Coronavirus Updates September 2024

[missy]

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Needle-free COVID-19 intranasal vaccine provides broad immunity, study finds​

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Published August 27, 2024 | Originally published on MedicalXpress Breaking News-and-Events

A next-generation COVID-19 mucosal vaccine is set to be a gamechanger not only when delivering the vaccine itself, but also for people who are needle-phobic.
New Griffith University research, "A single-dose intranasal live-attenuated codon deoptimized vaccine provides broad protection against SARS-CoV-2 and its variants" in Nature Communications, has been testing the efficacy of delivering a COVID-19 vaccine via the nasal passages.
Professor Suresh Mahalingam from Griffith's Institute for Biomedicine and Glycomics has been working on this research for the past four years.
"This is a live attenuated intranasal vaccine, called CDO-7N-1, designed to be administered intranasally, thereby inducing potential mucosal immunity as well as systemic immunity with just a single dose," Professor Mahalingam said.
Optimizing Care for Prurigo Nodularis - Evidence-Based Treatment Approaches and Personalized Strategie
"The vaccine induces strong memory responses in the offering long-term protection for up to a year or more.
"It's been designed to be administered as a single dose, ideally as a booster vaccine, as a safe alternative to needles with no in the short or long term."
Live-attenuated vaccines offer several significant advantages over other vaccine approaches.
They induce potent and long-lived humoral and cellular immunity, often with just a single dose.
Live-attenuated vaccines comprise the entire virus, thereby providing broad immunity, in contrast to a single antigen which is used in many other vaccine platforms.
Lead author Dr. Xiang Liu said the vaccine provides cross-protection against all variants of concern, and has neutralizing capacity against SARS-CoV-1.
"The vaccine offers potent protection against transmission, prevents reinfection and the spread of the virus, while also reducing the generation of new variants," Dr. Liu said.
"Unlike the mRNA vaccine which targets only the spike protein, CDO-7N-1 induces immunity to all major SARS-CoV-2 proteins and is highly effective against all major variants to date.
"Importantly, the vaccine remains stable at 4°C for seven months, making it ideal for low- and middle-income countries."
The vaccine has been licensed to Indian Immunologicals Ltd, a major vaccine manufacturer.
Dr. K. Anand Kumar, co-author of the publication and Managing Director of Indian Immunologicals Ltd. Said, "We are a leading 'One Health' company that has developed and launched several vaccines for human and animal use in India and are currently exporting to 62 countries."
"We have completed all the necessary studies of this novel COVID-19 vaccine which offers tremendous advantages over other vaccines.
"We now look forward to taking the vaccine candidate to clinical trials."
Professor Lee Smith, Acting Director of the Institute for Biomedicine and Glycomics, said he was delighted with the research findings.
"These results towards developing a next-generation COVID-19 vaccine are truly exciting," Professor Smith said.
"Our researchers are dedicated to providing innovative and, crucially, more accessible solutions to combat this high-impact disease."

 

[Gloria27]

rats first

 

[missy]

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Updated COVID Vaccines: Who Should Get One, and When?​

Sandra Adamson Fryhofer, MD

DISCLOSURES | September 06, 2024


New updated COVID vaccines are now available, but who can get them, who should get them, and when? Two updated mRNA COVID vaccines, one by Moderna and the other by Pfizer, have been authorized or approved by the US Food and Drug Administration (FDA) for those aged 6 months or older.

Both vaccines target Omicron's KP.2 strain of the JN.1 lineage. An updated protein-based version by Novavax, also directed at JN.1, has been authorized, but only for those aged 12 years or older.

The Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) recommends a dose of the 2024-2025 updated COVID vaccine for everyone aged 6 months or older. This includes people who have never been vaccinated against COVID, those who have been vaccinated, as well as people with previous COVID infection.



The big question is when, and FDA and CDC have set some parameters. For mRNA updated vaccines, patients should wait at least 2 months after their last dose of any COVID vaccine before getting a dose of the updated vaccine.

