India may have had 11.9 lakh excess deaths due to the effects of the COVID-19 pandemic in 2020, an international team of researchers has reported in the journal Science Advances.
The estimate is at odds with the Indian governments repeated claim that far fewer people died than they would have without the pandemic in that year. It also stands on firmer footing than many previous estimates previous studies because the studys authors used data from the fifth National Family Health Survey (NFHS-5), conducted in 2019-2021.
Using this exceptionally large dataset helps to address major gaps in knowledge about pandemic mortality in India that stem in part from incomplete administrative data and low-quality survey data, they wrote in their paper, published on July 19.
The researchers used NFHS-5 data collected in 2021, of 7.6 lakh people in households in 14 States and Union territories. This sub-sample, they wrote, is representative of about one fourth of Indias population. Based on this data, they found that the overall life expectancy in India in 2020 was comparable to that a decade prior, dropping by 2.6 years at birth between 2019 and 2020. This, they estimated, translated to a 11.9 lakh excess deaths around the country.
An important reason for the life expectancy decline is reportedly because more people aged younger than 60 years lost their lives in 2020. They also estimated the life expectancy of women at birth declined by one year more than it did for men at birth.
Based on numbers of the socio-economic indicators the NFHS tracks, the researchers also wrote, Relative to high-caste Hindus, the gap in life expectancy at birth for [Scheduled Caste groups] increased from 4.5 years in 2019 to 5.9 years in 2020; for [Scheduled Tribe groups], it increased from 2.2 to 5.0 years, and for Muslims, it increased from 2.2 to 6.3 years.
The studys first author and a University of Oxford research fellow, Aashish Gupta, told PTI, Marginalised groups already had lower life expectancy, and the pandemic further increased the gap between the most privileged Indian social groups, and the most marginalised social groups in India.
By 2022, the U.S. had officially recorded the most number of deaths due to COVID-19. On the other hand modelling studies by various independent scientists had suggested India may have recorded the most deaths overall in 2020-2023, up to 5 million, due to COVID-19 as well as the lockdown and disruptions in global supply chains.
On July 20, the Ministry of Health and Family Welfare issued a statement disputing the studys findings, saying, The excess mortality reported in the Science Advances paper in 2020 over the previous year is a gross and misleading overestimate. The study is erroneous and methodology followed by the authors has critical flaws; the claims are inconsistent and unexplainable. The all-cause excess mortality in 2020 compared with the previous year in India is markedly less than the 11.9 lakh deaths reported in the Science Advances paper.
The Ministry also disputed the studys use of NFHS-5 data and said it wouldnt be representative of national data. The paper had acknowledged this limitation: Although our 2021 subsample is similar to the full NFHS-5 sample on many characteristics, the subsample has a different social and religious composition compared to the full sample and that its data is geographically clustered in 14 states and union territories. For these reasons, our results from analyses of the subsample may not provide a full understanding of changes in mortality at the national level...
But the authors also added that changes in mortality in this subsample might not have been so different from regions that are not in this subsample. Indias third national [seroprevalence survey] shows that disease spread was similar in the subsample states compared to states that were not in the subsample.
The Ministrys statement contended that another flaw was related to possible selection and reporting biases in the included sample due to the time in which these data were collected, at the peak of the COVID-19 pandemic.
It also disagreed with the researchers statement in the paper that the NFHS-5 allowed an alternative window with which to estimate deaths to COVID-19 and its effects in India considering administrative data from Indias Civil Registration System (CRS), which have been used for many existing estimates of excess mortality in India ... do not capture all births and deaths, are unavailable for many states, and were disrupted by Indias severe lockdown in 2020.
The Ministry said the Civil Registration System ... recorded a substantial increase in death registrations (over 99%) in 2020. However, Dr. Gupta told The Hindu, The governments own National Family Health Survey found death registration coverage to be 71%. It is likely that the lockdown further reduced registration coverage. So the claim that death registration is above 99% is hard to buy.
A new variant of coronavirus known as FLiRT has taken hold in the Netherlands this summer and people can still become extremely ill, experts say.
One in 80 people taking part in the public health institute RIVMs infection monitor, tested positive for coronavirus in the past week. In the week of April 15, for example, no positive tests were reported at all.
Waste water analysis, the most important monitor of how the virus is spreading, shows the number of coronavirus particles is now 14 times higher than at this time last year. It is now even higher than in July 2021 when the government relaxed the strict coronavirus measures, leading to a surge in autumn infections.
The current wave, says professor Marion Koopmans, is causing far fewer people to become seriously ill and hospital admissions are barely rising, despite the surge in infections.
