Category: Covid-19

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Clarifying the current protocols for JN.1 Covid-19 infections – The Hindu

January 1, 2024

After a pleasant lull of over a year during which Covid-19 was not making headlines, the virus is back in the news. On December 19, 2023, the World Health Organisation classified the JN.1 variant, a descendent of the BA.2.86 Omicron lineage, as a variant of interest. This was done because this strain of SARS-Co-V-2 is spreading rapidly, leading to an uptick in cases globally, including in India. However, the WHO has said that with the available evidence, the additional public health risk posed by JN.1 is currently evaluated as low at the global level

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Many parts of India have seen a rise in Covid-19 cases as well, with current active cases at over 4,000. Fatalities too, have risen marginally. While the Union Health Ministry has asked the State government to stay alert and prepare for a surge, government authorities and doctors have said that while residents must remain vigilant and take precautions, there is no need to panic.

Also read: As JN.1 emerges as variant of interest, time to evaluate preparedness and effective testing and treatments

What causes the coronavirus to mutate, and how is its spike protein involved? The spike (S) protein is one of the key biological characteristics of Sars-CoV-2. This protein allows the virus to penetrate into the cells of its host (human beings) and cause the infection. This means that without the S protein, the virus would not be able to infect human beings, and so, this is a protein that is of interest to scientists making vaccines and anti-viral drugs.

In its initial risk evaluation, the WHO said that previously, JN.1 was tracked as part of BA.2.86, the parent lineage that is classified as a variant of interest. The earliest sample of JN.1 was collected on August 25, 2023. In comparison with the parent lineage BA.2.86, JN.1 has the additional L455S mutation in the spike protein.

A paper published in The Lancet Infectious Diseases said that theL455S mutation may slightly reduce JN.1s ability to bind to human cells, but may have increased this sub-variants immune evasion properties.

The challenge has always been making effective drugs and vaccines when the virus is constantly mutating, points out Deepak Sehgal, professor, department of life sciences, Shiv Nadar Institute of Eminence, Delhi. Prof Sehgal, along with his student Aditya Trivedi and others, recently published a paper in the FEBS Journal on their research about an inhibitor that can bind to the viral proteins of the coronavirus in order to prevent its replication. This, he said, could eventually help the development of drugs to treat Covid-19.

In Focus podcast | What we know about the new Covid variant JN.1

Will the current Covid-19 vaccines work? The Centers for Disease Control and Prevention, in an update issued earlier this month, said there was no indication of increased severity from JN.1 at this time. Existing vaccines, tests, and treatments still work well against JN.1, the bulletin stated.

The Pune-based Serum Institute of India (SII), has said it will be aiming to obtain licensure for XBB1 COVID variant vaccine which is very similar to the JN.1 variant for use in India, as reported by The Hindu previously.

Do we need booster shots of vaccines? Subramanian Swaminathan, vice president, Clinical Infectious Diseases Society, India, says that given that the JN.1 strain seems to have significant immune evasion, another dose of the same vaccine may not provide added protection. A majority of people in India have hybrid immunity. Since we cannot give people a new vaccine immediately, and since this surge in cases is likely to conclude by the end of January, the benefits of a booster of the same, previous shot, are low. Those who are immuno-compromised however, could consider a booster shot, he says, adding that there are now multiple treatment options for patients, provided the infection is picked up early.

A booster shot could help protect vulnerable populations, Prof Sehgal adds. Masks, hand-washing and avoiding crowded places must continue, especially for senior citizens and those with co-morbidities, he emphasises.

Covid is here to stay. We need to learn how to take precautions and live with it, says Prof Sehgal.

(zubeda.h@gmail.com)

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Clarifying the current protocols for JN.1 Covid-19 infections - The Hindu

Covid JN.1 variant: Is the new virus a cause to panic? Expert reveals – Editorji

January 1, 2024

A new variant of covid has created havoc across the world. JN.1 variant has also made its way to India and many have been affected by the virus. More than 100 cases of the new covid variant have been detected in many states including Kerala and Delhi.

