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CLEVELAND Mpox has been declared an international emergency by the World Health Organization. A mpox variant has been rapidly spreading across parts of Africa. Doctors warn local cases are rising, too.
As of Aug. 15, there are currently 459 cases of mpox across Ohio, with Cuyahoga County leading the number with 174 cases. While experts said this outbreak shouldnt cause COVID-like lockdowns, testing must be ramped up, and vaccinations must continue for at-risk communities.
Mpox is a highly contagious viral disease that can cause flu-like symptoms and painful skin lesions. It often spreads through close physical contact. A new strain of the mpox virus has been surging in Africa over the past few months, leading the World Health Organization to declare an international health emergency. This is the second time mpox has been declared an international emergency recently. The first was in 2022, when mpox sickened nearly 32,000 Americans, according to the Centers for Disease Control and Prevention.
Mpox is a little bit different from chickenpox and smallpox, said Dr. Amy Edwards, infectious disease specialist at UH Rainbow Babies and Childrens Hospital. Smallpox, there tends to be more of them. Mpox is a little more sparse, but the difference between smallpox and chickenpox is chickenpox typically has ones that are different ages.
According to the Ohio Department of Health, five people in the state have died from mpox. If you think you have contracted mpox, doctors recommend going to the hospital or calling your primary care physician. From there, treatment will be given, and quarantining will be recommended. There is a mpox vaccine available for people who are most at risk, like those who are immune compromised, HIV positive, or have cancer.
It just emphasizes that this is a disease that we have to keep an eye on because we still are seeing people infected with it, said Edwards. We're still seeing people die with it. That potential always exists."
COVID-19 cases are also on the rise again statewide. Gov. Mike DeWine tested positive for COVID-19 Tuesday morning, which marks his third time testing positive.
It is absolutely something to worry about and we don't currently have a vaccine that's active against the current circulating strength, Edwards added. They're still in production for the fall. So, it's a little unfortunate that the spike is coming before the vaccine is ready.
Doctors recommend regular hand washing and social distancing to avoid contracting COVID-19.
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News Release
Wednesday, August 21, 2024
Adolescents were most likely to experience low energy/tiredness while children were most likely to report headache.
Scientists investigating long COVID in youth found similar but distinguishable patterns between school-age children (ages 6-11 years) and adolescents (ages 12-17 years) and identified their most common symptoms. The study, supported by the National Institutes of Health (NIH) and published in JAMA, comes from research conducted through the NIHs Researching COVID to Enhance Recovery (RECOVER) Initiative, a wide-reaching effort to understand, diagnose, treat, and prevent long COVID, a condition marked by symptoms and health problems that linger after an infection with SARS-CoV-2, the virus that causes COVID-19.
Children and adolescents were found to experience prolonged symptoms after SARS-CoV-2 infection in almost every organ system with most having symptoms affecting more than one system.
Most research characterizing long COVID symptoms is focused on adults, which can lead to the misperception that long COVID in children is rare or that their symptoms are like those of adults, said David Goff, M.D., Ph.D., division director for the Division of Cardiovascular Sciences at the NIHs National Heart, Lung, and Blood Institute. Because the symptoms can vary from child to child or present in different patterns, without a proper characterization of symptoms across the life span, its difficult to know how to optimize care for affected children and adolescents.
The observational study included 3,860 children and adolescents with a SARS-CoV-2 infection history at more than 60 sites across the United States between March 2022 and December 2023. A comparison group of 1,516 children and adolescents with no history of a SARS-CoV-2 infection were also included to disentangle whether prolonged symptoms of those who had experienced COVID-19 were related to SARS-CoV-2 itself or more broadly related to the effects of the pandemic.
Caregivers completed a comprehensive symptom survey that asked about 75 prolonged symptoms in all major body systems that occurred at least 90 days after an initial SARS-CoV-2 infection and lasted for at least a month. They also completed a survey asking for their perception of the childs overall health, physical health, and quality of life. The researchers then employed a commonly used statistical technique to identify which symptoms were best at differentiating participants who did and did not have history of SARS-CoV-2 infection. They identified combinations of symptoms distinct for each age group that together generated a long COVID research index, which indicates the likely condition of long COVID.
Researchers identified 18 prolonged symptoms that were more common in school-age children, including headache (57%), followed by trouble with memory or focusing (44%), trouble sleeping (44%), and stomach pain (43%). Other common symptoms in school-age children not included in the research index included body, muscle, and joint pain; daytime tiredness/sleepiness or low energy; and feeling anxious.
In adolescents, 17 symptoms were more common, including daytime tiredness/sleepiness or low energy (80%); body, muscle, or joint pain (60%); headaches (55%); and trouble with memory or focusing (47%). Feeling anxious and trouble sleeping were other commonly reported symptoms that were not included in the research index.
The symptoms that make up the research index are not the only symptoms a child may have and theyre not the most severe, but they are most predictive in determining who may have long COVID, said Rachel Gross, M.D., associate professor in the departments of pediatrics and population health at New York University Grossman School of Medicine and lead author on the study.
Fourteen symptoms overlapped between the age groups. Comparing previous research on long COVID in adults, the new study found that adults and adolescents had a greater overlap in symptoms, such as loss of or change in smell or taste. Researchers found less overlap between adults and school-age children, underscoring the importance of age-based long COVID research.
The study identified separate research indexes for school-age children and adolescents along with overlapping, but distinguishable symptom patterns in each group. Of the 751 school-age children that had COVID-19, 20% met the long COVID research index threshold. Of the 3,109 adolescent children with a history of SARS-CoV-2 infection, 14% met the research index threshold, though researchers noted that these numbers should not be used as measures of incidence in the general population, since their study may have included more children with long COVID than the overall population.
Scientists note that the research index provides a framework for looking at common symptoms for research purposes not necessarily as a guide for clinical care and will likely be refined as researchers study more children with and without long COVID.
