ROCK HILL, S.C. Kashyap Patel looked forward to his teams Friday lunches. All the doctors from his oncology practice would gather in the open-air courtyard under the shadow of a tall magnolia tree and catch up. The atmosphere tended to the lighthearted and optimistic. But that week, he was distressed.
It was 2021, a year into the coronavirus pandemic, and as he slid into a chair, Patel shared that hed just seen a patient in his 40s with cholangiocarcinoma, a rare and lethal cancer of the bile ducts that typically strikes people in their 70s and 80s. Initially, there was silence, and then one colleague after another said theyd recently treated patients who had similar diagnoses. Within a year of that meeting, the office had recorded seven such cases.
Ive been in practice 23 years and have never seen anything like this, Patel, CEO of Carolina Blood and Cancer Care Associates, later recalled. Asutosh Gor, another oncologist, agreed: We were all shaken.
There was other weirdness, too: multiple patients contending with multiple types of cancer arising almost simultaneously, and more than a dozen new cases of other rare cancers.
Increasingly, Patel was left with an unsettling thought: Could the coronavirus be inflaming the embers of cancer?
The uptick in aggressive, late-stage cancers since the dawn of the pandemic is confirmed by some early national data and a number of large cancer institutions. Many experts have mostly dismissed the trend as an expected consequence of disruptions to health care that began in 2020.
The idea that some viruses can cause or accelerate cancer is hardly new. Scientists have recognized this possibility since the 1960s, and today, researchers estimate 15 to 20 percent of all cancers worldwide originate from infectious agents such as HPV, Epstein-Barr and hepatitis B.
It will probably be many years before the world has conclusive answers about whether the coronavirus is complicit in the surge of cancer cases, but Patel and other concerned scientists are calling on the U.S. government to make this question a priority knowing it could affect treatment and management of millions of cancer patients for decades to come.
We are completely under-investigating this virus, said Douglas C. Wallace, a University of Pennsylvania geneticist and evolutionary biologist. The effects of repeatedly getting this throughout our lives is going to be much more significant than people are thinking.
But there is no real world data linking SARS-CoV-2 to cancer, and some scientists remain skeptical.
John T. Schiller, a National Institutes of Health researcher and pioneer in the study of cancer-causing viruses, said pathogens known to cause cancer persist in the body long-term. But the class of respiratory viruses that includes influenza and RSV a family that counts the coronavirus as a member infects a patient and then typically goes away instead of lingering and is not believed to cause cancer.
You can never say never, but that sort of virus does not suggest being implicated in cancers, Schiller said.
David Tuveson, director of the Cancer Center at Cold Spring Harbor Laboratory and former president of the American Association for Cancer Research, said theres no evidence the coronavirus directly transforms cells to make them cancerous. But that may not be the full story.
Tuveson said a number of small and early studies many of which have been published within the past nine months suggests that coronavirus infection can induce an inflammatory cascade and other responses that, in theory, could exacerbate the growth of cancer cells.
He has wondered whether it could be more akin to an environmental stressor like tobacco, alcohol, asbestos or microplastics.
Covid wrecks the body, and thats where cancers can start, Tuveson said, explaining how autopsy studies of people who died of covid-19 showed prematurely aged tissue.
Even as the first wave of the coronavirus pummeled the United States, public health officials predicted a surge of cancer cases. A Lancet Oncology paper analyzed a national registry showing increases of Stage 4 disease the most severe across many cancer types in late 2020. Baptist Health Miami Cancer Institute, UC San Diego Health and other large institutions have released data showing continued increases in late-stage cancers.
Xuesong Han, scientific director of health services research at the American Cancer Society and lead author of the Lancet Oncology study, attributed the jump to people delaying or skipping care because of fears related to the virus or because of economic reasons and also to cultural factors, language barriers and discrimination. But Han acknowledged that biological mechanisms of SARS-CoV-2, the virus that causes covid-19, could be at play.
I dont have the data to support this opinion, Han said. But its an important question to follow up on.
The human body is made up of trillions of cells in a constant state of growth, repair and death. Most of the time, cells with damaged DNA fix themselves, or simply disappear. Sometimes, they start collecting mistakes in their genetic code and rampage out of control into tumors, destroying parts of the body.
Afshin Beheshti is president of the COVID-19 International Research Team, a group of scientists from eclectic backgrounds who got together during the pandemic to consider out-of-the-box of ways to tackle the virus. Beheshtis background is in cancer biology, and he said that as the science on the virus evolved including studies showing widespread inflammation following infection, impact on the vascular system and infection in multiple organs vulnerable to cancer stem cell development he kept thinking the signals seemed to be related to early cancer changes.
It kept nagging on my mind, he said.
About a year ago Beheshti, a visiting researcher at MIT and Harvards Broad Institute, reached out to Patel, who is a past president of the Community Oncology Alliance, a national group of independent cancer specialists, and they hosted a symposium with other scientists that concluded compelling evidence exists suggesting links between the coronavirus and cancer.
Hopefully, were wrong, Beheshti said. But everything is, unfortunately, pushing toward that being the case.
The groups loosely affiliated members are launching research studies that are trying to piece together the puzzle of coronavirus infection, long covid and cancer.
Wallace the University of Pennsylvania scientist considered a father of the field of human mitochondrial genetics, which explores the power plants that fuel human cells is researching how covid affects energy production in cells and how that might influence cancer vulnerability.
