Covid-19 Updates & Info

[dryrunguy]

Received my bivalent booster yesterday.

I received my most recent booster (Pfizer) on July 21--right before the bivalent boosters came out. Is it too soon for me to get the bivalent booster? Generally, it seems like the guidance on how often to get boosters is every 6 months. But the regular boosters clearly aren't as effective against today's most prevalent subvariants.

[atlpam]

Recommendation is to wait 4-6 months, so I would think if you want the extra protection heading into the holiday season, you would be fine to get it the end of Nov. I waited the full 6 months, which worked well for me, timing wise. The hubs is still needing to get his, but he’s always down for a full day after the shot, so he has to plan for a lost day.

[MJ2004]

Because I'm under 50, I wasn't eligible for another booster until this Oct (I got the bivalent) - one year from my first booster. Now unless something changes I plan to stay on the fall plan and boost once per year. Every six months is too often for me. I do however continue to wear masks almost everywhere.

[ti-amie]

I got my booster earlier this month and had no side effects at all. I mask everywhere I go.

[Deuce]

I was going to get my third booster - a bivalent - at the beginning of this month, which would be 5 months after the previous (second) booster. But a month ago, I became ill with a virus, and the rapid COVID antigen test showed positive... and so I wait, as the medical people say to wait 3 months after you have COVID before getting your next vaccine.

Last month was the first time I've been ill since the pandemic began. I'm still not completely convinced I had COVID. As I have since the spring of 2020, I wear a mask in every indoor setting (except at home), and outright avoid unnecessary indoor locations, and so it's a mystery as to where I contracted it (if it was indeed COVID).

The 3 month wait before the next vaccine is not mandatory (it would be impossible to enforce anyway) - it's simply a recommendation. There is no danger in getting vaccinated right after your COVID symptoms disappear - it's simply a matter of mathematics: when one has COVID, the antibodies remain in the person's system strongly for about 3 months after the fact - and so it makes no sense to waste 3 months of the vaccine's effective protective time range by getting vaccinated right after you have COVID, as you're already protected by the natural antibodies. Getting vaccinated on top of that will not protect you any more.

And so I think I will end up compromising between the two and get the bivalent vaccine 2 months after my positive test, which will be in about a month.

[ti-amie]

[ponchi101]

:slap to the face: emoji
(We don't have it)

[skatingfan]

:slap to the face: emoji
(We don't have it)

[atlpam]

Cruise ships are floating petri dishes. (my opinion)

[dryrunguy]

Here's the latest Situation Report. We called the section on long COVID and disability. I thought the last section on the Indian vaccine approval process was interesting.

::

EPI UPDATE The WHO COVID-19 Dashboard reports 633.3 million cumulative cases and 6.59 million deaths worldwide as of November 17. Global weekly incidence increased significantly for the first time since August, rising 5% compared to a decrease of 10% the previous week. A total of 2.4 million cases were confirmed the week of November 7. Weekly incidence fell over the previous week in Europe (-15%) and the Eastern Mediterranean (-12%) and remained steady in Africa (0.42%). The Americas (+17%), South-East Asia (+15%), and Western Pacific (+18%) regions experienced increasing weekly incidence. Global weekly mortality declined from the previous week, down 26%, reaching the lowest level since the beginning of the pandemic.*
*The WHO dashboard notes that data from the Eastern Mediterranean and Africa regions are incomplete.

UNITED STATES
The US CDC is reporting 97.9 million cumulative cases of COVID-19 and 1.07 million deaths. Incidence for the week ending November 2 rose slightly over the previous week, rising to 288,989 from 273,021 for the week ending November 2. Weekly mortality remained relatively steady for the week ending November 9, down slightly to 2,344 reported deaths from 2,489 deaths the week ending November 2.**
**The US CDC updates weekly COVID-19 data on cases and deaths on Thursdays by 8pm ET.

Both new hospital admissions and current hospitalizations remained stable, falling slightly by 0.9% and 0.8%, respectively.

The BA.5 sublineage is expected to lose dominance in the US over the next week. BA.5 now accounts for 29.7% of sequenced specimens. The Omicron sublineages BQ.1.1 (24.1%) and BQ.1 (20.1%) are exhibiting growth advantages over other sublineages, including BF.7 (7.8%) and BA.4.6 (5.5%). The CDC is now tracking the Omicron sublineage BN.1, which is now responsible for 4.3% of cases. Other Omicron sublineages appear to be declining in prevalence, including BA.5.2.6 (2.9%), BA.2.75 (1.2%), and BA.2.75.2 (0.9%).