Our next step is to study children ages 5 years and younger so we can better understand long COVID in the very young, said Gross.
In compliance with NIHs Data Sharing and Management Policy, a dataset containing RECOVER Pediatric Observational Cohort Study data collected through June 15, 2024 which includes data used for this publication will be released on NHLBI BioData Catalyst this fall.
Research reported in this press release was supported by NIH under award numbers OT2HL161841, OT2HL161847, and OT2HL156812. Additional support came from grant R01 HL162373. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. For more information on RECOVER, visit https://recovercovid.org.
HHS Long COVID Coordination:This work is a part of theNational Research Action Plan(PDF, 1.3 MB), a broader government-wide effort in response to thePresidential Memorandumdirecting the Secretary for the Department of Health and Human Services to mount a full and effective response to Long COVID. Led by Assistant Secretary for Health Admiral Rachel Levine, the Plan and its companionServices and Supports for Longer-term Impacts of COVID-19 report(PDF, 1.6 MB) lay the groundwork to advance progress in the prevention, diagnosis, treatment, and provision of services for individuals experiencing Long COVID.
About RECOVER:The National Institutes of Health Researching COVID to Enhance Recovery (NIH RECOVER) Initiative brings together clinicians, scientists, caregivers, patients, and community members to understand, diagnose, and treat long COVID. RECOVER has created one of the largest and most diverse groups of Long COVID study participants in the world. In addition, RECOVER clinical trials are testing potential interventions across five symptom focus areas. For more information, please visitrecoverCOVID.org.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIHTurning Discovery Into Health
###
While the COVID-19 pandemic quickly reversed decades of progress in closing the gap between life expectancies for Black and white people in the United States, the disease's toll may have obscured the impact of another significant public health concern -; a sharp increase in homicide rates -; on the life expectancy of Black men, according to researchers at the University of WisconsinMadison.
In 2019, Black men in the U.S. were expected to live an average of 71.4 years, 5 years less than white men. Just one year later, life expectancy for Black men had plummeted to 67.7 years, while white men fell just a year and a half. That opened the gap between the two groups to 7.2 years, far higher than the gap was even 20 years earlier (6.6 years in 2000).
The pandemic period knocked out a huge amount of those gains in just one year's time. COVID played the larger role in that reversal -; especially because it was initially more deadly among non-white people -; but it was not the only important change going on. In 2020, we also saw the largest increase in homicide that we've ever recorded."
Michael Light, Professor,University of WisconsinMadison
His research lies at the intersection of criminology and demography.
The difference between the homicide rates for Black men and white men, in particular, also erased a decades-long shift toward parity.
Homicide rates peaked in the U.S. in the late 1980s and early '90s, then fell by more than half by 2014. They remained relatively stable until, from 2019 to 2020, homicides jumped up by 30%.
Black men fared worst among homicide victims, rising from 43.8 deaths per 100,000 men in 2019 to 61 per 100,000 in 2020. Over the same period, the rate of death by homicide for white men rose from 3.6 to 4.4 per 100,000.
According to an analysis published on August21st, 2024, in the journal,PLOS ONE by Light and UWMadison graduate student Karl Vachuska, the rising homicide rate was responsible for 26% of the increase in the life expectancy gap between Black and white men from 2019 to 2021.
Compared to COVID-19, homicides carried extra weight in life-expectancy calculations, in which younger deaths pull harder on the averages. Light and Vachuska found that, in 2020, when racial disparities in COVID-19 deaths were most acute, homicides contributed more to Black-white inequality in life expectancy among men than any other cause of death, including COVID-19.
"COVID deaths were concentrated among older people," Light says. "But while homicide still represents a small proportion of overall deaths in the United States, it has a disproportionate impact on life expectancy because it's mostly killing young men."
When COVID-19 vaccines became available and public health measures more commonplace, homicide's influence on the Black-white life expectancy gap grew more pronounced. In 2021, homicide rates continued to rise, though not as fast as the 2020 jump. But the COVID-19 mortality imbalance between Black and white lives vanished.
"There was still a severe difference in life expectance between Black and white men in 2021," Light says. "That gap declined only slightly from 2020, even though the racial differences in COVID outcomes completely disappeared."
The new study's results show just how much sway murders can have on even broad measures of public health.
"While COVID was new and particularly devastating, it wasn't hard to look at the shifts in life expectancy and say, 'OK, when we get a handle on COVID, this will turn around,'" Light says. "But that does some minimizing of other important factors that need to be near the top of the list when we consider preventable deaths. That's important when we decide where public health resources should be placed."
The good news is the U.S. had already found success curbing homicides for decades pre-pandemic, and crime statistics for 2022 and 2023 show a renewed decline in homicide rates.
"Within our lifetime, within easy living memory, we achieved marked decreases in homicide and marked declines in racial disparities in homicide that had very real impacts on mortality inequality," Light says. "We know that emphasis on this problem can make a difference. What we learned about the pandemic period helps us understand just how significant those differences can be."
Source:
Journal reference:
Light, M. T., et al. (2024) Increased homicide played a key role in driving Black-White disparities in life expectancy among men during the COVID-19 pandemic. PLOS One. doi.org/10.1371/journal.pone.0308105
This study revealed a mortality rate of about 11% in patients diagnosed with CAM. Factors contributing to increased odds of death included a history of cigarette smoking, ICU admission, higher CAM stage, specific treatment methods, and ocular involvement.
Although different studies elucidated various mortality rates among CAM patients (14%37%) [10, 20,21,22], the pooled prevalence of all-cause mortality was reported as 24% [23]. However, the mortality rate during hospitalization of the cases in our study was 10.9%. According to the literature, it could be said that the survival rate of patients with mucormycosis associated with Covid-19 is higher than that of patients with other concomitant diseases (oncohematological and uncontrolled diabetes mellitus) [24]. A study on 49 patients that followed them up for six months reported that 81.8% of the non-survivors, were older than 60years old, 90.9% had intracranial involvement, and all had HBA1C>8.0% [21]. In a similar pattern to our result, a retrospective casecontrol study on 73 CAM cases, which have been followed up for 30days at minimum, showed no significant differences in age, gender, vaccination status, DM presence, remdesivir, and tocilizumab use among survivors and non-survivors [25]. Patients with malignancies, hematological disorders, or poorly controlled diabetes may have a more compromised immune status, predisposing them to poorer outcomes with invasive fungal infections like mucormycosis.
