Coronavirus Updates November 2024

[missy]

Low COVID and Flu Vaccine Uptake Among Risk Groups in Europe​

Annie Lennon



Uptake of seasonal influenza and COVID-19 vaccination among risk groups such as older adults in many European Union/European Economic Area member states between 2023 and 2024 has been suboptimal, according to two reports released by the European Centre for Disease Prevention and Control.

Influenza vaccination coverage for those aged 65 years or older ranged from 12% to 78% during this period, whereas COVID-19 vaccination coverage among those aged 60 years or older varied between 0.02% and 66.1%. The median COVID-19 vaccine coverage of target age groups stood at 14%. Only six countries exceeded 50% coverage, and none exceeded 80%.

Máire Connolly, MB BCh, professor of global health at the University of Galway in Ireland, discussed these findings with Medscape Medical News. Suboptimal vaccination coverage rates could increase the risk of importing COVID-19 and influenza among unimmunized individuals across European states, including those with high vaccination rates like Ireland, she said.

Building Trust​

“Decreased vaccine uptake will lead to more infections and therefore more strain on healthcare systems everywhere. But any short-term attempt to increase uptake risks damaging the long term. If we keep touting the benefits of vaccines without addressing concerns, we damage public trust,” Anton Pottegård, PhD, professor of public health at the University of Southern Denmark, told Medscape.

Denmark had some of the highest rates of influenza and COVID-19 vaccination among senior citizens. Between 2023 and 2024, 78% of individuals aged 65 years or older were vaccinated against seasonal influenza, while 80.7% of individuals aged 70-79 years and 88.6% of those aged 80 years or older were vaccinated for COVID-19.

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Pottegård noted that public trust is a cornerstone of Denmark’s relatively high vaccination rates. While some countries and health institutions may worry that research revealing adverse effects from vaccines could reduce vaccine uptake, he explained that being open and direct about all findings, whether positive or negative, increases trust in health systems and, thus, vaccine uptake.


“We need to build trust as health regulators to collaborate with people and help them live healthy lives. People often say the anti-vaxxers are the problem, but the problem lies not with the population, but with the regulators. With the best of intentions, they sometimes erode trust by being overly confident in their messages,” he said.

Pottegård added that more must be done to communicate uncertainties in health sciences.

“If we ignore or downplay uncertainties today, the same uncertainties may come back and hit us on the head tomorrow. COVID-19 really upgraded people’s understanding of health science’s inherent uncertainties. You can no longer tell people it’s black and white,” he said.

High-Quality Data Lacking​

Some countries, however, may not have access to the high-quality data needed for proper public information. Germany, for example, lacks high-quality, population-based, epidemiologic data on the burden of disease and case-fatality rates, Oliver A. Cornely, MD, director and chair of translational research at the CECAD Institute of the University of Cologne, told Medscape.

Although Germany did not report rates of flu or COVID-19 vaccination between 2023 and 2024, the country had flu vaccination coverage of 43% among older adults in 2021-2022.

“Surprisingly, there are no randomized clinical trials assessing the effects of vaccine boosters for both influenza and COVID-19. We can only assume that repeatedly low vaccine uptake may not [sufficiently] protect unvaccinated high-risk patients,” Antoine Flahault, MD, PhD, director of the Institute of Global Health at the University of Geneva, told Medscape.

He explained that authorities currently approve seasonal boosters based on “thin data sets,” such as immunologic studies and safety clinical data, as opposed to randomized controlled trials, which physicians and pharmacists use to make clinical decisions.

He added that health authorities should “probably be more demanding” and ask vaccine producers to provide better evidence on whether vaccine boosters protect high-risk patients.


To improve vaccination rates, a spokesperson from the World Health Organization (WHO)/Europe told Medscape that it is crucial to gain an in-depth understanding of why key target groups remain unvaccinated.

“Some challenges, such as structural, logistical, and cost-related barriers, as well as a lack of awareness, may be easier to address initially through increasing access to vaccination sites, enhancing convenience, providing vaccines free of charge, and increasing knowledge about the disease and the vaccination program,” said the WHO.

Annie Lennon is a medical journalist. Her writing appears on Medscape, Medical News Today, and Psych Central, among other outlets.

 

[missy]

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COVID on the Floor Linked to Outbreaks on Two Hospital Wards​

Fran Lowry

November 01, 2024


The viral burden of SARS-CoV-2 on floors, even in healthcare worker–only areas, was strongly associated with COVID-19 outbreaks in two acute-care hospitals, according to a new study from Ontario, Canada.

With every 10-fold increase in viral copies, the chance of an impending outbreak of COVID-19 rose 22-fold. The results suggest that frequent floor sampling could play an important role in a more localized surveillance of the virus, the authors wrote.

“These data add to the mounting evidence that built environment detection for SARS-CoV-2 may provide an additional layer of monitoring and could help inform local infection prevention and control measures,” they wrote.


The study was published online on September 20 in Infection Control & Hospital Epidemiology.

Preventing Future Suffering​

The current study builds on the researchers’ previous work, which found the same correlation between viral load on floors and COVID outbreaks in long-term care homes.

Caroline Nott, MD
Currently, the best-known method of environmental surveillance for COVID is wastewater detection. “Swabbing the floors would be another approach to surveillance,” senior author Caroline Nott, MD, infectious disease physician at the Ottawa Hospital, told Medscape Medical News.


“We do have environmental surveillance with wastewater, but while this may tell you what’s going on in the city, it doesn’t tell you what is going on in a particular ward of a hospital, for instance,” she added.

Nott and her colleagues believe that swabbing, which is easy and relatively inexpensive, will become another tool to examine the built environment. “Instead of having to close a whole hospital, for example, we could just close one room instead of an entire ward if swabbing showed a high concentration of COVID,” Nott said.

The current study was conducted at two hospitals in Ontario between July 2022 and March 2023. The floors of healthcare worker–only areas on four inpatient adult wards were swabbed. These areas included changing rooms, meeting rooms, staff washrooms, nursing stations, and interdisciplinary team rooms.


SARS-CoV-2 RNA was detected on 537 of 760 floor swabs (71%). The overall positivity rate in the first hospital was 90% (n = 280). In the second hospital, the rate was 60% (n = 480).

Four COVID-19 outbreaks occurred in the first acute care hospital, and seven outbreaks occurred at the second hospital. Outbreaks occurred mostly among hospitalized patients (140 cases), but also in four hospital workers.

COVID-19 still requires vigilance, said Nott. “We weren’t prepared for COVID, and so as a result, many people died or have suffered long-term effects, especially vulnerable people like those being treated in hospital or in long-term care facilities. We want to develop methods to prevent similar suffering in the future, whether it’s a new COVID variant or a different pathogen altogether.”

Changing Surveillance Practice?​

“This is a good study,” Steven Rogak, PhD, professor of mechanical engineering at the University of British Columbia (UBC) in Vancouver, told Medscape Medical News. “The fundamental idea is that respiratory droplets and aerosols will deposit on the floor, and polymerase chain reaction [PCR] tests of swabs will provide a surrogate measurement of what might have been inhaled. There are solid statistics that it worked for the hospitals studied,” said Rogak, who studies aerosols at UBC’s Energy and Aerosols Laboratory. Rogak did not participate in the study.

Steven Rogak, PhD
“The authors note several limitations, including that increased healthcare worker testing may have been triggered by the higher values of PCR counts from the floor swabs. But this doesn’t seem to be a problem to me, because if the floor swabs motivate the hospital to test workers more, and that results in identifying outbreaks sooner, then great,” he said.

“Another limitation is that if the hospital has better HVAC or uses air purifiers, it could remove the most infectious aerosols, but the large droplets that fall quickly to the ground would remain, and this would still result in high PCR counts from floor swabs. In this case, perhaps the floor swabs would be a poorer indication of impending outbreaks,” said Rogak.

