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February 23, 2022

Are We Reopening Just as Omicron Subvariant BA.2 is Increasing?

Are we reopening too fast, just when the Omicron BA.2 subvariant is now present across the country and is already slowly increasing as a percentage of all cases?  Everyone is anxious to return to our pre-Covid lives, but scientists have no idea whether BA.2 will soon surge or remain at very low levels in the US.  There is data demonstrating that BA.2 is 30% more transmissible than BA.1. There is no information about whether it causes more severe disease.  To date there is no more immune evasion than is seen with BA.1, even though it has many more mutations.

BA.2 is 3.9% of new infections in the US, and already 6% in NY.  In NY it was reported at 1.6% on 1/29, 2.5% on 2/5, and 6.0% on 2/12.  It takes up to a week for the genomic sequencing to be reported, so the 6% is a report from samples collected a week before.  Those 3 numbers look like exponential growth - hopefully the next data will be published soon, and we may know whether the BA.2 subvariant will cause another surge.  Although the infection rate in NY was steadily decreasing it is now steady at approximately 1-2% in NY state, New York City, and Manhattan for the last 6 days.  Is this because the BA.2 subvariant is increasing as the BA.1 subvariant is decreasing? The US still has more than 100,000 new Covid cases each day, and more than 2000 deaths/day.  Another surge now will be dangerous for the unvaccinated, <5. and vaccinated older adults, and immunodeficient people.   

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We all have to decide how much risk we are willing to take.  But as you make these decisions, please be ready to mask up again, especially in indoor crowds.  And if you have been vaccinated, but not boosted, there is accumulating evidence from recent studies that the booster doses even maintain some immune protection against the subvariants.   

February 16, 2022

Interesting Info About Covid Vaccinations

Today I have my "guest editor" providing the info to my twice weekly COVID blog post.  Our son Jason is a physician at NIH and he writes commentaries on all facets of the pandemic for his followers.  
 
"Do you realize that more than half of the planet has now been vaccinated against COVID?  We're exactly 14 months since the first shots went into arms outside of clinical studies, and 11 BILLION doses of vaccine have been delivered to 4.3 billion people.  It's basically unfathomable to consider what the planet would look like if the vaccines HADN'T done what we needed them to do. It's estimated that we'd have lost more than 1.2 million additional lives, and had over 14 million more infected people, in the US alone had it not been for the immense effort that resulted in safe and effective shots." 
 
"In a way, we're immensely FORTUNATE that we're in the position of having inane debates about masking - because in a world in which vaccines hadn't been successful, there'd be no getting back to normal, there'd be an acclimation at a much worse NEW normal.  And I read something today that I hadn't internalized - prior to the pandemic, 90% of all vaccine doses manufactured worldwide came from four companies, but all the success came despite the failure of three of them to deliver!  Pfizer got to the finish line with its effort, but Merck halted two attempts due to poor results, Sanofi had quality issues that sidelined its vaccine, and GSK didn't even try to join the party.  So while I continue to lament us only managing to vaccinate 65% of Americans, my spirits are buoyed by the work being done across the planet to end the ravages of COVID." 

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February 12, 2022

Covid Infections in Children

The American Academy of Pediatrics and the Children's Hospital Association are collaborating on Covid data collection.  Over 12,000,000 cases have occurred in children since the start of the pandemic, and the incidence of Covid cases among children has spiked dramatically in 2022 during the omicron surge.  Almost 4.2 million cases were reported since the beginning of January 2022.  For the week ending Feb. 3rd 632,000 cases were reported.  Over 7000 hospitalizations occurred in January (especially in the <5 year old group), and 70 of those children died with the omicron variant.  Some children were hospitalized with other health problems but were found to be Covid positive.

The number of children vaccinated is low in all age groups.  The 6 mos-5 year olds are  not eligible yet, but only 30% or less of the 6 -11 year old group are vaccinated, and only half of the 12-17 year old group are vaccinated and may not be boosted.  Everyone was hoping the FDA was going to meet with their independent advisory board on Tuesday Feb 15th, but yesterday the meeting was cancelled and will be rescheduled. The clinical trial data on antibody levels for the 6 mos. to 2 year old children met the criteria for FDA approval.  However the clinical trial data for the 3-5 year old group fell short - producing only 60% of the required immune response.  Since then the clinical trial recipients were given a 3rd dose of vaccine and they are waiting for that data to be available.   

