Category: Covid-19

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What to know about the end of the COVID-19 five-day quarantine. - IndyStar

BOSTON (AP) Four years after the COVID-19 pandemic closed schools and upended child care, the CDC says parents can start treating the virus like other respiratory illnesses.

Gone are mandated isolation periods and masking. But will schools and child care centers agree?

In case youve lost track: Before Friday, all Americans, including school children, were supposed to stay home for at least five days if they had COVID-19 and then mask for a set period of time, according to the Centers for Disease Control and Prevention.

Now, with COVID deaths and hospitalizations dropping, the CDC says children can go back to school when their overall symptoms improve and theyre fever-free for 24 hours without taking medication. Students are encouraged to wear a mask when they return.

Still, the change may not affect how individual schools urge parents to react when their children fall sick. Schools and child care providers have a mixed record on following CDC recommendations and often look to local authorities for the ultimate word. And sometimes other goals, such as reducing absences, can influence a state or districts decisions.

The result can be a confusing array of policies among states and districts, not to mention workplaces confounding parents whose lives have long been upended by the virus.

This is so confusing, said Gloria Cunningham, a single mom in the Boston area. I just dont know what I should think of COVID now. Is it still a monster?

Cunningham, who manages a local store for a national restaurant chain, said her company requires her to take off 10 days if she gets COVID-19. And the school system where her son is in second grade has still been sending home COVID test kits for kids to use before returning to school after long breaks.

I feel like we should just do away with anything that treats COVID differently or keep all of the precautions, she said.

The public education system has long held varying policies on COVID. During the 2021-2022 school year, only 18 states followed CDC recommendations for mask-wearing in class. When the CDC lifted its masking guidelines in February of 2022, states like Massachusetts followed suit, but California kept the mask requirement for schools.

And in the child care world, some providers have long used more stringent testing and isolation protocols than the CDC has recommended. Reasons have ranged from trying to prevent outbreaks to keeping staff healthy both for their personal safety and to keep the day care open.

Some states moved to more lenient guidelines ahead of the CDC. California and Oregon recently rescinded COVID-19 isolation requirements, and many districts followed their advice.

In an attempt to minimize school absences and address an epidemic of chronic absenteeism, California has encouraged kids to come to school when mildly sick and said that students who test positive for coronavirus but are asymptomatic can attend school. Los Angeles and San Diegos school systems, among others, have adopted that policy.

But the majority of big-city districts around the country still have asked parents to isolate children for at least five days before returning to school. Some, including Boston and Atlanta, have required students to mask for another five days and report positive COVID-19 test results to the school.

Some school leaders suggest the CDCs previous five-day isolation requirement was already only loosely followed.

Official policy in Burlington, Massachusetts, has been to have students stay home for five days if they test positive. But Superintendent Eric Conti said the real policy, in effect, is: Its a virus. Deal with it.

Thats because COVID is managed at home, using the honor system.

Without school-based testing, no one can enforce a five-day COVID policy, he said via text message.

Ridley School District in the Philadelphia suburbs was already using a policy similar to the new CDC guidelines, said Superintendent Lee Ann Wentzel. Students who test positive for COVID must be fever-free without medication for at least 24 hours before returning to school. When they come back, they must mask for five days. Wentzel said the district is now considering dropping the masking requirement because of the new CDC guidance.

A school or day cares specific guidelines are consequential for working parents who must miss work if their child cant go to school or child care. In October 2023, during simultaneous surges of COVID, respiratory syncytial virus and influenza, 104,000 adults reported missing work because of child care issues, the highest number in at least a decade. That number has fallen: Last month, child care problems meant 41,000 adults missed work, according to the Bureau of Labor Statistics.

Melissa Colagrossos child care center in West Virginia dropped special guidelines for COVID about a year ago, she said. Now, theyre the same as other illnesses: A child must be free of severe symptoms such as fever for at least 24 hours before returning to the center.

We certainly are treating COVID just like we would treat flu or hand, foot and mouth disease, said Colagrosso, CEO of A Place To Grow Childrens Center in Oak Hill.

As for kids without symptoms who test positive for COVID? Most parents have stopped testing kids unless they have symptoms, Colagrasso said, so its a quandary she has not encountered.

Still, some parents worry the relaxed rules put their communities at greater risk. Evelyn Alemn leads a group of Latino and Indigenous immigrant parents in Los Angeles County. The parents she represents, many of whom suffer from chronic illnesses and lack of access to health care, panicked when California did away with isolation requirements in January.

I dont think theyre considering what the impact will be for our families, she said of California officials. It feels like they dont care that were almost expendable.

Other impacts of the pandemic linger, too, even as restrictions are lifted. In Ridley, the Philadelphia-area district, more students are reclusive and struggle to interact in-person with peers, said Wentzel, the superintendent. Interest in school dances has plummeted.

Emotionally, Wentzel said, theyre having trouble.

Balingit reported from Washington.