Determining the best timing and location for floor swabbing might be challenging and specific to the particular hospital, he added. ”For example, you would not want to take swabs from floors right after they are cleaned. Overall, I think this method deserves further development, and it could become a standard technique, but the details might require refinement for widespread application,” he said.

Adrian Popp, MD, chair of the Infectious Disease Service at Huntington Hospital-Northwell Health in Huntington, New York, said that although interesting, the study would not change his current practice.

Adrian Popp, MD
“I’m going to start testing the environment in different rooms in the hospital, and yes, I might find different amounts of COVID, but what does that mean? If pieces of RNA from COVID are on the floor, the likelihood is that they’re not infectious,” Popp told Medscape Medical News.

“Hospital workers do get sick with COVID, and sometimes they are asymptomatic and come to work. Patients may come into the hospital for another reason and be sick with COVID. There are many ways people who work in the hospital, as well as the patients, can get COVID. To me, it means that in that hospital and community there is a lot of COVID, but I can’t tell if there is causation here. Who is giving COVID to whom? What am I supposed to do with the information?”

The study was supported by the Northern Ontario Academic Medicine Association Clinical Innovation Opportunities Fund, the Ottawa Hospital Academic Medical Organization Innovation Fund, and a Canadian Institutes of Health Research Operating Grant. One author was a consultant for ProofDx, a startup company creating a point-of-care diagnostic test for COVID-19, and is an advisor for SIGNAL1, a startup company deploying machine-learning models to improve inpatient care. Nott, Rogak, and Popp reported having no relevant financial relationships.



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[missy]

This post is about vaccines for fall. Including the Covid vaccines

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Fall Vaccine Updates From the Advisory Committee on Immunization Practices: New Recommendations​

Sandra Adamson Fryhofer, MD
DISCLOSURES | November 08, 2024

This episode of Medicine Matters reviews highlights from the Advisory Committee on Immunization Practices’ (ACIP's) October 2024 meeting, with new recommendations for pneumococcal, COVID, and meningococcal B (Men B) vaccines, as well as a safety update for maternal RSV vaccination.

Pneumococcal Vaccination and New Lower Age-Based Recommendations​

New age-based recommendation. ACIP has lowered the age for routine vaccination with the pneumococcal conjugate vaccine (PCV) from age 65 down to age 50, but only with PCV. Review of data revealed that more than half of those in the 50- to 64-year-old age group already had a risk indication to receive a PCV dose. In addition, rates of invasive pneumococcal disease peak at younger ages in Black patients compared with White patients. The rate of invasive pneumococcal disease (IPD) among Black adults aged 50 or older exceeds the average rate of IPD for all adults aged 65 or older. The goal of this age-based change is to reduce disease in demographic groups with the highest burden of disease.

The new expanded age-based recommendation applies only to vaccination with PCV. Conjugate vaccines trigger memory B-cell production and therefore induce greater long-term immunity. New research is now focusing on higher-valent PCV vaccines. Two 24-valent pneumococcal conjugate vaccines and one 31-valent pneumococcal conjugate vaccine are now in advanced stages of development.



Risk-based recommendation. A risk-based recommendation for ages 19 through 49 years still applies to those with certain medical conditions, including diabetes; chronic heart, lung, liver, or kidney disease; and also for those with immunocompromising conditions. Risk-based recommendations are harder to implement particularly because many vaccines are now administered in pharmacies and pharmacists don’t know the patients as well as their physicians do, so it’s harder for them to know who should get the vaccine if the recommendation is based on risk.

COVID-19 Vaccines With Additional Dose Recommendations​

Everyone 6 months or older is recommended to receive a dose of the updated 2024-2025 COVID vaccine. An additional updated COVID vaccine dose is now recommended for everyone aged 65 or older, and for those aged 6 months or older with immunocompromising (moderate or severe) conditions. Review of data revealed that 1 in 6 patients hospitalized with COVID have an immunocompromising condition, and 70% of COVID hospitalizations are in those aged 65 or older. This older age group also has the highest death rates due to COVID-19. We know that vaccination protection wanes with time. Data from previous studies show that additional vaccine doses provide additional protection. Additional doses are now being recommended for those at highest risk.

Timing of additional doses. This second dose is recommended at 6 months after the last updated COVID-19 vaccine dose. However, the additional dose can be given as early as 2 months after the last dose. Those who recently had COVID-19 can wait 3 months before getting an additional vaccine dose. This flexibility allows patients to maximize additional protection by timing additional doses around travel and life events, such as weddings, family get-togethers, or chemotherapy.

Those with immunocompromising conditions may receive more doses. Patients with immunocompromising conditions can receive even more additional doses, if recommended by their physician, under shared clinical decision-making.

Meningococcal Vaccines​

Meningococcal disease is rare but deadly. The disease can progress rapidly. As many as 10%-15% of people with meningococcal infection die, even with appropriate antibiotic therapy. And for those who survive, about 20% suffer long-term sequalae (cognitive deficits, hearing loss, limb amputations).

Aligning Men B vaccine dosing intervals. The new ACIP vote applies only to Men B vaccines, of which there are two: one by GSK (brand name Bexsero), and the other by Wyeth, a Pfizer subsidiary (brand name Trumenba). The two MenB vaccine products are not interchangeable. The same type of MenB vaccine has to be used to complete the series.

The MenB vaccines initially had different dosing schedules and now they don't. ACIP voted to harmonize and align the dosing schedule for the two different MenB products to mirror recent FDA labeling updates. So now the dosing recommendations for both MenB vaccines are the same: either two doses given 6 months apart to healthy adolescents and young adults, or a three-dose series given at zero, 1-2 months, and 6 months for those at high risk or for those who want to optimize rapid protection (for example, if they are starting the series within 6 months of going off to college). But understand that the current recommendation for MenB vaccination for healthy adolescents and young adults is based on shared clinical decision-making, preferably for those aged 16-18.

MenACWY. Two doses of MenACWY are routinely recommended, with the first dose at age 11-12 and a second dose at age 16. The MenACWY vaccines are interchangeable.

Implementation challenges and new pentavalent vaccines. Having to use the same MenB vaccine product for all doses in a patient’s series is difficult. It’s even more difficult when the patient needs both MenACWY and MenB vaccinations.

Adding to the complexity is a new pentavalent vaccine from Pfizer (brand name Penbraya) that combines MenACWY with the MenB vaccine. And another pentavalent vaccine version by GSK is up for regulatory decision in February 2025.

The work group did say that they plan to take a fresh look at the meningococcal vaccination schedule. Let's hope it gets simpler, so more to come on that.

Respiratory Syncytial Virus (RSV) Vaccines​

Current RSV vaccine recommendations for older adults. RSV vaccine has both age- and risk-based recommendations. Now, everyone aged 75 or older needs a dose of RSV vaccine. Adults aged 60-75 with risk factors for severe RSV are also recommended to receive a dose of RSV vaccine, but not adults without these risk factors. The conditions associated with increased risk for severe RSV disease include lung disease, heart disease, immune compromise, diabetes, obesity with BMI of 40 or higher, neurologic or neuromuscular conditions, chronic kidney disease, liver disorders, and hematologic disorders. Frailty, as well as living in a nursing home or other long-term care facility, are other risk factors for severe RSV disease. Those aged 60-75 without these risk factors are no longer recommended to receive it.

Three RSV vaccines. We now have three RSV vaccine to choose from. Two are protein subunit vaccines. One is by Pfizer (brand name Abrysvo) that does notcontain an adjuvant. The other protein-based RSV vaccine by GSK (brand name Arexvy) does contain an adjuvant. The third RSV vaccine by Moderna (brand name mRESVIA) uses an mRNA platform, and durability of protection is still unclear. However, recent studies now suggest that the RSV protein subunit vaccines confer 36 months of protection rather than only 24 months.

