Category: Covid-19

Most Americans have already had COVID-19 at least once with infections lasting a few weeks. But roughly 10 percent of patients have never fully recovered.

Ziyad Al-Aly is a global expert in long COVID, a condition that has left 65 million people worldwide reeling with fatigue, cardiovascular problems, shortness of breath, cognitive impairments, and chronic pain even months or years after infection.

At first, Al-Aly didnt believe what the data and patient accounts told him: that COVID-19 could wreak havoc on multiple organ systems long after the acute infection phase.

From all my education, we're not trained to think that viruses, especially respiratory viruses, have these myriad effects in all these organ systems. So I doubted it for the longest time, but the results came back exactly consistent every single time, Al-Aly said on the "Ground Truths" podcast in September. He directs the Clinical Epidemiology Center and is chief of the Research and Development Service at the U.S. Department of Veterans Affairs St. Louis Health Care System.

Al-Aly will explain his latest findings during a public presentation titled Long COVID: The Lasting Legacy of the COVID-19 Pandemic, at 5:30 p.m. Thursday, Jan. 25, at the Fralin Biomedical Research Institute at VTC in Roanoke.

Dr. Al-Aly is a world-class physician-scientist and an emerging thought leader examining the hidden population health consequences of the pandemic, said Michael Friedlander, executive director of the Fralin Biomedical Research Institute (FBRI) and Virginia Techs vice president for health sciences and technology. We are especially excited to hear from him and share ideas as many of our researchers here at the FBRI are carrying out research on some of the key systems that are impacted by COVID-19 including the brain and the heart and vascular systems. Moreover, our molecular diagnostics COVID-19 testing team is very connected to his work. We expect to learn a great deal from his lecture and are honored to host such an eminent thought leader with our community, particularly as we see Centers for Disease Control data on COVID-19 severity indicators trending up yet again.

Over the past three years, Al-Aly has analyzed health data from millions of veterans nationwide. He has published evidence in top-tier journals that the virus leads to an increased risk of diabetes onset, long-term neurological symptoms, dyslipidemia, cardiovascular disorders, and a wide range of gastrointestinal disorders.

Al-Alys pioneering research also involves one of the worlds largest longitudinal studies to evaluate COVID-19s long-term impacts. His team found that even patients with mild infections remained at higher risk of developing post-acute symptoms and health conditions.

But if youve already had a mild infection, whats the harm in getting COVID-19 again? Al-Alys research published in Nature last year demonstrated how reinfection increases risks of death, hospitalization, and disease.

The results are very, very clear that a second infection or reinfection is consequential, Al-Aly said. I think the best interpretation for this is for people to think that two infections are worse than one and three are worse than two.

Before the pandemic, Al-Alys research focused on the impact of various health conditions, including kidney diseases, on a population level. He analyzed veterans health and satellite air quality data from NASA in a series of studies to define a link between air pollution and chronic kidney disease, obesity, interstitial lung disease, and rheumatoid arthritis.

He also has evaluated the efficacy and long-term side effect profile of a variety of commonly prescribed therapeutics, ranging from metformin for diabetes and proton pump inhibitors for acid reflux to newer drugs marketed to treat diabetes and weight loss, such as GLP-1 receptor agonists like Ozempic.

Al-Alys research program is funded by the National Institutes of Health to conduct randomized trials comparing the impacts of these various drug classes on cardiovascular and kidney health.

Most clinical trials for these things track them for 30 days or at the most for a few months. The long-term risk profiles of these medications have not been characterized previously, Al-Aly said.

Raised in Lebanon, Al-Aly completed his medical degree at the American University of Beirut and his residency and fellowship at Saint Louis University. He has authored over 112 peer-reviewed scientific papers, amassing over 108,000 citations. He holds a faculty appointment at the Washington University School of Medicine in St. Louis and is a member of the American Society of Nephrology.

The institutes free public lecture series is made possible by Maury Strauss, a longtime Roanoke businessman and benefactor who recognizes the importance of bringing leading biomedical research scientists to the community.

The public is welcome to attend the lecture, including a 5 p.m. reception with refreshments in the Fralin Biomedical Research Institute at 2 Riverside Circle in Roanoke. Al-Alys talk will be streamed live via Zoom and archived on the institutes website.

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Researcher explores the long and short of COVID-19 in public lecture - Virginia Tech

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Jan. 16, 2024 | LITTLE ROCK Researchers at the University of Arkansas for Medical Sciences (UAMS) found significant declines in WIC participation during and after the COVID-19 pandemic, according to a study published in the American Journal of Public Health.

The researchers led by student-researcher and UAMS College of Medicine student Savannah Busch measured changes in participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) among more than 10 million Medicaid-covered births across the United States between 2016 and 2022. During this time period, researchers found that participation in WIC went from 66.6% to 57.9%.

In addition to significant declines in WIC participation during and after the pandemic, researchers discovered even greater reductions in the programs participation among individuals of minority race/ethnicity.

WIC services have been consistently shown to improve infant outcomes at birth, as well as throughout infancy, while providing other maternal health benefits, said researcher Clare Brown, Ph.D., MPH, an assistant professor in the UAMS Fay W. Boozman College of Public Health. Anything that suggests reduced utilization of WIC for those who may need WIC services is a bad thing, and we found that the COVID-19 pandemic reduced the use of WIC services overall, and there were even larger reductions for individuals of minority races or ethnicities.

According to the U.S. Department of Agricultures Food and Nutrition Services, WIC provides supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age 5 who are found to be at a nutritional risk.

To apply for WIC, women must visit a health professional to determine whether they are at a nutritional risk. The availability of such processes and other eligibility screenings, Brown said, was greatly impacted during the pandemic, as many clinics and agencies had reduced or limited hours and many populations faced new transportation challenges, particularly in areas that more commonly use public transportation. Additionally, for individuals who speak limited or no English, or who work during daytime hours, applying for WIC can be even more challenging, she said.

When we see that the use of WIC declines for a community whos already at increased risk of bad infant and maternal health outcomes, those bad health outcomes might get even worse, Brown said. Many public health programs have strict eligibility requirements. Understanding what those requirements are and finding ways to create flexibilities in those requirements is really important, particularly for reducing health disparities.