The Associated Press education coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find APs standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

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The CDC has relaxed COVID guidelines. Will schools and day cares follow suit? - The Associated Press

The emergence of the COVID-19 pandemic caused by the novel coronavirus, SARS-CoV-2, has evolved into a global health crisis. Initially focused on respiratory symptoms, it's now clear that COVID-19 presents a complex clinical picture affecting various organ systems32,33. Neurological manifestations have gained attention for their potential impact on both immediate clinical care and long-term health outcomes34,35. This systematic review and meta-analysis aimed to provide a comprehensive assessment of the abnormal neuroimaging findings in children with COVID-19.

Our findings reveal that a substantial proportion of pediatric COVID-19 patients with neurological symptoms exhibit abnormal neuroimaging findings, with 43.74% of children in the included studies demonstrating such abnormalities. These findings underscore the importance of considering neurological complications in the management of pediatric COVID-19 cases.

In a systematic review conducted by Choi et al. an extensive exploration was undertaken to comprehensively assess the spectrum of COVID-19-related neurological manifestations and associated abnormal neuroimaging findings in adults. Their meta-analysis unveiled that 42.6% of adult patients exhibited abnormal neuroimaging findings, as observed through brain CT or MRI36. With acute to subacute infarcts were the most common (24.0%), followed by cerebral micro hemorrhages (6.9%), acute spontaneous intracerebral hemorrhages (5.4%), and encephalitis/encephalopathy (3.3%)36. It is important to note that their investigation exclusively centered on specific COVID-19-related neuroimaging findings in the adult population and specifically considered MRI and CT as the imaging modalities of interest, although acknowledging that alternate modalities such as OCT, and TCD are also utilized.

In contrast, our study takes a unique approach, focusing exclusively on the pediatric group of COVID-19 patients, which is an area with limited research. Additionally, we aimed to cover a wide range of neuroimaging findings using diverse range of methods commonly used in pediatric cases. This broader scope is in response to the frequent use of various imaging techniques in pediatric clinical settings, extending the depth of our investigation.

In terms of specific neuroimaging abnormalities, our analysis categorized them into neurovascular findings, ADEM-like lesions, encephalitic pattern, myelitis, transient splenial lesions, and other findings. Neurovascular findings, encompassing findings like arterial or venous stroke, exhibited a pooled incidence of 8.22%. ADEM-like lesions showed a pooled incidence of 7.69%. Encephalitic pattern, including findings like Acute Hemorrhagic Necrotizing Encephalitis, showed a pooled incidence of 13.95%. Myelitis had a pooled incidence of 4.60%. Transient splenial lesions, encompassing findings like RESLES and MERS, exhibited a pooled incidence of 16.26%. Other abnormalities, such as PRES, neuritis, and brain edema, had a pooled incidence of 12.03%. These findings emphasize the diversity of neurological involvement in pediatric COVID-19 cases, spanning from inflammatory processes to vascular events.

In a recent systematic review led by Falsaperla et al. in 2023, undertook an exhaustive examination of COVID-19-related neurological manifestations in the pediatric population. Although this study primarily emphasized clinical symptoms, it did not include a meta-analytic assessment. Nevertheless, their conclusions align closely with our own findings, albeit with distinct categorization. Their results highlighted that encephalitis represented the most frequent diagnosis, accounting for 20.83% of cases, followed by seizures (10.42%), GBS (10.42%), cerebrovascular involvement (10.42%), ADEM (8.33%), and encephalopathy (8.33%). Additionally, a fraction of cases exhibited neurological signs secondary to central nervous system lesions (4.17%), and peripheral neuropathy (4.17%)37.

The cellular and molecular basis of SARS-CoV-2's ability to affect the nervous system is not fully understood. In light of this, several theoretical mechanisms have been posited to shed light on the acute and postacute neurological manifestations associated with COVID-19. Firstly, one hypothesis proposes that SARS-CoV-2 exhibits an affinity for infecting olfactory neurons, subsequently spreading through axons and across the synapse, thereby causing central nervous system infection38. Secondly, considering the viral-induced depletion of ACE-2, there is a perturbation in the renin-angiotensin system equilibrium. Consequently, a prothrombotic state may ensue, impairing both large vessel and microvascular blood flow. This vascular dysfunction heightens the risk of thrombotic and hemorrhagic stroke following SARS-CoV-2 infection39. Thirdly, perhaps the most pivotal mechanism at play is immune dysregulation, culminating in autoimmunity and hyperinflammatory responses. The aberrant immune response is recognized as a central contributor to neurological involvement in COVID-19 cases40. Lastly, the cytokine storm and systemic hyperinflammatory responses incited by the virus present an additional avenue through which neurological manifestations may occur. Elevated pro-inflammatory cytokine levels can disrupt normal neuronal function, impede neurotransmitter systems, and induce neuronal damage41,42. Understanding the mechanisms responsible for the neurological manifestations of COVID-19 is crucial for the development of potential therapeutic interventions. These mechanisms can operate independently or in concert within individual patients, giving rise to a range of clinical and neuroimaging presentations that, while varied, often exhibit overlapping features. This underscores the significance of investigating these mechanisms in our pursuit of effective treatments43.