All three RSV vaccines are licensed for those aged 60 or older. The age indication for GSK’s RSV vaccine, Arexvy, has already been lowered by the FDA to age 50. FDA recently lowered the age approval for Abrysvo to age 18 for those at high risk. However, ACIP has not yet expanded its age recommendations for getting these vaccines. One of the main hesitations is vaccine safety concerns. FDA's safety update presented to ACIP still suggests an increased risk for Guillain-Barré syndrome with both protein-based RSV vaccines among those aged 65 or older. Fortunately, the risk is rare: less than 10 cases per million vaccinations.

RSV immunization for infant protection. RSV season starts in October and goes through March. W e now have two new ways to protect babies. One is a maternal RSV vaccine, given at 32-36 weeks of pregnancy to moms who will deliver their babies during RSV season. But only Pfizer’s RSV vaccine (brand name Abrysvo, without an adjuvant) can be given during pregnancy.

A maternal RSV vaccine safety update, presented at ACIP, was reassuring. Abrysvo was not associated with increased risk for preterm birth or small gestational age at birth.

Nirsevimab, a long-acting monoclonal antibody, can be given to infants. Nirsevimab is indicated for all babies under 8 months of age entering their first RSV season.

People who received a maternal RSV vaccine during a previous pregnancy are notrecommended to receive additional doses during subsequent pregnancies. However, infants born to women who were vaccinated during a prior pregnancy should receive nirsevimab.

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[missy]

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Fall Vaccine Updates From the Advisory Committee on Immunization Practices: New Recommendations​

November 11, 2024|Internal Medicine

Sandra Adamson Fryhofer, MD

This episode of Medicine Matters reviews highlights from the Advisory Committee on Immunization Practices’ (ACIP’s) October 2024 meeting, with new recommendations for pneumococcal, COVID, and meningococcal B (Men B) vaccines, as well as a safety update for maternal RSV vaccination.

Pneumococcal Vaccination and New Lower Age-Based Recommendations​

New age-based recommendation. ACIP has lowered the age for routine vaccination with the pneumococcal conjugate vaccine (PCV) from age 65 down to age 50, but only with PCV. Review of data revealed that more than half of those in the 50- to 64-year-old age group already had a risk indication to receive a PCV dose. In addition, rates of invasive pneumococcal disease peak at younger ages in Black patients compared with White patients. The rate of invasive pneumococcal disease (IPD) among Black adults aged 50 or older exceeds the average rate of IPD for all adults aged 65 or older. The goal of this age-based change is to reduce disease in demographic groups with the highest burden of disease.
The new expanded age-based recommendation applies only to vaccination with PCV. Conjugate vaccines trigger memory B-cell production and therefore induce greater long-term immunity. New research is now focusing on higher-valent PCV vaccines. Two 24-valent pneumococcal conjugate vaccines and one 31-valent pneumococcal conjugate vaccine are now in advanced stages of development.

Risk-based recommendation. A risk-based recommendation for ages 19 through 49 years still applies to those with certain medical conditions, including diabetes; chronic heart, lung, liver, or kidney disease; and also for those with immunocompromising conditions. Risk-based recommendations are harder to implement particularly because many vaccines are now administered in pharmacies and pharmacists don’t know the patients as well as their physicians do, so it’s harder for them to know who should get the vaccine if the recommendation is based on risk.

COVID-19 Vaccines With Additional Dose Recommendations​

Everyone 6 months or older is recommended to receive a dose of the updated 2024-2025 COVID vaccine. An additional updated COVID vaccine dose is now recommended for everyone aged 65 or older, and for those aged 6 months or older with immunocompromising (moderate or severe) conditions. Review of data revealed that 1 in 6 patients hospitalized with COVID have an immunocompromising condition, and 70% of COVID hospitalizations are in those aged 65 or older. This older age group also has the highest death rates due to COVID-19. We know that vaccination protection wanes with time. Data from previous studies show that additional vaccine doses provide additional protection. Additional doses are now being recommended for those at highest risk.

Timing of additional doses. This second dose is recommended at 6 months after the last updated COVID-19 vaccine dose. However, the additional dose can be given as early as 2 months after the last dose. Those who recently had COVID-19 can wait 3 months before getting an additional vaccine dose. This flexibility allows patients to maximize additional protection by timing additional doses around travel and life events, such as weddings, family get-togethers, or chemotherapy.

Those with immunocompromising conditions may receive more doses. Patients with immunocompromising conditions can receive even more additional doses, if recommended by their physician, under shared clinical decision-making.

Meningococcal Vaccines​

Meningococcal disease is rare but deadly. The disease can progress rapidly. As many as 10%-15% of people with meningococcal infection die, even with appropriate antibiotic therapy. And for those who survive, about 20% suffer long-term sequalae (cognitive deficits, hearing loss, limb amputations).

Aligning Men B vaccine dosing intervals. The new ACIP vote applies only to Men B vaccines, of which there are two: one by GSK (brand name Bexsero), and the other by Wyeth, a Pfizer subsidiary (brand name Trumenba). The two MenB vaccine products are not interchangeable. The same type of MenB vaccine has to be used to complete the series.

The MenB vaccines initially had different dosing schedules and now they don’t. ACIP voted to harmonize and align the dosing schedule for the two different MenB products to mirror recent FDA (Food and Drug Administration) labeling updates. So now the dosing recommendations for both MenB vaccines are the same: either two doses given 6 months apart to healthy adolescents and young adults, or a three-dose series given at zero, 1-2 months, and 6 months for those at high risk or for those who want to optimize rapid protection (for example, if they are starting the series within 6 months of going off to college). But understand that the current recommendation for MenB vaccination for healthy adolescents and young adults is based on shared clinical decision-making, preferably for those aged 16-18.
MenACWY. Two doses of MenACWY are routinely recommended, with the first dose at age 11-12 and a second dose at age 16. The MenACWY vaccines are interchangeable.

Implementation challenges and new pentavalent vaccines. Having to use the same MenB vaccine product for all doses in a patient’s series is difficult. It’s even more difficult when the patient needs both MenACWY and MenB vaccinations.

Adding to the complexity is a new pentavalent vaccine from Pfizer (brand name Penbraya) that combines MenACWY with the MenB vaccine. And another pentavalent vaccine version by GSK is up for regulatory decision in February 2025.

The work group did say that they plan to take a fresh look at the meningococcal vaccination schedule. Let’s hope it gets simpler, so more to come on that.

Respiratory Syncytial Virus (RSV) Vaccines​

Current RSV vaccine recommendations for older adults. RSV vaccine has both age- and risk-based recommendations. Now, everyone aged 75 or older needs a dose of RSV vaccine. Adults aged 60-75 with risk factors for severe RSV are also recommended to receive a dose of RSV vaccine, but not adults without these risk factors. The conditions associated with increased risk for severe RSV disease include lung disease, heart disease, immune compromise, diabetes, obesity with BMI (body mass index) of 40 or higher, neurologic or neuromuscular conditions, chronic kidney disease, liver disorders, and hematologic disorders. Frailty, as well as living in a nursing home or other long-term care facility, are other risk factors for severe RSV disease. Those aged 60-75 without these risk factors are no longer recommended to receive it.

Three RSV vaccines. We now have three RSV vaccine to choose from. Two are protein subunit vaccines. One is by Pfizer (brand name Abrysvo) that does not contain an adjuvant. The other protein-based RSV vaccine by GSK (brand name Arexvy) does contain an adjuvant. The third RSV vaccine by Moderna (brand name mRESVIA) uses an mRNA platform, and durability of protection is still unclear. However, recent studies now suggest that the RSV protein subunit vaccines confer 36 months of protection rather than only 24 months.