In contrast, COVID-19 can lead to immune dysregulation and increase susceptibility to opportunistic infections like mucormycosis. However, the underlying immune deficit may be less severe or variable compared to conditions like advanced malignancies or long-standing uncontrolled diabetes. In opposition to some studies [25, 26], our study elucidated considerable differences in corticosteroid usage and treatment methods among patients discharged from hospitals and patients who expired. Although the univariate analysis in a systematic review and meta-analysis on 851 non-COVID-19 associated mucormycosis cases elucidated DM and corticosteroid use as substantial mortality-associated factors, those lost significance in multivariate analysis [27]. While glucocorticosteroids are a known risk factor for invasive mycoses, their role in the treatment of severe COVID-19 has been pivotal in managing the hyperinflammatory response associated with the disease. In our study, we observed that the history of systemic corticosteroid use during COVID-19 was significantly associated with reduced odds of mortality. However, it is important to note that we did not have data on the effect of steroids on survival as all patients had started steroid treatment before the study period. This finding contrasts with the established risk of corticosteroids contributing to the development of mucormycosis, suggesting that while steroids may mitigate the severe effects of COVID-19, their dosing and duration need careful consideration to avoid predisposing patients to invasive fungal infections like mucormycosis. Further research is necessary to delineate the balance between their therapeutic benefits and potential risks in this context.
COSMIC study [10] elucidated that mortality and disease progression were considerably higher in stage 3c or worse when compared to stage 3b or better. Likewise, the results of our study demonstrated that patients with higher ROCM stages had a significantly higher mortality ratio. A review study on CAM cases from 18 countries reported higher mortality rates in case of CNS involvement among ROCM patients [22]. A multicenter study on 287 CAM and non-COVID-19-associated mucormycosis patients showed that higher age, cerebral involvement, and ICU admission were associated with higher mortality odds ratios at six weeks [28]. Our results confirmed that expired patients had lower visual acuity at the time of CAM diagnosis than those discharged from hospitals. The multiple logistic regression suggested that higher stage of CAM, treatments in the setting of ocular involvement, bilateral ocular involvement, and history of cigarette smoking and ICU admission due to COVID-19 could be considered as possible mortality-associated factors. Our findings regarding the potential relationship between cigarette smoking, severity of COVID-19 illness, and mortality from mucormycosis aligns with existing evidence demonstrated that smoking is known to impair lung function and increase susceptibility to respiratory infections like COVID-19 [29]. Smokers have been reported to have higher rates of severe COVID-19 illness and mortality compared to non-smokers [30]. Therefore, it is plausible that in this study, cigarette smoking may have predisposed patients to more severe COVID-19 illness, requiring ICU admission, and consequently increased the risk of mortality from the subsequent mucormycosis infection.
Secondary outcomes findings revealed that diabetes mellitus emerged as the predominant underlying condition, reflecting the high prevalence of this comorbidity in the study population. The exploration of COVID-19 characteristics brought to light a substantial positive rate for SARS-CoV-2 RT-PCR, emphasizing the association between mucormycosis and recent COVID-19 infection. Noteworthy was the observation that most patients had not received vaccination against SARS-CoV-2. ROCM clinical presentations showcased facial pain, swelling, and nasal discharge as common complaints, while ocular signs such as ptosis and periorbital swelling were highly prevalent. Imaging findings demonstrated ethmoid sinus involvement as the most common, and cavernous sinus involvement was observed in a relatively low percentage of cases. The majority of patients were classified as Stage 3 ROCM. Ocular involvement was prevalent in 92.3% of patients, with only 6.7% experiencing binocular issues. The 72.8% exhibited extraocular movement restriction, and frozen eyes were observed. Relative afferent pupillary defect (RAPD) was present in 61.8% of evaluated eyes. Chemosis was the most common ocular finding in slit-lamp biomicroscopy. Fundoscopy revealed atrophic discs in 23.3% and optic disc swelling in 3.7% of affected eyes. Microvascular events (CRAO, CRVO, BRVO) occurred in a minority of cases.
On average, CAM patients in our study were in the sixth decade of life, similar to other studies [10]. However, male predominance in our study was less (54.7%) than in other studies (71 to 73%) [10, 22]. The latest meta-analysis on a total of 3718 CAM patients [23] revealed DM as the most frequent underlying disease among these patients (89%) and reported that the pooled prevalence of systemic corticosteroid use in the treatment setting of COVID-19 disease was 79%, which all are consistent with our results (82.8% and 73.7%, respectively). According to the literature on non-COVID-19-associated [24] and CAM, the mean age of the patients and the existence of DM and corticosteroid use are quite similar in both groups. Lately, a casecontrol study confirmed the role of DM and corticosteroid use in CAM infection [31]. The inflammatory state and reduced immune response during hyperglycemic status that is intensified via SARS-CoV-2, the increased expression of GRP-78 (glucose-regulated protein 78) on epithelial and endothelial cells in response to increased glucose concentration and ketone bodies, and the increased free iron level that is intensified by ketoacidosis in COVID-19 patients altogether lead to a suitable environment for angioinvasion, hematogenous spread, and proliferation of mucormycosis [1, 9, 22, 32, 33]. Also, utilizing systemic corticosteroids in the treatment strategy of COVID-19 infection results in hyperglycemic media and the cytokine storm through the inflammatory state, providing a suitable condition for the fungi [9]. Impairment of immune function against mucormycosis caused by corticosteroids could increase the infection risk [22].