Is the new variant a cause for alarm and what is the best way to not transmit it? We at Editorji spoke to Dr Venkat Ramesh, Infectious Disease Physician, regarding its characteristics and transmissibility. The doctor also revealed if the virus is a cause to panic.

Dr Venkat Ramesh revealed that there is no need to worry and precautions is the best way to ensure you stay safe. He told us, "As of now, there is really no need to be panicked or alarmed, we need to be cautious and vigilant. But certainly do not need to panic. The month of January will give us some clarity in terms of which direction we are headed. As infectious disease physicians, we have not seen an increase in the number of cases due to covid in our hospitals in case of patients being admitted with covid."

He further added, Another thing I would like to emphasise is that the three doses of vaccine may not provide gove great protection against infection with this new variant but it will definitely protect against serious infection, severe disease, ICU admission, and death. So will past infections also. So in that sense, as a country and society we are well protected."

Also watch: Covid-19 JN.1 variant: Do you need booster shots to fight surge? Expert weighs in

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Covid JN.1 variant: Is the new virus a cause to panic? Expert reveals - Editorji

India records over 4000 active Covid cases, 5 deaths today | 10 updates – Mint

January 1, 2024

India on Friday reported 4,091 active Covid cases and five deaths. According to the data by the Union Health Ministry, Kerala accounts for the maximum number of Covid-19 cases at 2,522 followed by Karnataka at 568, Maharashtra at 369, Tamil Nadu at 156, etc.

Covid-19 LIVE updates

Two people have died due to Covid-19 in Kerala while in Maharashtra, Puducherry, and Tamil Nadu one each has died as per health ministry data.

The number of daily cases had dropped to double-digits by December 5, but the cases have again gone up after the emergence of a new variant and cold weather conditions.

Covid update: 109 JN.1 cases in India to K'taka's home isolation. 10 points

The daily numbers were in lakhs at the peak of the pandemic, which began in early 2020 and has seen more than 4.5 crore people getting infected and over 5.3 lakh deaths in about four years since then across the country.

Covid, epilepsy and UTI drugs supplied to Delhi hospitals fail quality tests

The number of people who recuperated from the infection stands at over 4.4 crore with a national recovery rate of 98.81%, according to the ministry's website. Accordinlivg to the website, 220.67 crore doses of Covid vaccines have so far been administered in the country.

1. Jammu on Thursday reported the first cases of coronavirus in a "long time". The patient has no history of travel but came in contact with someone who had returned from abroad a few days ago

2. The Delhi government is keeping an eye on the new variant JN.1 of the coronavirus. Health Minister Saurabh Bharadwaj visited Lok Nayak Jai Prakash Narayan Hospital to assess the preparedness yesterday.

Delhi reports first case of Covid's JN.1 sub-variant

3. On Thursday, Delhi reported two new cases of Covid-19. The reports of both the infected patients were sent for genome sequencing to confirm whether they were instances of sub-variant, JN.1.

4. In Gujarat, 22 of the 36 patients infected with sub-variant JN.1 have recovered

5. As of Thursday, 157 cases of Covid-19 sub-variant have been detected in the country, with Kerala reporting the highest number of 78, followed by Gujarat at 34.

COVID-19: 10 latest updates; active cases, advisory, JN.1 variant and more

6. Gurugram District Magistrate Nishant Kumar Yadav ordered hospitals to set up isolation wards, a dedicated section within each ICU, and a separate OPD for patients amid a rise in active cases.

7. Popular Tamil Nadu actor Vijayakant died after testing positive for Covid-19.

8. Karnataka's health government has mandated home isolation for Covid positive patients.

Amid Covid cases surge, Karnataka mandates 7-day home isolation

9. The Maharashtra government has once again formed the Covid-19 special task force. The first meeting of the task force was held on Thursday where Health Minister Tanaji Sawant urged people not to panic about the JN.1 variant but follow COVID-19 guidelines, and mask up in crowded places during the New Year celebrations and visits to religious places. People with comorbidities are advised to be extra careful.