Separately, biodata experts are sequencing the gene profiles of organs from people who succumbed to covid and underwent autopsies.
And a University of Colorado team is studying whether covid reawakens dormant cancer cells in mice. Their provocative findings, according to a preprint report released in April, showed that when mice that were cancer survivors were infected with SARS-CoV-2, dormant cancer cells proliferated in the lungs. They saw similar results with the flu virus.
Ashani Weeraratna, a professor at the Johns Hopkins Bloomberg School of Public Health, said the Colorado study, which she did not participate in, is part of a new field of work that emerged during the past decade that drills into what stimuli can reawaken cancer cells.
She said it is consistent with research highlighting the importance of the immune system in activating cells from dormancy, so it makes sense that something like influenza or covid that triggers inflammation could change in the immune microenvironment. But the results surprised her because its rare the data are so striking.
Weeraratna said that while she believes the Colorado studys findings are important, they should be interpreted with caution. Studies in mice often do not translate to human experiences. She said its also important to emphasize that the research and other recent papers focusing on covid and cancer involve acute infection or long covid; they do not suggest a link between the coronavirus vaccine and cancer misinformation that some anti-vaccine groups have spread in recent months.
Still, Weeraratna said, theres an important public health takeaway.
Mitigating risk of infection may be of particular importance for cancer patients, Weeraratna said. Based on the studys findings, measures adopted by vulnerable patients starting in the early days of the pandemic wearing masks, avoiding crowded places, getting vaccines become even more important.
Other studies offer telltale clues about the link between viruses and cancer.
Pathologists from the University of Arkansas for Medical Sciences reported in 2021 in the journal Communications Biology that SARS-CoV-2 proteins fueled the replication of a herpesvirus considered one of the major viruses leading to cancer. Other studies have implicated the coronavirus in helping to stimulate dormant breast cancer cells.
A paper published in 2023 in the journal Biochimie explored mechanisms the coronavirus could exploit to aggravate several forms of cancer, including lung, colorectal, pancreatic and oral. Researchers suggested the most likely pathway was through disrupting the bodys ability to suppress tumors, but researchers acknowledged a lack of direct evidence to support the theory.
Wallace believes the dearth of hard data on the coronavirus and cancer reflects policy choices more than scientific challenges.
I would say most governments dont want to think about long covid and much less long covid and cancer. It cost them so much to deal with covid. So there is very little funding for the long-term effects of the virus, he said. I dont think thats a wise choice.
From his practice in this Southern town, Patel is conducting his own research into what he has taken to calling an unusual pattern of cancers. He is driven by watching patients especially younger ones die so quickly.
Hes looking at potential correlations between long-covid markers and unusual cancers. He has collected data from nearly 300 patients and wants to create a national registry to analyze trends. So far, his office has logged more than 15 patients with multiple cancers, more than 35 patients with rare cancers and more than 15 couples with new cancers since the pandemic began in 2020.
Patel theorizes the effects of coronavirus infections could be cumulative in people infected multiple times. Pandemic-related stress may compound the threat, he said, by exacerbating inflammation.
If a link is established between the virus and cancer, he said, doctors might identify patients at greater risk and implement screenings earlier and even put some patients on anti-inflammatory drugs.
Mammograms and colonoscopies would have done nothing to prevent the illness of one of Patels patients, a 78-year-old diagnosed with three cancers throat, liver and lungs within a year.
Then theres Bob and Bonnie Krall, a couple who in a 14-month stretch endured three types of cancer between them, despite neither having a family history or genetic predisposition.
Cancers typically start in one part of the body and spread. Its rare for discrete cancers to begin in different parts of the body during a short window of time. Patel said the Kralls and the 78-year-old had coronavirus antibodies through the roof in their blood although hes not sure how that relates to cancer, if at all.
Patel met the Kralls in 2022 when Bob was diagnosed with chronic lymphocytic leukemia, a cancer of the blood and bone marrow. During one of her husbands treatments, Bonnie mentioned she was dealing with her own health issues related to long covid, including stomach pain. Medications werent helping. Patel ran tests and discovered Bonnie had cancer, too. By the time she was scheduled for surgery a few weeks after diagnosis, the malignancy in her abdomen had grown three more centimeters and weighed 8.5 pounds. This year, Bobs doctors found cancer in his lungs.
Bobs blood cancer, CLL, is considered rare with only four or five cases in every 100,000 people, but he has been surprised to find four of his neighbors and friends have it, too.
Its like a cold. It seems like everyone has it, said Bob, 73, a flight instructor.
Even before Patel mentioned his research, Bonnie, 74, who used to work part-time as a front desk assistant and lives with her husband in Fort Mill, S.C., had wondered whether their cancers were related to the coronavirus. She was infected shortly before her cancer diagnosis.
Maybe if we didnt get covid she started before trailing off. Bob shrugged and finished for her. Maybe we would have been better? Maybe we would have been worse.
correction
A previous version of this article incorrectly said Ashani Weeraratna is a physician. She holds a PhD, not an MD. The article has been corrected.
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(NewsNation) Bonnie and Bob Krall are a married couple who got through the COVID-19 pandemic with relative ease. Bonnie had a couple of mild cases, and Bob had a case that brought no symptoms.
We were both healthy as can be, said Bonnie Krall. We had just finished a giant trip to the Western United States, we came back, and bam, Bob was diagnosed.
Bob didnt have COVID but instead two very rare forms of cancer. Then, Bonnie got similar news.