The observed incidence of neurological abnormalities in pediatric COVID-19 patients raises several important clinical and research implications. First, it highlights the necessity for a high index of suspicion for neurological complications in children with COVID-19, especially those presenting with neurological symptoms. Timely neuroimaging assessments and consultations with pediatric neurologists may be essential for early diagnosis and appropriate management.

Second, the findings of this study emphasize the importance of continued research into the long-term consequences of COVID-19 in children. Even in cases where acute neurological symptoms resolve, it remains to be seen whether these children may be at risk of long-term cognitive or neurological sequelae. Longitudinal studies are needed to assess the evolution of these abnormalities and their potential impact on a child's development and quality of life.

To the best of our knowledge, this study represents the first systematic review and meta-analysis of neuroimaging findings in pediatric SARS-CoV-2 cases. Nonetheless, it is important to acknowledge several limitations of this study. Firstly, some of the studies included in our analysis exhibited substantial heterogeneity, attributed to variations in study designs, patient cohorts, and imaging protocols. This inherent diversity, though mitigated through statistical methods, somewhat limits the generalizability of our findings. Secondly, the potential presence of publication bias, although not overtly evident in our assessments, cannot be entirely dismissed. Thirdly, the relatively limited number of studies constrained our ability to conduct more detailed subgroup analyses and explore specific aspects comprehensively. Moreover, in this study, our research commenced on December 1, 2019. It is essential to acknowledge a limitation related to the evolving nature of information about COVID-19 during that early period. Detailed and comprehensive information about COVID-19, including its clinical manifestations and neurological implications, may not have been readily available at the beginning of our study. As a result, some aspects of our analysis may be based on limited data and evolving knowledge in the early stages of the pandemic. Furthermore, establishing a causal relationship between COVID-19 infection and the observed neuroimaging abnormalities remains an ongoing area of investigation. These abnormalities may be influenced by systematic confounding factors such as comorbidities, mechanical ventilation, and the complex pharmacological regimens administered for respiratory distress with hypoxia. These limitations underscore the necessity for future prospective studies that consider comorbidities and conduct more intricate analyses to affirm the potential association between COVID-19 and neuroimaging findings.

Link:

Neuroimaging findings in children with COVID-19 infection: a systematic review and meta-analysis | Scientific Reports - Nature.com

New York to follow CDC's updated COVID-19 isolation guidance

by Steven Pappas

Four years after COVID-19 shut down much of the world, the CDC is making changes to its COVID-19 isolation guidance. (File photo)

Four years after COVID-19 shut down much of the world, the CDC has now made changes to its COVID-19 isolation guidance.

People who test positive for the virus will no longer have to isolate at home for five days. Instead, the CDC says you can return to normal activities after you're fever-free for 24 hours.

The rule change marks the first time the agency has revised its COVID guidelines since 2021.

On Friday, The New York State Department of Health announced it will follow the CDC's new directives.

Regardless of the CDC rules, experts say people should still use common sense when dealing with COVID-19.

If you are sick stay home. Stay home until you are feeling better for about 24 hours, said Kate Ott, Ontario County's Health Director. I think what the CDC is saying makes very good sense, but it does not negate the risk of transmission."

Ott also suggests being aware of personal space, and washing your hands.

For those who are over the age of 65 or maybe immunocompromised, it is still recommended that you get tested if symptoms develop.

If you have older folks in your family, parents, grandparents, great-grandparents, or people who have auto-immune illnesses or have had a transplant...these are some of the folk now that could really get severely ill from any of these viruses, cautioned Ott.

Strong and Highland hospitals announced that the new policy will not change their current requirement of a five day isolation.

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New York to follow CDC's updated COVID-19 isolation guidance - 13WHAM-TV

Even after your other symptoms from COVID-19 have gone away, you might experience sadness, fatigue, and other signs of depression. Scientists are still studying how COVID can affect the brain in some people and why this may put them at greater risk of depression.

Depression is one of the most common issues some people experience after a COVID infection, as part of long COVIDsometimes referred to as PASC (post-acute sequelae of COVID-19). According to one analysis, roughly 10% to 30% of people may still experience depression symptoms three months later, which may be severe in 3% to 12% of people.

This article explains more about the link between depression and COVID. It discusses how the virus that causes COVID directly affects the brain, other mental health effects of the pandemic, and tips on how to cope with depression after COVID.

FG Trade / Getty Images

Although scientists were initially most concerned about COVID-19 symptoms such as shortness of breath from lung infection, the virus causing COVID-19 (SARS-CoV-2) can also affect other body systems, including your brain.

People who have COVID have a higher rate of depression than people in the general population. You might be more prone to getting depression even after your other symptoms from COVID, like sore throat, are gone, and you no longer have an active viral infection.