10. The Karnataka government has decided to impose mandatory seven-day home isolation for infected patients and monitor those in ICUs through Tele ICU.

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Published: 29 Dec 2023, 11:38 AM IST

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India records over 4000 active Covid cases, 5 deaths today | 10 updates - Mint

COVID-19 hospitalizations are up in Arizona and around the U.S. – KJZZ

January 1, 2024

Centers for Disease Control and Prevention

COVID-19 hospital admissions in Arizona by week

COVID-19 hospital admissions increased nearly 17% nationwide during the week of Dec. 23, according to the Centers for Disease Control and Prevention. Hospitalization numbers are up in Arizona, too.

There were 502 people admitted to Arizona hospitals for COVID-19 during the week of Dec. 23.

Thats much higher than weekly admissions the state reported during summer and fall. But its a small fraction of the hospitalizations the state saw during the last three years. Its about a 40% decrease compared to the same point last winter.

Medical experts say getting an updated COVID-19 vaccine is the best way to protect yourself from severe outcomes of the virus. The CDC reports only about 18% of Arizona adults had gotten the updated shot as of mid-December.

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COVID-19 hospitalizations are up in Arizona and around the U.S. - KJZZ

COVID-19 case updates: India sees 529 new cases, active number at 4,093; 109 JN.1 cases reported – Business Today

January 1, 2024

COVID-19 cases in India: India saw a single-day rise of 529 cases of coronavirus, with the number of active cases at 4,093 cases. According to the Ministry of Health and Family Welfare data at 8 am, three new fatalities have been reported two from Karnataka and one from Gujarat in the last 24 hours.

Meanwhile, 40 more cases of COVID-19 sub-variant JN.1 were recorded with the tally of cases reaching 109 till December 26. Thirty-six cases were detected in Gujarat, 34 from Karnataka, 14 from Goa, nine from Maharashtra, six from Kerala, four each from Rajasthan and Tamil Nadu, and two from Telangana.

Most of the patients are currently in home isolation.

COVID-19 infections have been on the rise after the emergence of the new JN.1 variant and due to cold weather conditions. The daily numbers had soared to lakhs amid the pandemic, resulting in the infection of over 4.5 crore people and death of over 5.3 lakh since the pandemic began in early 2020.

As many as 4.4 crore people recovered from the disease, with the national recovery rate at 98.81 per cent. The case fatality rate stands at 1.19 per cent.

All about new COVID-19 variant, JN.1:

The JN.1 variant, a descendant of the BA.2.86 lineage of SARS COV2, first emerged in August this year in Luxembourg.

NITI Aayog member (Health) Dr V K Paul highlighting the importance of ramping up tests and strengthening surveillance systems, said last week that the new variant JN.1 was being closely investigated. Officials have said that while JN.1 cases have been reported across multiple states in the country, there is no cause of immediate concern. They said that 92 per cent of those infected by JN.1 have opted for home treatment. This indicates that the illness is mild, they pointed out.

Officials further said that there has been no increase in hospitalisation rates and that COVID-19 is an incidental finding in those hospitalised due to other medical conditions.

Meanwhile, Union Health Secretary Sudhansh Pant wrote to states and Union Territories asking for requisite public health measures to be put in place and underlined critical COVID-19 control and management strategies. States have been asked to ensure effective compliance of operational guidelines for COVID-19.

Influenza-like Illness (ILI) and Severe Acute Respiratory Illness (SARI) have also been asked to be monitored and reported district-wise for early detection of the rising trend of cases.

Also read: New Covid variant JN.1: As cases spike, can it impact India's economy? Here's what experts say

Also read: COVID-19 in India: 69 JN.1 variant cases reported till Monday, highest from Karnataka

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COVID-19 case updates: India sees 529 new cases, active number at 4,093; 109 JN.1 cases reported - Business Today

Study: COVID-19 increased premature birth rate during height of the pandemic – Wisconsin Public Radio

January 1, 2024

At the start of the COVID-19 pandemic, many health experts were concerned about the new disease's impact on older adults and people who are immunocompromised.

