Coronavirus updates October 2024

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Long COVID fatigue shows up as distinct changes in brain scans​

Published September 27, 2024 | Originally published on ScienceAlert Latest

Fatigue is one of the most frequent and debilitating symptoms of long COVID, and yet it is also one of the hardest to measure objectively.
A new study suggests the extreme mental and physical fatigue experienced by many long COVID patients is, in fact, observable in the central nervous system.
Scanning the brains of 127 long COVID patients, scientists found some parts of the brain were communicating with others in a slightly altered way.
These regions include the frontal lobe, the temporal lobe, and the cerebellum, and while it's not clear how long the changes might last, the pattern could be used to identify those battling ongoing fatigue.
"These findings suggest a role of central nervous system involvement in the pathophysiology of fatigue in post-COVID syndrome," writeresearchers at the Complutense University of Madrid in Spain.
"The existence of several brain characteristics associated with fatigue severity detected by magnetic resonance imaging could constitute a neuroimaging biomarker to objectively evaluate this symptom in clinical trials."
The frontal lobe is the part of the brain associated with higher executive functions, like planning, reasoning, and problem solving. Meanwhile, the temporal lobe is associated with memory and processing, and the cerebellum is linked to movement, posture, and balance.
All three areas have previously shown changes in connectivity among patients with chronic fatigue syndrome or myalgic encephalomyelitis(CFS/ME).
CFS/ME comes with many of the same symptoms as long COVID; however, it remains unclear how the two illnesses relate.
Recent findings suggest brain changes associated with long COVID mirror those of CFS/ME, but further research using larger and more diverse sample sizes is needed.
The new study on long COVID, led by neuropsychologist Maria Diez-Cirarda, does not consider CFS/ME, but it analyzes the brain scans of 127 people who had contracted SARS-CoV-2 at least three months before. Around 74 percent of participants were female, and most had only been sick with COVID-19 once.
Roughly 87 percent reported symptoms of global fatigue, including physical or mental fatigue, and 86 percent said they were suffering from cognitive complaints, like memory, attention, or processing issues.
Ultimately, those with global fatigue, physical fatigue, or cognitive complaints showed reduced connectivity between the frontal and occipital brain regions. They also showed increased connectivity between the cerebellar and temporal areas.
Mental fatigue, however, stood out. It was associated with distinct changes in the left prefrontal areas, the anterior cingulate, and the left insula – the central hubs of a known mental fatigue network.
Changes to white matter were also found in the brains of long COVID patients with lingering fatigue. White matter contains the nerve fibers that connect neurons, and these are covered in white sheaths, which protect and allow messages to be sent faster.
In long COVID patients, the recent study suggests that physical and mental fatigue is "partly related to several microstructural changes, including demyelination."
Demyelination is when the insulating sheath that protects neurons and transmits electrical signals is damaged, resulting in reduced functionality, such as muscle weakness, blurry vision, or slurred speech.
Interestingly, the current brain study found no changes in gray matter, which contains the bodies of neurons. Previous studies have shown reduced gray matter in COVID patients, but this shrinkage was recorded during or shortly after an infection, and it may not last over the longer term.
Given how malleable the brain can be, it's important that future studies investigate the changes of long COVID over greater lengths of time. Further research could also investigate how fatigue due to long COVID compares to other conditions, like ME/CFS or multiple sclerosis.
"The involvement of the central nervous system in the pathophysiology of fatigue in post-COVID syndrome paves the way for the use of non-invasive brain stimulation techniques to alleviate fatigue in these patients," the researchers conclude.
The study was published in Psychiatry Research.
This article was originally published on ScienceAlert Latest.

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Two studies find SARS-CoV-2 virus becoming resistant to antiviral drugs used to treat patients​

Published September 30, 2024 | Originally published on MedicalXpress Breaking News-and-Events