I had an 8 1/2 pound tumor in my abdomen, she told NewsNations Elizabeth Vargas Reports. I was healthy in December, and by April, they diagnosed the cancer.
The Kralls are among a growing number of people who had COVID and then developed rare kinds of cancer, often more than one kind.
We started noticing some very unusual patterns, said the Kralls physician, Dr. Kashyap Patel. He and his colleagues at Carolina Blood and Cancer Care Associates have documented some very concerning links between COVID and cancer:
Patel says the inflammation that often accompanies COVID may be key to finding the link to the cancers people are contracting.
Inflammation triggers many genetic changes in a genome that can create a propensity of developing cancer in certain individuals, said Patel. Im analyzing close to 300 patients data on the inflammatory biomarkers in the body with Long COVID antibodies and if they had an unusual cancer, he added.
For Bob and Bonnie Krall, at least, the immediate prognosis is good. Bob is in remission, and Bonnie is close to it, she says. But learning exactly why it happened to them may always be a mystery.
Who knows? How can we ever know that?
Early June has seen a "burstof COVID" along with a variety pack of colds, viruses and other seasonal ailments that are on the rise, according to Long Island medical professionals.
While some of the viruses being seen tend to be more prevalent assummer approaches, possible factors driving the uptick in COVID-19 cases include the circulation of new variants as well as morepeople gathering and travelingduring warmer weather, experts say.
Positive tests for rhinoviruses andenteroviruses, which can cause anything from a common cold to serious respiratory illness, have been steadily going upsince March nationwide, according to national data from the Centers for Disease Control and Prevention. About 26% of tests were positive at the end of May compared with about 15% in March.
Enteroviruses are especially commonin the summer.We are definitely seeing our fair share of colds and fever viruses, said. Dr. Eve Meltzer Krief, who has a pediatric practice in Huntington.
Positive COVID-19 tests, which don't include results from home tests, have ticked up slightly nationwideafter being steady since March, according to the CDCchart.
Many of the illnesses share symptoms, such as coughs and muscle aches, which make it difficult for people to figure out what is making them sick. While it's important to identify COVID and flu, which have particular treatments, in most cases it's more important to monitor and manage symptoms.
We don't really differentiate between all the summer viral infections, said Erin Hunt, Northwell Health-GoHealth Urgent Cares lead physician assistant. We care most about the ones that have a different treatment like COVID and flu.
Although far from thewaves of the winter, cases of COVID-19are still popping up all around Long Island, experts said. The new variants KP.2 and KP.3 appear to be driving recent infections.
We are seeing a burst of COVID, Hunt said of the GoHeath urgent care centers on Long Island. I think its related to the new variant thats circulating, plus an increase in travel. People are traveling all over.
As of Tuesday, there were 99 people hospitalized with COVID-19 on Long Island and 539 across the state, the highest since April, according to the state Health Department.
National early indicators, which represent a portion of COVID-19 tests and emergency department visits, are up .08% and 5.1%,respectively, as of May 25,according to the CDC
Krief said most of the COVID-19 cases she is seeing are in babies and young children, and she has noticed a spikein recent weeks.
Hunt said its important to test a person with symptoms such as cough, sore throat, nasal congestion and fatigue for COVID-19.
Especially if you are feeling really run down, we want to make sure we're not dealing with COVID as opposed to just your standard upper respiratory infection, Hunt said.
Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Childrens Hospital, said if the current variant becomes much more highly infectious and peoples antibody levels aren't strong enough to fight it,there could bea shift that signals more cases.
Many people suffering with stuffy noses, cough and sore throats could just have seasonal allergies. But sometimes its more than that. Health practitioners said there are a few ways to tell the difference.
Generally with allergies, youre going to have watery eyes, itchy eyes, runny nose, maybe itching in your throat, Hunt said. With a viral infection, if you do have discharge from your eyes or your nose, it's going to be a little bit thicker. Youre not going to have the itching." With allergies, however, "You might notice your symptoms are worse on days with a high pollen count.
Another telltale sign that you might have COVID-19 and not an allergy is shortness of breath, said Dr. Robert Schreiber, a retired pulmonary care physician and former director of the pulmonary division at St. Francis Hospital in Roslyn.
Shortness of breath from allergies would be uncommon unless you already have asthma, he said. Air pollution can also exacerbate respiratory disease.
Common colds, generally caused by a rhinovirus, tend to have more mild symptoms than those of COVID-19.
Fever, chills, nausea, vomiting, diarrhea those are not typical of colds, Schreiber said. Those are not typical of allergies.
Nachman said May and June are prime times for mononucleosis, a contagious disease caused by the Epstein-Barr virus.
Everybody is going to parties and sharing drinks and the stuff you didn't do in December, she said. Every high school kid is going to a party, going to a prom, and it incubates for a month. We are going to see mono, and tons of it.
With the exception of COVID-19 and influenza, which can be treated with specific antiviral medicines, viral illnesses need to run their course.
People can treat the symptoms like fever and aches with pain relievers and stay hydrated. Antibiotics will not work, even though some people ask their doctors for them anyway.
People who overuse and misuse antibiotics may be adding to the number of drug-resistant germs.
This type of season contributes to our overuse of antibiotics significantly because you're getting sick and you want to get places and do things, she said. People think if they get an antibiotic they will get better faster. They wont, and this will contribute to antibiotic overuse in our environment. And that's a very worrisome thing for us.
Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.