US RESPONSE The Biden administration is expected to keep in place the public health emergency status of the COVID-19 pandemic through spring 2023 to address a potential winter surge in cases and provide more time to transition vaccines and treatments to the private market, according to 2 unnamed officials. The declaration, most recently renewed in October, was set to expire in January. The US HHS has promised to provide states 60 days’ notice before winding down the emergency, and did not do so on November 11, which marked that date. This week, the White House requested the US Congress authorize an additional US$9.25 billion in pandemic funding for this year. According to officials, about US$8.25 billion would go toward purchasing treatments and vaccines ahead of a possible winter surge, efforts to accelerate research into next-generation vaccines and treatments, and long COVID research, with an additional US$1 billion going toward global vaccination and response efforts. The Biden administration has repeatedly tried to secure additional funding with no success; observers say the best chance might be during the current lame-duck session while Democrats retain control of both congressional chambers.

Though the need remains for additional spending for COVID-19 and general pandemic preparedness and response, public and congressional interest is waning. On November 15, the US Senate voted 62-36 to end the emergency declaration, with support from 12 Democrats. In response, the Office of Management and Budget said abruptly ending the emergency would be “a reckless and costly mistake” and noted US President Joe Biden would veto the measure if passed by Congress. It is unclear whether the US House will take up the resolution.

WINTER SURGE PREDICTIONS The WHO on November 16 announced that the worldwide number of new COVID-19 cases increased last week for the first time in 4 months, warning that the true number of infections is likely higher due to declines in testing. Additionally, upticks in influenza and respiratory syncytial virus (RSV) cases also are straining hospitals, particularly some countries in the Americas.

While many in the US work to find balance between COVID-19 precautions and returning to a sense of normalcy, there are signs the coronavirus has not gone away. The number of new weekly COVID-19 cases are beginning to increase, raising concerns over a potential winter surge amid waning immunity and the emergence of new subvariants. About 330 people die of COVID-10 each day in the US, and around 21,000 are hospitalized with COVID-19 on any given day. Despite low levels of uptake of the bivalent booster vaccine—only 10% of the population aged 5 and older have received the updated shot—some US health officials, including White House COVID-19 Response Coordinator Dr. Ashish Jha, say they are not expecting a large surge in cases during the winter holiday season. Dr. Jha is confident that broad vaccine coverage and widespread previous infections will help keep a large surge at bay. Other experts are not so assured, saying the possibility remains for a substantial surge, with several factors making the US underprepared. Declining support for community vaccination campaigns, a public that is tuning out renewed government vaccination messaging, few remaining treatments effective against emerging Omicron sublineages, waning use of nonpharmaceutical interventions (NPIs) such as mask use, and diminishing surveillance place the US in uncharted territory heading into what is traditionally the height of respiratory virus season.

MODERNA BIVALENT BOOSTER On November 14, Moderna announced data showing its updated Omicron BA.4/BA.5-adapted bivalent vaccine booster offers a strong immune response against BA.5 by increasing antibodies levels, when compared to the company’s original booster. The bivalent vaccine (mRNA-1273.222) demonstrated a 15-fold increase in neutralizing antibody titers compared to pre-booster levels. The data are not yet peer-reviewed or posted to a preprint server. An exploratory analysis of data from 40 participants suggested both of the company’s bivalent boosters—with the other targeting BA.1 (mRNA-1273.214)—showed robust levels of neutralizing antibodies against the emerging Omicron subvariant BQ.1.1, which has the potential to become dominant in the US by next week. Notably, however, the demonstrated antibody responses were lower than those against BA.4 and BA.5. Since Omicron-adapted booster shots began to rollout earlier this fall, acceptance and uptake has been dismal. Only 10% of the US population aged 5 and older have received an updated booster, spurring the Biden administration to launch a new campaign urging residents to get boosted ahead of Thanksgiving.