Most people, she told the AD, are well protected against the virus because they have either had it earlier or have been vaccinated.
Nevertheless, Koopmans and the RIVM stress that coronavirus can lead to long-term health problems such as Long Covid. The chance is lower, but it is still there, Koopmans said. We are still getting new cases.
The basic rules introduced during the main pandemic sneezing into your elbow, working from home and wearing masks should become part of our everyday behaviour, she said. As with flu, people who are in poor health can become extremely ill, she said. Simple measures can help protect them.
The summer surge shows that coronavirus is not seasonal, Alma Tostmann from Radboud University hospital told the Volkskrant. We are currently in a phase in which new variants lead to a rise in infections, even if it is summer, she said.
Research institute Nivel said last week that the number of coronavirus patients reporting to their family doctor remains low but that there is an upward trend and that the over-65s are most likely to be affected.
The government will launch a new vaccination round for the over-60s and younger people with certain health conditions in mid-September. The first invitations will begin to arrive at the end of August.
FLiRT takes its name loosely from its scientific moniker.
The new COVID-19 variant FLiRT is rapidly spreading through the Netherlands, and the amount of coronavirus particles in the sewage is now even higher than in the Dancing with Jansen summer of 2021. But hospital admissions are barely increasing, so there is no reason to panic, virologist Marion Koopmans told AD.
The best indicator of how actively the virus is spreading is the sewage water measurements, Koopmans said. Currently, the number of coronavirus particles found in the sewage is 14 times higher than at this time last year. It is even higher than in the summer of 2021, when the Delta variant was spreading quickly, and the governments over-enthusiasm for relaxing measures caused a wave of infections.
The current wave is in many ways incomparable to the 2021 situation, Koopmans, a professor of virology at Erasmus MC in Rotterdam, stressed to AD. The current variants make people a lot less sick. You now see that the number of hospital admissions is barely increasing despite the rising number of coronavirus infections. Most people are also well protected against the virus through vaccinations and previous infections, resulting in often milder symptoms.
Despite this, Koopmans and the public health institute RIVM are stil concerned about Long Covid, when Covid-19 symptoms last for a year or longer. The chance is gradually decreasing, but it is still there, Koopmans said. New cases continue to emerge. So that is something to take into account.
FLiRT is a group of Omicron subvariants that are just different enough to bypass immunity. Officially, the subvariants are called KP.2, JN.1.7, but to keep things simple, scientists have named the group as a whole the FLiRT variant.
President Joe Biden tested positive for Covid-19 on Wednesday while he was in Las Vegas for a series of events, the White House said.
In a statement, White House press secretary Karine Jean-Pierre said Biden tested positive following his first event in Las Vegas.
He is vaccinated and boosted and he is experiencing mild symptoms, Jean-Pierre said. He will be returning to Delaware where he will self-isolate and will continue to carry out all of his duties fully during that time. The White House will provide regular updates on the Presidents status as he continues to carry out the full duties of the office while in isolation.
Biden was already scheduled to head to Delaware after his trip to Las Vegas.
Biden was tested after he experienced upper respiratory symptoms, Bidens doctor said in a statement released by the White House. Dr. Kevin OConnor is the presidents physician; the White House did not attribute the statement to him by name.Bidens symptoms included a runny nose, nonproductive cough and general malaise, the statement said.
His doctor said he has already taken his first dose of Paxlovid, a medication that is associated with reducing the chance of hospitalization or death.
Biden does not have a fever, and his respiratory rate is normal, according to the doctor.
When Biden arrived later at the Las Vegas-area airport, he responded to a question about how he was feeling by saying, Good, I feel good.
En route to Delaware, Biden tweeted, "I'm sick." He followed it up two minutes later with a post saying, "of Elon Musk and his rich buddies trying to buy this election," with a link to donate to his re-election campaign. Musk endorsed former President Donald Trump moments after Saturday's assassination attempt.
Biden, 81, has kept a full schedule in Nevada this week after questions were raised about his health and capabilities after a dismal debate performance in late June.
Both Biden and Trump, 78, have had Covid. Biden last tested positive in 2022. Trump tested positive in 2020.
News of Bidens Covid test was announced at the conference where he was scheduled to speak Wednesday.
Regrettably, I was just on the phone with President Biden, and he shared his deep disappointment at not being able to join us this afternoon. The president has been at many events, as we all know, and he just tested positive for Covid," said Janet Murgua, president of UnidosUS, which bills itself as the largest Latino advocacy organization in U.S.
Biden, who had been expected to speak at the group's event in Las Vegas, was about an hour and a half late before the announcement was made.