People with severe COVID symptoms seem to have a greater risk of initial depressive symptoms. However, some studies have shown that people with mild COVID symptoms have a similar risk of post-COVID depression as people who had more severe infections that required hospitalization.

Long COVID broadly refers to symptoms still present at least three months after a COVID-19 infection.

Not everyone with long COVID has the same symptoms. Some people have shortness of breath, dizziness, or pain without a clear cause. However, others have symptoms that are very common in clinical depression.Others might have mild depressive symptoms.

For example, many people with long COVID have fatigue, apathy (lack of interest), sleep problems (too much or too little), or decreased mental sharpness (brain fog). Many people also experience increased anxiety or sadness. In some cases, depression might be part of a long COVID syndrome, with or without additional symptoms.

Scientists are still learning about what causes depression in people whove had COVID-19. They do know that circumstances contribute to COVID-related depression. For example, if youve lost income or have to cancel plans due to a COVID infection, you may naturally feel some sadness.

However, the virus that causes COVID also seems to directly affect the brain in ways scientists dont fully understand. Other infections may also trigger syndromes that can cause symptoms like depression, like the original SARS virus or Lyme disease.

Scientists theorize that inflammation plays a role in the development of depression with COVID-19. The virus that causes COVID can trigger immune-signaling molecules that can enter the brain and affect your mood, sleep, sense of motivation, and enjoyment. Scientists think inflammation plays a role in depression, even in people who have never had COVID.

However, the link between COVID and depression is complex. The virus that causes COVID binds to specific receptors in your brain, which might worsen depression. Some scientists speculate that low levels of the virus might be present in some people with long COVID, which could contribute to depression symptoms.

Alterations in the normal immune response (autoimmune disease) may also play a role, but more research on the relationship between autoimmune disease, COVID, and depression is needed.

Some people seem to be at greater risk of depression after COVID. For example, women have an increased risk compared to menwhich is true for depression in general, as well.People with a history of depression or other mental health issues also have an increased risk.

The pandemic significantly increased rates of anxiety and depression overall, even in people who didnt have the COVID-19. This was especially true early in the pandemic before vaccines and targeted treatments were available. Uncertainty about the virus was particularly stressful and profoundly affected peoples lives.

The pandemic also had broader effects, which varied based on individual circumstances. Some people were grieving from losing a loved one or managing the physical challenges of regaining their health, including from long COVID.

People were also dealing with the indirect impacts of the virus, such as job and income loss, social isolation, and burnout from increased responsibilities at home and/or work. Alcohol-related deaths and rates of suicide also increased.

Many of these trends improved as the impact of COVID lessened and disease outcomes became more predictable. Some scientists believe the overall effects on peoples mental health have been overestimated.

However, some people are still struggling with mental health issues that might have been triggered or worsened by circumstances related to the pandemic.

Depression after COVID-19 is relatively common, and symptoms decrease with time in most people.

If your depression is severely interfering with your life, reach out to a healthcare provider or mental health professional. Its especially critical to do so if you are having thoughts of self-harm or suicide. They can help you determine how to best navigate this time.

Even if your symptoms are less severe, getting some input from a mental health provider is often helpful. Depending on your situation and personal preferences, you might consider drug treatments for depression or therapy such as cognitive behavioral therapy (CBT).

Many people benefit from a holistic, multifaceted approach to depression treatment. Some considerations to help you cope include the following:

A holistic approach may also work best if you have depression in the context of other symptoms from long COVID. You may want to connect with a long COVID clinic (facilities specializing in long COVID care), where they can provide additional expertise and treatment approaches.

COVID-19 causes an increased risk of depression, both during active infection and for months following. Sometimes, this is part of a broader long COVID syndrome, which might include additional symptoms like pain, light-headedness, brain fog, and fatigue.

Social isolation and other factors surrounding COVID negatively affect many peoples mental health. But infection with the virus itself also seems to leave you more prone to depression, whether by inflammation or other unclear brain changes.

A holistic approach may work best in managing symptoms of depression related to COVID. Often, a combination of psychological therapy, medication, mind/body approaches, solid nutrition, and other lifestyle changes are needed.

See more here:

COVID-19 and Depression: Understanding the Connection - Verywell Health

NEW YORK (AP) Older U.S. adults should roll up their sleeves for another COVID-19 shot, even if they got a booster in the fall, U.S. health officials said Wednesday.

The Centers for Disease Control and Prevention said Americans 65 and older should get another dose of the updated vaccine that became available in September if at least four months has passed since their last shot. In making the recommendation, the agency endorsed guidance proposed by an expert advisory panel earlier in the day.

Most COVID-19 deaths and hospitalizations last year were among people 65 years and older. An additional vaccine dose can provide added protection ... for those at highest risk, CDC Director Dr. Mandy Cohen said in a statement.

The advisory panels decision came after a lengthy discussion about whether to say older people may get the shots or if they should do so. That reflects a debate among experts about how necessary another booster is and whether yet another recommendation would add to the publics growing vaccine fatigue.