Jenna Nobles, sociology professor at the University of Wisconsin-Madison, was interested in another potentially vulnerable group pregnant people.

"We know that emerging infectious diseases can be extremely consequential for pregnancies, both people who are carrying the pregnancies and the infants who are born from them," Nobles said.

Now, more than three years later, Nobles and her research partner Florencia Torche from Stanford University have published a studythat identifies a spike in premature births caused by COVID-19.

They found that from 2020 into 2023, maternal COVID infection increased the risk of preterm births by 1.2 percentage points. The rate was especially high during the second half of 2020, coming in 5.4 percentage points higher than anticipated.

"A one percentage point jump is already very large," Nobles said. "To move the needle that much on population risk is akin to exposing pregnant people to weeks of very high levels of environmental exposure, air pollution from wildfire for example."

The study also found that the premature birth rate returned to normal levels after the roll-out of the COVID-19 vaccine. Nobles said the decline in early births happened earlier in communities that had early adoption of the vaccines by residents.

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"That becomes a really important piece of information to have," she said. "It's not just that vaccines are safe and effective in pregnancy. It's also that avoiding vaccines can be very harmful, particularly in the context of emerging infections like COVID."

She said the research could help people who are pregnant now and considering getting the vaccine for the first time or even the latest booster.

Nobles' research used data from 40 million people provided by the California Department of Public Health, which recorded COVID-19 test results for people in a hospital to give birth during the three-year period. She said the state agency was also able to provide information about those peoples' previous births, allowing the researchers to understand a person's risk for premature birth prior to the pandemic and more definitively link the increase to COVID-19.

"That's a really important part of this study design," Nobles said. "A challenge is that who gets COVID is not random in populations and certainly early in the pandemic, people were differentially exposed who had frontline jobs and who lived in more crowded settings."

While the research offers a look back on how COVID-19 impacted pregnancies during the height of the pandemic, Nobles said she hopes the study will also inform how healthcare providers and officials are thinking about what data should be collected during a future epidemic or pandemic.

"Data like vital statistics records that are partnered with information about infectious disease and vaccine uptake, they can be a very important tool to study how the effects of epidemics are evolving in real time," she said.

She said maternal and infant health outcomes should be among the metrics that leaders consider as they develop a public health response to future infectious disease.

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Study: COVID-19 increased premature birth rate during height of the pandemic - Wisconsin Public Radio

Respiratory virus activity is high and rising across the United States, CDC data shows – WBAL TV Baltimore

January 1, 2024

Temperatures are dropping and we are in the middle of the season where everyone begins to get sick. There are *** variety of respiratory illnesses going around like the flu, COVID and RSV. As we spend more time indoors, there has reportedly also been an uptick in *** persistent cough that doctors say does not fall in any of these categories. Baltimore, Doctor Janet o'mahoney told the Huffington Post that these links coughs may be purely viral and caused by the regular viruses that cause colds like Rhinovirus. Another doctor told the site that *** persistent cough is most likely due to prolong inflammation in the airways which can last anywhere from two weeks to two months after initially getting sick. Experts say it could also be sinus congestion, *** sore throat and postnasal drip if your symptoms persist for *** couple of weeks. Doctors say it's important to continue to follow up with your physician.