Top campaign officials Jen O'Malley Dillon and Julie Chavez Rodriguez informed campaign staff members of the Covid test in a 6:40 p.m. ET email.
"The president is doing fine and looking forward to being back on the campaign trail as soon as he is COVID free," the email said.
Biden said in an interview with BET on Tuesday that he would drop out of the presidential race if he developed a medical condition that prevented him from running.
The Centers for Disease Control and Prevention said in March that people who test positive for Covid no longer need to isolate for five days.
The CDC's latest guidance recommends that people who test positive stay home and away from others, noting that people can resume normal activity after symptoms are improving and there is no fever without "fever-reducing medication" for at least 24 hours.
The CDC encourages people to continue to wear masks and maintain distance from others for five days after they resume regular activities.
Biden was not wearing a mask as he walked to Air Force One after having tested positive; neither were the staff members boarding with him.
Megan Lebowitz is a politics reporter for NBC News.
Mike Memoli is an NBC News correspondent.
Tara Prindiville and Rebecca Shabad contributed.
Since 2020, the condition known as long COVID-19 has become a widespread disability affecting the health and quality of life of millions of people across the globe and costing economies billions of dollars in reduced productivity of employees and an overall drop in the work force.
The intense scientific effort that long COVID sparked has resulted in more than 24,000 scientific publications, making it the most researched health condition in any four years of recorded human history.
Long COVID is a term that describes the constellation of long-term health effects caused by infection with the SARS-CoV-2 virus. These range from persistent respiratory symptoms, such as shortness of breath, to debilitating fatigue or brain fog that limits peoples ability to work, and conditions such as heart failure and diabetes, which are known to last a lifetime.
I am a physician scientist, and I have been deeply immersed in studying long COVID since the early days of the pandemic. I have testified before the U.S. Senate as an expert witness on long COVID, have published extensively on it and was named as one of Times 100 most influential people in health in 2024 for my research in this area.
Over the first half of 2024, a flurry of reports and scientific papers on long COVID added clarity to this complex condition. These include, in particular, insights into how COVID-19 can still wreak havoc in many organs years after the initial viral infection, as well as emerging evidence on viral persistence and immune dysfunction that last for months or years after initial infection.
A new study that my colleagues and I published in the New England Journal of Medicine on July 17, 2024, shows that the risk of long COVID declined over the course of the pandemic. In 2020, when the ancestral strain of SARS-CoV-2 was dominant and vaccines were not available, about 10.4% of adults who got COVID-19 developed long COVID. By early 2022, when the omicron family of variants predominated, that rate declined to 7.7% among unvaccinated adults and 3.5% of vaccinated adults. In other words, unvaccinated people were more than twice as likely to develop long COVID.
While researchers like me do not yet have concrete numbers for the current rate in mid-2024 due to the time it takes for long COVID cases to be reflected in the data, the flow of new patients into long COVID clinics has been on par with 2022.
We found that the decline was the result of two key drivers: availability of vaccines and changes in the characteristics of the virus which made the virus less prone to cause severe acute infections and may have reduced its ability to persist in the human body long enough to cause chronic disease.
Despite the decline in risk of developing long COVID, even a 3.5% risk is substantial. New and repeat COVID-19 infections translate into millions of new long COVID cases that add to an already staggering number of people suffering from this condition.
Estimates for the first year of the pandemic suggests that at least 65 million people globally have had long COVID. Along with a group of other leading scientists, my team will soon publish updated estimates of the global burden of long COVID and its impact on the global economy through 2023.
In addition, a major new report by the National Academies of Sciences Engineering and Medicine details all the health effects that constitute long COVID. The report was commissioned by the Social Security Administration to understand the implications of long COVID on its disability benefits.
It concludes that long COVID is a complex chronic condition that can result in more than 200 health effects across multiple body systems. These include new onset or worsening:
Long COVID can affect people across the lifespan from children to older adults and across race and ethnicity and baseline health status. Importantly, more than 90% of people with long COVID had mild COVID-19 infections.
The National Academies report also concluded that long COVID can result in the inability to return to work or school; poor quality of life; diminished ability to perform activities of daily living; and decreased physical and cognitive function for months or years after the initial infection.
The report points out that many health effects of long COVID, such as post-exertional malaise and chronic fatigue, cognitive impairment and autonomic dysfunction, are not currently captured in the Social Security Administrations Listing of Impairments, yet may significantly affect an individuals ability to participate in work or school.
Whats more, health problems resulting from COVID-19 can last years after the initial infection.
A large study published in early 2024 showed that even people who had a mild SARS-CoV-2 infection still experienced new health problems related to COVID-19 in the third year after the initial infection.