Some doctors say most older adults are adequately protected by the fall shot, which built on immunity derived from earlier vaccinations and exposure to the virus itself. And preliminary studies so far have shown no substantial waning in vaccine effectiveness over six months.

However, the bodys vaccine-induced defenses tend to fade over time, and that happens faster in seniors than in other adults. The committee had recommended COVID-19 booster doses for older adults in 2022 and 2023.

COVID-19 remains a danger, especially to older people and those with underlying medical conditions. There are still more than 20,000 hospitalizations and more than 2,000 deaths each week due to the coronavirus, according to the CDC. And people 65 and older have the highest hospitalization and death rates.

Some members of the advisory panel said a should recommendation is meant to more clearly prod doctors and pharmacists to offer the shots.

Most people are coming in either wanting the vaccine or not, said Dr. Jamie Loehr, a committee member and family doctor in Ithaca, New York. I am trying to make it easier for providers to say, Yes, we recommend this.

In September, the government recommended a new COVID-19 shot recipe built against a version of the coronavirus called XBB.1.5. That single-target vaccine replaced combination shots that had been targeting both the original coronavirus strain and a much earlier omicron version.

The CDC recommended the new shots for everyone 6 months and older, and allowed that people with weak immune systems could get a second dose as early as two months after the first.

Most Americans havent listened. According to the latest CDC data, 13% of U.S. children have gotten the shots and about 22% of U.S. adults have. The vaccination rate is higher for adults 65 and older, at nearly 42%.

In each successive vaccine, the uptake has gone down, said Dr. David Canaday, a Case Western Reserve University infectious diseases expert who studies COVID-19 in older people.

People are tired of getting all these shots all the time, said Canaday, who does not serve on the committee. We have to be careful about over-recommending the vaccine.

But there is a subset of Americans those at higher danger of severe illness and death who have been asking if another dose is permissible, said Dr. William Schaffner, a Vanderbilt University vaccines expert who serves on a committee workgroup that has been debating the booster question.

Indeed, CDC survey data suggests that groups biggest worry about the vaccine is whether its effective enough.

Agency officials say that among those who got the latest version of the COVID-19 vaccine, 50% fewer will get sick after they come into contact with the virus compared with those who didnt get the fall shot.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institutes Science and Educational Media Group. The AP is solely responsible for all content.

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Older US adults should get another COVID-19 shot, health officials recommend - The Associated Press

CDC released today updated recommendationsfor how people can protect themselves and their communities from respiratory viruses, including COVID-19. The new guidance brings a unified approach to addressing risks from a range of common respiratory viral illnesses, such as COVID-19, flu, and RSV, which can cause significant health impacts and strain on hospitals and health care workers. CDC is making updates to the recommendations now because the U.S. is seeing far fewer hospitalizations and deaths associated with COVID-19 and because we have more tools than ever to combat flu, COVID, and RSV.

Todays announcement reflects the progress we have made in protecting against severe illness from COVID-19, said CDC Director Dr. Mandy Cohen. However, we still must use the commonsense solutions we know work to protect ourselves and others from serious illness from respiratory virusesthis includes vaccination, treatment, and staying home when we get sick.

As part of the guidance, CDC provides active recommendations on core prevention steps and strategies:

When people get sick with a respiratory virus, the updated guidance recommends that they stay home and away from others. For people with COVID-19 and influenza, treatment is available and can lessen symptoms and lower the risk of severe illness. The recommendations suggest returning to normal activities when, for at least 24 hours, symptoms are improving overall, and if a fever was present, it has been gone without use of a fever-reducing medication.

Once people resume normal activities, they are encouraged to take additional prevention strategies for the next 5 days to curb disease spread, such as taking more steps for cleaner air, enhancing hygiene practices, wearing a well-fitting mask, keeping a distance from others, and/or getting tested for respiratory viruses. Enhanced precautions are especially important to protect those most at risk for severe illness, including those over 65 and people with weakened immune systems. CDCs updated guidance reflects how the circumstances around COVID-19 in particular have changed.While it remains a threat, today it is far less likely to cause severe illness because of widespread immunity and improved tools to prevent and treat the disease. Importantly, states and countries that have already adjusted recommended isolation times have not seen increased hospitalizations or deaths related to COVID-19.

While every respiratory virus does not act the same, adopting a unified approach to limiting disease spread makes recommendations easier to follow and thus more likely to be adopted and does not rely on individuals to test for illness, a practice that data indicates is uneven.

The bottom line is that when people follow these actionable recommendations to avoid getting sick, and to protect themselves and others if they do get sick, it will help limit the spread of respiratory viruses, and that will mean fewer people who experience severe illness, National Center for Immunization and Respiratory Diseases Director Dr. Demetre Daskalakis said. That includes taking enhanced precautions that can help protect people who are at higher risk for getting seriously ill.