Respiratory virus activity is high and rising across the United States, CDC data shows

Updated: 4:21 PM EST Jan 1, 2024

As seasonal virus activity surges across the United States, experts stress the importance of preventive measures such as masking and vaccination and the value of treatment for those who do get sick.Tens of thousands of people have been admitted to hospitals for respiratory illness each week this season. During the week ending Dec. 23, there were more than 29,000 patients admitted with Covid-19, about 15,000 admitted with the flu and thousands more with respiratory syncytial virus, or RSV, according to data from the U.S. Centers for Disease Control and Prevention.Nationally, COVID-19 levels in wastewater, a leading measure of viral transmission, are very high higher than they were at this time last year in every region, CDC data shows. Weekly emergency department visits rose 12%, and hospitalizations jumped about 17% in the most recent week.And while Covid-19 remains the leading driver of respiratory virus hospitalizations, flu activity is rising rapidly. The CDC estimates that there have been more than 7 million illnesses, 73,000 hospitalizations and 4,500 deaths related to the flu this season, and multiple indicators are high and rising.RSV activity is showing signs of slowing in some parts of the U.S., but many measures, including hospitalization rates, remain elevated. Overall, young children and older adults are most affected."It's a wave of winter respiratory pathogens, especially respiratory viruses. So it's Covid, it's flu, and we can't diminish the importance of RSV," said Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine. "So it's a triple threat, and arguably a fourth threat because we also have pneumococcal pneumonia, which complicates a lot of these virus infections."Respiratory virus activity has been on the rise for weeks. Now, flu-like activity is high or very high in two-thirds of the United States, including California, New York City and Washington, as well as throughout the South and Northeast, according to the CDC."Remember, all of these numbers are before people got together for the holidays," Hotez said. "So don't be disappointed or surprised that we even see a bigger bump as we head into January."Vaccines can help prevent severe illness and death, but uptake remains low this season despite a historic first, with vaccines available to protect against each of the three major viruses. Just 19% of adults and 8% of children have gotten the latest Covid-19 vaccine, and 17% of adults 60 and older have gotten the new RSV vaccine, CDC data shows. Less than half of adults and children have gotten the flu vaccine this season."We have, as a population, underutilized both influenza and the updated Covid vaccines, unfortunately," said Dr. William Schaffner, an infectious disease expert at Vanderbilt University. "But it's not too late to get vaccinated, because these viruses are going to be around for a while yet."According to the CDC, hospital bed capacity remains "stable" nationally, including within intensive care units. But with high levels of respiratory viruses, hospitals in at least five states are returning to requiring masks.Mass General Brigham spokesman Timothy Sullivan said it will require masking for health-care staff who interact directly with patients starting Tuesday, and patients and visitors will be "strongly encouraged to wear a facility-issued mask."In Wisconsin, UW Health and UnityPoint Health Meriter have expanded mask policies to cover more people. UW requires all staff, patients and visitors to wear a mask for patient interactions in clinic settings, including waiting areas and exam rooms.UnityPoint Health Meriter says masks continue to be required for team members and visitors in patient rooms.Bellevue, a public hospital in New York City, said on social media last week that it had reinstated its mandatory masking policy due to an uptick in respiratory illnesses.In Pennsylvania, the University of Pittsburgh Medical Center has required everyone to wear a mask when entering or inside since Dec. 20. The systemwide masking policies were adjusted to "address the increase of respiratory virus cases" but may change when there is a "marked decrease in respiratory health cases," according to the health care system.An order posted last week by the Los Angeles County Health Officer requires all health-care personnel and visitors to mask while in contact with patients or in patient-care areas, based on the CDC's categorization of Covid-19 hospital admission levels.During the week ending Dec. 23, more than 230 U.S. counties were considered to have "high" levels of Covid-19 hospital admissions, defined by the CDC by at least 20 new hospital admissions for every 100,000 people. Nearly a thousand other counties, about a third of the country, have "medium" Covid-19 hospital admission levels, with at least 10 admissions for every 100,000 people.Vaccines and masks can help reduce the risk of severe illness before getting sick, but treatments are also available to help prevent people from getting very sick if they do become infected.Antiviral treatments for Covid-19, such as Paxlovid, and flu, such as Tamiflu, can be especially helpful for people who are more likely to get very sick, including people who are 50 or older and those with certain underlying conditions, such as a weakened immune system, heart disease, obesity, diabetes or chronic lung disease."If more people at higher risk for severe illness get treatment in a timely manner, we will save lives," the CDC said in a recent blog post. But "not enough people are taking them."Seasonal respiratory virus activity can be hard to predict, but CDC forecasts suggest that hospitalization rates will continue at elevated levels for weeks and that this season, overall, will probably result in a similar number of hospitalizations as last season."One of the ways to help us all go into a happy new year is for us to be as protected as we can against these viruses," Schaffner said."Of course, I continue to recommend vaccination, prudent use of the mask by high-risk people and, should you become sick, do not go to work and spread the virus further. Call your health care provider, because you may have some treatment available that will get you healthier sooner."