If the patient has recently had COVID, the wait time is even longer: Patients can wait 3 months after a COVID infection to be vaccinated, but they don't have to. FDA's instructions for the Novavax version are not as straightforward. People can get an updated Novavax dose at least 2 months after their last mRNA COVID vaccine dose, or at least 2 months after completing a Novavax two-dose primary series. Those two Novavax doses should be given at least 3 weeks apart.

Patients can personalize their vaccine plan. They will have the greatest protection in the first few weeks to months after a vaccine, after which antibodies tend to wane. It is a good idea to time vaccination so that protection peaks at big events like weddings and major meetings.

If patients decide to wait, they run the risk of getting a COVID infection. Also keep in mind which variants are circulating and the amount of local activity. Right now, there is a lot of COVID going around, and most of it is related to JN.1, the target of this year's updated vaccine. If patients decide to wait, they should avoid crowded indoor settings or wear a high-quality mask for some protection.


Here's the bottom line: Most people (more than 95%) have some degree of COVID protection from previous infection, vaccination, or both. But if they haven't recently had COVID infection and didn't get a dose of last year's vaccine, they are sitting ducks for getting sick without updated protection. The best way to stay well is to get a dose of the updated vaccine as soon as possible. This is especially true for those in high-risk groups or who are near someone who is high risk.

Two thirds of COVID hospitalizations are in those aged 65 or older. Hospitalization rates are highest for those aged 75 or older and among infants under 6 months of age. These babies are too young to be vaccinated, but maternal vaccination during pregnancy and breastfeeding can help protect them.

We're still seeing racial and ethnic disparities in COVID-related hospitalizations, which are highest among American Indians, Alaska Natives, and Black populations. People with immunocompromising conditions, those with chronic medical conditions, and people living in long-term care facilities are also at greater risk. Unlike last year, additional mRNA doses are not recommended for those aged 65 or older at this time, but that could change.

Since 2020, we've come a long way in our fight against COVID, but the battle is still on. In 2023, nearly a million people were hospitalized from COVID. More than 75,000 died. COVID vaccines help protect us from severe disease, hospitalization, and death.

Let's face it — we all have booster fatigue, but COVID is now endemic. It's here to stay, and it's much safer to update antibody protection with vaccination than with infection. Another benefit of getting vaccinated is that it decreases the chance of getting long COVID. The uptake of last year's COVID vaccine was abysmal; only about 23% of adults and 14% of children received it.

But this is a new year and a new vaccine. Please make sure your patients understand that the virus has changed a lot. Antibodies we built from previous infection and previous vaccination don't work as well against these new variants. Antibody levels wane over time, so even if they missed the last few vaccine doses without getting sick, they really should consider getting a dose of this new vaccine. The 2024-2025 updated COVID vaccine is the best way to catch up, update their immunity, and keep them protected.

Furthermore, we are now entering respiratory virus season, which means we need to think about, recommend, and administer three shots if indicated: COVID, flu, and RSV. Now is the time. Patients can get all three at the same time, in the same visit, if they choose to do so.

Your recommendation as a physician is powerful. Adults and children who receive a healthcare provider recommendation are more likely to get vaccinated.

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[missy]

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Newly discovered antibody protects against all COVID-19 variants​