For the WIC program, those flexibilities could include increased hours of clinics and agencies that facilitate the WIC application process, providing non-English applications and resources, allowing various proofs of residency, increasing the number of stores that participate in the WIC program, and increasing WIC-eligible food products.

Brown added that Native Hawaiian and other Pacific Islander groups saw one of the greatest relative declines in WIC participation over the studys six-year period. This is a critical finding for mothers in Arkansas a state that was recently ranked worst in the nation for maternal mortality and given the states large population of Marshallese mothers.

The study, Association of the COVID-19 Pandemic With Women, Infants and Children (WIC) Receipt Among Pregnant Individuals: United States, 2016-2022, can be viewed at https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307525. For more information about WIC, visit fns.usda.gov/wic.

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WIC Use Decreased During and After COVID-19 - UAMS News

Study design

The purpose of the study was to examine the antibody response in RA patients vaccinated against COVID-19 and to identify clinical factors affecting the antibody response in a real-world setting. In this study, the type of vaccination and the intervals between vaccinations were heterogeneous among the patients; this is because COVID-19 vaccinations were administered as part of routine clinical practice. The primary analysis involved measurement of antibody titers from RA patients that received the BNT162b2, mRNA-1273, ChAdOx1, or Ad26.COV2.S vaccines. All vaccines were monovalent as no bivalent vaccines were available at the time. A patient was censored if he/she was infected with COVID-19 during follow-up. Antibody response curves were constructed after the 1st, 2nd, 3rd, and 4th vaccinations; these were based on the anti-RBD antibody titers measured after each vaccination. To identify factors that contribute to a peak response, the antibody response for each patient was modeled based on their individual clinical factors.

The study was carried out in accordance with the Declaration of Helsinki, and was approved by the Institutional Review Boards of Seoul National University Hospital (IRB No. 2205-060-1322).

South Korea experienced two major peaks of COVID-19 infection: Feb 2022 and Sep 2022. Two groups of RA patients attending Seoul National University Hospital (SNUH), a nationwide tertiary referral center in South Korea, were enrolled before the COVID-19 peaks occurred. Group 1 comprised RA patients enrolled in an influenza vaccination study between October 6 and November 3, 2021 (IRB No. 2109-020-1252). The original study was a randomized controlled trial to evaluate the vaccination response by comparing a 1-week versus 2-week temporary discontinuation of MTX after influenza vaccination. According to the enrollment criteria, all RA patients in Group 1 had taken stable dose of methotrexate over the preceding 6weeks of influenza vaccination. Serial serum samples were obtained at 0, 4, and 16weeks after the influenza vaccination. Group 2 comprised patients who participated in the SNUH RA cohort study between January 1 and June 3, 2022 (IRB No. 2105-085-1219). The study was a cohort study to monitor disease activity and treatment response. For these patients, sera were obtained once at the start of participation. The samples analyzed in the study were all archived samples, not additional blood draws. Informed consent was obtained from all participants to use their samples for further study at the time of the enrollment.

Among the enrolled patients, only those with an available vaccination history and who were nave to COVID-19 infection were included in data analysis. The exclusion criteria were as follows: (1) self-reported or a Korea Disease Control and Prevention Agency (KDCA) record of COVID-19 infection before sampling; (2) positive for anti-nucleocapsid (anti-N) antibodies; (3) did not receive a COVID-19 vaccination before sampling.

Patient demographics, comorbidities, and concurrent immunosuppressive medications were obtained from electronic medical records. Comorbidities included diabetes mellitus, hypertension, chronic liver disease, chronic kidney disease, and history of tuberculosis. Concomitant medications were defined as those prescribed within 3months of blood sampling. These included glucocorticoids (GCs), methotrexate (MTX), hydroxychloroquine, sulfasalazine (SSZ), leflunomide, tacrolimus, tumor necrosis factor alpha inhibitors (TNFi), tocilizumab, abatacept (ABA), Janus kinase inhibitors (JAKi), and rituximab (RTX).

Since February, 2021 in South Korea, COVID-19 vaccinations have been mandatory in accordance with the national guidelines. The type of vaccine and intervals between vaccinations were decided by the government. The first approved vaccines were BNT162b2, mRNA-1273, ChAdOx1, and Ad26.COV2.S. With the exception of Ad26.COV2.S, all primary vaccinations required a follow-up 2nd dose after 312weeks. Cross-vaccination was allowed. In December 2021, the 3rd dose of vaccine was administered (i.e., an interval of 23months after the previous vaccination). In April 2022, a 4th dose was recommended (i.e., an interval of 4months from the previous vaccination). The vaccination history of each patient was listed by the KDCA. Any PCR-proved COVID-19 infection should be reported to the KDCA through the regional infection center or a local clinic.

Information on the dose, date and the type of COVID-19 vaccination, was obtained from the patients and cross-checked with the data from KDCA. Previous COVID-19 infection was reported by the patients, and confirmed by an infection certificate from KDCA and a positive anti-nucleocapsid (anti-N) antibody test. When the patient tested positive in the self-antigen test but did not undergo a formal diagnostic test for any reason, the patient was considered as a positive infection case and excluded.

The titer of IgG antibodies specific for the SARS-CoV-2 receptor binding domain of spike 1 protein (anti-RBD) was measured in stored serum samples using a chemiluminescence microparticle immunoassay (Abbott, USA). The anti-RBD ranged from 21 to 40,000AU/mL. A value<21 or>40,000AU/mL was documented as 20 or 44,000AU/mL, respectively. Anti-RBD antibodies represent the humoral response to COVID-19 vaccination10.

In addition, the titer of anti-N antibodies was measured using an electrochemiluminescence immunoassay (Roche, Germany). Anti-N antibody titers above the cut-off value of 1.00AU/mL denoted a previous natural COVID-19 infection11.

Since the two studies (influenza vaccination study and SNUH RA cohort study) used in this model were not specifically designed for modeling of antibody response to COVID-19 vaccination, vaccination and sampling schedules were heterogenous among individuals. Therefore, we performed several sensitivity analyses to reconfirm our results.