As seasonal virus activity surges across the United States, experts stress the importance of preventive measures such as masking and vaccination and the value of treatment for those who do get sick.

Tens of thousands of people have been admitted to hospitals for respiratory illness each week this season. During the week ending Dec. 23, there were more than 29,000 patients admitted with Covid-19, about 15,000 admitted with the flu and thousands more with respiratory syncytial virus, or RSV, according to data from the U.S. Centers for Disease Control and Prevention.

Nationally, COVID-19 levels in wastewater, a leading measure of viral transmission, are very high higher than they were at this time last year in every region, CDC data shows. Weekly emergency department visits rose 12%, and hospitalizations jumped about 17% in the most recent week.

And while Covid-19 remains the leading driver of respiratory virus hospitalizations, flu activity is rising rapidly. The CDC estimates that there have been more than 7 million illnesses, 73,000 hospitalizations and 4,500 deaths related to the flu this season, and multiple indicators are high and rising.

RSV activity is showing signs of slowing in some parts of the U.S., but many measures, including hospitalization rates, remain elevated. Overall, young children and older adults are most affected.

"It's a wave of winter respiratory pathogens, especially respiratory viruses. So it's Covid, it's flu, and we can't diminish the importance of RSV," said Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine. "So it's a triple threat, and arguably a fourth threat because we also have pneumococcal pneumonia, which complicates a lot of these virus infections."

Respiratory virus activity has been on the rise for weeks. Now, flu-like activity is high or very high in two-thirds of the United States, including California, New York City and Washington, as well as throughout the South and Northeast, according to the CDC.

"Remember, all of these numbers are before people got together for the holidays," Hotez said. "So don't be disappointed or surprised that we even see a bigger bump as we head into January."

Vaccines can help prevent severe illness and death, but uptake remains low this season despite a historic first, with vaccines available to protect against each of the three major viruses. Just 19% of adults and 8% of children have gotten the latest Covid-19 vaccine, and 17% of adults 60 and older have gotten the new RSV vaccine, CDC data shows. Less than half of adults and children have gotten the flu vaccine this season.

"We have, as a population, underutilized both influenza and the updated Covid vaccines, unfortunately," said Dr. William Schaffner, an infectious disease expert at Vanderbilt University. "But it's not too late to get vaccinated, because these viruses are going to be around for a while yet."

According to the CDC, hospital bed capacity remains "stable" nationally, including within intensive care units. But with high levels of respiratory viruses, hospitals in at least five states are returning to requiring masks.

Mass General Brigham spokesman Timothy Sullivan said it will require masking for health-care staff who interact directly with patients starting Tuesday, and patients and visitors will be "strongly encouraged to wear a facility-issued mask."

In Wisconsin, UW Health and UnityPoint Health Meriter have expanded mask policies to cover more people. UW requires all staff, patients and visitors to wear a mask for patient interactions in clinic settings, including waiting areas and exam rooms.

UnityPoint Health Meriter says masks continue to be required for team members and visitors in patient rooms.

Bellevue, a public hospital in New York City, said on social media last week that it had reinstated its mandatory masking policy due to an uptick in respiratory illnesses.

In Pennsylvania, the University of Pittsburgh Medical Center has required everyone to wear a mask when entering or inside since Dec. 20. The systemwide masking policies were adjusted to "address the increase of respiratory virus cases" but may change when there is a "marked decrease in respiratory health cases," according to the health care system.