[21, 34]. Although the mean duration from COVID-19 infection to the CAM diagnosis (about 25days) among the included patients is comparable with the data (25.6days) from a recent systematic review [35], some other studies reported lower intervals [10, 36]. Most patients had mild or moderate lung involvement due to COVID-19 infection; this may state that CAM occurs more frequently in patients with less COVID-19 severity, which is suggested by another study [22].
In concurrence with our study, the most common presenting symptoms reported by a cross-sectional study on 270 CA-ROCM patients and a prospective study on 49 CA-ROCM patients were facial/periorbital pain and swelling [21, 37]. A systematic review and meta-analysis on 2,312 proven CAM patients reported headache (54%), periorbital swelling/pain (53%), facial swelling/pain (43%), ophthalmoplegia (42%), proptosis (41%), and nasal discharge/congestion (36%), decreased or loss of vision (31%), ptosis (28%), dental pain or loosened teeth (25%), palatal discoloration or ulcers (22%) as common symptoms [38], which are almost consistent with our study.
Consistent with other studies, the most commonly involved paranasal sinuses among CAM patients were ethmoid and maxillary sinuses [39, 40]. Mucormycosis usually starts from the maxillary sinus, extends to the ethmoid or sphenoid, and can invade the orbit through ethmoid foramina or splitting lamina papyracea [9].
Orbital involvement among CAM patients in our study (92.3%) was higher compared to a meta-analysis conducted on 3718 patients (61%) [23]. Also, in a study on 2826 probable/ possible/ proven ROCM Indian patients, orbital involvement among the patients was reported at 72% [10]. Consistent with other studies [34, 37], ptosis, periorbital edema, periocular pain/tenderness, ophthalmoplegia, and proptosis are common ocular and periocular signs and symptoms among CAM patients. Of 35 involved eyes in a cross-sectional study, retinal artery occlusion and disc edema were observed in 23% and 11%, respectively [34]. In another study on 49 CAM patients [21], the observed keratopathy, CRAO, and CRVO rates were reported at 24.49%, 4.08%, and 2.04%, respectively.
In this study, the number of patients who expired was 30 (11%), while the number of patients who were discharged was 244 (89%). Unbalanced data in a relatively small sample size reduces the statistical power of the tests. Therefore, it is necessary to interpret the results with caution due to this limitation.
Demography
We aimed to evaluate for cognitive, structural, and functional alteration in patients recovering from COVID-19 and how this alteration depends on the clinical profile of the patients (see Figs.1 and 2). Two clinical factors were assessed: Anosmia (An, involving anosmia and hyposmia/microsmia, see below) during the acute episode as a potential marker for neurological involvement, and hospitalization (HR) during the acute episode to indicate the severity of respiratory symptoms. Using linear modeling, we observed variations in age and the time elapsed between diagnosis and the first session, which includes MRI, behavioral task and clinical anamnesis (see Methods), among patients exhibiting these factors. Concerning age, there were no significant differences observed between patients with and without COVID-19 (age in z-score, beta=0.05, se=0.2, t=0.2, p=0.8) or between patients with and without anosmia (beta=0.05, se=0.2, t=0.2, p=0.8). However, patients with COVID-19 who required hospitalization were older than those with COVID-19 who did not require hospitalization (beta=0.7, se=0.2, t=3.4, r=0.35 [0.15 0.55], p=0.0008). Additionally, patients with COVID-19 requiring hospitalization presented a longer time interval between diagnosis and the first session (time in z-score, beta=0.6, se=0.2, t=3.1, r=0.32 [0.12 0.52], p=0.002). We did not find a difference in educational level between groups (betas<0.2, ts<1, ps>0.3). Consequently, age and time between diagnosis and the first session were used as control regressors in all analyses comparing clinical factors, as indicated in Fig.2A.
Reversal learning task. (A) Timeline of a trial. (B) Earnings for the three phases of the task for the complete sample. (C) Trial means and standard errors of the evaluation of earnings during the three phases of the task for the complete sample.
Behavioral and functional results. (A) Model applied to behavioral and brain data. B-C. Behavioral data from Reversal Learning Task. (B) Regressor effects over the rate of option change after a negative outcome during shift periods. (C) Regressor effects over learning rate following a negative outcome. (D) BOLD activity during the Reversal Learning Task. The left panel shows the global effect of the task. The right panel indicates the negative effect of the Anosmia regressor. HR: Hospitalization required; An: Anosmia; CTD: cluster-threshold detection.
All patients were queried about persistent post-COVID symptoms during initial anamnesis in the first session (see Methods).24 Twenty-two patients diagnosed with COVID-19 reported experiencing some degree of attention and memory issues, which persisted at the time of cognitive assessment battery administered in the study (second sessions, see Methods). The frequency of these reported cognitive symptoms did not show modulation by clinical factors (linear model dof=93, Anosmia: beta=0.05, se=0.09, t=0.5, r=0.06 [0.17 0.29], p=0.6; Hospitalization required: beta=0.08, se=0.09, r=0.09 [0.13 0.32], t=0.8, p=0.4). Additionally, seven patients reported cephalea, and six reported fatigue. Only four patients reported persistent olfactory alteration post-acute episodes. Patients reported an average duration of 1.3months (range: 0.514months) for their olfactory dysfunction. Of these patients, 68% (n=29) experienced a complete loss of smell (anosmia), while 32% (n=14) experienced varying degrees of changes in their sense of smell (hyposmia/microsmia). For the following analysis, we pooled these categories as 'patients with anosmia.' Patients underwent screening for olfactory alterations associated with SARS-CoV-2 using the KOR test.25 In addition to self-reported olfactory alterations, 6 out of 43 patients with anosmia during the acute episode identified less than 5 odors, suggesting a persistent olfactory dysfunction (for details, see Methods). Despite this, when evaluating the KOR test scores with the model (Fig.2A), no group differences were observed (linear model dof=93, Anosmia: beta=0.39, se=0.24, t=1.6, r=0.19 [0.44 0.05], p=0.11; Hospitalization required: beta=0.14, se=0.24, t=0.5, r=0.07 [0.30 0.17], p=0.5). Functional capacity was also evaluated using 6MWT.26 We did not find differences in this score between groups (linear model dof=93, An beta=0.003, se=0.02, t=0.16, r=0.06 [0.17 0.29], p=0.8; HR beta=0.007, se=0.02, t=0.3, r=0.09 [0.13 0.32], p=0.7).