First, we estimated the change of the log anti-RBD titer over time for the subjects who received the same type of vaccination. Second, the group 1 (influenza vaccination study) and group 2 (SNUH RA cohort study) were separately analyzed to investigate the clinical factors affecting anti-RBD titer and to reveal time-course of anti-RBD antibodies following vaccination.

The characteristics of the subjects were expressed as mean (standard deviation) for continuous variables and numbers (percentage) for categorical variables. The anti-RBD titer was log-transformed to improve normality. The second-degree fractional polynomials which covers wide range of curve shapes were applied since the pattern of change in the log anti-RBD titer over time is unknown and may not be linear12. The change of the log anti-RBD titer over time was determined in the fractional polynomial regression while adjusting the vaccination dose. Robustness of the curve was confirmed with adjustment of clinical factors affecting log anti-RBD titer: age, ABA use JAKi use, SSZ use, and the vaccination dose. Then clinical variables related to humoral responses to COVID-19 vaccination were determined. A regression model using a generalized estimating equation was applied to account for the correlation among anti-RBD titers among the subjects. Since only 22% subjects (120 out of 550) have two or three antibody responses, we chose the population average model, instead of a subject specific estimate. The exchangeable variance structure was applied because the interval between repeated measurements were various from subject to subject, and only 20% of the subjects had three anti-RBD titer. However, the mixed effect model was used to estimate the change of the log anti-RBD for Group1 subjects (from whom serial samples were obtained). The time and vaccination dose were fixed effects and the subject was a random effect. The linear assumption of continuous variables was checked using scatter plot and locally weighted scatterplot smoothing with clinical knowledge of relationship with log anti-RBD titer. The significant variables at 0.1 significance levels in the univariable analysis were considered for the multivariable model. The forward variable selection method was used to detect significant clinical variables affecting the log anti-RBD titer. The all two-way interaction terms were tested in the multivariable model one by one at 0.01 level of significance. The goodness of fit for the multivariable model was measured using R-square.

Statistical analysis was performed using R (version 4.3.1; R Foundation for Statistical Computing) and SAS software (version 9.4; SAS Institute).

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Modeling of antibody responses to COVID-19 vaccination in patients with rheumatoid arthritis | Scientific Reports - Nature.com

02:04 (IST), Jan 15

Pakistan: 3 passengers test positive for JN.1 Covid-19 variant at Karachi airport

Three travellers who landed at Jinnah International Airport in Karachi tested positive for JN.1 sub-variant of coronavirus, ARY News reported on Sunday. The antigen tests that were performed at Jinnah International Airport on three individuals yielded positive results, according to the Sindh Health Department.

Here is the original post:

Covid cases in India live updates: India records 375 fresh new covid cases; 2 deaths in 24 hours - Times of India

Jan 11

Please try again

A whole host of winter respiratory viruses is circulating in the first weeks of 2024 which means you probably know several people who are sick right now. And for a fourth January running, we still have to worry about COVID-19.

At this stage in the pandemic, worrying that your sore throat, cough or congestion might, in fact, be COVID-19 is a natural thought, especially as the Bay Area is experiencing another wave of infections fueled by the new JN.1 strain.

But while testing negative on an at-home antigen test can bring some relief, unfortunately, you may no longer be able to trust that initial result in the way you could earlier in the pandemic.

Keep reading for what you need to know about COVID-19 incubation periods in 2024, why an early negative test could be a false result, and what to do if youre caught in a Wait, so do I have COVID or not? testing limbo.

Some medical experts say theyve noticed that at this stage of the pandemic, its often taking much longer for people to get a positive test result on an at-home COVID-19 antigen test. In other words, theyre observing that people with COVID-19 symptoms are taking an antigen test and getting a negative result only to get a positive result on a different test several days later.

This means that many people could wrongly assume they dont have COVID-19 after that first negative test and then inadvertently spread the virus to friends and family.

Dr. Peter Chin-Hong, an infectious disease expert at UCSF, said he and his colleagues are now seeing people take longer to get a positive test even though they have COVID-19 symptoms. Dr. Elizabeth Hudson, regional chief of infectious diseases at Kaiser Permanente Southern California, told the Los Angeles Times that shes also noticed this delay and that a patient might not get a positive test result up until the fourth day after the start of their symptoms.

But theres a confusing additional aspect to this too: Paradoxically, said Chin-Hong, incubation times for the virus have gotten shorter throughout the pandemic. This means people have tested positive for COVID-19 more quickly than in 2020, when the average incubation period was five days because the incubation period has changed with each new variant. Chin-Hongs advice in the last year has been that if youre having COVID-19 symptoms, it now makes sense to take a test as early as two days after exposure.

So how do shorter incubation times square with this newly observed delay on positive COVID-19 tests?

Right now, experts arent 100% sure why antigen tests are taking longer to return a positive COVID-19 result. But Chin-Hong said that the hypothesis that makes sense to him is less about the efficacy of the antigen tests themselves and way more about how much quicker someone with COVID-19 might develop symptoms in 2024 than they would have done in 2020.

As a reminder, those symptoms are the sign that your bodys immune system is mounting a response to an invading virus and back at the start of the pandemic, by the time you developed COVID-19 symptoms and took a test it would probably already be positive, Chin-Hong said.

But at this stage of the pandemic, most of us now have a lot of immune experience with COVID-19, Chin-Hong said and the average persons immune system is increasingly on guard and activated more than in 2020, he said. So when your body detects a burgeoning coronavirus infection now, your whole immune system just gets agitated and active, and you begin to get sick sooner, but you actually dont have as much virus in your blood yet, Chin-Hong said.

Dr. Abraar Karan, an infectious disease physician and researcher at Stanford University, also put it this way for NPR: With our immune systems primed, the bodys response [now] comes much more quickly than it would have back in 2020 when SARS-CoV-2 was a novel pathogen.

And because many of us take a COVID-19 test when we start to feel sick, we might be testing way too early at that time for an at-home antigen kit to successfully detect enough virus inside us. This mismatch between when your symptoms start and when youve enough virus present in your body to result in a positive COVID-19 test was started to be observed in early omicron, but I think it just seems more accentuated now, Chin-Hong said.

However, Hudson of Kaiser Permanente Southern California told the L.A. Times that for her, this delay in positive tests might be attributable to peoples accumulated immunity from COVID-19over the years either from getting infected or getting vaccinated.