Another new version of the COVID-19 vaccine will probably be coming this fall.The Food and Drug Administrations committee of independent advisers voted unanimously Wednesday to recommend that the agency tell vaccine manufacturers to update the COVID-19 shots so they will be more effective against the JN.1 lineage of the coronavirus.The committee voted on the question, For the 2024-2025 Formula of COVID-19 vaccines in the U.S., does the committee recommend a monovalent JN.1-lineage vaccine composition? All 16 of the advisers voted yes.The decision now goes to the full FDA. If the agency agrees with its advisory committee, the new shot will be a monovalent vaccine, offering protection against one coronavirus variant. Some previous vaccines have been bivalent, meaning they were formulated to protect against two variants.There are a few virus variants in circulation now, but they are relatively similar.JN.1 and its descendants KP.2 and KP.3 are the versions of the virus that are most common in the U.S. right now, according to the Centers for Disease Control and Prevention.The FDA told the advisory committee Wednesday that studies have shown that currently available COVID-19 vaccines appear to be less effective against the variants that are now in circulation.When manufacturers updated their vaccines last year to better match the variants that were in circulation then, it seemed to offer better protection. Match does matter somewhat, said Dr. Jerry Weir, director of the Division of Viral Products in the Office of Vaccines Research and Review at the FDAs Center for Biologics Evaluation and Research.JN.1 has continued to evolve, and it makes it somewhat difficult to pick the particular specific strain to be used this year, he told the committee. Because of manufacturing timelines, experts have to make predictions now if they want a new vaccine for fall. This is what the FDAs committee has done for the past couple of years, and I think its worked pretty well, Weir said.COVID-19 cases are relatively low right now. Only 3% to 4% of people who are getting tested are positive for the virus, said Dr. Natalie Thornburg, acting chief of the Laboratory Branch of the Coronavirus and Other Respiratory Viruses Division of the National Center for Immunization and Respiratory Diseases at the CDC. By comparison, at the peak of the Omicron surge in late 2021, test positivity rates were at 30%.Hospitalization rates are also the lowest they have been since March 2020, Thornburg said.Many people have some protection against the disease through vaccination or because theyve had COVID before.People who got the current COVID-19 vaccine which was updated last fall have protection from serious disease and death across all age groups, but as with past formulations, that protection wanes over time, Dr. Ruth Link-Gelles, vaccine effectiveness program lead with the National Center for Immunization and Respiratory Diseases, told the committee.The advisers agreed that more people need to get updated vaccines. Only about 25% of adults have gotten the most recent shot, according to a presentation to the committee.In only the fall and winter months last season, COVID-19 sent more than half a million people in the U.S. to the hospital and killed 40,000, according to data presented at the meeting.The people most likely to get seriously ill or die were unvaccinated, Link-Gelles said, and among the children who were hospitalized, half had no underlying conditions.This, I think, emphasizes the need for vaccination regardless of underlying condition, status or age, she said.The COVID-19 vaccine manufacturers told the committee that they have done some work to prepare for the FDAs decision on the composition of the vaccine. Animal and lab studies show that shots made by Pfizer/BioNTech, Moderna and Novavax that target the JN.1 variant seem to work well and are safe, the companies said.Novavax said its updated shot would need to be the JN.1 version because its protein vaccine takes about six months to make, and thats the version it has been working on. The company said it could get the shot to U.S. warehouses by August.Pfizer and Modernas mRNA vaccines can be developed more quickly, and those companies said they could have either a JN.1 shot or a KP.2 shot ready for fall. Moderna said it could supply the U.S. market by mid-August, and Pfizer said its shot could be immediately ready upon approval.The committee discussed but did not vote on whether the shot should match JN.1 or KP.2. Most of the members preferred JN.1 so Americans would have an option to get an mRNA vaccine or a more traditional protein-based vaccine.Dr. Peter Marks, director of the FDAs Center for Biologics Evaluation and Research, told the committee that the FDA will take these recommendations into consideration as it makes its final choice.
Another new version of the COVID-19 vaccine will probably be coming this fall.
The Food and Drug Administrations committee of independent advisers voted unanimously Wednesday to recommend that the agency tell vaccine manufacturers to update the COVID-19 shots so they will be more effective against the JN.1 lineage of the coronavirus.
The committee voted on the question, For the 2024-2025 Formula of COVID-19 vaccines in the U.S., does the committee recommend a monovalent JN.1-lineage vaccine composition? All 16 of the advisers voted yes.
The decision now goes to the full FDA. If the agency agrees with its advisory committee, the new shot will be a monovalent vaccine, offering protection against one coronavirus variant. Some previous vaccines have been bivalent, meaning they were formulated to protect against two variants.
There are a few virus variants in circulation now, but they are relatively similar.
JN.1 and its descendants KP.2 and KP.3 are the versions of the virus that are most common in the U.S. right now, according to the Centers for Disease Control and Prevention.
The FDA told the advisory committee Wednesday that studies have shown that currently available COVID-19 vaccines appear to be less effective against the variants that are now in circulation.
When manufacturers updated their vaccines last year to better match the variants that were in circulation then, it seemed to offer better protection. Match does matter somewhat, said Dr. Jerry Weir, director of the Division of Viral Products in the Office of Vaccines Research and Review at the FDAs Center for Biologics Evaluation and Research.