Patients were evaluated using cognitive and psychological assessment batteries. ACE-III evaluation showed that the sample had a mean score of 92 with no differences between groups (linear model, df=93, COVID-19 diagnosis beta=1.9, se=3.0, t=0.6, r=0.08 [0.33 0.17], p=0.5; Anosmia beta=3.2, se=2.6, t=1.1, r=0.15 [0.10 0.39], p=0.2; Hospitalization required beta=-3.0, se=2.7, t=1.0,r=0.13 [0.3 0.11], p=0.2). In the same way, IFS-Ch frontal screening evaluation showed a mean of 21.8 with no differences between groups (COVID-19 diagnosis beta=1.8, se=0.9, t=1.8, r=0.22 [0.02 0.46], p=0.06; Anosmia beta=0.4, se=0.8, t=0.4, r=0.05 [0.18 0.28], p=0.6; Hospitalization required beta=-0.37, se=0.8, t=0.4, r=0.05 [0.29 0.18], p=0.6). We found similar results when analyzing the PHQ-9 (COVID-19 diagnosis beta=2.0, se=1.4, t=1.4, r=0.18 [0.07 0.43], p=0.15; Anosmia beta=0.9, se=1.2, t=0.7, r=0.09 [0.34 0.15], p=0.4; Hospitalization required beta=-0.5, se=1.2, t=0.4, r=0.05 [0.29 0.19], p=0.6), and GAD-7 screenings (COVID-19 diagnosis beta=2.5, se=1.4, t=1.8, r=0.22 [0.02 0.47], p=0.07; Anosmia beta=0.2, se=1.2, t=0.1, r=0.02 [0.22 0.26], p=0.8; Hospitalization required beta=-0.07, se=1.2, t=0.06, r=0.007 [0.24 0.23], p=0.9).
Initially, we assessed whether participants adapted their behavior during the game (Fig.1). For this purpose, we analyzed three phases during the game: a phase we labeled as 'Shift,' which encompasses the five trials following the programmed probability change; a 'Pre-Shift' phase, comprising the last five trials of the initial stable phase of each game, and a final Post-Shift phase, representing the final five trials of each game (corresponding to the conclusion of the second stable phase, see Fig.1C).
All participants decreased their earnings during the Shift phase, but increased them in the Post-Shift phase, reflecting learning and adaptation (Friedman test, stat=44.8, df=2, Kendall W=0.22, p=2e10; mixed model over single trials, b=0.14, se=0.01, t=10.29, r=0.11 [0.130.09], p=2e16, Fig.1B). Subsequently, we investigated an indicator of the strategies individuals employ during transitions. To do so, we assessed the rate of alternative change following a negative outcome. An exceedingly low value in this indicator suggests a tendency for individuals to uphold the value of the chosen option after experiencing negative outcomes, a phenomenon known as perseverative decision-making27. Conversely, exceedingly high values in this indicator may signify impulsive shifts or the tendency to alter one's choice immediately following an error without updating the value. This indicator decreases in value during the Shift compared to the Pre-Shift phase, reflecting the tendency to accumulate more evidence before shifting from the previously advantageous option (linear model, averaged data: beta=0.04, se=0.01, t=2.6, r=0.11 [0.19 -0.03], p=0.008; mixed-effects logistic model over single trials: beta=0.24, se=0.05, t=4.4, r=0.11 [0.15 -0.06], p=9e-6). These initial analyses indicate that the entire sample exhibited the expected behavior in the task, adapting their decisions after a shift with a cost in the transition.
Next, we applied the strategy indicator during the Shift phase to investigate potential differences among groups using the model described in Fig.2A. We observed that the clinical characteristics of COVID-19 patients differentially influenced the strategy indicator. The diagnosis of COVID-19 did not significantly impact the indicator (linear model: beta=0.01, se=0.03, t=0.4, r=0.03 [0.13 0.20], p=0.6); however, patients requiring hospitalization exhibited a decrease in this parameter (linear model: beta=0.1, se=0.03, t=3.2, r=0.26 [0.43 -0.10], p=0.001, similar results from Bayesian estimation shown in Fig.2B). In contrast, patients presenting anosmia demonstrated an increase in this parameter (linear model: beta=0.09, se=0.03, t=2.9, r=0.25 [0.08 0.41], p=0.003, similar results from Bayesian estimation shown in Fig.2B). None of this modulation occurred in the other phase of the task (ps>0.1). This strategic modulation significantly impacted total earnings, leading to higher earnings among patients with anosmia (linear model, beta=0.02, se=0.01, t=2.43, r=0.10 [0.02 0.19], p=0.015).
Then, we test if this behavioral modulation is related to specific cognitive computation. We fitted a cognitive model of participants responses using prospect theory and a Rescorla-Wagner algorithm to estimate the individual learning of the probability of each desk. We used a different learning rate estimated following a win and a no-win. Based on the preceding results, we tested if the clinical condition of hospitalization and anosmia modulated the differences between the learning rates. We found a similar pattern to the prior results: COVID-19 diagnosis per se did not affect the learning rate (linear model df=90, b=0.1, se=0.2, t=0.6, r=0.1 [0.11 0.21], p=0.3), Hospitalization generated a decrease in the learning rate after negative outcome (b=0.44, se=0.16, t=2.7, r=0.21 [0.37 -0.06], p=0.007, similar results from Bayesian estimation shown in Fig.2C), and Anosmia presents an increased learning rate (b=0.4, se=0.15, t=2.5, r=0.2 [0.05 0.35], p=0.01, similar results from Bayesian estimation shown in Fig.2C).