The updated guidance also includes specific sections with additional considerations for people who are at higher risk of severe illness from respiratory viruses, including people who are immunocompromised, people with disabilities, people who are or were recently pregnant, young children, and older adults. Respiratory viruses remain a public health threat. CDC will continue to focus efforts on ensuring the public has the information and tools to lower their risk or respiratory illness by protecting themselves, families, and communities.

This updated guidance is intended for community settings.There are no changes to respiratory virus guidance for healthcare settings.

See more here:

CDC updates and simplifies respiratory virus recommendations | CDC Online Newsroom | CDC - CDC

This is a retrospective study of COVID-19 hospitalized patients in Spain during 2020 and 2021 with a nosocomial fungal coinfection. To the best of our knowledge, this is the first study analyzing fungal coinfection at a national level in hospitalized patients with COVID-19 in Spanish population. We found that (i) The incidence of fungal coinfections in patients with COVID-19 was 1.41%, (ii) Patients with fungal coinfection had a longer general hospital stay, higher ICU admission, mortality and stay, as well as and a greater need for mechanical ventilation, (iii) The respiratory tract was the most frequent site of infection, followed by the genitourinary tract, (iv) Risk factors for the development of fungal infection included surgery, sepsis, age, male sex, obesity and chronic obstructive pulmonary disease.

Previous studies analyzing the association between fungal coinfections and SARS-CoV-2, reported highly variable incidences, ranging from 0.70% in a study by Garca-Vidal8 to 26.70% in another study by White23. In our study, the incidence found was 1.41%, which is within the lower range of the previously described incidences. Estimating the coinfection rate in all COVID-19 cases is a challenging task as not all patients undergo sequential testing for coinfection. Also, this disparity could be attributed to the different methodologies used in these studies (case series, retrospective studies, prospective studies) with varying numbers of patients, and conducted in different populations.

Critically ill patients have a higher risk of developing coinfections. These patients exhibit increased levels of pro-inflammatory and anti-inflammatory markers, elevated cytokine levels, and reduced CD4+and CD8+lymphocyte levels10,24. These conditions, along with invasive procedures performed in the ICU25, and prolonged hospital stays26, increased the risk of developing fungal coinfections. In our study, patients with fungal coinfection had longer hospital stay, higher risk of death, increased ICU admission, and longer duration of ICU stay.

Furthermore, the most commonly fungal microorganisms found in the population studied, were Candida and Aspergillus that have been previously described2,27. In our cohort, the most frequent site of infection was the respiratory tract. This could be explained by the destruction of the respiratory tract epithelium and suppression of the immune response in the site after viral infections. Also, the antibiotic treatment and the microbiota alteration, may lead to the emergence of fungal infection13. The second most frequent site of infection was the genitourinary tract. This could be attributed to the presence of risk factors in COVID-19 patients that promote the occurrence of fungal infections in the urinary tract, such as renal failure, advanced age, diabetes, cancer, and immune system disorders28.

Multiple factors have been associated with the risk of fungal coinfection in COVID-19 patients, such as admission to the ICU, high-dose steroid administration, presence of diabetes mellitus, COPD, among other15,29,30. In our study, the main risk factors described were surgery, sepsis, obesity, advanced age, men gender, and COPD.

Surgery, especially abdominal surgery, causes damage to the body's natural barrier, which can favor gastrointestinal translocation and lead to Candida infection, as Candida often colonizes the intestines31. This risk factor has not been described in previous studies conducted in COVID-19 patient groups, but in the literature, different risk assessment scales analyze the main risk factors for developing invasive fungal infection in non-COVID-19 patients, such as the scale developed by Len et al.32, where surgery was identified as a significant risk factor, consistent with our study findings. This is the first time that surgery has been described as a risk factor for the development of aspergillosis in patients with SARS-CoV-2. The presence of surgery as a risk factor for the development of aspergillosis in patients with SARS-CoV-2 may not have been previously identified due to the lack of information on surgical procedures in previous studies or because this variable was not considered in those studies. Therefore, further research and data collection are required to better understand the relationship between surgery and fungal infections in COVID-19 patients.

Sepsis and the presence of multiorgan dysfunction further contribute to the occurrence of superinfections due to the immunosuppressive state they induce. Patients with sepsis and multiorgan failure have multiple risk factors for developing fungal infections, such as antibiotic administration, invasive therapeutic strategies33, sepsis-induced immunosuppression34, and intestinal barrier dysfunction35. The presence of sepsis was a significant risk factor for Aspergillus spp. infection in COVID-19 patients, which is consistent with the findings of the meta-analysis by Chong et al.36.

Obese patients have an increased risk of bacterial, viral, and fungal infections37,38 due to the inflammatory state they experience, which leads to elevated proinflammatory cytokines and favors the development of chronic inflammation. Additionally, obese patients often require invasive mechanical ventilation, which further contributes to the development of superinfections39.

We observed that age was independently associated with an increased incidence of fungal infection. Advanced age is a known risk factor for infections due to immunosenescence, which results in reduced activation of the immune system (increased immature T lymphocytes, altered CD4+/CD8+T cell ratio, and decreased immune response), thus promoting the occurrence of infections40,41.