Its actually pushing back the time that peoples COVID tests are coming up positive, Hudson said.

The bottom line is: If youre testing because youve started feeling unwell, its unwise to assume in 2024 that a negative result automatically means you dont have COVID-19, because you might just be testing too early.

Experiencing the onset of symptoms that feel like COVID-19 is unpleasant and worrying enough. And now, this new possible delay around even knowing if you have COVID-19 adds another element of frustration and uncertainty to whats already a stressful situation. Even if youve been able to find free COVID-19 tests being given away or by order from the U.S. government via USPS, one COVID-19 scare in a family can run through that stockpile pretty fast and the cost of purchasing new COVID-19 antigen kits can really add up.

If youre in the limbo of not knowing whether you actually have COVID-19 yet, heres what to do:

If your first test is negative for COVID-19, test again later

If you have symptoms but have tested negative, dont assume it means youre COVID-free. The CDC recommends that you take another antigen test 48 hours laterand then test again after another 48 hours.

Chin-Hong advises that you can also seek out a PCR test, which is more sensitive.

While youre unsure, play it safe

If you have symptoms and dont know why yet for sure, stay home as much as you can. If you truly cant stay indoors and away from others, wear a well-fitted mask to protect your community and try to ensure youre in well-ventilated spaces.

Be especially careful not to spread any virus around folks who are at higher risk for serious illness or hospitalization from COVID-19, which includes older people, immunocompromised and disabled people.

Remember: Just because its not COVID-19 doesnt mean youre not still sick

Even if you turn out not to have COVID-19 after several days of testing but youre still experiencing symptoms, you might still be infected with one of the other highly infectious winter respiratory viruses out there like flu, RSV or a bad cold. And if youre sick, you could easily infect your friends, family or colleagues with whatever youre suffering from.

Give yourself permission not to trust a friends negative test, too

What if its a friend whos experiencing COVID-19 symptoms, and theyre insisting that theyre safe to meet with you because they took a test and its negative?

Knowing what you know that it can sometimes take folks longer to get a positive COVID-19 test in 2024 you should feel free to compassionately tell your friend that while you trust them, you cant trust an early negative test right now. Theres a good chance that they have no idea that positive tests can be increasingly delayed and will be relieved to know that by staying home, they havent accidentally spread an infectious disease to you or other loved ones.

And if they disagree and insist theyre still safe to meet up? You should feel free to decline, even if it feels awkward. Remember, its not weird to not want to get COVID-19.

Stock up on free COVID-19 tests

Finding a quick, free COVID-19 test whether an at-home antigen test or a PCR test has gotten progressively harder at this stage of the pandemic as more sites and services have shuttered. The federal government has, at least, restarted its free at-home COVID-test-ordering service through USPS, meaning you can once again order another four free antigen tests to be delivered to your door for a future time.

Read more about where to find free or low-cost COVID-19 tests this winter.

but make sure your COVID-19 tests havent expired

Many of the COVID-19 tests being made available right now (for example, at your local public library) may be approaching their expiration date if they havent already passed it. And an expired test could give you an unreliable result.

You can check the FDAs list of antigen test types to see whether the box youre holding has had its shelf life extended by the manufacturer. The FDA said that if a tests shelf life has been extended, its because the manufacturer has given the agency enough data showing that the shelf-life is longer than was known when the test was first authorized. (In other words, its still OK to use that test.)

At KQED News, we know that it can sometimes be hard to track down the answers to navigate life in the Bay Area. Weve published clear, practical explainers and guides about COVID-19, how to cope with intense winter weather, and how to exercise your right to protest safely.

So tell us: What do you need to know more about? Tell us, and you could see your question answered online or on social media. What you submit will make our reporting stronger and help us decide what to cover here on our site and on KQED Public Radio, too.

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Why Your Negative COVID Test Might Be Less Reliable in 2024 - KQED

You probably know a lot of sick people right now. Most parts of the U.S. are getting pummeled by respiratory illness, with 7% of all outpatient health care visits recorded during the week ending Dec. 30 related to these sicknesses, according to the U.S. Centers for Disease Control and Prevention (CDC).

Many people are sick with flu, while others have RSV or other routine winter viruses. But COVID-19 is also tearing through the population, thanks largely to the highly contagious JN.1 variant. Just like every year since 2021, this one is starting with a COVID-19 surgeand Americans are getting a good glimpse of what their new normal may look like, says Katelyn Jetelina, the epidemiologist who writes the Your Local Epidemiologist newsletter.

Unfortunately, she says, signs are pointing to this [being] the level of disruption and disease were going to be faced with in years to come.

The CDC no longer tracks COVID-19 case counts, which makes it harder than it once was to say exactly how widely the virus is spreading. Monitoring the amount of virus detected in wastewater, while not a perfect proxy for case counts, is probably the best real-time signal currently availableand right now, that signal is a screaming red siren. According to some analyses, wastewater data suggest the current surge is second in size only to the monstrous first wave of Omicron, which peaked in early 2022. By some estimates, more than a million people in the U.S. may be newly infected every single day at the peak of this wave.

Wastewater isnt the only sign that things are bad. Almost 35,000 people in the U.S. were hospitalized with COVID-19 during the week ending Dec. 30far fewer than were admitted at the height of the first Omicron wave, but a 20% increase over the prior week in 2023. Deaths tend to lag a few weeks behind hospitalizations, but already, about 1,000 people in the U.S. are dying each week from COVID-19.

Yet even as the trends veer in the wrong direction, people are still working in offices, going to school, eating in restaurants, and sitting shoulder-to-shoulder in movie theaters, largely unmasked. It can be hard to know how to feel about that reality. Viewed through a 2020 lens, many people would consider it catastrophically concerning that people are living normally even as COVID-19 sickens the equivalent of an entire citys population every single day. But is it as worrisome in 2024, when the pandemic is over on paper, if not in practice?