JN.1 has continued to evolve, and it makes it somewhat difficult to pick the particular specific strain to be used this year, he told the committee. Because of manufacturing timelines, experts have to make predictions now if they want a new vaccine for fall. This is what the FDAs committee has done for the past couple of years, and I think its worked pretty well, Weir said.
COVID-19 cases are relatively low right now. Only 3% to 4% of people who are getting tested are positive for the virus, said Dr. Natalie Thornburg, acting chief of the Laboratory Branch of the Coronavirus and Other Respiratory Viruses Division of the National Center for Immunization and Respiratory Diseases at the CDC. By comparison, at the peak of the Omicron surge in late 2021, test positivity rates were at 30%.
Hospitalization rates are also the lowest they have been since March 2020, Thornburg said.
Many people have some protection against the disease through vaccination or because theyve had COVID before.
People who got the current COVID-19 vaccine which was updated last fall have protection from serious disease and death across all age groups, but as with past formulations, that protection wanes over time, Dr. Ruth Link-Gelles, vaccine effectiveness program lead with the National Center for Immunization and Respiratory Diseases, told the committee.
The advisers agreed that more people need to get updated vaccines. Only about 25% of adults have gotten the most recent shot, according to a presentation to the committee.
In only the fall and winter months last season, COVID-19 sent more than half a million people in the U.S. to the hospital and killed 40,000, according to data presented at the meeting.
The people most likely to get seriously ill or die were unvaccinated, Link-Gelles said, and among the children who were hospitalized, half had no underlying conditions.
This, I think, emphasizes the need for vaccination regardless of underlying condition, status or age, she said.
The COVID-19 vaccine manufacturers told the committee that they have done some work to prepare for the FDAs decision on the composition of the vaccine. Animal and lab studies show that shots made by Pfizer/BioNTech, Moderna and Novavax that target the JN.1 variant seem to work well and are safe, the companies said.
Novavax said its updated shot would need to be the JN.1 version because its protein vaccine takes about six months to make, and thats the version it has been working on. The company said it could get the shot to U.S. warehouses by August.
Pfizer and Modernas mRNA vaccines can be developed more quickly, and those companies said they could have either a JN.1 shot or a KP.2 shot ready for fall. Moderna said it could supply the U.S. market by mid-August, and Pfizer said its shot could be immediately ready upon approval.
The committee discussed but did not vote on whether the shot should match JN.1 or KP.2. Most of the members preferred JN.1 so Americans would have an option to get an mRNA vaccine or a more traditional protein-based vaccine.
Dr. Peter Marks, director of the FDAs Center for Biologics Evaluation and Research, told the committee that the FDA will take these recommendations into consideration as it makes its final choice.
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This story is part of CBC Health's Second Opinion, a weeklyanalysis of health and medical science news emailed to subscribers on Saturday mornings. If you haven't subscribed yet, you can do that by clicking here .
A cursory glance at Canada's wastewater trends for COVID-19 reveals a messy, unpredictable picture: Viral loads ebb and flow all throughout the year, at different times, in different cities.
While SARS-CoV-2 is now a familiar threat, the virus isn't neatly seasonal. It still circulates year-round, humming in the background. And for the fifth year in a row, some scientists are bracing for the possibility of a small summer wave.
That reality might come as a surprise to anyone who hoped this virus would quickly join the typical colder-weather cold and flu season, offering a break from COVID infections over the warmer months. But we're not quite there yet.
"When you look at the other four coronaviruses the cause of 25 per cent of our common colds they do have this really stark seasonality," said infectious diseases specialist Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. "But we don't know how long it took for them to settle into that pattern."
SARS-CoV-2, on the other hand, is still in its infancy. And its spike protein, which allows the virus to penetrate our cells and cause infections, keeps mutating at a brisk pace.
"This is a virus that was never known to infect humans before 2019, so it's still a lot of evolutionary pressure, especially with the immunity that people have developed," Adalja said.
Close watchers of SARS-CoV-2's ongoing evolution are tracking several new variants, all growing more dominant in recent months.
The JN.1 group remains the dominant form of the virus in Canada, while KP.2 and KP.3 among the lineages nicknamed "FLiRT"by some scientists, after the technical names for specific genetic mutations and LB.1 are all showing signs of growth, Public Health Agency of Canada data shows (PHAC).
All of them are offshoots of Omicron, the variant that sparked a massive wave of infections midway through the pandemic. This still-circulating family of viruses remains more contagious than earlier forms, with spike protein mutations that help bypass the protection offered by vaccines or prior infections ensuring people can get reinfected over and over.
"We've had nothing but Omicron for about two years," said Adalja. "That lineage is still trying to find the optimal combination to infect people, and there's always going to be some evolution going on. It's still at a high enough pace that seasonality is not quite as predictable as people would like it to be."
While the results of nationwide tests suggest low circulation of common respiratory viruses such as influenza and respiratory syncytial virus in recent weeks, SARS-CoV-2 levels rose over several weeks untillate May, says the most recent PHAC respiratory virus report.
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The figures are murky, however, given limited COVID testing in the community and varying trends between regions. Roughly half of Canada's wastewater sites are showing no recent change in SARS-CoV-2 trends, for instance, while a quarter are showing drops and the other quarter are showing increases.
Still, ever-evolving versions of the virus could lead to increased infections in the months ahead, much like the pattern in previous Omicron years, said Dr. Zain Chagla, an infectious diseases specialist with McMaster University in Hamilton, Ont.
"We could start seeing early trickles of a wave towardthe late summer," he added.