All three RSV vaccines are licensed for those aged 60 or older. The age indication for GSK’s RSV vaccine, Arexvy, has already been lowered by the FDA to age 50. FDA recently lowered the age approval for Abrysvo to age 18 for those at high risk. However, ACIP has not yet expanded its age recommendations for getting these vaccines. One of the main hesitations is vaccine safety concerns. FDA›s safety update presented to ACIP still suggests an increased risk for Guillain-Barré syndrome with both protein-based RSV vaccines among those aged 65 or older. Fortunately, the risk is rare: less than 10 cases per million vaccinations.


RSV immunization for infant protection. RSV season starts in October and goes through March. We now have two new ways to protect babies. One is a maternal RSV vaccine, given at 32-36 weeks of pregnancy to moms who will deliver their babies during RSV season. But only Pfizer’s RSV vaccine (brand name Abrysvo, without an adjuvant) can be given during pregnancy.

A maternal RSV vaccine safety update, presented at ACIP, was reassuring. Abrysvo was not associated with increased risk for preterm birth or small gestational age at birth.

Nirsevimab, a long-acting monoclonal antibody, can be given to infants. Nirsevimab is indicated for all babies under 8 months of age entering their first RSV season.

People who received a maternal RSV vaccine during a previous pregnancy are not recommended to receive additional doses during subsequent pregnancies. However, infants born to women who were vaccinated during a prior pregnancy should receive nirsevimab.

Sandra Adamson Fryhofer, Adjunct Clinical Associate Professor of Medicine, Emory University School of Medicine, Atlanta, Georgia, has disclosed conflicts of interest with the American Medical Association, the Medical Association of Atlanta, ACIP, and Medscape.

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[missy]

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Pemphigus, Bullous Pemphigoid Risk Increased After COVID-19 Infection​

November 11, 2024|Dermatology

Deepa Varma

TOPLINE:​

COVID-19 infection increases the risk for autoimmune blistering diseases (AIBDs), specifically pemphigus and bullous pemphigoid, according to a study that also found that vaccination against COVID-19 is associated with a reduced risk for these conditions.

METHODOLOGY:​

• Researchers conducted a population-based retrospective cohort study using data from the TriNetX Analytics Network, encompassing over 112 million electronic health records in the United States.
• The study compared the risk for AIBD within 3 months among individuals who had COVID-19 infection and no COVID-19 vaccination 6 months prior to the infection (n = 4,787,106), individuals who had COVID-19 vaccination but did not have COVID-19 infection (n = 3,466,536), and individuals who did not have COVID-19 infection or vaccination (n = 5,609,197).
• The mean age of the three groups was 44.9, 52.3, and 49.3 years, respectively.
• Propensity score matching included 4,408,748 individuals each for the comparison between COVID-19 infection and controls, 3,465,420 for COVID-19 vaccination and controls, and 3,362,850 for COVID-19 infection and vaccination. The mean follow-up ranged from 72.2 to 76.3 days.

TAKEAWAY:​

• Individuals with COVID-19 infection showed a 50.8% increased risk for AIBD within 3 months (P < .001) compared with those without infection or vaccination. The risk was more pronounced for pemphigus (hazard ratio
  

 

[missy]

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The future of vaccine policy in the United States​

Common misconceptions and what I'm paying attention to in the future​

KATELYN JETELINA NOV 13

Vaccines have saved millions of lives over the past century. However, the future of vaccines in the United States—availability, policy, and guardrails—is in question mainly due to the prospect of national leadership by individuals with an established track record of ignoring scientific evidence. This also comes when we see an underlying shift in some perceptions of routine vaccination policies.
We don’t know much right now, but many misconceptions are starting to bubble up on social media. Here are some clarifications on vaccine policy in the United States and thoughts on what I will watch closely and why.

Many, many Americans still support vaccinations ​

The vast majority of Americans—88%—still believe the benefits of routine childhood vaccines, like the measles vaccine (MMR), outweigh the risks. One statistic I think is greatly underappreciated is that 90% of adults got the first Covid-19 vaccine. When was the last time 90% of Americans agreed on something? This is credited with saving millions of lives in the United States.
In recent years, the strength of vaccine support (% who find routine vaccinations “extremely important”) and support for vaccine mandates across political parties have dramatically shifted. This came to the limelight during the pandemic but has also bled into mandates for routine vaccinations, as reflected in recent national polls by Pew and Gallup.

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Sources: Pew and Gallup; Annotated by YLE
Vaccine mandates date back to the mid-1800s, when the smallpox vaccine was introduced. Since then, there has been overwhelming evidence that mandates increase vaccine coverage and reduce the incidence of diseases compared to before the mandates were introduced. However, how some weigh this scientific evidence with their values (like the role of individualism vs. collective good) is shifting.

States primarily control vaccine policy, not the federal government ​

In the United States, vaccine policy is primarily governed by individual states rather than the federal government. Each state has the authority to create its laws and regulations around vaccination, including for school attendance and employment requirements for healthcare workers, public health interventions (like during a pandemic), and medical and non-medical exemptions.
Given strong bipartisan support, there has been little state-level policy variability. To this day, all 50 states still require certain school-entry vaccines, and most states align with the CDC recommendations.
Of course, mandates could be dropped in states in the coming years. But I think what is more likely is changes to vaccine exemptions. Routine vaccine exemptions can be granted for medical and non-medical reasons (religious or personal).
If we pool vaccine exemptions across all states, the percentage of kindergarteners with non-medical vaccine exemptions is still low (3.3%) but has increased since 2011 (1.5%). This equates to about 280,000 kindergarteners not up to date on vaccinations this year.

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There is great between-state variability, though. Some states, like Idaho, have reached an exemption rate upwards of 14%. This means that there are more pockets of unvaccinated children, which only need an ember for diseases to spread.

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On the other side of the spectrum, five states do not allow non-medical exemptions, and interestingly, they are a mixed bag of political party leanings: California, Mississippi, West Virginia, Connecticut, and Maine.

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Source: https://www.ncsl.org/health/routine-child-vaccination#:~:text=States%20play%20a%20significant%20role,to%20vaccines%20and%20insurance%20coverage.
The rise of vaccine exemptions could impact everyone because infectious diseases don’t see borders. An individual’s decision to get vaccinated changes everyone's risk-benefit calculation. In other words, your probability of encountering measles is low because so many people around you are vaccinated.
Similarly, what happens in one state can directly impact those around it. Even if that neighboring state has a high vaccination rate, vaccines aren’t perfect. Vaccines, like MMR, work well because they are safe and effective andbecause herd immunity means there isn’t a lot of disease circulating, preventing breakthrough cases.

The federal government can indirectly influence vaccine policy ​

Although vaccine policy is largely determined at the state level, there are certainly places where the federal government plays a critical role. My biggest questions lie here with the recent elections: What indirect federal levers will be pulled regarding vaccines, where, and how?
There are a lot of possibilities:

1. FDA determines the safety and effectiveness of vaccines. RFK, Jr. has repeatedly said that he wants a more rigorous vaccine review process, which signals changes in the FDA process. Given that the United States has one of the world’s most rigorous review processes for vaccine safety and effectiveness, it’s unclear what he wants changed or what data would be considered sufficient. More data or review processes could delay new vaccines. The FDA could also remove emergency use authorization (so we wouldn’t get vaccines as fast for the next pandemic). Removing vaccines already on the market is possible. We’ve done it in the past, but only with strong evidence that a vaccine is causing more harm than good. Removing vaccines for other reasons would be very hard to accomplish—it would probably land at the Supreme Court eventually.
2. CDC determines vaccine policy, including who is eligible for vaccines and when. RFK Jr has long criticized CDC for recommending the childhood vaccine schedule. CDC has an external advisory group of experts—called ACIP—that advises CDC. The HHS secretary selects ACIP members. We don’t know who has been slated for HHS secretary, but Joseph Ladapo is on the shortlist and could select members who ignore scientific evidence as he has in the past. Also, ACIP could be dismantled altogether, as Project 2025 has called for. This could be hugely problematic as insurance companies use CDC’s recommendations to determine what vaccines are covered. Adding cost to routine vaccinations could easily deter uptake. CDC policy also determines the Vaccines for Children (VFC) program, including which vaccines will be free to children. (1 in 2 American children are eligible for this program.)