Two studies have found that the virus that causes COVID-19 is becoming resistant to two drugs used to treat patients with infections.
In the first study, a combined team from Cornell University and the National Institutes of Health studied the treatment outcomes for patients with compromised immune systems who were given the drug remdesivir. They have published their results in the journal Nature Communications.
In the second study, a team of researchers from the University of Pittsburgh, Brigham and Women's Hospital, Stanford University and Harvard University studied the outcomes for COVID-19 patients given antiviral drugs over the years 2021 to 2023. They published their results in the journal JAMA Network Open.
Zhuo Zhou and Peng Hong, with the Chinese Academy of Medical Sciences & Peking Union Medical College and VA New York Harbor Healthcare System, respectively, have published a Commentary piece in the same JAMA Network Open issue outlining the work by the second team.
In the years since the height of the COVID-19 pandemic, medical researchers have continued to study SARS-CoV-2, along with new vaccine options. They have also been working on developing new therapies for people who are infected by the virus but have not been immunized or who have compromised immune systems.
As part of that effort, two such therapies, named remdesivir and nirmatrelvir, have become the go-to drugs for patients with immune systems that are not capable of fighting off the virus. But because they are antivirals, they run the risk of obsolescence as the virus mutates.
In the first study, the researchers sequenced the DNA of the virus infecting 15 COVID patients and found that the virus had developed a reduced sensitivity to both remdesivir and nirmatrelvir. They also found that the mutated viruses could infect others in the vicinity. One positive note: The researchers found that giving both antivirals to patients cleared the virus.
In the second study, the research team studied the treatment of 156 COVID-19 patients over two years—as part of that effort, the researchers divided the patients into two groups: those who had received the antiviral drugs and those who had not. Viruses with antiviral-resistant mutations were more likely to be found in patients who had received antiviral drugs. The effect was more evident in the immunocompromised and those who had received nirmatrelvir.
This article was originally published on MedicalXpress Breaking News-and-Events.
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They're idiots. Why don't they trust us? ​

Shame doesn't work, but we keep using it.​

KRISTEN PANTHAGANI, MD, PHD OCT 2

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This is post 3 of 4 in this mini-series looking back at the public health communication around the COVID vaccines, why trust was lost, and where communication broke down. The goal is not to point fingers or assign blame, but to get a view from outside our bubble and understand how messages were perceived. Catch up on the first two posts: misinformation versus miscommunication and expectation management.

Shame doesn’t work, but has become widely adopted as a response to vaccine misinformation.
“Denormalizing”—the process of reinforcing a negative behavior as socially unacceptable, can be beneficial, and has proven successful in public health efforts such as campaigns to reduce smoking. However, it’s a double-edged sword—efforts to denormalize a behavior can lead to shame and stigma, which don’t help. We know from the literature around smoking and alcohol use that shame and stigma not only don’t work, but often backfire. One studyfound exposure to negative stereotypes about smoking actually increased the drive to smoke.
Denormalization can help, but shame can cause harm. Where is the line?
Renowned shame researcher Brené Brown draws a distinction between shame and guilt that helps clarify: guilt says I’ve done something bad, shame says I am bad. Guilt is helpful—it reveals when behaviors need to change. Shame, on the other hand, smothers us. It employs the ad hominem fallacy—instead of addressing an argument or behavior, it attacks the person themselves.
Guilt says: this was the wrong decision. Shame says: you are idiots.

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New Yorker
Shame has, unfortunately, been widely adopted as a strategy to combat vaccination misinformation. An analysis of TikTok videos about vaccines revealed that videos promoting vaccines overall used more negative language and more judgment, while “anti-vax” videos used more positive language and had higher levels of positive appreciation and emotion. In particular, they found pro-vaccine videos sometimes labeled “anti-vaxxers as weak, stupid, fragile, selfish, or crazy and their behaviour as insane or dumb.”
In my own experience, I’ve found this to be true—while I’ve had my fair share of awful comments from people opposing vaccines, I’ve found some of the pro-vaccine comments can also be extremely vicious. For example, I’ve had to delete comments off my Instagram posts from pro-vaccine advocates telling those who distrust vaccines to go kill themselves.
Of course, these extreme vicious comments are the minority, but the ad hominem sentiment that “anti-vaxxers are stupid” has become mainstream, featured in headlines and late-night talk show segments.

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Huffpost, Chicago Tribune, Metro

Is this strategy working? No, it’s making things worse​

While often a well-intentioned effort to combat misinformation, shame-based or “mean” messaging backfires. This is intuitive: we generally don’t take advice from people who treat us with contempt and disgust, even if they have credentials. This is also backed up by data:

• In a study conducted during the COVID vaccine rollout, perceived ‘moral reproach’ (feeling morally judged for not being vaccinated against COVID) did not motivate people to get vaccinated, and instead did the opposite—it strongly predicted vaccine refusal.
• A study using natural language processing of Twitter conversations found that corrections to misinformation that used positive and polite language were more likely to be effective, whereas corrections that used negative language (calling someone an idiot) were more likely to backfire, further entrenching the recipient in their belief.