An order posted last week by the Los Angeles County Health Officer requires all health-care personnel and visitors to mask while in contact with patients or in patient-care areas, based on the CDC's categorization of Covid-19 hospital admission levels.

During the week ending Dec. 23, more than 230 U.S. counties were considered to have "high" levels of Covid-19 hospital admissions, defined by the CDC by at least 20 new hospital admissions for every 100,000 people. Nearly a thousand other counties, about a third of the country, have "medium" Covid-19 hospital admission levels, with at least 10 admissions for every 100,000 people.

Vaccines and masks can help reduce the risk of severe illness before getting sick, but treatments are also available to help prevent people from getting very sick if they do become infected.

Antiviral treatments for Covid-19, such as Paxlovid, and flu, such as Tamiflu, can be especially helpful for people who are more likely to get very sick, including people who are 50 or older and those with certain underlying conditions, such as a weakened immune system, heart disease, obesity, diabetes or chronic lung disease.

"If more people at higher risk for severe illness get treatment in a timely manner, we will save lives," the CDC said in a recent blog post. But "not enough people are taking them."

Seasonal respiratory virus activity can be hard to predict, but CDC forecasts suggest that hospitalization rates will continue at elevated levels for weeks and that this season, overall, will probably result in a similar number of hospitalizations as last season.

"One of the ways to help us all go into a happy new year is for us to be as protected as we can against these viruses," Schaffner said.

"Of course, I continue to recommend vaccination, prudent use of the mask by high-risk people and, should you become sick, do not go to work and spread the virus further. Call your health care provider, because you may have some treatment available that will get you healthier sooner."

Continued here:

Respiratory virus activity is high and rising across the United States, CDC data shows - WBAL TV Baltimore

Responding to the new COVID-19 sub-variants, now and in future – The Hindu

January 1, 2024

It is four years since the novel coronavirus (2019-nCoV, later renamed as Severe Acute Respiratory Syndrome Coronavirus-2 or SARS-CoV2) was first reported on December 31, 2019 from China. In the months which followed, it caused severe COVID-19 waves in nearly every country, across the world. Alongside, at end December or early new year, there would be news of a new variant or sub-variant, or of a surge in cases in some countries. At the end of 2021, it was an Omicron variant (BA.1.1.529), and by the end 2022, the COVID-19 case surge in China made news. Now, a new subvariant of the Omicron variant of SARS-CoV-2, the JN.1, is making news.

The JN.1 sub-variant of Omicron has been reported from multiple countries and designated as a variant of interest (VoI) by the World Health Organization. This has raised some concerns and caused some worries. But is it really cause for concern? The short answer is a no. The reason is that the reporting of a new variant or sub-variant is on expected lines. In fact, in May 2023, while declaring the end of the COVID-19 pandemic, WHO had highlighted the need for continuous tracking of the virus and its variants. The rationale was simple. The pandemic is over, but SARS-CoV-2 was and is circulating in all countries and all settings and will continue to do so for long, and possibly forever. That is how most viruses behave. Therefore, there is always the possibility of some seasonal changes in the number of cases, at unpredictable intervals. A linked feature is that the genetic material of the circulating viruses especially of the respiratory virus keeps changing over a period. These changes in genetic structure (genome) result in the designation of new variants and sub-variants.

Since the reporting of the novel virus in 2019, more than 1,000 subvariants and recombinant sub-lineages have been reported. Against this backdrop, the emergence of JN.1 is not surprising. However, every change in genome does not matter, and the international agencies and subject experts are on task to assess the risk. However, if mutations or genetic changes result in an alternation in the characteristics of the virus (such as higher transmission, more severe disease or immune escape from vaccine induced or natural immunity), it merits greater attention. The variants are then termed as VoI or variants of concern (VoC). At present, there is no VoC in circulation in any part of the world. On March 16, 2023, WHOs Technical Advisory Group on SARS-CoV-2 Virus Evolution had downgraded the Omicron as the previous variants of concern. However, national and global agencies are tracking the virus and JN.1 has been designated as VoI.