Such findings parallel other research showing that the virus persists in various organ systems for months or years after COVID-19 infection. And research is showing that immune responses to the infection are still evident two to three years after a mild infection. Together, these studies may explain why a SARS-CoV-2 infection years ago could still cause new health problems long after the initial infection.
Important progress is also being made in understanding the pathways by which long COVID wreaks havoc on the body. Two preliminary studies from the U.S. and the Netherlands show that when researchers transfer auto-antibodies antibodies generated by a persons immune system that are directed at their own tissues and organs from people with long COVID into healthy mice, the animals start to experience long COVID-like symptoms such as muscle weakness and poor balance.
These studies suggest that an abnormal immune response thought to be responsible for the generation of these auto-antibodies may underlie long COVID and that removing these auto-antibodies may hold promise as potential treatments.
Despite overwhelming evidence of the wide-ranging risks of COVID-19, a great deal of messaging suggests that it is no longer a threat to the public. Although there is no empirical evidence to back this up, this misinformation has permeated the public narrative.
The data, however, tells a different story.
COVID-19 infections continue to outnumber flu cases and lead to more hospitalization and death than the flu. COVID-19 also leads to more serious long-term health problems. Trivializing COVID-19 as an inconsequential cold or equating it with the flu does not align with reality.
President Biden tested positive for the coronavirus Wednesday, placing a renewed spotlight on covid-19 and the precautions the broader public can take as a summer wave of the disease sweeps over much of the United States.
In a statement, the White House said Biden is experiencing mild symptoms and plans to self-isolate at his home in Rehoboth Beach, Del., while continuing to work. The president, who previously tested positive for the coronavirus in 2022, told reporters he was doing well after landing at Dover Air Force Base late Wednesday.
President Biden arrived at Dover Air Force Base, as he headed back home to Rehoboth, Del., after testing positive for covid on July 17. (Video: The Washington Post)
Coronavirus levels in wastewater were considered high or very high in 26 states, the Centers for Disease Control and Prevention reported last week, but the nations approach to the pandemic has evolved significantly over the years meaning it can be difficult to determine how best to stay safe. Heres what to know.
When sick with symptoms of a respiratory virus, such as the coronavirus, the CDC advises individuals to stay home and isolate until both their overall symptoms have improved and they have been fever-free without using fever-reducing medication for 24 hours.
For five days after that, it recommends taking extra precautions such as wearing a mask, improving air circulation, physical distancing and testing. The CDC also recommends taking these precautions if covid is circulating widely in the community.
People who are asymptomatic do not need to stay home but should take those extra precautions, said Demetre Daskalakis, director of the CDCs National Center for Immunization and Respiratory Diseases.
If people do not have a fever, they should still isolate until their overall symptoms have improved for 24 hours, he said.
The stay-at-home guidance gets trickier when there are others in a household.
In that case, Daskalakis advises people with coronavirus to keep their distance from others if possible and to use additional precautions, such as masking or improving air circulation.
The currents coronavirus vaccines were developed with a formula targeting the defunct XBB variants but still offer some protection against the latest variants. An updated vaccine is expected in the late summer or fall.
Staying up to date with coronavirus vaccines significantly lowers the risk of getting very sick, being hospitalized, or dying from covid-19, the CDC says.
The CDC recommends adults 65 and older get a second dose of the current coronavirus vaccine, and everyone ages six months and older get the updated vaccine when it is available.
Experts say patients who have not recently been infected or vaccinated should consult their doctors about the trade-offs of getting an outdated shot for protection amid the summer covid wave or waiting for the new version expected to be available in the coming months.
While doctors are seeing far fewer hospitalizations for covid, older individuals remain at the highest risk and still can get quite ill, Tara Vijayan, an infectious diseases specialist at UCLA Health, wrote in an email, noting that taking antivirals early and getting vaccinated can mitigate that risk.
If an older adult tests positive, Vijayan recommends considering taking Paxlovid, which President Biden took Wednesday, or molnupiravir, which may have similar benefits. Doctors are divided on whether younger, otherwise healthy adults should take Paxlovid.
If people are charged for Paxlovid, which is no longer free, they can apply for support from patient assistance programs to cover out-of-pocket costs, or ask a provider or pharmacist to help.
For older adults looking to protect themselves, Vijayan said it is reasonable to consider masking indoors, especially in crowded or poorly ventilated spaces. She emphasized, however, that close family members are by far the most common source of infection.
Vijayan encourages relatives of older adults to take a test if they have signs of an upper respiratory tract infection and stay away from older family members until they are no longer contagious.