Of course, there are other indirect levers. For example, Trump suggested using the Department of Education to withhold funds from schools with vaccine mandates. However, given that schools receive 10% of their budget from the federal government, it’s unclear how much impact this would have. And, of course, an indirect lever could not be through policy at all. Continuing to sew doubt and confusion about vaccines from the most powerful office could profoundly impact Americans’ ability to make evidence-based decisions in an increasingly noisy world.

Bottom line​

The vast majority of Americans still support vaccinations. However, there are a few key areas to consider if and how vaccine policy will shift in the coming years, which may directly or indirectly impact you. Only time will tell how this may (or may not) unfold.


"

 

[Austina]

Had my Covid vax on Tuesday, and had a sore area around the injection site. Other than feeling a bit tired, no real reaction.

 

[dk168]

Had my Covid and flu vaccines on 03 October 2024, the first day of this year's vaccine campaign in UK.

I delayed my trip to Vancouver until after I had my vaccines and was very grateful that I managed to get an appointment at a large pharmacy in another town.
I flew out to Vancouver the next day.
Apart from slight sore arms around the injection sites (one vaccine on each arm), I did not experience any other issues.

Can't comment on the low uptake in the UK as reported in the news. Not sure if it is just Covid or both Covid and flu.

Both are free for those who are vulnerable, myself included.

Just being responsible for my own health, and not to be a burden on our crippling National Health Service by being ill with Covid or flu!

DK

 

[Ally T]

I turned 50 this year & as I am not in the vulnerable group, I am not offered a Covid jab & haven’t been eligible for the last 2 years, so haven’t had one. None of my siblings are eligible either, the youngest being 45 & oldest 59.

To be honest, it’s like covid never happened here now & it’s never talked about. The only reference I make is the fact that my ‘Covid Babies’ (the children that started Primary in Sept 2020 & kept in a bubble with me at school aged 4) are now in Year 5, so turning 10 this school year. Time flies!

I have had Covid 3 times since 2021 & each time, just a minor cold / inconvenience / lack of taste or smell. For me (everyone experiences Covid differently & so I am not judging) it has just become a way of life & isn’t talked about. The last time I had it (in May) I attended school as normal & worked through, as I felt well enough to do so (Just a loss of smell) & those are the guidelines here now.

Eventually Covid will just absorb into the umbrella of all strains of flu & don’t beat me up for this, but it’s just not a thing to me anymore.

 

[Austina]

You’re considerably younger than us @Ally T, and as we’ll be with a lot of people over Christmas, we decided to have the jab. Sounds like you had relatively mild cases thankfully. Colin’s had Covid but had immediate access to Paxlovid so was fine, I didn’t get it in spite of him coughing all over me during his incubation period. I have the jabs to stop him worrying.

 

[missy]

"​

MedPage's AI Search Assistant | MedPage Today

Enter your search topic or question: We’ll scour all of the MedPage content for relevant articles—and also provide an AI-generated synopsis of our findings.

www.medpagetoday.com

​

COVID Cases Update: Map Reveals Return of 'Very High' Water Virus Levels​

After weeks of decline, "very high" levels of coronavirus have been detected in wastewater samples in the U.S.
"High" levels of viral activity are also on the rise with detections now in five U.S. states, according to the U.S. Centers for Disease Control and Prevention (CDC).
"Very high" levels of viral activity have been detected in Montana, with "high" levels in Arkansas, Maine, Minnesota, Nebraska and Wyoming.
Meanwhile, "moderate" levels have been detected in Arizona, Idaho, Kentucky, New Mexico, Oklahoma, Oregon, Pennsylvania, South Dakota, and Vermont. "Low" viral activity has been reported in 21 states with "minimal" levels—the lowest classification—in 14 states.

Viral levels in wastewater are a helpful indicator of disease prevalence within a population.
After a surge in COVID-19 cases this summer, infection rates seem to be on the decline. As of October 26, positive results account for only 5 percent of all tests, excluding at-home testing, in the U.S., down 0.6 percent from the previous week, according to the CDC data.
As of October 31, the overall viral activity level in wastewater across the country has been classified as "low" by the CDC, with the highest wastewater levels concentrated in the Midwest.
The map below shows which states have seen the highest detections in wastewater:



Is COVID on the rise?
Recent spikes in COVID-19 cases have been largely driven by a new class of subvariants nicknamed FLiRT after the position of the mutations on the virus' spike proteins, the projections that allow them to enter our cells.
These proteins are also used as targets by immune systems and vaccinations, so changes in their structure can allow the virus to bypass the body's defenses more easily. However, existing vaccines are likely to provide at least some form of protection against more severe symptoms and long COVID-19.

"


@Austina that's a smart decision IMO..it surely will spike over the holidays and Covid is still responsible for many deaths sadly

Coronavirus Death Toll and Trends - Worldometer

Updated total and statistics, graphs and charts tracking the total number of deaths, deaths per day, and death by country from the Novel Coronavirus (2019-nCoV) originating from Wuhan, China

www.worldometers.info

 

[missy]

"

We Haven’t Kicked Our Pandemic Drinking Habit​

November 21, 2024|Internal Medicine News

F. Perry Wilson, MD, MSCE


You’re stuck in your house. Work is closed or you’re working remotely. Your kids’ school is closed or is offering an hour or two a day of Zoom-based instruction. You have a bit of cabin fever which, you suppose, is better than the actual fever that comes with COVID infections, which are running rampant during the height of the pandemic. But still — it’s stressful. What do you do?

We all coped in our own way. We baked sourdough bread. We built that tree house we’d been meaning to build. We started podcasts. And ... we drank. Quite a bit, actually.
During the first year of the pandemic, alcohol sales increased 3%, the largest year-on-year increase in more than 50 years. There was also an increase in drunkenness across the board, though it was most pronounced in those who were already at risk from alcohol use disorder.

Alcohol-associated deaths increased by around 10% from 2019 to 2020. Obviously, this is a small percentage of COVID-associated deaths, but it is nothing to sneeze at.

But look, we were anxious. And say what you will about alcohol as a risk factor for liver disease, heart disease, and cancer — not to mention traffic accidents — it is an anxiolytic, at least in the short term.

But as the pandemic waned, as society reopened, as we got back to work and reintegrated into our social circles and escaped the confines of our houses and apartments, our drinking habits went back to normal, right?

Americans’ love affair with alcohol has been a torrid one, as this graph showing gallons of ethanol consumed per capita over time shows you.

What you see is a steady increase in alcohol consumption from the end of prohibition in 1933 to its peak in the heady days of the early 1980s, followed by a steady decline until the mid-1990s. Since then, there has been another increase with, as you will note, a notable uptick during the early part of the COVID pandemic.

What came across my desk this week was updated data, appearing in a research letter in Annals of Internal Medicine, that compared alcohol consumption in 2020 — the first year of the COVID pandemic — with that in 2022 (the latest available data). And it looks like not much has changed.

This was a population-based survey study leveraging the National Health Interview Survey, including around 80,000 respondents from 2018, 2020, and 2022.

They created two main categories of drinking: drinking any alcohol at all and heavy drinking.

In 2018, 66% of Americans reported drinking any alcohol. That had risen to 69% by 2020, and it stayed at that level even after the lockdown had ended, as you can see here. This may seem like a small increase, but this was a highly significant result. Translating into absolute numbers, it suggests that we have added between 3,328,000 and 10,660,000 net additional drinkers to the population over this time period.

This trend was seen across basically every demographic group, with some notably larger increases among Black and Hispanic individuals, and marginally higher rates among people under age 30.