Published September 5, 2024 | Originally published on MedicalXpress Breaking News-and-Events[/COLOR]
Researchers have discovered an antibody able to neutralize all known variants of SARS-CoV-2, the virus that causes COVID-19, as well as distantly related SARS-like coronaviruses that infect other animals.
As part of a new study on hybrid immunity to the virus, the large, multi-institution research team led by The University of Texas at Austin discovered and isolated a broadly neutralizing plasma antibody, called SC27, from a single patient. Using technology developed over several years of research into antibody response, the team led by UT engineers and scientists obtained the exact molecular sequence of the antibody, opening the possibility of manufacturing it on a larger scale for future treatments.
CME Activity: Unraveling Prurigo Nodularis - Pathogenesis, Evaluation, and Impact on Quality of Life[COLOR=rgba(32, 37, 41, 0.4)] RealCME
"The discovery of SC27, and other antibodies like it in the future, will help us better protect the population against current and future COVID variants," said Jason Lavinder, a research assistant professor in the Cockrell School of Engineering's McKetta Department of Chemical Engineering and one of the leaders of the new research, which was recently published in Cell Reports Medicine.
During the more than four years since the discovery of COVID-19, the virus that causes it has rapidly evolved. Each new variant has displayed different characteristics, many of which made them more resistant to vaccines and other treatments.
Protective antibodies bind to a part of the virus called the spike proteinthat acts as an anchor point for the virus to attach to and infect the cells in the body. By blocking the spike protein, the antibodies prevent this interaction and, therefore, also prevent infection.
SC27 recognized the different characteristics of the spike proteins in the many COVID variants. Fellow UT researchers, who were the first to decode the structure of the original spike protein and paved the way for vaccines and other treatments, verified SC27's capabilities.
The technology used to isolate the antibody, termed Ig-Seq, gives researchers a closer look at the antibody response to infection and vaccination using a combination of single-cell DNA sequencing and proteomics.
"One goal of this research, and vaccinology in general, is to work toward a universal vaccine that can generate antibodies and create an immune response with broad protection to a rapidly mutating virus," said Will Voss, a recent Ph.D. graduate in cell and molecular biology in UT's College of Natural Sciences, who co-led the study.
In addition to the discovery of this antibody, the research found that hybrid immunity—a combination of both infection and vaccination—offers increased antibody-based protection against future exposure compared with infection or vaccination alone.
The work comes amid another summer COVID spike. This trend shows that while the worst of the pandemic may have passed, there's still a need for innovative solutions to help people avoid and treat the virus.
The researchers have filed a patent application for SC27.

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[missy]

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Alzheimer's-like brain changes found in long COVID patients
Published September 3, 2024 | Originally published on MedicalXpress Breaking News-and-Events
New research from the University of Kentucky's Sanders-Brown Center on Aging shows compelling evidence that the cognitive impairments observed in long COVID patients share striking similarities with those seen in Alzheimer's disease and related dementias.

The study, published in Alzheimer's & Dementia, highlights a potential commonality in brain disorders across these conditions that could pave the way for new avenues in research and treatment.

CME Activity: Unraveling Prurigo Nodularis - Pathogenesis, Evaluation, and Impact on Quality of Life RealCME

The study was a global effort, and brought together experts from various fields of neuroscience. Researchers at the UK College of Medicine led the study, including Yang Jiang, Ph.D., professor in the Department of Behavioral Science; Chris Norris, Ph.D., professor in the Department of Pharmacology and Nutritional Sciences; and Bob Sompol, Ph.D., assistant professor in the Department of Pharmacology and Nutritional Sciences. Their work focuses on electrophysiology, neuroinflammation, astrocytes and synaptic functions.

"This project benefited greatly from interdisciplinary collaboration," Jiang said. "We had input from experts, associated with the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART), across six countries, including the U.S., Turkey, Ireland, Italy, Argentina and Chile."

Jiang and the collaborative team focused their work on understanding the "brain fog" that many COVID-19 survivors experience, even months after recovering from the virus. This fog includes memory problems, confusion and difficulty concentrating. According to Jiang, "The slowing and abnormality of intrinsic brain activity in COVID-19 patients resemble those seen in Alzheimer's and related dementias."

This research sheds light on the connection between the two conditions, suggesting that they may share underlying biological mechanisms. Both long COVID and Alzheimer's disease involve neuroinflammation, the activation of brain support cells known as astrocytes and abnormal brain activity. These factors can lead to significant cognitive impairments, making it difficult for patients to think clearly or remember information.

The idea that COVID-19 could lead to Alzheimer's-like brain changes is a significant development.

"People don't usually connect COVID-19 with Alzheimer's disease," Jiang said. "But our review of emerging evidence suggests otherwise."

The research reveals that the cognitive issues caused by COVID-19 reflect similar underlying brain changes as those in dementia. The study's insights emphasize the importance of regular brain function check-ups for these populations, particularly through the use of affordable and accessible tools like electroencephalography (EEG).

The study not only highlights the shared traits between long COVID and Alzheimer's, but also points to the importance of further research.

