Information about various infectious diseases is constantly evolving. I am hoping to summarize some of that in these newsletters. New information will be in BOLD.
GENERAL:
As many of you may have figured out the hard way, the cold and flu season is upon us. A number of respiratory viruses are flourishing all over the country. Such viruses include (but are not limited to) COVID-19, RSV, and influenza, and are listed as "high levels" nationwide. Another virus that is rising is the HMPV virus ("human metapneumovirus").
But COVID-19 is still the worst! A study (JAMA Internal Medicine) compared RSV, influenza, and SARS-Cov-2 (COVID-19) infections and their likelihood of making you sick: COVID-19 was most likely to cause severe disease, hospitalization, and long-term mortality.
To add insult to injury, we are also seeing huge increases in cases of norovirus, which causes a nasty disease with diarrhea, nausea, and vomiting.
COVID-19
General Information
Looking at wastewater to predict future COVID-19 activity, experts note that levels are now "moderate." Nonetheless, for now, the incidence of COVID-19 seems to be low, which is a bit surprising as we've seen a surge of cases at this time of the year in each of the past few years. I guess we should both thank our lucky stars, for now, but recognize that it may get worse...
A new study found that people with COVID-19 have more rapid plaque buildup in their heart vessels, which suggests a higher risk of angina and heart attacks (Radiology). This finding makes sense to me, as we know that SARS-Cov-2 (the COVID virus) leads to much increased inflammation in the body. And inflammation leads to plaque buildup.
LONG COVID:
Luckily, the number of health care providers suffering from Long COVID is going down. Unfortunately, however, 1% of health care workers continue to suffer and are limited in their daily lives (Infection).
Multisystem Inflammatory Syndrome in children (the inflammation of many parts of the body seen in some kids with COVID-19) seems to have lessened in severity from 2020 to 2023 (Journal of Pediatrics). Also, JAMA Pediatrics published an article that almost all kids with this condition recovered well within 6 months of hospital discharge.
JAMA Network Open: Women are 31% more likely to develop Long COVID compared to men.
A different study (Lancet Regional health - Americas) found that the vast majority of people who developed Long COVID had actually been infected with the COVID virus many times over the last 4 years. One more reason to try to avoid getting COVID-19!
Other Infectious Diseases:
Norovirus:
Norovirus is an extremely contagious virus that causes severe diarrhea, nausea, and vomiting.
We have seen more norovirus outbreaks in the U.S. in 2024 than in the last 10 years.
Alcohol hand sanitizer does NOT kill the norovirus....but good old-fashioned soap and water does!
People should use home cleaning products that kill viruses. Otherwise, the virus can live on surfaces for up to 2 weeks!
Vaccines are being developed to protect against norovirus, but they are not yet ready for prime-time.
RSV:
I have written in the past about RSV ("Respiratory Syncytial Virus") that causes flu-like symptoms and pneumonia in the very young as well as the elderly. There is a vaccine out for this and this is recommended for people over 75, or those with underlying lung disease.
Although RSV infection in people older than 65 had been going up recently, that trend seems to have turned around! Rates of infection are now dropping in the Bay Area and also around the country.
AVIAN FLU:
AKA "Highly Pathogenic Avian Influenza" or HPAI (or " H5N1").
Bird flu has become the most recent concerning virus that could lead to an epidemic. The disease can lead to a pneumonia, neurological problems, and conjunctivitis. It has largely been found in animals such as cows, wild birds, and marine mammals, but has spread to many mammals at this point.
At this time, bird flu has infected more than 900 dairy herds and dozens of people. One has died. Concerns about a future pandemic are growing. We recently learned that cows can get re-infected with the virus multiple times, allowing the virus to mutate and become more dangerous. I'm not trying to scare you, but this is real. Please drink only pasteurized milk and stay away from dead or dying back yard birds or commercial livestock.
Actually, the bird flu was even recently found in our own San Mateo, infecting a backyard poultry flock! Luckily, no humans seem to have been infected from that.
To add insult to injury, the bird flu was also recently found in a domesticated (previously stray) cat in Half Moon Bay. This is the first case of the bird flu outside of chickens in the county. The CDC has noted that the risk of cats spreading the virus to humans is low, but possible.
H5N1 was found in two lots or raw milk from Fresno County. The affected farms have halted production and the milk has been recalled. Luckily, the virus is killed with pasteurization so that pasteurized milk is safe to drink. The Department of Agriculture has announced that the U.S. milk supply will now be tested for bird flu; as of December 16, all handlers of raw, unpasteurized milk will need to collect samples for government testing.
A more aggressive version of the bird flu has recently been found in six dairy herds in Nevada.