U.S. medical experts are also warning of similar trends there, albeit with smaller expected infection counts than prior summer waves.
It's another reminder that COVID is here to stay. But with overall case counts and death rates dropping thanks in part to higher levels of immunity across the population it's easier to brush the virus aside.
The threat has certainly lessened since the early days of the pandemic, Chagla said.
Yet this virus keeps hospitalizing vulnerable people, even through the spring and summer months. Some older and immunocompromised individuals are dying, Chagla said, andpeople with established immunity through vaccination or prior infection do occasionally develop severe disease.
As late as 2023, one U.S. study found COVID remained more deadly than influenza. This virus continues to kill in Canada: 23 people here died of COVID in just one week in May, according to the latest PHAC data.
Given how contagious the virus is and how fast immunity against infection fades, Adalja stressed that higher-risk groups older adults, and those with other risk factors such as being overweight or pregnant should continue approaching COVID differentlythan someone who's at an average risk.
"Those people, it's very important for them to be up-to-date on their vaccinations," he said.
Public apathy toward thepathogen could complicate that.
Vaccine uptake has dropped off over the years, with fewer than two in 10 Canadians getting the most recent updated shots. And although age has always been a risk factor for severe COVID, only 53 per cent of adults aged 80 and up had their latest round, according to PHAC.
"That's the highest vulnerable group," said Chagla, "and you can't even convince more than half of them to be vaccinated."
For those who opt for additional shot, there's good news: COVID vaccines continue to be updated to better match circulating strains. This week, U.S. officials approved fall shots based on the JN.1 lineage, and Canada tends to be in lockstep with those decisions south of the border.
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But physician-epidemiologist Dr. Nitin Mohan, an assistant professor at Western University in London, Ont., said the lag between the emergence of new variants and the approval of matched vaccines remains a constant challenge. That means the world is always a step behind the evolution of SARS-CoV-2, allowing it to continually circulate and reinfect people more often than many older viruses.
"Hopefully we get to the point one day where we have vaccinations that prevent transmission," Mohan said. "I think that will be sort of the real game changer."
Until that day comes, he said it's anyone's guess how long it will take for SARS-CoV-2 to become more seasonal and predictable.
"I probably have a better guess of when the Leafs will win the Stanley Cup at this point."
Lauren Pelley Senior Health & Medical Reporter
Lauren Pelley covers health and medical science for CBC News, including the global spread of infectious diseases, Canadian health policy, pandemic preparedness, and the crucial intersection between human health and climate change. Two-time RNAO Media Award winner for in-depth health reporting in 2020 and 2022. Contact her at: lauren.pelley@cbc.ca
Researchers at the University of So Paulo (USP) in Brazil have demonstrated for the first time that SARS-CoV-2, the virus responsible for COVID-19, can persist in sperm for up to 90 days post-hospital discharge and up to 110 days after initial infection, reducing semen quality.
These findings suggest that individuals planning to conceive should consider a quarantine period post-recovery.
Four years into the pandemic, it is established that SARS-CoV-2 can invade various human cells and tissues, including the reproductive system, using the testicles as a gateway.
Despite previous observations of the virus in testicles, its presence in semen was rarely detected through polymerase chain reaction (PCR) analysis, which typically focuses on viral DNA.
To bridge this knowledge gap, the study employed real-time PCR and transmission electron microscopy (TEM) to identify viral RNA in semen and spermatozoa donated by men recovering from COVID-19.
The samples, collected from 13 patients aged 21 to 50, revealed that the Covid virus was present in the sperm of 69.2% of the patients, indicating significant virus retention in sperm even after recovery.
We found that the sperm produced extracellular traps based on nuclear DNA, forming networks similar to those seen in the systemic inflammatory response to SARS-CoV-2, said corresponding author Jorge Hallak, a professor at USP.
These traps, known as neutrophil extracellular traps (NETs), are typically formed by white blood cells to immobilize and kill pathogens. However, hyperactive NETs can damage tissue throughout the organism.
TEM analysis revealed that sperm engage in a suicidal ETosis-like response, where they sacrifice themselves to contain the pathogen.
The finding that spermatozoa are part of the innate immune system and help defend the organism against attack by pathogens is unique in the literature and makes the study very important. It can be considered a scientific paradigm shift, Hallak said.
Traditionally, sperm are known for their roles in binding male and female gametes, fertilizing female gametes, promoting embryo development, and influencing the development of chronic diseases. This study adds a new function: participating in the innate immune response.
The findings have significant implications for assisted reproduction techniques, particularly intracytoplasmic sperm injection (ICSI), which involves injecting a single spermatozoon into an egg.
Hallak recommends postponing natural conception and assisted reproduction for at least six months after infection by SARS-CoV-2.
Hallak, who has been advocating for caution in reproduction protocols since the pandemic began, has conducted extensive research on the impact of COVID-19 on reproductive and sexual health.
His groups studies have highlighted the increased risk of severe COVID-19 infection and mortality in men, potentially due to the abundance of ACE2 receptors and TMPRSS2 in testes.
In previous studies, Hallaks group found a significant decrease in libido and sexual satisfaction among health workers during the pandemic.
The team also discovered that the testes are potential targets for SARS-CoV-2, causing subclinical epididymitis and severe testicular lesions associated with COVID-19.
Currently, Hallaks team, along with Professor Carlos Carvalho and other researchers at USP, are investigating the long-term effects of SARS-CoV-2 infection in over 700 patients as part of a Thematic Project funded by FAPESP.