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[missy]

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Novavax availability​

ANDREA TAMAYO AND KATELYN JETELINA SEP 6

Novavax Covid-19 is now available! ​

FDA approved Novavax's updated fall Covid-19 vaccine. This vaccine is the only protein-based (i.e., traditional) option with an updated formula targeting the latest circulating Covid-19 subvariants. Check out YLE’s guide to fall 2024 vaccines to decide if this vaccine is right for you.

• The challenge is always finding Novavax vaccines. I had luck at Costco last year. Word on the street is that Costco will have it available at all pharmacies this year. Vaccines.gov may have other options for you, too. (It will take a week or two to stock fully.)
• Timing for Covid-19 vaccines this season is tricky. I’m still waiting until Halloween to get my Covid-19 and flu shots.

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[missy]

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Pediatricians Scale Back on COVID Shots
Jackie Fortiér
September 05, 2024

When pediatrician Eric Ball opened a refrigerator full of childhood vaccines, all the expected shots were there — DTaP, polio, pneumococcal vaccine — except one.

"This is where we usually store our COVID vaccines, but we don't have any right now because they all expired at the end of last year and we had to dispose of them," said Ball, who is part of a pediatric practice in Orange County, California.

"We thought demand would be way higher than it was."


Pediatricians across the country are pre-ordering the updated and reformulated COVID-19 vaccine for the fall and winter respiratory virus season, but some doctors said they're struggling to predict whether parents will be interested. Providers like Ball don't want to waste money ordering doses that won't be used, but they need enough on hand to vaccinate vulnerable children.

The Centers for Disease Control and Prevention recommends that anyone 6 months or older get the updated COVID vaccination, but in the 2023-2024 vaccination season only about 15% of eligible children in the U.S. got a shot.

Ball said it was difficult to let vaccines go to waste last year. It was the first time the federal government was no longer picking up the tab for the shots, and providers had to pay upfront for the vaccines. Parents would often skip the COVID shot, which can have a very short shelf life compared with other vaccines.


"Watching it sitting on our shelves expiring every 30 days, that's like throwing away $150 repeatedly every day, multiple times a month," Ball said.

This year, Ball slashed his fall vaccine order to the bare minimum to avoid another costly mistake.

"We took the number of flu vaccines that we order, and then we ordered 5% of that in COVID vaccines," Ball said. "It's a guess."

That small vaccine order cost more than $63,000, he said.

Pharmacists, pharmacy interns, and techs are allowed to give COVID vaccines only to children age 3 and up, meaning babies and toddlers would need to visit a doctor's office for inoculation.

It's difficult to predict how parents will feel about the shots this fall, said Chicago pediatrician Scott Goldstein. Unlike other vaccinations, COVID shots aren't required for kids to attend school, and parental interest seems to wane with each new formulation, he said. For a physician-owned practice such as Goldstein's, the upfront cost of the vaccine can be a gamble.

"The cost of vaccines, that's far and away our biggest expense. But it's also the most important thing we do, you could argue, is vaccinating kids," Goldstein said.

Insurance doesn't necessarily cover vaccine storage accidents, which can put the practice at risk of financial ruin.

"We've had things happen like a refrigerator gets unplugged. And then we're all of a sudden out $80,000 overnight," Goldstein said.

South Carolina pediatrician Deborah Greenhouse said she would order more COVID vaccines for older children if the pharmaceutical companies that she buys from had a more forgiving return policy.

"Pfizer is creating that situation. If you're only going to let us return 30%, we're not going to buy much," she said. "We can't."

Greenhouse owns her practice, so the remaining 70% of leftover shots would come out of her pocket.

Vaccine maker Pfizer will take back all unused COVID shots for young children, but only 30% of doses for people 12 and older.

Pfizer said in an Aug. 20 emailed statement, "The return policy was instituted as we recognize both the importance and the complexity of pediatric vaccination and wanted to ensure that pediatric offices did not have hurdles to providing vaccine to their young patients."

Pfizer's return policy is similar to policies from other drugmakers for pediatric flu vaccines, also recommended during the fall season. Physicians who are worried about unwanted COVID vaccines expiring on the shelves said flu shots cost them about $20 per dose, while COVID shots cost around $150 per dose.

"We run on a very thin margin. If we get stuck holding a ton of vaccine that we cannot return, we can't absorb that kind of cost," Greenhouse said.