As mentioned in the last newsletter, a Louisiana resident had contracted bird flu and, for the first time, this resident had become severely ill. The individual had had contact with sick and dead birds on his property. Unfortunately, this person has now died of the disease. He was older than 65 and had other chronic medical conditions.
In addition, a 13-year old girls in British Columbia was recently admitted to the hospital with avian flu and was extremely ill and required admission to the ICU. She eventually recovered.
The Department of Health and Human Services has now allocated $306 million to help monitor the bird flu.
The U. S. government has tasked Moderna to develop a vaccine for the bird flu and provided funding for this also. The funding will also pay for clinical studies to look into other subtypes of influenza that could raise their ugly heads in the future. At this time, Moderna is planning for phase 3 trials for their mRNA vaccine for the avian flu.
FLU:
Unfortunately, there seem to be a sharp up-tick in cases of flu (and RSV) in Europe. Also, in the U.S., we are seeing a dramatic increase of cases all over.
Flu cases are "very high" both nationally and in our community. In fact, the amount of flu in our community seems to be much higher than at this point in time one year ago.
It is not too late to get a flu shot.
OTHER MEDICAL NEWS:
A lot of people seem to believe that regular use of marijuana is safe and "not a big deal." Well, a recent article (Nature Reviews Cardiology) found that regular cannabis use increased your risk of heart attacks, heart failure, and irregular heart rhythms.
Ok, here is an interesting study, but it requires a little bit of background: scientists are studying aging and how to prevent getting old (though nothing can prevent us from getting older!). And, just in time!, if I may say...At any rate, one thing scientists use to as a marker for aging is particular changes to our DNA (methylation patterns) that come with aging. So a recent study (Nature Aging) looked at changes in these methylation patters in 777 people in Switzerland and found that those who took 1 gm of omega-3 daily were able to slow these methylation changes within the 3 year study period. But I don't want everyone going out and buying omega-3 fatty acids just yet. Caution is advised: the study only looked at these DNA changes, not at the people themselves and how they felt and were doing. Also, the study is relatively small, so larger studies are needed. Finally, omega-3 fish oils can cause diarrhea, a fishy taste, and stomach upset....still, who knows?
I think I mentioned in past newsletters that there is a strong correlation between good oral hygiene and disease prevention. Well, we recently learned that regularly flossing your teeth can significantly reduce your risk of strokes and irregular heart rhythms. This information was presented at the American Stroke Association's International Stroke Conference 2025.
About Dr. Sujansky's Life in These Times
Happy Almost Valentine's Day!
I will dedicate this newsletter to my love of San Francisco. Some of you may remember when, about 18 months ago, I proclaimed my intent to get to know the City better, having lived here for over 30 years and not feeling like I knew it. I very much appreciate the tips you gave me of places and restaurants that I should not miss and, I promise you, I hit almost all of them! And I came away realizing that San Francisco is so beautiful and has so many interesting corners and such great food. Just consider: San Francisco is built a square of 7 x 7 miles....49 square miles is not a lot. Yet it encompasses so many diverse corners, from Chinatown to North Beach, Noe Valley to Fisherman's Wharf, the Marina to Golden Gate Park, and the list goes on!
Yes, parts of it are dirty and parts are dangerous. But I have not felt afraid, as long as I don't do anything stupid, a warning that applies to most bigger cities.
So, some favorite recommendations if you want to see more...in no particular order:
I love the 2-hour free walking tours put on by the SF Cityguides. There are over 70 of them and they explore everything from "Chinatown" to "Alfred Hitchcock's San Francisco." I will admit I have been on over 40 tours myself...
My favorite place in the city is the Palace of Fine Arts - it is just so beautiful. Get a cup of coffee and sit on a bench and enjoy!
There are some great hikes! I love the one at Land's End and the many ones in the Presidio. Also, if you are adventurous and don't mind being sore the next day, there are two hikes that crisscross the city;
1) The Crosstown Trail (17 miles) goes from Candlestick Point to Lands End.
2) the Double-Cross trail (15 miles) goes from Fort Funston to Pier 23.
Biking across the Golden Gate Bridge and into the Marin Headlands (and getting an Irish coffee at the Buena Vista Cafe when I'm done).
Watching all the shows! We just saw a musical version of the old movie "Some Like It Hot," which was great fun.
Restaurants, restaurants, restaurants! (Rooh (Indian), Boulevard, Colibri in the Presidio, Greens in Fort Mason....I can't even mention all of my favorites!
Watching a baseball game at Oracle park. And I don't even like baseball.
Kayaking in SF Bay (UCSF does kayak tours...)