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The FDA is rescheduling the Advisory Group Meeting so they will have more data to present on the clinical trial participants that are receiving a 3rd dose.  Pfizer told the FDA that the 3 drug trial was moving quickly enough that they should be able to meet in April and make the vaccine available to the 18 million children in that age group. Fortunately omicron cases are falling rapidly right now and the urgency that existed one month ago has lessened.  Pfizer has still been collecting data from the trial participants, and those who became infected had a lower incidence of symptomatic infection.   

February 9, 2022

Parallels From the 1918 Influenza Pandemic

The 1918 Flu didn't end in 1918.  What can it teach us asks the Washinton Post's Jeff McHugh. in an article this week  The flu epidemic began in the spring of 1918 and spread rapidly around the world.  The first wave in the US was relatively mild but was followed with a much more severe second wave in August-September of that year - it would turn out to be the most deadly surge. "In NYC street cars were converted into hearses and priests collected bodies with horse drawn carriages."  More Americans died during the surge than in WWI, WWII, Korea and the Vietnam wars.  There was then a third wave in the winter and early Spring of 1919 and historians report that "Americans were weary of the limitations on daily life" and masks and social distancing were discontinued and school and church closures were lifted.  In the winter of 1919-1920 more people in New York City died from Dec 1919 to April 1920 than in the first and second waves bringing the total US deaths to 675,000.  Mortality was highest the <5, 20-40, and 65+ year old people.

The 1918 flu virus didn't mutate as fast as the SARs-CoV-2 virus and the flu virus eventually grew milder. One-third of the world population was infected and there were 50 million deaths.  When the omicron variant of SARS-CoV-2 appeared, many scientists wondered if it was going to be like the milder flu virus which ended the 1918 pandemic.  The flu vaccine was not available in the US until 1945 and we have vaccines which modify the number of cases and deaths during the annual winter flu season.  Hopefully the number of Covid-19 cases will continue to decrease, as they are doing in NY, and it will become an endemic virus that will benefit from our vaccines and growing immunity.  However we could have another surge as society prematurely returns to a pre-pandemic life.  Which will it be?

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February 5, 2022

More Information About Long Covid

On November 11, 2021 I wrote about Long Covid, which can occur in up to half of the patients who develop Covid-19.  It is defined as residual symptoms which last more than 4 weeks after the onset of a Covid-19 infection.  There are many different symptoms that make up Long Covid, and they often last for more than a year.  It is now clear that Vaccinations reduce the risk.  See the Long Covid information:  http://www.paperandthreads.com/2021/11/see_below.php

Long Covid can occur after mild or moderate infections, but the exact incidence is unknown.  It can even occur in a small number of vaccinated people with breakthrough infections.  A recent study of approximately 1500 vaccinated health care workers in Israel demonstrated that 7 of 39 breakthrough patients developed Long Covid symptoms for more than 6 weeks after infection.  A recent large study in London just reported that the incidence of Long Covid could be reduced by 50% by 2 doses of vaccine.  In a study of Veterans here in the US 11% of unvaccinated Covid patients developed Long Covid and it only occurred in 5% of vaccinated patients.  Vaccination also reduced Long Covid symptoms in a small number of previously unvaccinated infected patients.  See Below

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NIH funded a large study in order to determine all aspects of the risk factors, development, and treatment of Long Covid  ( the trial is named RECOVER).  These studies will also collect data on vaccinated children and adolescents.  One study of more than 6700 adolescents found that about 30% of those who tested positive for SARS-CoV-2 had 3 or more symptoms 3 months after diagnosis compared with 16% of a control group that tested negative.  Many of the symptoms of long Covid occur in healthy people - like headache, fatigue, and muscle pain.  In randomized controlled, double blind studies the placebo group almost always reports some symptoms that are similar to those of the treatment group - making conclusions about cause and effect difficult.  Hopefully the individual programs that are funded through RECOVER help to elucidate the mechanism of disease, prevention, and treatment of Long Covid.    

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