But far be it from me to deny someone a tot of brandy on a cold winter’s night. More interesting is the rate of heavy alcohol use reported in the study. For context, the definitions of heavy alcohol use appear here. For men, it’s any one day with five or more drinks or 15 or more drinks per week. For women it’s four or more drinks on a given day or eight drinks or more per week.

The overall rate of heavy drinking was about 5.1% in 2018 before the start of the pandemic. That rose to more than 6% in 2020 and it rose a bit more into 2022. The net change here, on a population level, is from 1,430,000 to 3,926,000 new heavy drinkers. That’s a number that rises to the level of an actual public health issue.

Again, this trend was fairly broad across demographic groups. Although in this case, the changes were a bit larger among White people and those in the 40- to 49-year age group. This is my cohort, I guess. Cheers.

The information we have from this study is purely descriptive. It tells us that people are drinking more since the pandemic. It doesn’t tell us why, or the impact that this excess drinking will have on subsequent health outcomes, although other studies would suggest that it will contribute to certain chronic conditions, both physical and mental.

Maybe more important is that it reminds us that habits are sticky. Once we become accustomed to something — that glass of wine or two with dinner, and before bed — it has a tendency to stay with us. There’s an upside to that phenomenon as well, of course; it means that we can train good habits too. And those, once they become ingrained, can be just as hard to break. We just need to be mindful of the habits we pick. New Year 2025 is just around the corner. Start brainstorming those resolutions now.



Wilson is associate professor of medicine and public health and director of the Clinical and Translational Research Accelerator at Yale University, New Haven, Conn. He has disclosed no relevant financial relationships.

"

 

[missy]

"

We Haven’t Kicked Our Pandemic Drinking Habit​

November 21, 2024|Internal Medicine News

F. Perry Wilson, MD, MSCE


You’re stuck in your house. Work is closed or you’re working remotely. Your kids’ school is closed or is offering an hour or two a day of Zoom-based instruction. You have a bit of cabin fever which, you suppose, is better than the actual fever that comes with COVID infections, which are running rampant during the height of the pandemic. But still — it’s stressful. What do you do?

We all coped in our own way. We baked sourdough bread. We built that tree house we’d been meaning to build. We started podcasts. And ... we drank. Quite a bit, actually.
During the first year of the pandemic, alcohol sales increased 3%, the largest year-on-year increase in more than 50 years. There was also an increase in drunkenness across the board, though it was most pronounced in those who were already at risk from alcohol use disorder.

Alcohol-associated deaths increased by around 10% from 2019 to 2020. Obviously, this is a small percentage of COVID-associated deaths, but it is nothing to sneeze at.

But look, we were anxious. And say what you will about alcohol as a risk factor for liver disease, heart disease, and cancer — not to mention traffic accidents — it is an anxiolytic, at least in the short term.

But as the pandemic waned, as society reopened, as we got back to work and reintegrated into our social circles and escaped the confines of our houses and apartments, our drinking habits went back to normal, right?

Americans’ love affair with alcohol has been a torrid one, as this graph showing gallons of ethanol consumed per capita over time shows you.

What you see is a steady increase in alcohol consumption from the end of prohibition in 1933 to its peak in the heady days of the early 1980s, followed by a steady decline until the mid-1990s. Since then, there has been another increase with, as you will note, a notable uptick during the early part of the COVID pandemic.

What came across my desk this week was updated data, appearing in a research letter in Annals of Internal Medicine, that compared alcohol consumption in 2020 — the first year of the COVID pandemic — with that in 2022 (the latest available data). And it looks like not much has changed.

This was a population-based survey study leveraging the National Health Interview Survey, including around 80,000 respondents from 2018, 2020, and 2022.

They created two main categories of drinking: drinking any alcohol at all and heavy drinking.

In 2018, 66% of Americans reported drinking any alcohol. That had risen to 69% by 2020, and it stayed at that level even after the lockdown had ended, as you can see here. This may seem like a small increase, but this was a highly significant result. Translating into absolute numbers, it suggests that we have added between 3,328,000 and 10,660,000 net additional drinkers to the population over this time period.

This trend was seen across basically every demographic group, with some notably larger increases among Black and Hispanic individuals, and marginally higher rates among people under age 30.

But far be it from me to deny someone a tot of brandy on a cold winter’s night. More interesting is the rate of heavy alcohol use reported in the study. For context, the definitions of heavy alcohol use appear here. For men, it’s any one day with five or more drinks or 15 or more drinks per week. For women it’s four or more drinks on a given day or eight drinks or more per week.

The overall rate of heavy drinking was about 5.1% in 2018 before the start of the pandemic. That rose to more than 6% in 2020 and it rose a bit more into 2022. The net change here, on a population level, is from 1,430,000 to 3,926,000 new heavy drinkers. That’s a number that rises to the level of an actual public health issue.

Again, this trend was fairly broad across demographic groups. Although in this case, the changes were a bit larger among White people and those in the 40- to 49-year age group. This is my cohort, I guess. Cheers.

The information we have from this study is purely descriptive. It tells us that people are drinking more since the pandemic. It doesn’t tell us why, or the impact that this excess drinking will have on subsequent health outcomes, although other studies would suggest that it will contribute to certain chronic conditions, both physical and mental.

Maybe more important is that it reminds us that habits are sticky. Once we become accustomed to something — that glass of wine or two with dinner, and before bed — it has a tendency to stay with us. There’s an upside to that phenomenon as well, of course; it means that we can train good habits too. And those, once they become ingrained, can be just as hard to break. We just need to be mindful of the habits we pick. New Year 2025 is just around the corner. Start brainstorming those resolutions now.



Wilson is associate professor of medicine and public health and director of the Clinical and Translational Research Accelerator at Yale University, New Haven, Conn. He has disclosed no relevant financial relationships.

"

 

[missy]

"

Unwanted viral guests at Thanksgiving​

Your State of Affairs going into the holiday​

KATELYN JETELINA NOV 26

Happy Thanksgiving week to those of you in the States!
The respiratory season is mild but starting to heat up. On an individual level, this means your probability of getting sick at Thanksgiving is lower than previous four years! Woot woot. On a population level, social networks are opening (hello, family), and colder temperatures are here, which means that if we let viruses spread, they will springboard into exponential spread.
Here’s a State of Affairs so you’re well-equipped for the holiday week of travel and family.

Influenza-like illnesses: Low but increasing​

The climate of respiratory health in the United States—which the CDC defines as “influenza-like illnesses” (ILI)—is increasing but still below the “epidemic” level threshold. By the shape of the curve below, it seems we are on the precipice of exponential spread.

[td]

​

[/td]​

Influenza-like illnesses (Source: CDC; Annotated by YLE)
We have returned to pre-pandemic patterns, closely tracking the 2019 respiratory season (light blue line).
The South and Washington, D.C. are starting to heat up with low to moderate ILI levels. Eventually, this entire map will be red and purple. If you’re traveling to these states, you have a slightly higher chance of getting sick, but nothing dramatic.

[td]

​

[/td]​

2024-25 Influenza Season Week 46 ending Nov 16, 2024 (Source: CDC)
Now let’s get into more specific viruses.

Common cold: High​

If you’re sick right now or someone shows up sick on Thanksgiving, it’s most likely the common cold. Two viruses, enteroviruses or rhinoviruses, are, well, common right now.

[td]

​

[/td]​

Weekly percentage of positive tests for respiratory viruses (Source: CDC; Annotated by YLE)
If a cough has lingered for weeks, mycoplasma pneumonia or “walking pneumonia” is likely the culprit. Cases are typically mild (hence the name “walking”), but because bacteria cause the disease, antibiotics can help. The U.S. usually gets a surge every 3-7 years, and thus far, cases have been about 10 times higher this year than last year.

[td]

​

[/td]​

National Percentage of pneumonia-associated emergency department visits with Mycoplasma pneumoniae infection. Data and figure from CDC. Annotated by YLE.