Not according to Dr. Ashish Jha, dean of the Brown University School of Public Health and the Biden Administrations former COVID-19 response coordinator. Almost all of the U.S. population has some immunity from previous infections or vaccinations; treatments like the antiviral Paxlovid are available for people at risk of severe disease; and most people know the basics of masking, testing, and other mitigation measures. All of these factors, Jha says, mean COVID-19 is becoming less of a threat over time. Some groups of people, including the elderly and immunocompromised, are still at greater risk than others, and Long COVIDthe name for potentially debilitating chronic symptoms that sometimes follow a case of COVID-19remains a possibility for everyone. But Jha maintains that vaccines and treatments should make everyone feel safer.

The straight facts are: COVID is not gone, its not irrelevant, but its not the risk it was four years ago, or even two years ago, Jha says. Its totally reasonable for people to go back to living their lives.

The big challenge now, says Dr. Robert Wachter, chair of medicine at the University of California, San Francisco, is wrapping our heads around that change. Weve got to somehow reprogram our minds to think about this as a threat that is just not as profound as it was for a couple years, Wachter says. When your minds have been pickled in terror for a couple of years, its very hard to do."

In the earlier days of the pandemic, Wachter closely watched the COVID-19 data and used exact numbers and percentages to decide what he felt comfortable doing. Now, with fewer of those precise numbers and more disease-fighting tools available, he goes by trends.

During COVID-19 lulls, Im living my life about as normally as I did in 2019, Wachter says. Once indicators like COVID-19 hospitalizations and wastewater surveillance data start to suggest the virus is on the upswing, he wears a KN95 mask in crowded places like airports and theaters, where theres little downside to masking. And in a full-blown surge, like now, Wachter masks almost everywhere and avoids some places he cant, such as restaurants.

Those decisions feel right to Wachter, based on his personal risk tolerance and vulnerability to severe disease. Hes up-to-date on vaccines, which slashes his chances of being hospitalized or dying if he gets infectedbut, at 66, those outcomes are still likelier for him than for his 30-year-old children. Other people might make different choices, Wachter says. And there are going to be people who say, This is a lot of mental energy...screw it.

With hard numbers scarcer than they once were and lots of people no longer willing or able to make detailed risk assessments, Jetelina instead recommends letting your objectives shape your behavior. Want to avoid infecting your grandmother before a visit? Maybe skip having dinner in a crowded restaurant a few days before and test before you go to her house. Want to minimize your risk of getting very sick if you do get infected? Stay up-to-date on boostersas far too few people do, says Dr. Peter Hotez, co-director of the Texas Childrens Hospital Center for Vaccine Development.

The biggest failing right now in our response to COVID, Hotez says, is that only about 20% of U.S. adults got the latest vaccine, which was updated to target newer viral variants. That should be the number-one priority, he says, since vaccination is the best way to prevent complications like hospitalization, death, and, to some degree, Long COVID.

Even with boosters, Jetelina says Long COVID is a hard risk to plan around. The only tried-and-true way to avoid it is to avoid infection entirely; staying up-to-date on vaccines reduces the risk by up to 70%, according to recent research, but people can and do develop it even if theyre healthy, fully vaccinated, and have had previous infections without incident. With variants as contagious as JN.1 running rampant, doing almost anything in public opens up the possibility of getting sick.

But there are plenty of choices between ignoring the virus entirely and completely locking down at home, says Hannah Davis, one of the leaders of the Patient-Led Research Collaborative for Long COVID. She recommends wearing good-quality masks in public, socializing outside or using open windows and air filters to improve ventilation inside, asking people to test before gatherings, and avoiding especially crowded places during surges. I wish more of those were normalized, because they do at least decrease the chance of getting infected and causing long-term harm and disability to yourself or other people, she says.

But, Davis says, all responsibility shouldnt fall on individuals. She says its a huge injustice that the government hasnt done more to warn the public that people can still get Long COVID, and that reinfections can lead to serious health issues. She also feels the data support policy measures like ventilation requirements for public places and mask mandates on public transportation.

Some mask mandates in health care facilities and nursing homes have been reinstated during this surge. But Jha says widespread mandates are unlikely to come backand in his view, they shouldnt. There was a role for mandates in the early days of the pandemicwhen we had no other tools, no way of protecting people, he says. Mandates four years in, when we have plenty of tests, plenty of vaccines, plenty of treatments, plenty of masks, are not as crucial, he says.

Jetelina says she wouldnt be surprised if 2024 brings a further relaxation of COVID-19 guidance rather than increased mitigation measures. She speculates that the CDC may change its isolation guidelines, for example.

The threat [of COVID-19] will get baked into the other threats people have in their background that arent front of mind, Wachter predicts, similar to the ever-present risk of getting sick with other illnesses or getting into a car accident. And, as long as the virus doesnt shape-shift its way into laughing at our immune status, he says thats not such a bad thing. People will continue to reach different conclusions about the level of risk-taking they can stomach and behave accordingly, just as they do in other areas of life.

Its natural for guidance and behavior to change once a public-health menace begins to transition from emergency to endemic, Jha says. But that doesnt mean we should turn a blind eye toward COVID-19 or the numerous other pathogens swirling around.

"For a lot of people it's been about, 'How do we go back to 2019, to life before the pandemic?'" he says. But, in his view, that's not the right goal: "We actually want to look forward."

Jha says hes hopeful that lessons learned during the COVID-19 pandemic will spark a reimagining of how we deal with respiratory diseases in general. Such an approach wouldnt necessarily single out COVID-19, as much of the public-health messaging has done since 2020. Instead, Jha says, it could standardize and broaden guidance around all infectious diseases, hammering home the importance of things like vaccines, masks, ventilation, and sick-leave policies that allow people to stay home when they have any diseasenot just the one that has dominated our collective consciousness for the past four years.

Original post:

We're In a Major COVID-19 Surge. It's Our New Normal | TIME - TIME

Respiratory virus activity continues to remain elevated across the United States but there may be some signs that a peak has been reached for at least one virus, newly updated federal data shows.

As of Friday, "high" or "very high" levels of respiratory illness activity -- defined as people visiting a health care provider with symptoms including cough and fever -- were seen in 35 states in addition to New York City and the District of Columbia, according to the Centers for Disease Control and Prevention, down from 38 earlier this week.

Emergency department visits with diagnosed influenza, COVID-19 and RSV remain high, but all three conditions saw a decrease over the last week. The CDC, however, said this is may due to "holiday-related healthcare seeking behavior and will be monitored."