We report that fungal coinfection was more frequent in men than in women. This higher risk in males could be influenced by hormonal factors, genetic factors leading to differences in immune response, or even genetic polymorphisms.

In this research, the presence of COPD was identified as a risk factor for the development of Aspergillus spp. infection in COVID-19 patients, that do not present in patients with invasive candidiasis. This could be explained by the fact that Aspergillus spp. spores are normally cleared by the ciliary action of the respiratory epithelium, but in COPD patients (as in those infected with SARS-CoV-2), this ciliary clearance is impaired, facilitating the invasion of the bronchial mucosa and lung parenchyma42. Additionally, COPD patients often receive inhaled corticosteroid treatment, which can reduce immune activity and predispose them to fungal infection.

Our study presents certain limitations due to its retrospective design, relying on data obtained from the Spanish MBDS. As with any retrospective analysis, there is a possibility of under-coding of variables, leading to incomplete or inaccurate information. This could introduce potential bias and affect the robustness of our findings. Furthermore, the lack of coding for certain analytical variables and multiple admissions of the same patient might have influenced the precision and completeness of our results. Despite the limitations, our study possesses notable strengths. Foremost among these is the substantial sample size, which confers high statistical power and enhances the reliability of our analyses. The extensive dataset enabled us to provide a comprehensive and representative perspective on the epidemiological landscape of fungal co-infections in patients with COVID-19 within the Spanish population. This large-scale approach contributes to a more nuanced understanding of the prevalence and characteristics of fungal infections in this specific context.

More here:

Epidemiology of fungal infection in COVID 19 in Spain during 2020 and 2021: a nationwide study | Scientific Reports - Nature.com

The Centers for Disease Control and Prevention announced Friday that it would wind down much of its remaining guidance specifically targeted at COVID-19, including an official end to a pandemic-era plea for Americans to stay home for five daysafter testing positive.

The agency cited improvements in the rates of hospitalizations and deaths inflicted by the virus this past season for the change in its recommendations.

"COVID-19 remains an important public health threat, but it is no longer the emergency that it once was, and its health impacts increasingly resemble those of other respiratory viral illnesses," the agency said Friday in a report justifying its decision.

click to expand

Instead of offering recommendations specific to COVID-19, the agency said it would switch to offering a "unified, practical approach to addressing risk" from the virus alongside influenza and respiratory syncytial virus, or RSV.

"We're taking this unified approach so things can be simpler and more likely to be followed. And if they're easier and more likely to be followed, then we're protecting everyone, right? So the folks who are more vulnerable were top of mind when we did this," CDC Director Dr. Mandy Cohen told CBS News.

The decision follows a months-long effort started last year to draw up a new "pan-respiratory" approach blending together federal recommendations for COVID-19, flu and RSV. Cohen blamed the emergence of the highly mutated variant BA.2.86 last summer and fall, and the fast-spreading descendant it spawned, JN.1, for delaying the rollout of the new guidance.

"We wanted to see if the trends would hold through another respiratory season. We wanted to see continued decreases in hospitalizations, decreases in deaths, even with that larger change in the virus," Cohen said.

The changes include new guidance for when to stay home when sick, when people should test for COVID-19 and when to put on masks.

Here's the latest about the CDC's new recommendations.

Similar to influenza, where antiviral treatments are available for those who test positive and are more likely to face severe disease, the CDC's new guidance says everyone who is at higher risk should seek outtestingwhen they develop symptoms.

"If you are feeling sick, it is still important to know what you have, because you could get access to treatment. We have treatment for flu and COVID, and treatment can also save someone's life and reduce the risk of long COVID," said Cohen.

For people without additional risk factors, the agency says testing can be an "additional prevention" strategy to choose. Cohen said the agency would also continue to say testing was an option to be "proactive to protect those around you," like before visiting others who might be more vulnerable.

"If it's positive, we see very few false positives, we know that you have COVID. But it is still possible to have a false negative. So it can be reassuring, but it is not a guarantee that you don't have COVID if you see a negative," said Cohen.

A recent CDC survey found that less than half of people would do an at-home COVID-19 test if they had cough or cold symptoms.

It also acknowledged that mild cases are now often not detected by home tests until past the peak of infectiousness, given the risk of false negative results soon after an infection.

"Even when testing occurs, COVID-19 is often not identified early in illness. The overall sensitivity of COVID-19 antigen tests is relatively low and even lower in individuals with only mild symptoms," the CDC said in its report.

The agency's new guidance also moves away from an earlier recommendationon using test results to decide when to stop isolation after an infection.

"While COVID-19 at-home testing can give a rough approximation of whether a person is still infectious, at-home testing for other respiratory viruses is not widely available. CDC guidance throughout the pandemic recognized that repeated testing through the course of illness is not practical for many people," the agency says.

For people who are sick with COVID-19 or another respiratory virus, the CDC will suggest masking as part of five additional days of ramped-up precautions after they are no longer staying home, alongside distancing and improved ventilation.