Vaccine maker Moderna will accept COVID vaccine returns, but the amount depends on the individual contract with a provider. Novavax will accept the return of only unopened vaccines and doesn't specify the amount they'll accept.

Greenhouse wants to vaccinate as many children as possible but said she can't afford to stock shots with a short shelf life. Once she runs out of the doses she's ordered, Greenhouse said, she plans to tell families to go to a pharmacy to get older children vaccinated. If pediatricians around the country are making the same calculations, doses for very small children could be harder to find at doctors' offices.

"Frankly, it's not an ideal situation, but it's what we have to do to stay in business," she said.

Ball, the California pediatrician, worries that parents' limited interest has caused pediatricians to minimize their vaccine orders, in turn making the newest COVID shots difficult to find once they become available.

"I think there's just a misperception that it's less of a big deal to get COVID, but I'm still sending babies to the hospital with COVID," Ball said. "We're still seeing kids with long COVID. This is with us forever."


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[missy]

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Does everyone *really* need routine vaccinations?​

Your questions on Hep B, HPV, rubella, measles, and U.S. universal vaccinations​

KATELYN JETELINA AND KRISTEN PANTHAGANI, MD, PHD SEP 10

In Friday’s “The Dose” article, YLE noted that routine vaccinations are declining. Afterward, we received many great comments centered around a root question: I understand vaccines have saved many lives, but does everyone really need them?
In many ways, vaccines are victims of their success. Given the drama and polarization surrounding vaccines, it can be hard to find answers that aren’t simplistic, defensive, or angry. And, as everyone discovered during the pandemic, disease risks are often not uniform.
Here are a few of your top questions answered!

“Why are vaccines mandated for diseases that aren’t endemic, like rubella?”​

Rubella is the “R” in the MMR vaccine. It’s caused by a virus that spreads in airborne droplets from coughing or sneezing. It’s not endemic in the United States anymore. So yes, the risk is extremely low. Yet, it is mandated for children in all 50 states. Why?
Think of population immunity like a water dam built to prevent flooding. Once it’s built, we won’t have flooding anymore. But if the next generation comes along and says, “Hey, there’s not flooding anymore—do we really need this dam?” and decides to get rid of it, the flooding would return quickly.
Rubella is still alive and well in other parts of the world. In the U.S., we have rubella cases yearly, but only from international travelers. However, outbreaks don’t happen often in the U.S. because population immunity—an invisible shield—stops them in their tracks. In other words, vaccination is the reasonrubella isn’t endemic.
Once a virus is eliminated and has no risk of returning—like smallpox—we stop vaccinating for it.

“The NYT image you shared has always bothered me because it doesn’t consider the probability of getting measles is very low. If we consider that, do the vaccine's benefits still outweigh risks?” ​

This is a fantastic question. The calculation is mathematically and ethically tricky.
This is because the individual decision to get vaccinated changes the risk-benefit calculation for everyone. In other words, your probability of encountering measles is low because so many people around you are vaccinated.

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Data visualization by Kristen Panthagani; data sources here, here, and here
But you’re right—the risk of exposure makes a difference. Let’s look at two scenarios: nobody vaccinated and everybody vaccinated. Before the measles vaccine, nearly every child in the U.S. got measles by age 15, because it’s so contagious. So risk of exposure was near 100% (to be conservative, say 95%). At 100% vaccination, the risk of measles goes to zero. Using the risks in the NYT image, here’s what we get after accounting for exposure risk during childhood:

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Is there a situation where the probability of an individual getting a complication from measles infections roughly equals the likelihood of an adverse event from a vaccination? The math to calculate this is really tricky — it depends on not just vaccination coverage, but the risk of an outbreak, the density of the population, the size of an outbreak, etc. Even if this scenario happened, the average vaccine side effect isn’t equivalent to the average measles outcome—for example, fever-related seizures, while understandably scary to watch, fortunately often don’t require hospitalization or result in long-term problems.
At the community level, the benefits of measles vaccination far outweigh the risks. Fighting against infectious diseases is a team sport.