Influenza and RSV: Low but increasing​

Positive flu tests among physicians testing for respiratory illness are increasing slowly. However, RSV seems to be in full swing with a wave well underway.

[td]

​

[/td]​

Percentage of positive tests (Source: CDC; Annotated by YLE)
Children under 2 are at highest risk for RSV, especially if they don’t have protection from the maternal vaccine (during pregnancy) or monoclonal antibodies in infancy. If I were a mom of a newborn, I would keep my children close to me during Thanksgiving instead of passing them around for kisses. If you want people to hold the baby, asking people to wear masks is a great middle ground.
Children are also at risk for the flu. Levels are slowly increasing among kids, and CDC reported the first pediatric flu death of the season. Last year’s season didn’t get much attention but was the second most deadly flu season in two decades. Sadly, 80% of children who died and were eligible for the flu vaccine were not fully vaccinated (for their first flu season, children get 2 doses 1 month apart.)

[td]

​

[/td]​

Covid-19: Very low ​

One virus that is not on my mind this Thanksgiving is Covid-19. Can I get an amen? Wastewater levels—a good proxy for community transmission—are incredibly low across the entire United States. Given new variants, Covid-19 levels will likely start increasing soon.

[td]

​

[/td]​

Low levels of Covid-19 mean that if you’re symptomatic, you could pull out your at-home antigen test before your Thanksgiving event, but it will likely be negative. (And you should stay home regardless.) I would save your tests (and money) for later in the season.

Vaccinations: Higher than last season!​

The other thing that will help this Thanksgiving— preventing severe disease after the holiday and reducing transmission—is that vaccination rates are higher!
Today, the nationwide coverage of Covid-19 vaccination for seniors is 39%. That’s already higher than the total coverage for last year’s season (38%) and above where we were at this time last year (25%).

[td]

​

[/td]​

Covid-19 vaccination coverage by week, over 65 years old. Source: CDC. Note: vaccine availability dates differed between seasons. 2023–24 COVID-19 vaccines were first available mid-September, and 2024–25 COVID-19 vaccines were first available at the end of August.
Covid-19 vaccinations are also higher among those over 18 (18% vs. 12%) and across all races/ethnicities and urbanicity. We are seeing a similar story with RSV among pregnant folks. Vaccination coverage is at 31% compared to 18% last year.
Why is this higher than in previous years? Epidemiologists have a few guesses:

• HHS vaccination campaign. Millions of dollars were used for a public education campaign about Covid-19 and flu vaccines this fall (although we aren’t seeing any changes in flu coverage).
• Familiarity. People are getting more comfortable with the idea of an annual Covid-19 shot. It’s no longer seen as a pandemic, and people aren’t getting information shoved down their throats, causing fatigue and resistance. This is also the second season of the RSV vaccine—women saw that it worked and was safe last year.
• Timing of availability. For the first time, Covid-19 shots were approved at the same time as flu and RSV shots. Co-administration is massively convenient.

There is still room for improvement, but these developments are fantastic news.

What to do​

I’ve sprinkled some specific recommendations throughout this post, but regardless of what is circulating, what you can do to stay healthy is relatively consistent.

• It’s not too late to get vaccinated! Monoclonal antibodies, like those for RSV protection, kick in immediately. Protection from vaccines kicks in after about two weeks, so these can help with holiday parties after Thanksgiving.
• Mask up before the holiday to prevent contracting a virus in crowded areas, like at the airport or subway.
• Stay home if you feel sick. I know this isn’t fun, but it is the most important way to avoid spreading illness, especially to vulnerable friends or relatives.
• Ventilation and filtration help reduce transmission. When you’re together indoors, open a window, use a fan, or turn on an air purifier.

Bottom line​

Respiratory season is starting, but the risk of getting sick at Thanksgiving is lower than in the previous four years. Regardless, there are many things you can do to stay healthy and celebrate with loved ones.


"

 

[missy]

"

New Data: The Most Promising Treatments for Long COVID​

Sara Novak

November 27, 2024

Long COVID is a symptom-driven disease, meaning that with no cure, physicians primarily treat the symptoms their patients are experiencing. Effective treatments for long COVID remain elusive because what works for one patient may be entirely ineffective for another. But as 2024 winds down, researchers have begun to pinpoint a number of treatments that are bringing relief to the 17 million Americans diagnosed with long COVID.

Here’s a current look at what research has identified as some of the most promising treatments.

Low-Dose Naltrexone​

Some research suggests that low-dose naltrexone may be helpful for patients suffering from brain fog, pain, sleep issues, and fatigue, said Ziyad Al-Aly, MD, a global expert on long COVID and chief of research and development at the Veterans Affairs St Louis Health Care System.


Low-dose naltrexone is an anti-inflammatory agent currently approved by the US Food and Drug Administration for the treatment of alcohol and opioid dependence.

“We don’t know the mechanism for how the medication works, and for that matter, we don’t really understand what causes brain fog. But perhaps its anti-inflammatory properties seem to help, and for some patients, low-dose naltrexone has been helpful,” said Al-Aly.





A March 2024 study found that both fatigue and pain were improved in patients taking low-dose naltrexone. In another study, published in the June 2024 issue of Frontiers in Medicine, researchers found that low-dose naltrexone was associated with improvement of several clinical symptoms related to long COVID such as fatigue, poor sleep quality, brain fog, post-exertional malaise, and headache.

Selective Serotonin Reuptake Inhibitors (SSRIs) and Antidepressants​

Last year, University of Pennsylvania, Philadelphia, researchers uncovered a link between long COVID and lower levels of serotonin in the body. This helped point to the potential treatment of using SSRIs to treat the condition.

For patients who have overlapping psychiatric issues that go along with brain fog, SSRIs prescribed to treat depression and other mental health conditions, as well as the antidepressant Wellbutrin, have been shown effective at dealing with concentration issues, brain fog, and depression, said Nisha Viswanathan, MD, director of the University of California, Los Angeles (UCLA) Long COVID Program at UCLA Health.

A study published in the November 2023 issue of the journal Scientific Reports found that SSRIs led to a “considerable reduction of symptoms,” especially brain fog, fatigue, sensory overload, and overall improved functioning. Low-dose Abilify, which contains aripiprazole, an antipsychotic medication, has also been found to be effective for cognitive issues caused by long COVID.


“Abilify is traditionally used for the treatment of schizophrenia or other psychotic disorders, but in a low-dose format, there is some data to suggest that it can also be anti-inflammatory and helpful for cognitive issues like brain fog,” said Viswanathan.

Modafinil​

Modafinil, a medication previously used for managing narcolepsy, has also been shown effective for the treatment of fatigue and neurocognitive deficits caused by long COVID, said Viswanathan. She said that it’s another medication that she’s found useful for a number of her patients.

It’s thought that these cognitive symptoms are caused by an inflammatory cytokine release that leads to excessive stimulation of neurotransmitters in the body. According to a June 2024 article in the American Journal of Psychiatry, “Modafinil can therapeutically act on these pathways, which possibly contributed to the symptomatic improvement.” But the medication has not been studied widely in patients with long COVID and has been shown to have interactions with other medications.

Metformin​

Some research has shown that metformin, a well-known diabetes medication, reduces instances of long COVID when taken during the illness’s acute phase. It seems to boost metabolic function in patients.

“It makes sense that it would work because it seems to have anti-inflammatory effects on the body,” said Grace McComsey, MD, who leads one of the 15 nationwide long COVID centers funded by the federal RECOVER (Researching COVID to Enhance Recovery) Initiative in Cleveland. McComsey adds that it may reduce the viral persistence that causes some forms of long COVID.

A study published in the October 2023 issue of the journal The Lancet Infectious Diseasesfound that metformin seemed to reduce instances of long COVID in patients who took it after being diagnosed with acute COVID. It seems less effective in patients who already have long COVID.

Antihistamines​

Other data suggest that some patients with long COVID showed improvement after taking antihistamines. Research has shown that long COVID symptoms improved in 29% of patientswith long COVID.