Rants get views, and it’s easy to confuse virality with effectiveness. Social media content bashing antivaxxers is often popular because people who already trust vaccines cheer it on. But is this helping reach the people who actually need to be reached? Probably not, and if they do see it, the data suggests it will make them more hesitant about vaccines, not less.

It’s less about facts and more about values​

Shame-based messaging ignores a critical dynamic in vaccine hesitancy: vaccine refusal isn’t just about intelligence or lack of understanding of facts and data. Often it has far more to do with people’s values and identity.
Katherine Hayhoe, internationally recognized climate scientist and science communicator, recommends when talking about climate change, the solution is not just showing people more and more data. Instead, she recommends connecting over values they already hold dear. This allows them to incorporate new information into their worldview instead of trying to change a core piece of who they are.
Shame-based messaging does the opposite: instead of connecting with a person’s identity and values, it attacks them.

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Messaging like this has the potential to do more harm than good, as it tells the audience that their values and beliefs don’t matter. Source

Why is it so tempting to shame?​

A lot of shame-based messaging is driven out of genuine, valid frustration. Just like those rejecting vaccines are not “bad” humans, those shaming them are not “bad” people either. (That would be shaming people for shaming people! Also not helpful.)
Where is this frustration coming from? There are the obvious answers—rejecting vaccines puts both the person and the community at higher risk of disease, leads to worse health outcomes, etc.
But early on in the pandemic, I realized for me (and probably many of you), it was more than that. It wasn’t just about the individual vaccines. It was fundamentally about believing that evidence-based medicine actually works—that systematically collecting data and analyzing it will give us a clearer picture of reality than anecdotes. That we don’t have to go back to the days of basing medical decisions on hunches, fears, and vibes. We have a better way of figuring out what’s real and true.
The rejection of carefully collected, peer-reviewed data in favor of rumors and memes is understandably infuriating. If universally adopted, this would make our society collapse. For people who have devoted their lives to science, medicine, and public health, it makes sense that this gets under our skin and infuriates us.
But in the irony of ironies, reacting out of anger to defend evidence-based medicine is, itself, very much not evidence-based. Unfortunately, it will only make things worse, furthering the very problem we are trying to fix.

How to do better going forward​

• Focus criticism on the data, not the person. It’s perfectly valid to criticize false beliefs and misleading data about vaccines. But when doing it, make sure your criticism focuses on the data and argument, not the person themselves.
• Rant privately. The need to vent your anger is real, do it. But not online—it might entertain those who already agree, but alienate those who we most need to reach.
• Kindness will get you further than anger. In defending the data, remember the data: kindness helps, insults do not.
• Connect over shared values. People will be far more open to what you have to say if you connect over values you both hold dear.

Bottom line​

We must use science to figure out how to regain trust in science. And the science is clear: shaming isn’t helpful. Kindness, empathy, and connecting over shared values are critical for restoring trust in vaccines and science. This might not make us go viral, but it will build bridges instead of destroying them.
Sincerely, KP

Kristen Panthagani, MD, PhD, is a resident physician and Yale Emergency Scholar, completing a combined Emergency Medicine residency and research fellowship focusing on health literacy and communication. In her free time, she is the creator of the medical blog You Can Know Things and author of YLE’s section on Health (Mis)communication. You can find her on Threads,Instagram, or subscribe to her website here. Views expressed belong to KP, not her employer.

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How Experts Predicts This COVID and Flu Season Will Unfold​

October 3, 2024|Infectious Disease

Kathleen Doheny

What’s the outlook for COVID-19 and flu this fall and winter? It’ll probably be a lot like last year, experts say.

“We currently expect this flu season to be comparable to last year’s season,” said Adrienne Keen, PhD, of the Centers for Disease Control and Prevention’s (CDC) Center for Forecasting and Outbreak Analytics. “We expect this year’s COVID-19 season peak to be similar to last year’s or lower.” The CDC is still analyzing COVID surveillance data from the summer and will update the forecast as more is learned.

For COVID, that means it won’t be as bad as the pandemic years, and for the flu, it’s a typical pre-pandemic season. But status quo does not mean great.
Between October 2023 and April 2024, as many as 75 million people got the flu in the United States, according to CDC estimates, resulting in up to 900,000 hospitalizations and between 17,000 and 100,000 deaths. In 2023, about 900,000 Americans were hospitalized with COVID and 75,000 died.

Other experts agreed with Dr. Keen’s prediction.

But unknowns — such as a COVID variant that takes off quickly or a surprise influenza strain — could knock that forecast flat. Getting vaccinated remains crucial, public health officials stressed.