These days, most cases are caused by new KP variants, which are part of a group called FLiRT, and LB.1. They are more effective than their predecessors at infecting people who have some immunity from vaccines or previous infections. The new variants do not seem to cause more severe infections and deaths.
The new vaccines under development target the KP.2 strain, which is similar to the other commonly circulating variants.
Preeti Malani, an infectious-diseases physician at the University of Michigan, told The Washington Post earlier this month that the clinical difference is minor, if any.
TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.
This week's topics include nasal sprays and upper respiratory infections (URIs), nirmatrelvir/ritonavir (Paxlovid) in prevention, endometriosis and ovarian cancer, and diabetes after COVID.
Program notes:
0:53 COVID infection and nirmatrelvir/ritonavir
1:49 Did not reduce infection risk
2:51 Not noticed a difference with variants
3:14 Nasal sprays, behavioral interventions for URI
4:14 Stress management might help
5:14 Reduced antibiotic use
6:14 Stress reduction makes us less susceptible
6:35 Type 1 diabetes and COVID infection
7:32 Attacks pancreas and accelerates progression
8:32 Same thing in adults?
8:42 Endometriosis and ovarian cancer risk
9:44 597 women with ovarian cancer
10:45 If they have same origin it might provide insight
11:45 Arises in the fallopian tubes
12:35 End
Transcript:
Elizabeth: Can nasal sprays reduce the duration of colds?
Rick: Diabetes after COVID infection.
Elizabeth: The relationship between ovarian cancer and endometriosis.
Rick: Can Paxlovid prevent COVID infection for someone who has been exposed?
Elizabeth: That's what we're talking about this week on TTHealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I'm Elizabeth Tracey, a Baltimore-based medical journalist.
Rick: And I'm Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I'm also dean of the Paul L. Foster School of Medicine.
Elizabeth: Rick, it's been a bit since we have talked much at all about COVID. Our habit, of course, during the pandemic was to feature that material first. Now that we are having a pretty significant amount of COVID spreading around the country, why don't we turn to one of your two?
Rick: Yeah, Elizabeth, and I'm actually surprised that the infection rate has gone up, especially during the summer. It's interesting to note that initially if someone had COVID, the rate of a secondary attack among their household contacts was about 10% to 12%. But now with the new variants, it's as much as 60% to 80%.
All right. If we take Paxlovid, nirmatrelvir, and ritonavir -- because we know that that can be effective in high-risk individuals in reducing the severity of infection -- can we prevent infection in people that have been exposed to household contacts? [The study] took about 2,700 participants that did not have COVID at baseline, but they had a post-contact, someone in the household that did develop COVID.
They randomized them to receive either placebo or they received Paxlovid -- a typical dose -- either for 5 days or for 10 days, and what they discovered was statistically those who received Paxlovid did not have a decrease in the incidence of subsequent development of COVID. Those individuals that received placebo, only 3.9% developed COVID. For those that received 5 to 10 days of Paxlovid, the rate was about 2.4%.
You might ask why is the rate so low? Well, 90% of these individuals were already seropositive. They either received vaccines in the past or they had a previous infection. There were some side effects from taking the Paxlovid. They are relatively mild. The major one is dysgeusia -- that means an abnormal taste in your mouth. But the fact that it didn't significantly reduce the rate tempers our enthusiasm for giving it to a large population.
Elizabeth: Nobody wants to take anything that isn't really going to work. Let's mention that this is in the New England Journal of Medicine. Would this also suggest to you that maybe this variant is less susceptible to the machinations of Paxlovid?
Rick: That's certainly a possibility, because we know that the antibodies that we administered with the very early variants haven't been subsequently beneficial with the most recent ones. When we talk about Paxlovid in the treatment of individuals, we have not noticed a difference with variants. I'm not sure that explains it. Again, I think one of the major reasons is, so many people have been exposed or have been vaccinated that their risk of developing COVID after being exposed is relatively low and we can't get any lower with Paxlovid.
Elizabeth: Let's turn from here to The Lancet. This is sort of a corollary and maybe it could help as far as COVID is concerned. In fact, some of their populations did get COVID. It's nasal sprays and behavioral interventions compared with usual care for acute respiratory illness in a big primary care setting. This was in the U.K.
This randomized, controlled, open-label parallel-group trial of 332 general practitioner practices, and they enrolled adults who were older than 18 years of age with at least one comorbidity or risk factor that would increase their risk of adverse outcomes due to respiratory disease.