For the week ending Jan. 6, weekly COVID hospitalizations rose to 35,801. This marks the ninth straight week of increases, but remains lower than hospitalizations recorded at the same time last year.

Nearly 40% of all counties in the U.S. are in the medium category for hospital admission levels, meaning hospitals are seeing 10.0 to 19.9 new admissions for COVID-19 per 100,000 people in the past week.

Those aged 65 and older have the highest rate of weekly COVID hospitalizations by age group followed by those between ages 50 and 64, according to the CDC.

The rise of COVID-19 hospitalizations may be partly due to the spread of the JN.1 variant, which makes up an estimated 61.6% of cases in the U.S. as of Jan. 6.

JN.1 has mutations that may make it either more transmissible or more likely to evade the immune system, the CDC says, but there is no evidence that it causes different symptoms or more severe cases.

Nationally, COVID-19 wastewater viral activity levels are very high, typically an early sign of an increase in cases. There are indications, however, that wastewater activity levels may be slowing in the Midwest and Northeast, the CDC says.

Although influenza activity remains high and key indicators have been increasing for several weeks, the number of weekly new hospital admissions slightly decreased to 18,506, according to CDC data.

"CDC will continue to monitor for a second period of increased influenza activity that often occurs after the winter holidays," the federal health agency wrote on its website.

The CDC estimates that there have been at least 14 million illnesses, 150,000 hospitalizations and 9,400 deaths from flu so far this season. Adults over 65 have the highest rates of flu hospitalizations.

Meanwhile RSV hospitalizations appear to be remaining stable, with a very slight increase in the weekly hospitalization rate from 3.6 per 100,000 the week ending Dec. 16 to 3.7 per 100,000 for the week ending Dec. 23, the last week of complete CDC data.

Unlike with COVID and flu, RSV hospitalizations are highest among children aged 4 and younger followed by adults aged 65 and older.

Vaccines are available for COVID, flu and RSV, but the CDC says "the percent of the population reporting receipt of COVID-19, influenza, and RSV vaccines remains low for adults."

As of Friday, just 21.4% of adults aged 18 and older and have received the updated COVID vaccine, CDC data shows. Additionally, 46.8% of adults have received the flu vaccine. Meanwhile, just 20.1% of adults aged 60 and older have received the RSV vaccine, which was rolled out for the first time this season.

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COVID hospitalizations increase for 9th straight week: CDC - ABC News

Parents often bask in the glow of their childrens accomplishments, so if SARS-CoV-2 variants were like people, BA.2.86 would be busting its buttons right about now.

BA.2.86s spawn, JN.1, has become the dominant SARS-CoV-2 variant in the US, status its parent variant never achieved. Fortunately, although COVID-19 cases have surged, hospitalizations and deaths from the disease are still considerably lower than they were the same time a year earlier.

When BA.2.86 joined the SARS-CoV-2 Omicron family last summer, it grabbed pandemic trackers attention because it was so different from its progenitor, BA.2. Compared with BA.2, BA.2.86s spike protein carries more than 30 mutations, suggesting that it might spread more easily than its predecessors.

But even armed with those new mutations, BA.2.86 failed to dominate the other subvariants. Through early January of this year, BA.2.86 never exceeded much more than a 3% share of circulating SARS-CoV-2 subvariants in the US, according to Nowcast estimates from the US Centers for Disease Control and Prevention (CDC).

Globally, BA.2.86 represented 8.9% of available SARS-CoV-2 sequences by the first week of November 2023, according to the World Health Organization (WHO), which classified BA.2.86, including its sublineages, as a variant of interest on November 20. (In a January 4 opinion piece, Eric Topol, MD, professor of molecular medicine at Scripps Research Institute, argued that BA.2.86 was so different from previous Omicron subvariants that the WHO should have designated it as a variant of concern and christened it with a different Greek letter.)

Four weeks after labeling the entire burgeoning BA.2.86 family as a variant of interest, the WHO classified JN.1 alone as one, too, due to its rapidly increasing spread. By early January, JN.1s share of circulating variants in the US had soared to an estimated 61.6%, up from 38.8% just 2 weeks prior, according to the CDCs Nowcast estimate.

What a Difference a Mutation Makes

JN.1s spike protein has just 1 more mutation than BA.2.86s spike.

That mutation, called L455S, enhances the virus ability to bind to the angiotensin-converting enzyme 2 (ACE2) receptor, SARS-CoV-2s doorway into cells, Nicole Doria-Rose, PhD, chief of the Humoral Immunology Core at the National Institute of Allergy and Infectious Diseases Vaccine Research Center, noted in an interview with JAMA.

BA.2.86 didnt take off until it picked up this 1 mutation that made it JN.1, she said.

JN.1 appears to be highly contagious, perhaps more than any other member of the Omicron family, Vanderbilt University School of Medicine infectious disease and health policy professor William Schaffner, MD, said in an interview. Thats maybe why its outrunning them now.

As JN.1 gained traction, indicators of SARS-CoV-2 infection levels rose. In a January 5 report, the CDC estimated that compared with the same time last year, viral activity levels in wastewater were 27% higher and the percentage of positive COVID-19 tests was 17% higher.

The news wasnt all bad, though. Despite apparently higher infection levels, indicators of COVID-19 illness requiring medical attention were lower than a year earlier, the CDC said. For example, emergency department visits for COVID-19 were down 21%. And the percentage of all US deaths that were attributed to COVID-19 was 3.6% (839 deaths) for the week ending December 30, 2023, compared with 5.2% (3658 deaths) for the week ending December 31, 2022, according to provisional CDC data.

I think JN.1 clearly is driving transmission, epidemiologist Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told JAMA. Fortunately, theres no evidence its producing more severe illness.

Given the high JN.1 infection rates, people with respiratory symptoms should assume they have COVID-19, even though they might test negative for the first few days, Osterholm said. If you have any symptoms at all of respiratory illness, dont go to a public or private event, especially indoors.

Higher rates of COVID-19 and other respiratory infections have spurred hospitals in a handful of states to reinstitute mask mandates, according to news reports, at least for staff who directly interact with patients in their rooms or other clinical care areas. For example, Mass General Brigham implemented the policy on January 2 and will adhere to it until infection levels drop later in the winter or in the spring.

