective in preventing hospitalizations in the newborns (up to age 6 months) during the delta virus surge. Since the advent of the omicron virus, pregnant mothers need three doses of virus to provide 80% efficacy at preventing newborn hospitalization with COVID-19 (BMJ).
Pfizer/ BioNTech: The FDA has authorized the Pfizer bivalent booster for kids aged 6 months to 4 years (at least two months after their primary vaccination series).
Other treatments:
Paxlovid:
Yet another new analysis showed that people treated with paxlovid were NOT more likely to have rebound events compared to those who did not take the medication. As a consequence, a panel of experts at the FDA recommended on March 16 that Paxlovid be used to treat people who have COVID-19 and are at high risk of getting quite ill.
Many of us know of the common medication used for diabetes called "metformin." Well, it turns out metformin also has anti-inflammatory effects and also influences the immune system. Now a paper published in Lancet shows that people sick with COVID-19 who are also given metformin have significantly fewer viruses in they system. Moreover, the metformin patients were 42% less likely to end up in the emergency or hospital and also 42% less likely to develop long-COVID. At this time, the NIH is NOT yet recommending to start metformin on people diagnosed with COVID-19, but stay tuned!
Testing
The FDA has authorized a new over-the-counter at-home test that will check for influenza as well as COVID-19. It's a nasal swab and gives you results in 30 minutes or less...this sounds great, as it's often hard to distinguish between the flu and COVID-19 based on symptoms alone.
INFLUENZA:
Globally, influenza continues on the decline....however, Europe and China are seeing an uptick in cases in recent weeks. The United States has very low incidence of influenza now.
You have likely heard of the bird flu epidemic that has made the nation's chickens sick. This virus has now been found in other animals (like seals) and there are concerns that the virus may cross over and infect humans in the future, though this has NOT happened so far...
RSV:
RSV is a virus that leads to symptoms much like the flu. It is seen most often in kids and older adults.
A FDA advisory panel has just recommended the two different RSV vaccines for people aged 60 and older. It seems that the vaccine can reduce the risk of this illness by up to 86%. One of the vaccines is made by Pfizer, the other by GlaxoSmithKline (GSK). the FDA itself will decide on the issue in May.
OTHER MEDICAL NEWS:
The British Journal of Sports Medicine recently had an article that showed that walking for at least 11 minutes daily can lower your risk of dying prematurely by 25%!! Moreover, if you walk daily for 11 minutes or more, your risk of heart attacks drops by 17% and your risk of cancer by 7%...this is amazing and better than most any pill can do! Also, a study in JAMA Network Open showed that every 1-minute increase in cardiovascular fitness was associated with a lower risk of all-cause mortality! So for those of you who want to live long and healthy lives: you know what to do!
Brushing your teeth is not just good in preventing tooth decay - it also prevents heart attacks and strokes. An article published in the American Journal of Cardiology found that poor oral hygiene was associated with an over-two-fold increase in cardiovascular disease!
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
We are all doing well.
My husband and I celebrated our 25th wedding anniversary last week, on March 21....you may recall that this was also the date of one of our atmospheric river events and storms. We lost power (and heat!) in our house for two and a half days. We couldn't leave the house easily due to the roads being blocked in our neighborhood....so the anniversary was celebrated by the fireplace (the only source of heat!) and we ate luke-warm pizza. I gave my husband a knit hat I made (see picture below) - what more could anyone want! It was definitely an anniversary that we will remember!