“Could you comment on babies getting the Hep B vaccine even if they aren’t high risk?”​

The highest risk factor for Hep B (or HBV) is a history of sexually transmitted infections or multiple sex partners. So, if you’ve only had one partner for a decade, is this even applicable to your baby?
Yes, because the hep B virus is a tricky booger:

1. The majority of people with HBV globally are unaware they have it. Many who do have it don’t know how they contracted it. If we only give it to people who believe they are high-risk, we will miss many cases.
2. Hep B virus requires only a very tiny dose to cause infections, which means that even though it is bloodborne and sexually transmitted, it can be spread casually, like through sharing a toothbrush.
3. It’s very stable in the environment, capable of remaining infectious for weeks and even months on surfaces.
4. The outcomes can be severe. Mother-to-baby transmission at birth is the most common cause of chronic HBV infection, which can lead to liver cancer, liver failure, and death. If babies contract Hepatitis B disease near birth, 95% develop the chronic form.

The HBV vaccine induces protective immune responses in nearly everyone (80-100%). The vaccine risks are extremely low—the only safety signal found is rare allergic reactions (1 severe allergic reaction for every 2-3 million doses).

“Are there any long-term studies on whether HPV vaccine impacts infertility?”​

Some of these concerns stemmed from a case series that was published in 2012, describing six girls who developed primary ovarian insufficiency (POI) from 8 months to 2 years after they received the first human papilloma virus (HPV) vaccine dose. This stirred public concern that the HPV vaccine could cause infertility.
However, case series often generate more questions than answers because they can’t assess causality (correlation doesn’t equal causation). Fortunately, no rigorous lab or epidemiological follow-up studies have found a link:

• No effect of HPV vaccination on fertility has been found in 3 studies in rodents.
• A strong study in North America followed women planning on getting pregnant. Some of the women (and their partners) had their HPV vaccines, some of them didn’t. The scientists found no difference in infertility. In fact, in some groups, vaccinated women had higher fertility.
• Another large study found that 120 of 199,078 female patients at hospitals had POI. There was no difference between those with the HPV vaccine and those without.

“Why does the U.S. have sweeping recommendations when other countries have more targeted vaccine recommendations?”​

It’s fair to wonder why. We are all high-income countries. We all have the same vaccines. We are all looking at the same data. How could public health officials come to different conclusions across countries?
Three main reasons:

1. Behavioral: Universal vaccination recommendations work better than targeted vaccinations because of convenience and education. The U.S. used to have targeted Hep B vaccine recommendations, but uptake was poor. After a universal recommendation, there was a big decline in disease, and many lives (and livers) were saved. The same thing happened with the flu vaccine; universal recommendations increased uptake among high-risk groups. For this reason, in 2025, the U.K. is moving to universal flu vaccinations.

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1. Financial: Many countries’ governments pay for vaccines, so the cost-benefit analysis is a big consideration when making policy decisions—for some countries, it would be too expensive for the government to vaccinate everyone, so they try to find where the money will have the biggest impact.
2. Safety net: The U.S. has much less wiggle room because of worse healthcare access, social support, healthcare capacity, and health. Casting a larger net through universal vaccine recommendations is more critical than in other countries. I’ve covered this in another YLE post here.

Bottom line​

The effect of vaccines is often invisible—infections prevented, childhood deaths that never happened. It’s important to look back and remember why we do what we do. Thank you for your questions, and keep them coming! We’re here to answer them.


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[missy]