Latest Vaccine Is Good Enough

COVID-19 vaccine components must be determined at least a few months in advance to allow time for manufacturing and distribution, so its not surprising they dont exactly match currently circulating variants.

The most recent COVID-19 vaccine targets XBB.1.5, an Omicron subvariant whose prevalence in the US had already shrunk to less than 3% by the time people began getting the new shots last September. In the 2-week period ending January 6, XBB.1.5which emerged from a different branch of the Omicron family tree from BA.2.86 and JN.1appeared to be out of circulation in the US, according to the CDC Nowcast.

Fortunately, laboratory research and rates of COVID-19 hospitalizations and deaths suggest that the XBB.1.5 vaccine still protects against severe illness in the JN.1 era.

Our lab and others have shown thatJN.1 is about 3 to 5 times less susceptible to neutralizing antibodies than the XBB.1.5 variant that is in the updated booster, virologist David Montefiori, PhD, director of the Laboratory for HIV and COVID-19 Vaccine Research & Development at Duke University Medical Center, explained in an email. Most scientists are not very concerned about this reduced susceptibility because the titers of neutralizing antibodies remain in a range that is thought to be effective.

BA.2.86 and JN.1 carry more than 30 mutations in their spike proteins compared with XBB, noted a research letter published January 3 by University of Tokyo virologist Kei Sato, PhD, and colleagues, who concluded that JN.1 appears to be one of the most immune-evading SARS-CoV-2 variants to date. For example, the authors wrote, JN.1 shows robust resistance to monovalent XBB.1.5 vaccine sera compared with BA.2.86.

However, despite JN.1s rapid spread and dissimilarity from XBB.1.5, no one is calling for COVID-19 vaccines to be updated to target the new variant.

Given the current SARS-CoV-2 evolution and the breadth in immune responses demonstrated by monovalent XBB.1.5 vaccines against circulating variants, the WHO Technical Advisory Group on COVID-19 Vaccine Composition recommended keeping the current vaccine composition in December.

Although the latest COVID-19 vaccine might not consistently prevent infections caused by JN.1 or other circulating Omicron subvariants, it still can decrease disease severity in those who do get sick, Sato wrote in an email to JAMA.

The purpose of vaccination is to decrease the severity of diseases, Sato emphasized. Many people think that the purpose of vaccination is to prevent infection, but this is wrong.

However, vaccines are effective only if people get them. As was seen with the bivalent vaccine that preceded it, uptake of the latest COVID-19 vaccine has been low. Although everyone 6 months of age or older was eligible for the bivalent vaccine, available starting in September 2022, only 17% of the US population had received it as of May 10, 2023, according to the CDC. (The federal COVID-19 Public Health Emergency declaration ended May 11, as did the CDCs routine updating of vaccination statistics.)

About 29% of US adults said theyd received the latest COVID-19 vaccine, compared with 47% who said theyd received this seasons flu vaccine, according to a Gallup survey conducted the first week of December.

The people were seeing hospitalized today are generally people in the high-risk categories who have not taken advantage of the updated vaccine, Schaffner said.

Inevitably, JN.1 will peakif it hasnt alreadyas newer, cleverer SARS-CoV-2 variants replace it.

In the next few months, many people will get infected with JN.1, Sato explained in his early January email. As they acquire anti-JN.1 immunity, he said, SARS-CoV-2 will evolve to evade it.

At this point, most of the planet has been vaccinated or infected or both, Doria-Rose noted. The virus is under pressure to keep mutating so it can evade immunity and infect better. As a result, she said, this fall will surely bring another updated COVID-19 vaccine.

If this werent so horrible, it would be absolutely fascinating, Doria-Rose said of SARS-CoV-2. This is an animal virus that keeps evolving to adapt to its new host, which is people.

Published Online: January 12, 2024. doi:10.1001/jama.2023.27841

Conflict of Interest Disclosures: Dr Montefiori reported that his laboratory receives funding from Moderna to measure neutralizing antibody responses in their clinical studies; he is not a paid consultant to Moderna or any other entity. Dr Sato reported receiving consulting fees from Moderna Japan Co, Ltd, and Takeda Pharmaceutical Co Ltd, and honoraria for lectures from Gilead Sciences, Inc, Moderna Japan Co, Ltd, and Shionogi & Co, Ltd. No other disclosures were reported.

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What to Know About JN.1, the Latest SARS-CoV-2 Variant of Interest - JAMA Network

World Health Organization director-general Tedros Adhanom Ghebreyesus is pointing to holiday gatherings and a rapidly spreading variant as reasons behind a rise in COVID-19 hospitalizations and deaths worldwide, with nearly 10,000 COVID deaths reported last month.

"Although 10,000 deaths a month is far less than the peak of the pandemic, this level of preventable deaths is not acceptable," the head of the U.N. health agency told reportersWednesday from its headquarters in Geneva.

WHO says the JN.1 variantis now the most prominent in the world. In the U.S., the Centers for Disease Control and Prevention estimated late last month that the variant makes up about 44.1% of COVID cases across the country.

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"We are in January, and it's winter respiratory virus season COVID, along with influenza and RSV, is on the rise throughout much of the country today," Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center, told CBS News Thursday.

"Apropos of COVID, we're seeing an awful lot of mild infections that is, they don't require hospitalizations, but you can feel miserable for three to four days that are being caused by this JN.1 variant. However, it's not causing more severe disease."

You can think of the JN.1 variant as "a grandchild of the original Omicron strain," Schaffner said.

"These viruses like to mutate, and its distinctive characteristic is that it is contagious so it's spreading very, very widely. And as such, it's finding people who are more susceptible, including those people who have not yet taken advantage of the current vaccine," he explained.

He added the vaccine is still providing protection.

"The currently available updated vaccine still provides protection against hospitalization, but with so much widespread illness, it's going to find older people, people who are immune compromised, people who have underlying chronic medical conditions those are the folks we're seeing who currently are requiring hospitalizations," Schaffner said.

Public health experts continue to recommend getting the latest vaccination, in addition to consideringwearing masksin certain situations and making sure indoor areas are well ventilated.