These folks were randomized 1:1:1:1, and they were either given 1) a gel-based spray of this material called carrageenan. This was 2 sprays per nostril at the first sight of an infection or after potential exposure up to 6 times a day; 2) saline spray, same behavior; or 3) a brief behavioral intervention where they were given access to a website that would promote physical activity and stress management. This is based on previous information from studies that suggested that those might reduce one's severity of upper respiratory infections; then 4) usual care. There were just shy of 12,000 who had complete data.
Compared with the usual care group, who had a mean of 8.2 days of illness, the folks in both the gel-based and the saline group had 6.5 days of illness. I would take that reduction, no problem. Then as far as the behavioral website, 7.4 days, so slightly less. That was kind of protective, rather than treating what was going on. That's their speculation. Then they did say that their most common adverse event was headache or sinus pain in the gel-based group.
The other thing that happened that was really great in this study was that everybody who participated in any intervention used fewer antibiotics. This sounds like this is a pretty quick and easy way to try to reduce symptomatology to make people feel better, and reduce antibiotic use when it comes to URIs.
Rick: Elizabeth, this was a really well-done study where they used a really low cost -- I mean, we're talking about saline -- nasal spray that's easy to administer and effective. If you have upper respiratory tract symptoms -- by the way, almost all of us have a cold every year -- it reduced the duration of the symptoms by 3 days. It reduced antibiotic use by 25% and I think it ought to modify how we treat individuals. It's one of those common reasons people visit their general practitioner, and they won't leave unless they get an antibiotic prescription. We know that contributes to antibiotic resistance. I think this is a really well-done study.
Elizabeth: I will say two other things about it. Their speculation, of course, is that what happens with the stuff in the nose, whether that's the carrageenan-based or the saline-based nasal spray, is that it mechanically removes the virus rather than allowing it to adhere and then do all of its stuff after that. They also note that this advice to use a physical activity and stress management website resulted in a modest reduction in the incidence of disease. Their speculation, of course, is that stress reduction relative to increased physical activity makes us less susceptible. That clearly is something I would like to see followed up and studied in a more robust way.
Rick: Yep. No, there are clear advantages to obviously keep your immune state healthy.
Elizabeth: Let's move on, then, back to COVID, and that's in JAMA.
Rick: We have previously reported that the incidence of type 1 diabetes seemed to increase during the COVID pandemic. Type 1 diabetes is an autoimmune disease. Something has triggered an immune response that attacks the pancreas. It's no longer able to secrete insulin, so we have to administer it. Based upon that information, what these investigators wanted to know is, if we have kids and they have presymptomatic type 1 diabetes, does COVID infection accelerate that where they will develop clinical diabetes over the next 3 to 6 months?
There were 509 kids, the average age was 4 years old, but it included individuals that were 1 to 6 years of age. What they were able to determine was that from February of 2015 to 2020 is that the incidence per 100 person-years of developing type 1 diabetes was about 6.4 for every 100 person-years. For those who developed COVID infection, that rate doubled.
This viral infection with the COVID virus somehow stimulates an immune response that attacks the pancreas and accelerates the progression to type 1 diabetes. When kids get a viral infection and their body attacks that, they also develop antibodies to their own pancreas. The fact that this occurs with COVID shouldn't be terribly surprising, but it's not really been proven in a way until this particular study was done.
Elizabeth: One of the things I have a question about is, what in the world is prediabetes and how do you identify that?
Rick: These were kids that had had blood tests that showed that they had autoantibodies to their pancreas.
Elizabeth: Why would you look for that?
Rick: This particular study was done in Germany. It was part of a screening program, Elizabeth, so we wouldn't typically do that, for example, in the routine clinical setting.
Elizabeth: What would you say are the practical implications of this observation?
Rick: We certainly need to be aware of this so that in kids that develop this or other viral infections, we certainly should be aware that they could develop diabetes. The other question you have to ask, is the same thing true in adults? The other implication is, do vaccines help prevent this? We can use this as a launching pad to see whether vaccines help prevent this and also to identify this condition in adults.
Elizabeth: Remaining in JAMA, let's turn to a study about endometriosis typology and ovarian cancer risk. I think that this whole picture of ovarian cancer has really been changing a whole lot. Most of the folks I talked to are saying that, gosh, in fact, it's not ovarian cancer at all. It's fallopian tube cancer that ultimately migrates its way to the ovaries and that in women who are at risk, or who have risk factors like BRCA1 or 2 mutations, prophylaxis and removing the fallopian tubes might be a good idea.
This study was informative to me in a lot of ways, this notion that endometriosis has a bunch of types and also that ovarian cancer does too. This is using data from the Utah Population Database (UPDB). They matched almost 79,000 women with endometriosis in a 1:5 ratio to women without endometriosis.