In summary, participants adjusted to the changing probabilities, resulting in increased earnings following the decreases caused by the shift in probability. A behavioral indicator shows participants' ability to employ different strategies during reversals. Clinical characteristics of COVID-19-recovered patients influenced this indicator, with hospitalized patients decreasing and anosmic patients increasing, impacting total earnings. When testing specific cognitive computations, the modulation due to hospitalization affected the individual learning rate.
We evaluated the BOLD signal of the participants while they engaged in the Reversal Learning Task. Cognitive modeling was used to estimate the utility of the chosen option (see Materials and Methods). During the feedback period, we contrasted wins and no wins.
Initially, we assessed the consistent activity across the entire sample to identify the activity associated with value and feedback as classically described in this type of task. We found that during the decision-making process, the value of the chosen option correlated with an extensive frontal-parietal-striatal network, consistent with the literature, including ventromedial prefrontal, medial parietal, and striatal regions.28,29 Conversely, during feedback, we observed that the contrast between win and non-win revealed activity in the ventral striatum, consistent with prior research.29 Subsequently, we assessed the modulation of clinical parameters on BOLD activity. COVID-19 diagnosis and hospitalization required regressors did not show modulation in decision-related or feedback-related activity. However, the regressor associated with anosmia negatively modulated the BOLD signal during decision-making in a network that includes lateral prefrontal, medial frontal, and left temporoparietal regions.
The gray and white matter were segmented using T1w and T2w images. Cortical thickness was analyzed using the specified model in the methods (Fig.2A). We found that neither the COVID-19 diagnostic regressor nor the hospitalization requirement showed significant modulation in cortical thickness. However, the anosmia correlated with a thinning of the cortical thickness in parietal areas (Fig.3A).
Brain structural results. (A) The anosmia regressor effect over the cortical thickness. (B) The anosmia regressor effect over the fraction of anisotropy in a whole-brain analysis of white matter integrity. (C) Regressor effects over axial diffusivity measured in segmented white matter tracts. HR: hospitalization required, CTD: cluster-threshold detection, TFCE: threshold-free cluster enhancement.
The integrity of the white matter was assessed through diffusion images. First, we conducted a whole-brain analysis, evaluating changes in the fractional anisotropy (FA). Statistical modulations were calculated using the specified model outlined in the methods (Fig.2A), and cluster-based statistics were performed using TFCE. Anosmia was the only regressor with significant modulation, demonstrating decreased FA (Fig.3B). The main tracts involved in the affected areas were the corticospinal tract, arcuate fasciculus, inferior fronto-occipital fasciculus, thalamus-parietal fasciculus, thalamus-occipital fasciculus, and posterior corpus callosum.
Next, we conducted statistical analyses for individual tracts. Long and short fibers were segmented using deterministic tractography. Various diffusion measures were evaluated to assess the integrity of each tract (FA, radial diffusion, axial diffusion, and mean diffusion). Each tract was evaluated using the model specified in the methods. The analysis revealed that no modulation survived multiple comparisons (Bonferroni correction). However, when applying an uncorrected threshold (Z>3.1, commonly used for cluster detection in whole-brain functional and structural imaging studies), it was observed that frontal and parietal fascicles exhibited an increase in axial and mean diffusion, indicating a disruption in white matter integrity. This white matter integrity disruption correlated with the hospitalization requirement and COVID-19 diagnosis (Fig.3C).
While the reprieve from soaring temperatures may make it seem like the season is coming to a close, the COVID-19 summer wave persists. In fact,
While summer COVID waves are nothing newweve experienced them nearly every year since the pandemic beganthis wave has been drawn out. With kids headed back to school, its only natural to wonder if this wave will stretch right into fall and winter, especially with the contagious KP.3.1.1. and LB.1 variants circulating.
Meet the experts: Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York; infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security; Adriana Glenn, Ph.D., associate professor at the George Washington University School of Nursing.
So, whats the latest on the COVID summer wave 2024 and what does this mean for this winter? Heres what we know right now.
Theres a lot happening with COVID-19 in the U.S. right now. Percent positivitywhich is the percentage of all COVID-19 tests performed that are actually positivestands at a whopping 18.1% right now, according to data from the Centers for Disease Control and Prevention (CDC). Right now, 2.4% of people who head to the emergency room are diagnosed with COVID-19 and nearly 2% of all deaths in the country are due to the virus, per CDC data.
This is all being fueled by the so-called FLiRT variants, including KP.3. Currently variants KP.3.1.1, LB.1, and KP.2.3 are the most common ones circulating in the country, per the CDC.
Its hard to say for sure how long the COVID-19 summer wave will last, but we probably have a few more weeks to go, according to Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York.
The wave has been hitting different parts of the country at different times, he says. The South and West coast were hit first. In general, Dr. Russo says that the waves tend to rise over four to six weeks, plateau, and then decrease over six to eight weeks. Were still going to be in the middle of this for a few weeks, and certainly through Labor Day, he says.
Infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security, agrees. COVID summer waves usually last into about September and then the virus diminishes its activity, he says. Cases tend to ramp up again when the weather gets colder, Dr. Adalja adds.
Hopefully well have a respite before we hit the Thanksgiving and religious holiday seasons, which is the start of the winter waves, Dr. Russo says.
The official symptoms of COVID-19 have not changed. According to the CDC, those include:
But many people with COVID-19 right now are experiencing what feels like a cold, says Adriana Glenn, Ph.D., associate professor at the George Washington University School of Nursing. The symptoms do remain very similar to those of upper respiratory viruses, she adds.