"The vaccines may not stop you being infected, but the vaccines are certainly reducing significantly your chance of being hospitalized or dying," said Dr. Michael Ryan, head of emergencies at WHO.

-The Associated Press and Alexander Tin contributed reporting.

Sara Moniuszko is a health and lifestyle reporter at CBSNews.com. Previously, she wrote for USA Today, where she was selected to help launch the newspaper's wellness vertical. She now covers breaking and trending news for CBS News' HealthWatch.

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Nearly 10,000 COVID deaths reported last month as JN.1 variant spread at holiday gatherings, WHO says - CBS News

Coronavirus levels are high and rising throughout California amid a post-holiday spike in infections.

The uptick, documented through wastewater surveillance, is coinciding with a sharp rise in flu activity a one-two punch for whats proving to be a busy respiratory virus season.

We are certainly in some high levels of viral transmission. Flu is one of the bigger drivers of that right now, state epidemiologist Dr. Erica Pan said in a recent briefing. We are seeing some increases in COVID-19 activity, especially often after the travel and gatherings of the holiday season.

Around Christmas, flu was responsible for 4% of weekly emergency room visits statewide, up from about 1% a month earlier. COVID-19 was responsible for about 2%, up from about 1%.

For the week that ended Dec. 30 in Los Angeles County, the wastewater concentration of SARS-CoV-2 the virus that causes COVID-19 reached 60% of last winters peak, up from the prior weeks reading of 49%.

Statewide, the rates at which tests for COVID-19 and flu are coming back positive continue to rise. California continues to show very high flu-like activity, which includes non-flu illnesses such as COVID-19, according to the U.S. Centers for Disease Control and Prevention.

While COVID-19 is no longer exerting the dangerous and devastating pressure seen earlier in the pandemic, it has not been defanged. Officials from the World Health Organization noted that 10,000 deaths were reported globally from COVID-19 in December, based on data from fewer than 50 countries, mostly in the Americas and Europe.

Although 10,000 deaths a month is far less than the peak of the pandemic, this level of preventable death is not acceptable, Tedros Adhanom Ghebreyesus, director-general of the WHO, said at a recent briefing. We continue to call on individuals to be vaccinated, to test, to wear masks where needed and to ensure crowded indoor spaces are well ventilated.

The CDC reported more than 6,000 COVID-19 deaths nationally in December, a toll that is expected to rise.

Health officials noted that many deaths could have been avoided with higher rates of vaccination.

The vaccines may not stop you being infected, but the vaccines are certainly reducing significantly your chance of being hospitalized or dying, Dr. Michael Ryan, executive director of the WHOs health emergencies program, said at the briefing. And it really means that those people in vulnerable age groups with underlying conditions ... taking the opportunity to be vaccinated against SARS-CoV-2 and against influenza is the best investment you can make.

Uptake in COVID and flu vaccinations has been lackluster. Statewide, 31% of residents age 65 and older have received the updated COVID-19 vaccination since September, Pan said.

At nursing homes in California that report such data, 33% of residents and 10% of staff have received the updated COVID-19 vaccines well below typical uptake of the flu shot, which is about 50%.

This is where we see outbreaks. This is where we have the most deaths and, certainly, the most hospitalizations, Pan said.

California is doing worse than other states in terms of getting residents of nursing homes vaccinated against not only COVID-19, but flu and respiratory syncytial virus, or RSV, Pan said.

However, health officials are closely watching to see whether there are early indications that the winter respiratory viral season may be plateauing.

In California, there were 3,716 new coronavirus-positive hospitalizations for the week to Jan. 6, versus the prior weeks 3,720, which was the highest tally this winter, according to CDC data.

By contrast, last winter peaked at 5,260 coronavirus-positive hospitalizations for the week that ended Dec. 31, 2022. That was well shy of the heights seen during the devastating first two winters of the pandemic, when weekly hospital admissions topped out at more than 14,600.

Nationwide, coronavirus-positive hospitalizations are still rising. There were 35,801 for the week that ended Jan. 6, up 3% from the prior week. Last winters peak was 44,545, during the final week of 2022.

Its noteworthy that while national wastewater data suggest that this winter may be spawning the most coronavirus infections in any given week since the first Omicron wave in the winter of 2021-22, hospitalizations have remained lower than in any winter of the COVID-19 era.

Is this ... that were actually seeing more mild infection in people that are not getting tested, or reporting tests or seeking healthcare? Or are there are other reasons is there more shedding of the currently circulating variants? Pan said.

Hospitalizations remain elevated in L.A. County, public health officials say. But on Friday, the county moved out of the medium COVID-19 hospitalization level and back into low, according to the CDC. Orange County is still at medium.

The waning impact of COVID-19 has prompted public health officials for both California and L.A. County to relax guidance on isolation time after infection.

Previous isolation recommendations were implemented to reduce the spread of a virus to which the population had little immunity and had led to large numbers of hospitalizations and deaths that overwhelmed our healthcare systems during the pandemic, the California Department of Public Health said in a statement Tuesday. We are now at a different point in time with reduced impacts from COVID-19 compared to prior years, due to broad immunity from vaccination and/or natural infection and readily available treatments for infected people.

State and L.A. County officials say those who test positive need to isolate and stay home only while they have symptoms; they can end isolation once their symptoms are mild and improving and when they havent had a fever for 24 hours without using medication. Those who test positive yet are asymptomatic need not stay home, according to the guidance.

Previous guidance stated that those infected should stay home for at least five days.

Anyone with COVID-19 should wear a mask around others for 10 days after the beginning of symptoms or, if asymptomatic, after first testing positive. Infected people can stop masking sooner if they test negative on two consecutive rapid tests taken at least one day apart.

Still, anyone who has COVID-19 should stay away from people at higher risk for severe illness for 10 days, officials say. They should speak with a healthcare provider as soon as possible to learn whether they may be eligible for treatment, such as a prescription for Paxlovid or other antiviral medication.

The CDC, which most recently updated its guidance last spring, still recommends isolating for at least five days following the onset of symptoms or your first positive test if you have no symptoms.

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COVID-19 widely circulating in Los Angeles County - Los Angeles Times