"
Bloomberg Prognosis

Waiting for Covid answers ​

I was exposed to Covid at a family get-together in upstate New York last month. Two days later, I woke up feeling awful — sniffles, fatigue and fever. So I swabbed both nostrils with the last Covid test in our cabinet. To my great surprise, it was negative, and I went back to sleep. When I tested again two days later, it turned positive in seconds. I started to wonder: Are home Covid tests bad at detecting the latest variants? The short answer is no, the doctors I spoke with told me. But that answer comes with a big caveat. It turns out the way the immune system interacts with the virus these days means home tests may not turn positive until several days after you get sick. “That first negative test doesn’t mean you don’t have Covid,” says Elizabeth Hudson, regional chief of infectious diseases at Southern California Permanente Medical Group. “We really noticed it earlier this year.” Now, it can take several days for people with symptoms like mine to get a positive result from a home test, she says. Here’s why: While gold-standard PCR assays detect minute quantities of virus, home antigen tests require a larger amount to turn positive. Early in the pandemic, viral levels peaked when symptoms appeared, says Nira Pollock, co-director of the Infectious Diseases Diagnostic Laboratory at Boston Children’s Hospital. But now that most people have at least some immunity, viral load peaks later. “The tests perform the same way and they are detecting the same amount of virus,” she says. “It is just when the virus peaks in your nose seems to be different.” In a study of 348 people with Covid that Pollock and her colleagues published last year, median viral load didn’t crest until around the fourth day of symptoms. The study estimated that home antigen tests would only detect around 30% to 60% of cases on the first day of symptoms, rising to 80% to 93% of cases on day four. In other words, there are lots of false negative tests early in the illness. The need for repeat Covid testing isn’t new. Since 2022, US regulators have required home tests’ labels to recommend repeat testing for people whose first result is negative. If you’re sick and your first home test is negative, you have a few options besides waiting and repeating the test, says Thomas Russo, chief of infectious diseases at the University at Buffalo’s medical school. You can go to urgent care and request a PCR test. Or, if you are older or in a high-risk group due to a pre-existing condition, just call your doctor, who might be willing to prescribe Pfizer’s Paxlovid pills without a confirmatory test, he says. One thing you should never do when you have Covid-like symptoms, doctors say: use a single negative test as a permission slip to visit elderly relatives. Just don’t go. —Robert Langreth "

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[missy]

Your “weather” report for the week​

Covid-19 infection levels are “high,” while flu and RSV have yet to take off.

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Consider wearing a mask to protect yourself against Covid-19. It may be a good time to get your fall vaccines. Check here for a YLE guide on timing.

Good news: More people are dialing 988​

September 8th was 988 Day—a day to raise awareness of the 988 Suicide & Crisis Lifeline, which only 18% of adults are aware of. The three-digit number has been available for two years at no charge.
Dialing this number connects people with a network of crisis call centers, so that when a person calls, a trained crisis counselor answers, provides emotional support, and helps connect people with other resources. More and more people have been using this resource, which means more people are seeking help and more suicides are being prevented.

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(Source: KFF; Annotations by YLE) Note: Before 988, there was a hotline, but it had a longer number and was not mandated by law. See the fantastic historical infographic here.
Everyone can act to help save the life of someone who may be suicidal with these five steps:

• Ask
• Be there
• Keep them safe
• Help them connect
• Follow-up

In other mental health news, the Biden Administration announced new regulations that hold insurers accountable for mental health care coverage. The regulations will require health insurance plans to report more information on why they limit or deny mental health claims.

H5 infected a Missourian, but we don’t know how​

CDC confirmed another human case of H5 (also known as bird flu)—marking the 14th American to test positive. (Before this year, we had one case in our history.)
This case is unique because the person had no known contact with animals. In other words, we don’t know how they got infected. The risk remains low to the general public because there are no signs of onward spread.
At this time, we epidemiologists have more questions than answers:

1. How did this person get infected? Discovering this entails patient interviews with a long list of questions. (Did she drink raw milk? Attend any animal event? Etc.) In this case, there are no signs or signals with a clear route of exposure.
2. What clues can the virus provide? Sometimes, the genomics of a virus (gathered after swabbing the patient) can provide clues. The problem is that laboratory scientists don’t have a large enough sample in this case, so it’s hard to get a full picture. From what we have, the virus that infected this patient is close to what’s circulating among cows. But, we don’t even know if it’s H5N1. (It could be H5N3, for example.)
3. How many people are we missing? The patient had significant underlying health problems, so was hospitalized. This case happened to be picked up by the hospital surveillance system. This is great, but how many human cases have we missed this year?

We need to ramp up testing to prevent this from becoming a pandemic.

A guide to fall 2024 vaccines

And a 1-page PDF summary

yourlocalepidemiologist.substack.com

 

[AprilBaby]

Glad to see science has found a potential way to kill all covid! I picked up a bad cold last week with sore throat and runny nose. I was sure it was Covid AGAIN. Thankfully not! I should be immune until Nov 1.