This cold-like experience is a reflection of the level of immunity in the population in the virus, causing more cold-like symptoms as a persons immune system is able to control it much better, Dr. Adalja explains.
Some people have a cough, but it tends to be more of a throat-clearing cough vs. something deep in the chest, Dr. Russo says. Theres a sense of not feeling well in the first few days. That tends to go away and leaves you with a head cold.
But Dr. Russo stresses that people who are at high risk for serious COVID-19 infections may have a different experience. Symptoms to watch out for include shortness of breath, chest pain, dizziness, and confusion, among others, Dr. Russo says. While high-risk patients are the most likely to experience these, he points out that anyone can become seriously ill with COVID-19.
Its not entirely clear at the moment. This virus does tend to increase in circulation in the winter, so we have to anticipate that, Dr. Adalja says. This has occurred despite summer increases every year the virus has been with us.
But if you happen to get infected with the virus now and the same variants are still circulating this winter, its possible youll have a reasonable degree of protection in the winter, Dr. Russo says. However, we know that immunity wanes over time, he continues. Protection against severe disease tends to last four to six months and protection against infections tends to last even less than that.
Its also entirely possible that a new variant will surface and cause a new wave of infections, Dr. Russo says. Glenn agrees. The viruses year-long presence provides more opportunities for mutation and when that happens there are new variants that emerge, she says.
So, what does this mean for you? Once the new COVID-19 vaccine is released, Dr. Russo recommends getting it. The new formulation should be available soon, he says. Were still seeing 400 to 500 deaths from COVID a week and theyre largely preventable. Im hoping we can do a little bit better with vaccination as we move forward into the fall.
From barbecues to festivals and elder facilities to crowded airports, COVID has been infecting many people this summer. Cases are likely to keep rising this fall and winter. Photo: Getty Images.
The most dramatic evidence that COVID-19 cases have been spiking this summer came during the Paris Olympic Games when the Worlds Fastest Man collapsed on the track after one of his races.
U.S. sprinter Noah Lyles still managed to win a bronze medal in the 200-meter race that he was projected to win, but after the sprint, it became obvious that he was sick and struggling.
Lyles, who has coped with asthma since he was a child, later told NBC interviewers that he had tested positive for COVID-19 two days before the 200-meter final.
After finishing, Lyles remained splayed on the track until medical authorities came to help him. They insisted he ride in a wheelchair to get fluids and a checkup.
It was extremely hard to breathe. My chest started getting tight. It was hard to get up because I was so fatigued, Lyles told reporters from USA Today.
Earlier in the Games, Lyles dazzled crowds and was full of bravado before eking out a razor-thin win in the 100-meter, which earned him bragging rights as the speediest man on Earth.
After Lyles chose to compete following a positive COVID-19 test, viewers around the world could see he was sick. The spark had disappeared from his eyes, and some questioned whether Lyles should have compromised his own health or perhaps put others at risk by competing while sick.
But there were no strict COVID-19 protocols at the Olympics this year, and four years after the pandemic began, it has become obvious that COVID-19 is a party crasher that can strike in all seasons.
From barbecues to festivals and elder facilities to crowded airports, COVID-19 has been infecting many people this summer. COVID cases are likely to keep rising this fall and winter.
Experts at the World Health Organization recently declared that COVID-19 infections are surging around the world, with 84 countries from the Americas to Europe to the Western Pacific reporting summer spikes. While other respiratory illnesses like the flu typically hit people during the winter months, its now clear that COVID-19 infections can strike during any season, and Dr. Maria Van Kerkhove, a director of pandemic preparedness, warned that more severe variants may be on the horizon.
Many people who are sick with COVID-19 now either dont take a test or dont report test results to any government or medical authorities, so its difficult to say exactly how bad current COVID-19 spikes are. But both the U.S. Centers for Disease Control and Prevention (CDC) wastewater monitoring and anecdotal reports from doctors indicate that COVID-19 cases have been rising all summer, and the newest infections can hit people hard.
So, what symptoms are people experiencing? Whats different about COVID-19 infections now compared to the earliest days of the pandemic? How long are symptoms lasting? What are the protocols if you test positive? What should you do if youre traveling? And when can people get the newest vaccines? To answer your top questions, we consulted with Dr. Michelle Barron, UCHealths senior medical director of infection prevention and control.
Most people who have had COVID-19 this year will tell you that it really knocked them down, said Barron, who is also a professor at the University of Colorado School of Medicine on the Anschutz Medical Campus.
I know quite a few people who have gotten it recently, and they were very sick. Theyd tell me, I had a fever and I couldnt get out of bed, Barron said.
Barron said most people are describing common symptoms that are similar to a bad cold or a case of the flu.
Its primarily the same symptoms that weve seen all along like a sore throat, body aches, headaches, sinus pressure, runny nose, fatigue and a fever that goes away pretty quickly, Barron said.
The duration of illness seems to be shorter than COVID-19 infections were in the past, especially in the earliest days of the pandemic, Barron said.
People have been getting sick but not for long periods of time. They tend to spike fevers and feel really, really tired, like they have the flu, Barron said. But then they get better quickly, as early as Day 3.
Inspired by track and field events, Barron compared the current course of COVID-19 infections to Olympic sprinters like Lyles.
Its like your 100-meter-dash people where its intense, and in 10 seconds, its over, Barron said.
Some people get infections that last longer. But many people these days are getting an intense illness that passes relatively quickly.
It hits you hard, and then its done, Barron said.
It is unusual for respiratory viruses (other than Rhinovirus which causes the common cold) to surge in the summer, Barron said. But viruses are opportunistic. They spread when they can find new hosts, regardless of the season.
And the newest COVID-19 variants are clearly pros at infecting people.
The newest variants are much more efficient at transmitting themselves. Theyre faster at infecting people, and they get more people sick, Barron said.
Plus, many people have not been vaccinated recently, or their immunities from previous infections or booster shots have worn off.