COVID-19 can impact human reproductive health in several ways, though research is still ongoing to fully understand the extent and mechanisms.
Some studies suggest that COVID-19 can cause testicular damage in infected individuals, potentially due to viral entry into cells via ACE2 receptors, which are abundant in testicular tissue.
This could lead to reduced testosterone levels and impaired sperm production, though the evidence is still emerging and not definitive.
There have been reports of menstrual irregularities in women who have contracted COVID-19. These changes include alterations in menstrual cycle length, volume of menstrual flow, and increased menstrual pain.
The exact cause isnt well understood but could be related to the stress of illness, immune response, or other factors associated with the infection.
There is limited data on the direct impact of COVID-19 on fertility. Some concerns were initially raised about potential impacts due to illness and fever, which can affect sperm and egg quality temporarily.
However, there is no conclusive evidence yet that COVID-19 leads to long-term fertility issues.
Pregnant women with COVID-19 are at increased risk of severe illness and adverse pregnancy outcomes compared to pregnant women without COVID-19.
These risks include preterm birth and possibly other complications for both the mother and baby. However, vertical transmission (transmission from mother to baby during pregnancy) appears to be rare.
Further research is needed to better understand the full spectrum of COVID-19s impact on reproductive health across different populations.
The study is published in the journal Andrology.
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NEW DELHI: A recent study conducted by researchers at Vrije Universiteit in Amsterdam has called for thorough investigations into the potential side effects of Covid-1919 vaccines and their links to mortality rates. The study, published in BMJ Public Health, reports over three million excess deaths in Western countries during the first three years of the pandemic. According to the study, 3,098,456 excess deaths were recorded across 47 countries between January 1, 2020, and December 31, 2022. The breakdown of excess deaths is as follows: 2020: 1.03 million excess deaths. 2021: Over 1.25 million excess deaths, coinciding with the rollout of Covid-1919 vaccines. 2022: Over 808,000 excess deaths, even as Covid-19related restrictions were lifted. The researchers highlighted that "excess mortality has remained high in the Western World for three consecutive years, despite the implementation of containment measures and Covid-1919 vaccines." They described the figures as "unprecedented" and emphasized the need for policymakers to investigate the "underlying causes of persistent excess mortality." As per a Russia Today report, the study noted that adverse events following vaccination have been recorded in various official databases. These adverse events included ischaemic stroke, acute coronary syndrome, brain haemorrhage, cardiovascular diseases, coagulation issues, gastrointestinal events, and fatal blood clotting. Despite vaccines being intended to protect against severe illness and death due to Covid-1919, medical professionals and vaccine recipients reported "serious injuries and deaths following vaccination." The researchers pointed out the challenges in differentiating the causes of excess mortality due to varying national statistics, different testing policies for Covid-1919, and disagreements on what qualifies as a Covid-1919 death. They stressed that, "during the pandemic, it was emphasised by politicians and the media on a daily basis that every Covid-1919 death mattered and every life deserved protection through containment measures and Covid-1919 vaccines. In the aftermath of the pandemic, the same moral should apply." The World Health Organization (WHO) declared in May 2023 that Covid-1919 was no longer a global health emergency. However, Covid-1919 cases and related deaths continue to be reported globally, with the WHO tracking 36,014 cases in the week before May 19, showing a week-on-week rise of 2,336.
SINGAPORE Covid-19 mRNA vaccines may have contributed to the 3.1 million excess deaths that is, the number of deaths beyond what would be normal in 47 Western countries between 2020 and 2022, suggested an article in a journal.
But experts in Singapore disagreed with the article published on June 3 in the BMJ Public Health journal, one of more than 60 titles published by the British Medical Journal.
They said the piece was unbalanced and that correlation is not the same as causation. The Ministry of Health (MOH) said it is aware of the article.
Its spokesman told The Straits Times: MOH has studied excess deaths in Singapore from 2020 to 2022. Our studies showed that the excess deaths could be accounted for by deaths directly due to Covid-19, or due to underlying medical conditions which were made worse by Covid-19 infections.
The authors of the article three paediatric oncologists and an independent researcher, all from the Netherlands pointed out that in 2021, the year in which both containment measures and Covid-19 vaccines were used to address virus spread and infection, the highest number of excess deaths was reported.
In that year, excess deaths in the countries studied hit 1.26 million. The figure was 1.03 million in 2020, the year the pandemic started, and 808,392 in 2022, when most Covid-19 measures were lifted. Britain was the first to approve the mRNA vaccine, in December 2020.
The pandemic, from Jan 30, 2020, to May 5, 2023, accounted for seven million deaths.
The authors noted that investigations into worrying trends were not made public, such as the discovery of batch-dependent levels of toxicity in mRNA vaccines in Denmark, and the simultaneous onset of excess mortality and Covid-19 vaccination in Germany.
The article also said secondary analysis of clinical trials had shown that the mRNA vaccines from Pfizer had a 36 per cent higher risk of serious adverse events, while Moderna was at 6 per cent.
It said: These serious adverse events lead to either death, are life-threatening, require inpatient (prolongation of) hospitalisation, cause persistent/significant disability/incapacity, concern a congenital anomaly/birth defect or include a medically important event, according to medical judgment.
Most of these serious adverse events are common conditions like stroke and heart problems, the authors said. This commonality hinders clinical suspicion and consequently its detection as adverse vaccine reactions.