Their mean age at first diagnosis of endometriosis was 36 years. They had 597 women who developed ovarian cancer. It was higher in those women with endometriosis compared to those without, almost 4 times higher. Their risk of what is called type 1 ovarian cancer was especially high, 7 times higher.
The ovarian cancer risk is highest in women with two types of endometriosis: what's called deep infiltrating and/or ovarian endometriomas. For all ovarian cancers, we really need to carefully assess types of endometriosis and then subsequently potentially counsel women who have it that their index of suspicion with regard to developing ovarian cancer is also way higher.
Rick: Women that have endometriosis -- and about a third of them may -- it's associated with an increased risk of ovarian cancer. You said type 1 and type 2. The type 1 is generally slow-growing, less likely to spread, and more responsive to estrogen. The type 2 is faster-growing and it doesn't respond to estrogen. If they have the same origin, then the endometriosis may give us some insight into ovarian cancer, either prevention or treatment.
Ultimately, we would like to be able to screen for it. We know that if you just screen the general population, you don't do a very good job of identifying ovarian cancer early enough to treat it. But maybe if we take these high-risk individuals, maybe they are the ones that the cancer screening should be offered to and maybe it will be effective in that circumstance. For those reasons, I think this is a study that requires further follow-up.
Elizabeth: No question about that. I think that there are a couple of things that are noteworthy. This notion that endometriosis, which is often associated with cramping and really painful menses, could be, I'm going to call it, almost a masking against some of the early symptoms of ovarian cancer, which, as we know, are extremely nonspecific. I am wondering if women become accustomed to that feeling during their menstrual cycle if that's something that causes them to not be that tuned in to some changes that might predict ovarian cancer.
Then the other thing is that this idea that it really arises in the fallopian tubes has a lot of traction, and removing the fallopian tubes is fairly benign if you're finished with childbearing, and sounds like it could be something that would be a useful strategy.
Rick: If in fact the ovarian endometriosis is a risk factor for ovarian cancer, then maybe just removing the fallopian tube alone may not prevent that. The ovaries may have to be addressed as well.
Elizabeth: On that note then, that's a look at this week's medical headlines from Texas Tech. I'm Elizabeth Tracey.
Rick: And I'm Rick Lange. Y'all listen up and make healthy choices.
LAS VEGAS (AP) President Joe Biden tested positive for COVID-19 while traveling Wednesday in Las Vegas and is experiencing mild symptoms including general malaise from the infection, the White House said.
Press secretary Karine Jean-Pierre said Biden will fly to his home in Delaware, where he will self-isolate and will continue to carry out all of his duties fully during that time. The news had first been shared by UnidosUS President and CEO Janet Murgua, who told guests at the groups convention in Las Vegas that president had sent his regrets and could not appear because he tested positive for the virus.
Dr. Kevin OConnor, the presidents physician, said in a note that Biden, 81, presented this afternoon with upper respiratory symptoms, to include rhinorhea (runny nose) and non-productive cough, with general malaise. After the positive COVID-19 test, Biden was prescribed the antiviral drug Paxlovid and has taken his first dose, OConnor said.
Biden was slated to speak at the UnidosUS event in Las Vegas Wednesday afternoon as part of an effort to rally Hispanic voters ahead of the November election. Instead, he departed for the airport to fly to Delaware, where he had already been planning to spend a long weekend at his home in Rehoboth Beach.
The presidents diagnosis comes amid intense scrutiny of his health and stamina after a disastrous debate with former President Donald Trump that sparked a flurry of concern among Democrats that Biden is not up to the rigors of winning another presidential term.
Biden gingerly boarded Air Force One and told reporters traveling with him, I feel good. The president was not wearing a mask as he walked onto Air Force One.
The president had previously been at the Original Lindo Michoacan restaurant in Las Vegas, where he was greeting diners and sat for an interview with Univision.
Biden has been vaccinated and is current on his recommended annual booster dose for COVID-19. The vaccines have proven highly effective at limiting serious illness and death from the virus, which killed more than 1 million people in the U.S. since the pandemic began in 2020. Paxlovid has been proven to curtail the chances of serious illness and death from COVID-19 when prescribed in the early days of an infection, but has also been associated with rebound infections, where the virus comes back a few days after clearing up.
Biden last tested positive for COVID-19 twice in the summer of 2022, when he had a primary case and a rebound case of the virus.
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Health officials have reported recent upticks in emergency room visits and hospitalizations from COVID-19. There has also been a pronounced increase in positive test results in much of the country particularly the southwestern U.S.
Associated Press writers Josh Boak, Stephanie Nano and Zeke Miller contributed to this report.