Immunities are not permanent. Thats why people get colds every year. Viruses change slightly, and your immune system is like, Oh. Who are you? I havent seen you in a while. We need to retrain our bodies to respond. Thats why we need updated vaccines, Barron said.
This years summer wave of infections shows that the current variants are sneaky and talented.
People who get sick have a higher viral load. You have more virus out there, and it transmits much better, Barron said.
The current variants that are causing COVID-19 infections now are all descendants of the omicron variant. Experts name the omicron sub-variants alphabetically, and were now into the Ks. The KP.3 subvariants make up nearly 50% of the variants now circulating and causing infections, according to the CDCs Nowcast data tracker.
The newest vaccine, which is due out any day now, was supposed to target the newest variants, so Barron and other infectious disease experts hope it will be highly effective in preventing deaths, hospitalizations and serious illnesses this fall and winter.
We dont know yet where were going to land in fall or if theres going to be yet another variant, but COVID-19 is now behaving a lot like the flu, so we most certainly recommend that people get both their flu shots and their new COVID-19 shots this fall, Barron said.
Whether you dont like being sick yourself or if you have vulnerable people in your life who you want to protect, youll want to get vaccinated, Barron said. And people who like to travel should definitely get vaccinated so they dont acquire COVID-19 while theyre abroad.
People of all ages should get it, Barron said. I would prioritize anyone over age 65 and anyone with underlying immunologic issues like cancer or lung disease or any kind of chronic condition like diabetes or heart disease.
For everyone else, its a good idea to get the new vaccine, Barron said.
Learn all about the new COVID-19 vaccine that is coming this fall.
The new vaccine is due out within days. As of mid-August, UCHealth medical providers do not have the new COVID-19 vaccine yet.
Barron expects the new COVID-19 vaccines to be available for patients by September.
If youve had a recent case of COVID-19, you should have some natural immunities that will last about three months. You can get the new vaccine any time you are better but can wait up until about 90 days after you had a COVID-19 infection, Barron said.
Barron encourages people to go with convenience rather than worrying too much about precise timing for fall vaccines.
For older adults, especially, get your vaccines when its convenient, Barron said.
People who delay vaccines might not get them before the respiratory virus season hits hard. So, if youre going to your doctor for another reason, and the vaccines are available, Barron encourages people to go ahead and get them.
Others will want to be sure to get the newest vaccine before traveling or getting together with a lot of family and friends.
You might want to time your vaccines so youll be protected for the holidays. Just remember that it takes two weeks for vaccines to go fully into effect, Barron said.
Barron always jokes that she doesnt have a Magic 8 Ball that allows her to predict whats going to happen in the coming months with infectious diseases.
I expect my Magic 8 Ball would say, Ask me later, Barron said with a laugh.
In all seriousness, its typical to see an increase in cases of flu and COVID-19 during the fall and winter months. So, Barron and other infectious disease experts can make educated guesses and are preparing for spikes in infections and hospitalizations during the traditional respiratory virus season.
Last year, during the fall and winter, we saw COVID and flu without as many RSV cases. Were certainly prepared for that kind of perfect storm again, Barron said.
The conditions in the late fall and winter months make it easy for viruses to spread.
Kids will be in school, people are traveling, the temperatures start to change and more people are indoors, so I expect thats what well see, Barron said.
COVID-19 is now part of the repertoire of viruses we see every year in the fall and winter, and we should anticipate that were going to see it along with flu and other common viruses, Barron said.
The best preparation for respiratory virus season is to get updated vaccines.
We have very good, effective vaccines against flu and COVID that will keep you out of the hospital and keep you from getting a severe form of the disease, Barron said.
We dont know how severe the season will be until we know whats circulating, Barron said.
But its always wise to get your vaccine so you can enjoy the lovely fall and winter months and all the wonderful holidays we get to celebrate, she said. You wont want to be sick with the flu or COVID and have to stay home and miss out on the fun.
For older people, others who are immunocompromised or people who are trying to stay healthy to protect other high-risk family members or friends, its best to be cautious while you travel since the virus that causes COVID-19 is clearly spreading widely now.
If youre traveling soon and havent been able to get an updated vaccine, you can wear a mask in crowded indoor settings, like airports, Barron said.
If health insurance covers the older version of the vaccine, travelers could get the current shot now. Then, in about 90 days, they could get the updated 2024/2025 vaccine. Immunities from that shot would go into effect in time to protect people during the busy holiday season.
You could get an extra layer of protection, Barron said.
And I most certainly emphasize the benefits of masks. You dont have to wear them all the time. But in dense crowds, the mask might give you a little more protection. Theres certainly no harm from wearing one, Barron said.
The most crucial place to protect yourself is when youre in the airport because you cant control whos around you. Once youre on the plane, the air filtration system is actually quite good.
As long as the person sitting next to you isnt hacking on you, youd be fine taking your mask off on the plane, Barron said.
Anyone who wishes to get an extra dose of the 2023/2024 COVID-19 vaccine should check with their doctor and insurance provider to make sure the cost is covered.
The tried-and-true methods for staying healthy still hold true.
Wash your hands, cover your cough and wear a mask if youre in dense crowds, Barron said.
Plus, stay home and isolate yourself from loved ones if youre sick.
Whether youve got a cold, the flu, RSV or COVID-19, its kind not to share your germs with other people.
Barron said doctors encourage their patients to manage COVID-19 now just as they would if they got the flu.
Please stay home and isolate until youre feeling better and you dont have a fever.
You should not expose yourself to others until youve had no fever for at least 24 hours, and thats without taking acetaminophen or ibuprofen to bring a fever down. So you really have no fever, Barron said.
After that, you can probably interact with people, Barron said.
Wearing a mask as you recover is courteous.
Wed ask you to wear a mask for a total of five days, and in the hospital, we have stricter protocols because people are sick and we have people who are much more vulnerable, Barron said. We also have health care workers and we dont want to expose them, so they dont expose others.