Professor Dale Fisher, a senior infectious diseases consultant at the National University Hospital (NUH), said most excess deaths were due to Covid-19 infection, including those that were not included as Covid-19 deaths.
He explained: The other major cause comes from other medical conditions that received inadequate attention from the health system. This happens especially when the system, especially its hospitals, is overwhelmed.
Beds are full, staff are unwell or burnt out. Patients can be afraid to even come to hospital.
Excess deaths from pre-existing cardiovascular disease, other respiratory diseases and dementia are well documented. Some services were closed and we saw tuberculosis and malaria programmes impacted in some countries.
Prof Fisher said theauthors over-emphasised the negative health impact of vaccines and social restrictions on the excess mortality rate.
While there were surely some deaths caused by vaccines, he said: The authors present their findings in an unbalanced way.
The restrictions and vaccines saved millions of lives and allowed the world to exit the pandemic earlier and more safely.
Professor Paul Tambyah, speaking in his capacity aspresident of the International Society for Infectious Diseases, said that if the authors hypothesis was correct, then the countries with the highest vaccination rates would also have the highest mortality rates.
But he noted: The countries with the highest excess mortality appear to have the lowest vaccination rates, while the countries with the lowest excess mortality have the highest vaccination rates, which seems to imply that there is no correlation between vaccination rates and excess mortality.
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Pandemic-era social distancing guidelines have taken a beating this week. Critics have argued passionately that the Centers for Disease Control and Preventions recommendation to remain six feet apart was arbitrary, wrong and should never have been implemented.
I disagree. The guidance, like other public health recommendations, wasnt perfect. But it did help to reduce transmission and was an important point of reference at a time when people needed simple, easy-to-follow guidelines.
Anthony S. Fauci, who during the pandemic was the nations top infectious-diseases expert, endured the brunt of the criticism during a bruising congressional hearing on Monday. Questions zeroed in on testimony he gave during a closed-door session in January that the six-foot rule sort of just appeared and wasnt based on data. At times, the exchange devolved into personal attacks, with Rep. Marjorie Taylor Greene (R-Ga.) repeatedly refusing to address Fauci as Dr. Fauci, saying his medical license should be revoked and that he belongs in prison.
Recall that, at the start of the pandemic, SARS-CoV-2 was a novel coronavirus. Health officials knew little about it and assumed it behaved like other common respiratory viruses. Influenza and respiratory syncytial virus (RSV) are among the viruses that are transmitted predominantly via small droplets expelled when someone coughs, sneezes and breathes. These particles can land on someones nose, mouth or eyes, or they can be inhaled by those in proximity. They can also land on surfaces and infect people who touch them.
Over time, scientists learned that the covid-19 virus and especially new variants of the pathogen was highly contagious. Studies demonstrated that it not only spread via droplets, but also by much smaller aerosol particles. Whereas droplets are heavier and quickly fall to the ground, aerosols can linger and be carried over longer distances.
Public health guidance eventually pivoted toward improving ventilation as an infection control measure, as aerosol experts had long advocated. Today, the science is pretty well settled that covid-19 can be transmitted via both droplets and aerosols.
Critics of the six-foot rule are right in some ways. With aerosol transmission, someone could become infected even if they are further than six feet away. And, as Fauci suggested in his testimony, there have been no randomized-controlled trials looking at six feet of distancing vs., for instance, the World Health Organizations more lenient recommendation of one meter, which is just over three feet.
But heres what the six-foot rule got right: Droplet transmission remains one of two dominant routes of spread. A rule that reduces droplet transmission wont curb all spread, but it can help protect people from the virus.
Moreover, I think Americans understood there wasnt something magical about the exact distance. Did anyone really believe that being five feet away from others was dangerous while seven feet was safe? Rather, this guidance was based on a common-sense understanding that being in close contact with an infected person is risky.
This understanding is still correct. A large contact-tracing study published last year in Nature found that household contacts accounted for 6 percent of exposures to the covid-19, but 40 percent of transmissions. Most positive cases occurred after at least an hour of exposure, suggesting that prolonged close contact is of highest risk.
Another interesting study examined a cluster of covid cases on a 10-hour commercial flight with 217 passengers and crew. Of the 16 people who ended up testing positive, 12 were seated near the infected person. Seating proximity increased infection risk more than sevenfold.
As readers of the Checkup newsletter know, I often discussed the six-foot rule alongside two other ways to reduce transmission: being outdoors and masking. If the goal is to avoid covid, someone in an indoor crowded area should wear a high-quality mask, but its not necessary if they are outdoors or well-spaced from others. The six-foot rule provided a helpful starting point to help people decide what precautions they needed to take.
Dont get me wrong: I think its crucial for lawmakers to discuss whether workplaces and schools needed to impose six-foot separation rules And I would love to have more research on how much mitigation measures such as social distancing and masking reduced transmission. We also need data on their very real harms. Such information is necessary to guide policy decisions moving forward.
But none of this means people were misguided in keeping their distance from potentially infected people. It also does not mean that we should disregard social distancing as a mitigation measure against other contagious diseases. If, for example, the avian flu outbreak progresses to human-to-human transmission, we might need to bring back distancing to reduce droplet exposure.
And it definitely does not mean that Fauci somehow misled the public. Those viewing Mondays congressional testimony should ignore the partisan noise and focus on the calm responses from the physician-scientist who guided the country through a once-in-a-generation health crisis and continues to serve as the very model of a dedicated public servant.