Predicting COVID​

Two key predictors of how bad an upcoming COVID season will be are the cycling of new variants and the population’s immunity (protection from an infectious disease that happens when a population is immune through vaccination or previous infection).

When new variants go up and immunity goes down, “we tend to see the increase in cases,” said Michael T. Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy and a professor of public health at the University of Minnesota, Minneapolis. But if the number of variants goes down and immunity levels go up, the outlook is more favorable.

The new COVID variant called XEC has been found in at least 25 states. On September 27, the CDC added the variant to the COVID tracker. It now accounts for 6% of US cases. This was expected, as the variant has been circulating in Europe, said Amesh Adalja, MD, a senior scholar and infectious disease expert at the Center for Health Security at Johns Hopkins University, Baltimore, Maryland.

“There will always be a new variant appearing, and one falling,” he said. “So the fact that this is happening is not surprising.”

Meanwhile, the summer COVID surge has provided postinfection immunity for some people. “What’s likely is, we are going to see substantial protection of the population for several months based on previous infection and in some cases vaccination,” Dr. Osterholm said. That means protection from serious illness, hospitalizations, and deaths (but not necessarily infection). That protection could last through the year or into early 2025.

The timing of 2024’s winter surge will likely be a bit later than 2023’s, said Andrew Pekosz, PhD, a professor and vice chair of molecular microbiology and immunology at Johns Hopkins University, Baltimore, “peaking just after the Christmas/New Year holiday.”

During the 2023-2024 season, weekly COVID hospitalizations peaked the week of Dec. 30, said Justin Lessler, PhD, a professor of epidemiology at the University of North Carolina at Chapel Hill and a member of the COVID-19 Scenario Modeling Hub.

But variants are unpredictable. “There’s a chance that the XEC variant may take off and spread, or might not,” said Dr. Adalja. As of September 28, the Omicron variant KP.3.1.1 was leading, accounting for 58.7% of US cases, according to the CDC.

While Dr. Adalja agreed that 2024’s COVID season will probably be like 2023’s, “we have to be prepared for cases and hospitalizations going up,” he said, “but not to the point of a crisis.” A return to lockdowns and social distancing is unlikely.

Still, older adults and others at higher risk of getting very sick from COVID should consider masking during travel, said Rajendram Rajnarayanan, PhD, MSc, an associate professor at the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro.

Flu Forecasts​

Predicting flu season this early is hard, said Jeffrey Shaman, PhD, a professor of environmental health sciences and professor of climate at Colombia University, New York.

“You can look at the CDC forecast and use it as a very loose guide right now,” said Dr. Shaman, who won the CDC’s first “Predict the Influenza Season Challenge” in 2014. “Until there is actually flu, it’s like trying to predict the landfall of a hurricane.” Flu activity remained low as of September 14 (the most current data available), according to the CDC.

When flu activity picks up, typically in mid-October or November, experts look at the dominant strain, exposure to similar strains in previous years, and how well-matched the current flu vaccine is to that dominant strain, Dr. Shaman said. Vaccine makers must make an educated guess months in advance regarding which strain to target, to allow time for production.
The vaccination rate plays a role, too, but that tends to remain constant, Dr. Shaman said. According to the CDC, less than half of adults age 18 and up got a flu vaccination last year.

Experts also consider flu patterns in the Southern Hemisphere, where 2024 flu activity has mostly involved two subtypes of influenza A — H1N1 and H3N2 — and some influenza B, the CDC found.

How Well Do This Year’s Vaccines and Viruses Match Up?​

The FDA has authorized three updated COVID vaccines for this fall. Novavax targets the JN.1 strain of SARS-CoV-2, the virus that causes COVID-19. Both mRNA vaccines, Moderna and Pfizer, target KP.2, a descendant of JN.1. All three target current predominant variants, and any one of them is recommended by the CDC.

The vaccines are a good “though not perfect match to virtually all the circulating variants of SARS-CoV-2,” said Dr. Pekosz.

Experts said that the shots will protect against the XEC variant.

“XEC and its sublineages are expected to be the dominant fall/winter variant group,” said Dr. Rajnarayanan.

This year’s flu vaccines, all trivalent (protecting against three viruses), will target the three strains expected to circulate — H1N1, H3N2, and influenza B (Victoria), according to the CDC.

People should still get vaccinated, Dr. Adalja said, and use home tests for flu and COVID and take antivirals promptly when needed. The goal should not be status quo but rather fewer COVID and flu hospitalizations and deaths.

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