Hawaii is among 21 states with very high levels of the COVID-19 virus in local sewage, according to the latest figures from the Centers for Disease Control and Prevention.
Other western states that show very high levels of COVID-19 include Alaska, California, Oregon, Washington, Idaho, New Mexico, Texas, Utah, and Wyoming.
As of July 17, Hawaiis COVID-19 weekly count was at 937 cases. The 7-day daily average of cases came out to 135 cases.
The CDC says that the national COVID levels in wastewater have been heightened for the second week in a row.
The FliRT subvariant is the most recent strain to hit the country, and the CDC says the latest findings show that it makes up about 80% of the cases nationally.
The Wastewater Viral Activity Levels are categorized into minimal, low, moderate, high or very high as follows:
For more information on COVID-19 and wastewater, click here.
Temperatures arent the only thing on the rise this summer. COVID-19 cases are climbing too, making your risk of getting infected higher than its probably been in a while.
[1]Nationwide, cases are up in at least 42 states. And, in the week ending July 13, emergency room visits for COVID-19 infections increased 16 percent over the week before, the CDC reported.
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All this may have you wondering how concerned you should be about getting COVID this summer, and what to do if you get sick. What symptoms can you expect? Do you need to isolate or wear a mask? Should you take Paxlovid? Read on for the latest expert advice.
For many people, COVID-19 is now producing fewer and less severe symptoms than during the height of the pandemic, says George Rutherford MD, a professor emeritus of epidemiology and biostatistics at the University of California in San Francisco.
However, if youre elderly, have underlying medical conditions, or are unvaccinated, all bets are off, and you can have just as severe disease as earlier on in the pandemic, Dr. Rutherford says.
COVID symptoms can vary from one person to the next, says Emily Hyle, MD, an infectious disease physician at Massachusetts General Hospital and an associate professor at Harvard Medical School in Boston.
A wide range of symptoms can occur when people have COVID-19: mild respiratory symptoms [like runny or stuffy nose, sore throat, coughing, and sneezing], nausea, vomiting, diarrhea, fever, and flu-like symptoms, as well as more severe symptoms including shortness of breath, Dr. Hyle says.
Overall, people tend to have more mild symptoms if they have previously been infected, although this can vary; vaccination is the safest and most effective way to protect against more severe symptoms, she adds.
In a word: yes. If you have COVID-19, it is recommended that you help prevent the spread of COVID-19 to others, especially people who are at increased risk of severe illness such as older people, people with medical problems, and people with immunosuppression, Hyle says.
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After that, people can return to normal activities while still taking some precautions for five additional days to reduce the spread of illness, the CDC advises. These types of precautions can include masking indoors, improving ventilation by opening windows, and testing before interacting with people at high risk for serious illness, Hyle says.
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Paxlovid remains effective as an antiviral for people who become infected with COVID-19 and are at increased risk for severe illness, Hyle says. It does have some drug-drug interactions, so its important to talk with a clinician about the individual risks and benefits.
People who get COVID-19 infections right now typically have symptoms for four or five days, Rutherford says.
But this, too, can vary, Hyle notes. The best way to shorten the duration and severity of symptoms is to seek treatment promptly, Hyle adds.
If you are at increased risk for severe illness with COVID-19, then its recommended to call your doctor as soon as you develop any symptoms or test positive since Paxlovid might be recommended and is most effective when taken soon after symptom onset, Hyle says. Shortness of breath or chest pain should prompt emergency care in anyone.
A lot of the same things you would do at home to manage cold and flu symptoms can also work for COVID-19 symptoms if you get sick this summer with a relatively mild case.
[6]You can also take over-the-counter medicines such as fever reducers, pain relievers, or cough syrup.
If youre isolating at home with COVID-19, Mayo Clinic also offers the following tips to promote physical and mental health:
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The CDC recently okayed reformulated 20242025 COVID vaccines that target the currently circulating variants, recommending everyone age 6 months and up get a shot this fall.
Individuals at high risk of severe disease should get boosters twice a year, waiting at least eight weeks between doses, Hyle says.
Because people are diagnosed with long COVID only when their symptoms from acute infections persist for at least three months, it will take some time to see for sure what the risk of long COVID looks like for people who are getting sick right now.
However, some recent data suggests that the risk of long COVID is going down, Rutherford says.
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Overall, the study found that about 5.3 percent of vaccinated people infected when the delta variant was circulating went on to get long COVID, compared with 3.5 percent of individuals infected later in the pandemic when the omicron variant was circulating.
Among unvaccinated people, long COVID rates dipped from about 10.4 percent to 7.8 percent over the same time frame.
Thats still a substantial number of cases given the number of cases of COVID, Rutherford says.