The agency had previously suggested wearing a mask for up to 10 days after stopping isolation when indoors near other people.

Much of the data the CDC had tracked on COVID-19 alongside other trends, like influenza and RSV, will also continue to be published. But specific benchmarks, which had guided county-by-county recommendations on when people should wear masks to avoid getting sick, are now being discarded.

"This guidance is not going to tie to any specific colors or anything like that. We're trying to give folks broad tools that they can use to protect themselves, and then give them information about what's happening in their community," said Cohen.

Cohen stressed that guidance for health care facilities, like long-term care nursing homes, would not be changing at this time.

It is unclear how benchmarks will be updated for these settings. This past season, some hospitals and other more vulnerable settings had relied on the weekly map to make decisions on when to require masks and take other precautions.

A pandemic-era plea for Americans to isolate at home for five days after testing positive for COVID-19 is also being ended.

Instead, the CDC will urge people sick with symptoms of respiratory viruses to stay home until their fever has disappeared for at least 24 hours without relying on fever-lowering medications and their symptoms are improving.

The agency cited states that have already adopted these kinds of recommendations, like Oregon and California, as well as other countries abroad. Experts have questioned how often the five-day recommendations were followed, given hurdles like the lack of paid sick leave.

"Importantly, states and countries that have already shortened recommended isolation times have not seen increased hospitalizations or deaths related to COVID-19," the agency said.

Over the following five days, the CDC suggests people take additional precautions like distancing, improving ventilation and wearing masks especially around vulnerable people.

"Keep in mind that you may still be able to spread the virus that made you sick, even if you are feeling better. You are likely to be less contagious at this time, depending on factors like how long you were sick or how sick you were," the guidance says.

Alexander Tin is a digital reporter for CBS News based in the Washington, D.C. bureau. He covers the Biden administration's public health agencies, including the federal response to infectious disease outbreaks like COVID-19.

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CDC shortens 5-day COVID isolation, updates guidance on masks and testing in new 2024 recommendations - CBS News

Saturday 2 March 2024 16:32, UK

Lockdowns imposed during the COVID-19 pandemic saw changes in newborn babies that may have protected them against allergies, according to a study.

Infants raised when coronavirus social distancing restrictions were in place were found by Irish researchers to have more of the beneficial microbes acquired after birth from their mother, which could act as a defence against disease.

The scientists believe this led "pandemic babies" to have lower than expected rates of allergic conditions, such as to food, compared to pre-COVID babies.

The findings, published in the journal Allergy, highlighted the gut health benefits for the youngsters as a result of the COVID-19 lockdowns, including lower rates of infection and consequent antibiotic use, and increased duration of breastfeeding.

The ecosystem of naturally-occurring bacteria in the gut, known as the microbiome, plays an essential role in human health.

The researchers analysed faecal samples from 351 babies born in the first three months of the pandemic, comparing these with a pre-pandemic group.

Online questionnaires were used to collect information on diet, home environment and health.

Stool samples were collected at six, 12 and 24 months and allergy testing was performed at 12 and 24 months.

The study highlighted significant differences in the microbiome development of babies born during lockdown periods when compared to pre-pandemic babies.

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It revealed only about 5% of the lockdown babies had developed a food allergy at age one, compared to 22.8% in the pre-COVID group.

Fewer infections through not being exposed to germs also reduced the need for antibiotics, which kill good bacteria.

Of the lockdown babies only 17% needed an antibiotic by the age of one.

In the pre-pandemic group, 80% of infants had taken antibiotics by 12 months.

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Professor Jonathan Hourihane, consultant paediatrician at Children's Health Ireland Temple Street and joint senior author of the research, said: "This study offers a new perspective on the impact of social isolation in early life on the gut microbiome.

"Notably, the lower allergy rates among newborns during the lockdown could highlight the impact of lifestyle and environmental factors, such as frequent antibiotic use, on the rise of allergic diseases.

"We hope to re-examine these children when they are five years old to see if there are longer-term impacts of these interesting changes in early gut microbiome."

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Fellow joint senior author Liam O'Mahony, professor of immunology at University College Cork, said: "While we all start life sterile, communities of beneficial microbes that inhabit our gut develop over the first years of life.

"We took the opportunity to study microbiome development in infants raised during the early COVID-19 era when strict social distancing restrictions were in place, as the complexity of early life exposures was reduced and this facilitated a more accurate identification of the key early life exposures.

"Prior to this study it has been difficult to fully determine the relative contribution of these multiple environmental exposures and dietary factors on early-life microbiome development."

He added: "One fascinating outcome is that due to reduced human exposures and protection from infection, only 17% of infants required an antibiotic by one year of age, which correlated with higher levels of beneficial bacteria such as bifidobacteria.

"The study has provided a rich repository of data, which we will continue to analyse and investigate in the future."

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COVID-19 'pandemic babies' developed 'fascinating' protection against common condition, study finds - Sky News