JN.1 has been designated a VoI, which means it has some genetic changes and indicative characteristics in circulating viruses which need to be monitored by the health agencies and government. Such a designation is a call to step up genomic sequencing scientific work and use data to track the virus. JN.1 is not a new virus but a sub-variant of BA.2.86, which itself is a subvariant of the Omicron variant of SARS-CoV-2. Till now, there is no evidence that JN.1 causes more severe disease or causes immune escape and is, thus, not a reason for worry. In short, designating a variant as VoI does not automatically mean there is a reason to worry. Till now, there is no evidence that JN.1 is responsible for severe disease or immune escape. In fact, the waste-water surveillance in some Indian cities had indicated that the new sub-variant has circulated to a majority of the population without major change in reported or clinical cases in the way of a silent wave.

Does it mean we need to get additional shots of COVID-19 vaccines? Current scientific evidence supports that vaccines and natural infection continue to provide protection from any sub-variant, though there is some possibility of a decline in protection, as time has lapsed since the last vaccination. Immunologically, the natural infections which have happened in addition to vaccine shots, have provided hybrid immunity to people in India and many countries. Therefore, there is no immediate reason to worry. There is no scientific evidence to support having a fourth shot of COVID-19 vaccines, for any age group.

We also need to interpret the rise in COVID-19 cases more carefully. The spike in COVID-19 cases in India could be more artificial than real. It is likely that ramped up COVID-19 testing is picking more cases. Then, some deaths are being attributed to COVID-19. However, there is no evidence that those deaths are causally linked to SARS-CoV-2. These appear to be in the individuals who were already sick and had COVID-19, as an incidental finding. The average five or six deaths in a day in India also need to be considered in perspective.

To put this in context, every day in India, an estimated 27,000 people die due to a range of reasons that include old age. In contrast, respiratory diseases and tuberculosis kill 50 to 60 times more people every day than COVID-19 now. We need to shift attention to preventable deaths due to many other reasons.

Yet, four years should help us to learn. The governments COVID-19 response and actions should be more nuanced and informed by all evidence and real time data. Citizens need to act responsibly and not share unverified social media messages or forwards. Science communication from the government needs to be more interactive, and public communication messaging should be more routine and easy to understand. There is a possibility scenario where reported COVID-19 cases may increase slightly in the days ahead, or in the months ahead as it happened in April 2023 when daily cases had spiked. However, for most circulating respiratory viruses including SARS-CoV-2, mere transmission or an increase in cases is not an immediate concern. Right now, SARS-CoV-2 infections do not appear to change clinical outcomes in any age groups.

How should we respond to current or any future uptick due to SARS-CoV-2? The short answer is in the same way that we respond to any seasonal rise in cases of flu, respiratory illnesses or dengue virus. By the government increasing standard public health preventive measures such as Severe Acute Respiratory Infections (SARI) and Influenza-like Illness (ILI) surveillance, waste water surveillance and improving provision of required services at health facilities. The clinical management should focus on a syndromic approach to respiratory illnesses. At the individual and community levels, there is no need to disturb the routine or change your travel or vacation plans. People with cough and cold or flu-like illness must follow good respiratory etiquette such as wearing masks in public places, covering their nose and mouth when coughing or sneezing and frequent handwashing, irrespective of whether it is a type of SARS-CoV-2, seasonal flu or any other respiratory illness. It is proven that the risk to children is the lowest among any age group and thus, school closure should never be considered an option in response to a COVID-19 case surge.

It is time we handle SARS-CoV-2 or COVID-19 just like any other respiratory illness. It is more of an individual health concern than a public health concern. COVID-19 is not a novel virus any more and is here to stay. But it is not a reason to worry.

Dr. Chandrakant Lahariya is a medical doctor with over 15 years of work experience with the World Health Organization (WHO) in the India Country office, the regional office for Africa, Brazzaville; and the WHO headquarters in Geneva. The views expressed are personal

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Responding to the new COVID-19 sub-variants, now and in future - The Hindu

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