While researchers aren’t sure why antihistamines work to quell long COVID, the thought is that when mast cells, a white blood cell that’s part of the immune system, shed granules and cause an inflammatory reaction, they release a lot of histamines. Antihistamine medications like famotidine block histamine receptors in the body, improving symptoms like brain fog, difficulty breathing, and elevated heart rate in patients.

“For some patients, these can be a lifesaver,” said David Putrino, the Nash Family Director of the Cohen Center for Recovery from Complex Chronic Illness and a national leader in the treatment of long COVID.

Putrino cautions patients toward taking these and other medications haphazardly without fully understanding that all treatments have risks, especially if you’re taking a number of them.


“Often patients are told that there’s no risk to trying something, but physicians should be counseling their patients and reminding them that there is a risk that includes medication sensitivities and medication interactions,” said Putrino.

The good news is that doctors have begun to identify some treatments that seem to be working in their patients, but we still don’t have the large-scale clinical trials to identify which treatments will work for certain patients and why.

There’s still so much we don’t know, and for physicians on the front lines of treating long COVID, it’s still largely a guessing game. “This is a constellation of symptoms; it’s not just one thing,” said Al-Aly. And while a treatment might be wildly effective for one patient, it might be ineffective or worse, problematic, for another.



"

 

[Karl_K]

Someone I know is on round 5+ of covid.
No smell no taste and breathing issues,
Was very close to going to er but getting better.
Cancer survivor who had chemo.

 

[Lookinagain]

Well, none of these viruses are gone. People just need to try to be considerate of others, not knowing their health status. If they feel sick, just stay home. That's what I always told my employees before Covid and what I would tell them now. That's what makes sense to me.

 

[monarch64]

"

New Data: The Most Promising Treatments for Long COVID​

Sara Novak

November 27, 2024

Long COVID is a symptom-driven disease, meaning that with no cure, physicians primarily treat the symptoms their patients are experiencing. Effective treatments for long COVID remain elusive because what works for one patient may be entirely ineffective for another. But as 2024 winds down, researchers have begun to pinpoint a number of treatments that are bringing relief to the 17 million Americans diagnosed with long COVID.

Here’s a current look at what research has identified as some of the most promising treatments.

Low-Dose Naltrexone​

Some research suggests that low-dose naltrexone may be helpful for patients suffering from brain fog, pain, sleep issues, and fatigue, said Ziyad Al-Aly, MD, a global expert on long COVID and chief of research and development at the Veterans Affairs St Louis Health Care System.


Low-dose naltrexone is an anti-inflammatory agent currently approved by the US Food and Drug Administration for the treatment of alcohol and opioid dependence.

“We don’t know the mechanism for how the medication works, and for that matter, we don’t really understand what causes brain fog. But perhaps its anti-inflammatory properties seem to help, and for some patients, low-dose naltrexone has been helpful,” said Al-Aly.





A March 2024 study found that both fatigue and pain were improved in patients taking low-dose naltrexone. In another study, published in the June 2024 issue of Frontiers in Medicine, researchers found that low-dose naltrexone was associated with improvement of several clinical symptoms related to long COVID such as fatigue, poor sleep quality, brain fog, post-exertional malaise, and headache.

Selective Serotonin Reuptake Inhibitors (SSRIs) and Antidepressants​

Last year, University of Pennsylvania, Philadelphia, researchers uncovered a link between long COVID and lower levels of serotonin in the body. This helped point to the potential treatment of using SSRIs to treat the condition.

For patients who have overlapping psychiatric issues that go along with brain fog, SSRIs prescribed to treat depression and other mental health conditions, as well as the antidepressant Wellbutrin, have been shown effective at dealing with concentration issues, brain fog, and depression, said Nisha Viswanathan, MD, director of the University of California, Los Angeles (UCLA) Long COVID Program at UCLA Health.

A study published in the November 2023 issue of the journal Scientific Reports found that SSRIs led to a “considerable reduction of symptoms,” especially brain fog, fatigue, sensory overload, and overall improved functioning. Low-dose Abilify, which contains aripiprazole, an antipsychotic medication, has also been found to be effective for cognitive issues caused by long COVID.


“Abilify is traditionally used for the treatment of schizophrenia or other psychotic disorders, but in a low-dose format, there is some data to suggest that it can also be anti-inflammatory and helpful for cognitive issues like brain fog,” said Viswanathan.

Modafinil​

Modafinil, a medication previously used for managing narcolepsy, has also been shown effective for the treatment of fatigue and neurocognitive deficits caused by long COVID, said Viswanathan. She said that it’s another medication that she’s found useful for a number of her patients.

It’s thought that these cognitive symptoms are caused by an inflammatory cytokine release that leads to excessive stimulation of neurotransmitters in the body. According to a June 2024 article in the American Journal of Psychiatry, “Modafinil can therapeutically act on these pathways, which possibly contributed to the symptomatic improvement.” But the medication has not been studied widely in patients with long COVID and has been shown to have interactions with other medications.

Metformin​

Some research has shown that metformin, a well-known diabetes medication, reduces instances of long COVID when taken during the illness’s acute phase. It seems to boost metabolic function in patients.

“It makes sense that it would work because it seems to have anti-inflammatory effects on the body,” said Grace McComsey, MD, who leads one of the 15 nationwide long COVID centers funded by the federal RECOVER (Researching COVID to Enhance Recovery) Initiative in Cleveland. McComsey adds that it may reduce the viral persistence that causes some forms of long COVID.

A study published in the October 2023 issue of the journal The Lancet Infectious Diseasesfound that metformin seemed to reduce instances of long COVID in patients who took it after being diagnosed with acute COVID. It seems less effective in patients who already have long COVID.

Antihistamines​

Other data suggest that some patients with long COVID showed improvement after taking antihistamines. Research has shown that long COVID symptoms improved in 29% of patientswith long COVID.

While researchers aren’t sure why antihistamines work to quell long COVID, the thought is that when mast cells, a white blood cell that’s part of the immune system, shed granules and cause an inflammatory reaction, they release a lot of histamines. Antihistamine medications like famotidine block histamine receptors in the body, improving symptoms like brain fog, difficulty breathing, and elevated heart rate in patients.

“For some patients, these can be a lifesaver,” said David Putrino, the Nash Family Director of the Cohen Center for Recovery from Complex Chronic Illness and a national leader in the treatment of long COVID.

Putrino cautions patients toward taking these and other medications haphazardly without fully understanding that all treatments have risks, especially if you’re taking a number of them.


“Often patients are told that there’s no risk to trying something, but physicians should be counseling their patients and reminding them that there is a risk that includes medication sensitivities and medication interactions,” said Putrino.

The good news is that doctors have begun to identify some treatments that seem to be working in their patients, but we still don’t have the large-scale clinical trials to identify which treatments will work for certain patients and why.

There’s still so much we don’t know, and for physicians on the front lines of treating long COVID, it’s still largely a guessing game. “This is a constellation of symptoms; it’s not just one thing,” said Al-Aly. And while a treatment might be wildly effective for one patient, it might be ineffective or worse, problematic, for another.



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Ms. Novak needs to check their facts. LDN is not only approved as an opioid antagonist; it has been long approved in conjunction with bupropion (Wellbutrin) as “Contrave “ which is a weight loss drug. And et cetera. I can’t even read the rest of the publication knowing she’s wrong right off the bat.

 

[missy]

Ms. Novak needs to check their facts. LDN is not only approved as an opioid antagonist; it has been long approved in conjunction with bupropion (Wellbutrin) as “Contrave “ which is a weight loss drug. And et cetera. I can’t even read the rest of the publication knowing she’s wrong right off the bat.

I can't find where she wrote it is *only* approved as an opioid antagonist...I have been taking it for over 7 years now as an anti-inflammatory and have found it to be very helpful re my Hashimoto's