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
I've got some great news: for the first time since the onset of the pandemic, the number of people dying in the United States of any cause is no longer higher than usual. In the last 3 years, we have seen significantly increased mortality rates: some of this increase was certainly due to COVID-19 - but other causes of death had also increased, likely related to social isolation and decreased treatment options: we have seen an increase in suicide and drug-related deaths, gun deaths, and deaths due to missed treatments and cancer screening. Finally, the overall death rate is "back to normal!"
The FDA advisory panel recommended that vaccine manufacturers target the prevalent XBB Sars-Cov-2 variant when formulating the next COVID-19 vaccine for the fall. Currently, the XBB 1.5 variant is the dominant circulating virus variant worldwide.
Meanwhile, China has developed a new COVID vaccine that incorporates strains from the XBB, delta, BA.5 (from omicron) variants. This vaccine contrasts with the recommendations by the WHO to move to a vaccine containing only the XBB strain, as the delta and omicron strain are no longer circulating to any large extent.
At this time the EG.5 SARS-Cov-2 strain is becoming the dominant variant in the U.S. This is a derivative from XBB.1.9.2 and should be covered by the new COVID XBB strain coming out in the fall.
The CDC now estimates that at the end of 2022, about 25% of the American population still had not been infected with the COVID-19 virus (aka SARS-Cov-2). Those people who had not been infected yet tended to be older (and presumably more careful and less-likely to throw caution to the wind and party hard :)).
The federal administration has announced that it will provide free vaccinations against COVID-19 for uninsured people until December, 2024. These vaccinations will be available at pharmacies.
Have you noticed that there are some people who seem to be immune to COVID-19? Well, researchers have found a particular gene that makes you much less likely to get sick from the virus. People who have two copies of this gene (called "HLA-B*15.01") are 8-times LESS likely not to develop symptoms of infection (Nature).
Researchers are also now beginning to understand why people with blood group A seem to get infected and sick with the virus more often: the SARS-Cov-2 virus interacts with the surface markers of the blood group A cells, so that they are more likely to become infected (Blood).
Finally, we are seeing that sometimes the Covid-19 virus infects animals (pet hamsters, rats, white-tailed deer) and the virus "hangs out" in these animal populations and then gets passed back to humans.
Symptoms and Risk Factors:
Although we still don't have any way to treat Long-Covid (aka "PASC"), new studies suggest that the diabetes medication metformin is helpful in preventing people from getting PASC (Lancet). Metformin needs to be started within 7 days of onset of symptoms and has only been studied in overweight adults.
The anti-viral medication Paxlovid has also been shown to reduce the likelihood of PASC.
Incidence/ Prevalence:
Nothing new here...
Treatment
Vaccines:
Multiple doses of COVID-19 mRNA vaccines were found to be safe in kids as young as 6 months (MMWR)
Other treatments:
The anti-viral Paxlovid has recently gained full FDA approval, so it is no longer an "experimental" treatment for COVID-19. This medications can significantly reduce your likelihood of being hospitalized if you are infected: hospitalization rates are reduced by 80-90% if taken within 5 days of symptom onset. Paxlovid is indicated for people with mild to moderate COVID-19 who at high risk of getting worse (due to age or underlying conditions)
Testing
Nothing new to report....
Other Infectious Diseases:
RSV:
RSV is a virus that causes lung diseases in young children and older adults. Most older adults who get seriously ill with RSV live in senior living communities or have multiple other medical problems. Two new vaccines have just been developed for this infection GSK and Pfizer). The vaccine was showed to be 67-85% effective in people older than 60 with symptoms of RSV. It is hoped that these vaccines will be available to the public by the fall.
At this time, there are several manufacturers making the new RSV vaccine. It is NOT available yet, but will hopefully be available in the fall in time for the cold and flu season.
Last season, more than twice as many seniors died of RSV compared to the 2019/2020 season, and more than three times as many as in 2018/2019. The reason for this increase in death rate may have to do with the social distancing and masks that had left our immunity less robust. It's anyone's guess what kind of a season 2023/24 will be...
Unfortunately, getting infected with RSV one year does NOT prevent you from getting sick with it the next year!
It is unclear if vaccination against RSV will protect you for just one year or for longer.
On June 8, an FDA advisory committee recommended (unanimously) that the antibody "nirsevimab" be used to prevent RSV infections in newborns and vulnerable young children. Nirsevimab will likely receive official FDA approval prior to the upcoming cold and flu season. Similarly, advisers for the CDC have recommended the vaccine for adults aged 60 and older. Studies show that the vaccine is 78% effective in preventing pneumonia due to RSV, even 2 years after it is given.
NOROVIRUS:
Norovirus is a common food-borne virus that can cause terrible diarrhea and vomiting. Unfortunately, this is the virus that is usually responsible for diarrhea outbreaks on cruise ships. We saw fewer outbreaks during the pandemic, as fewer people were going on cruises. But 2023 is seeing a lot of outbreaks and it looks like it will be the worst year since 2004. So: if you go on a cruise ship, please wash your hands often with soap and water (hand sanitizers don't tend to work for this!). Also, use bleach-based wipes on frequently touched surfaces.
INFLUENZA: Recent studies have shown that the flu shots (egg-based or non-egg-based) are safe even for people with egg-allergies.
MALARIA:
For the first time in 20 years, people are getting malaria in the United States: Florida health officials have identified 8 people who acquired the infection in Florida, mostly Sarasota County. No cases have been reported in California.
OTHER MEDICAL NEWS:
Independent advisors to the FDA have recommended full approval of the new Alzheimer's drug "lecanemab." The medication has been found to be effective in people with early Alzheimer's Disease to modestly slow cognitive decline by 27% at 18 months. The FDA has granted full approval for this medication and Medicare has said it will cover much of its high cost ($26,500/ year). The bad side?: Lecanemab needs to be given by vein every 2 weeks. Also, there are significant safety risks, including brain swelling and bleeding in the brain.
On 6/22/23, the Center for Medicare Services said they were planning on requesting doctors who prescribe lecanemab to collect information on the patients. This data would be used to make up a nationwide registry that will be helpful studying the medications effectiveness and risks going forward.
Another new Alzheimer's drug ("donanemab") was found to modestly slow mental decline in people with early Alzheimer's or "Mild Cognitive Impairment" (JAMA). The manufacturer, Eli Lilly, has filed an application to the FDA to make this medication commercially available. It is not currently readily available.