COVID-19 REBOUND Cases of COVID-19 rebound—the return of test positivity or symptoms after clearance or resolution—following treatment with the antiviral Paxlovid appear to be more common than previously believed, a preprint study posted November 15 to medRxiv suggests. The prospective observational study, which is not yet peer-reviewed, found that viral rebound among the 127 participants who took a 5-day course of Paxlovid was 14.2%, while 9.3% of the control group of 43 people experienced viral rebound. There were no significant differences in viral rebound by demographics, pre-existing conditions, or major symptoms experienced during the acute phase or at 1 month. Additionally, COVID-19 symptom rebound incidence was higher in the Paxlovid group (18.9%) compared with the control group (7.0%). Though the study was not able to determine whether the observed differences were due to chance or as a result of treatment, many researchers agree the results mirror their real-life experiences that rebound is more common in people who take Paxlovid.

Larger studies are being planned to better understand the issue, which hopefully will help alleviate one of the causes for underprescription of Paxlovid. High-profile cases of rebound likely are contributing to underuse of the treatment. In clinical trials, Paxlovid was nearly 90% at preventing hospitalizations and deaths of high-risk patients with COVID-19. Notably, another preprint study suggests treatment with Paxlovid is associated with a 26% reduction in the occurrence of post-acute symptoms, commonly known as long COVID.

PASC/LONG COVID Although many people with COVID-19 recover within weeks, some continue to experience a constellation of symptoms—or start experiencing new ones—that can last long after their acute infection. The US CDC has recognized that post-acute sequelae of SARS-CoV-2 infection (PASC), commonly called long COVID, includes new or ongoing symptoms such as fatigue, brain fog, shortness of breath, headaches, chest pain, loss of taste or smell, and more. Notably, however, there is no widely accepted definition of the condition, often leaving clinics wrestling with how to treat long COVID patients with varying conditions.

To understand the prevalence of post-COVID-19 symptoms, a recent cross-sectional cohort study published in JAMA Network Open compared the presence of post-COVID symptoms in 360 hospitalized and 308 nonhospitalized patients at 2 healthcare centers in Madrid, Spain, 2 years after their initial acute infection early in the pandemic. The study reported that 2 years after initial infection, 59.7% of those who were hospitalized and 67.5% of those who were not hospitalized still had at least one symptom of COVID-19, with the most prevalent symptoms being fatigue (44.7% vs. 47.7%, respectively), pain and headaches (35.8% and 29.9%, respectively), and memory loss (20% and 15.9%, respectively). Overall, the research team observed no significant differences in post–COVID symptoms between hospitalized and nonhospitalized patients, although hospitalized patients experienced slightly higher levels of anxiety.

Similarly, a recent study published in PLOS Medicine investigated post-COVID-associated morbidity in children, adolescents, and adults using comprehensive healthcare data on half of the German population. The study determined that children, adolescents, and adults have the same relative risk of experiencing post-COVID-19 symptoms 90 days after their initial acute infection. Children, adolescents, and adults experienced shared symptoms like cough, fever, headache, malaise/fatigue/exhaustion, and throat or chest pain. Adults were slightly more likely to experience disturbances of smell and taste, fever, and respiratory symptoms, while children and adolescents were slightly more likely to experience malaise, fatigue/exhaustion, cough, throat or chest pain, and adjustment disorder.

This growing evidence base around the characterization and prevalence of long COVID can help inform efforts to support people whose symptoms have a significant impact on their lives. Although the US HHS and US Department of Justice have jointly declared long COVID as a disability, some Americans with long COVID have faced barriers to accessing disability benefits. Long COVID-related disability assistance is frequently denied due a lack of specific guidance on how to evaluate the claims and lack of standard processes for diagnosing the condition. HHS in August released a report outlining federal services and support for people with long COVID, and advocates and researchers are working to raise awareness of these resources. A recent report from the Brookings Institution estimated that long COVID could be contributing to a national labor shortage, with as many as 4 million people out of work due to the condition.

VACCINE MANDATES Vaccine mandates—for COVID-19 and other diseases—are contentious issues in the US. On several occasions, the US Supreme Court has refused to hear arguments or let lower court rulings stand, allowing COVID-19 vaccine mandates to remain in force. Now, the Blackfeet Nation is challenging a Montana law that prohibits businesses and governments from discriminating against people who are not vaccinated against COVID-19 or other diseases, after a meeting on the Blackfeet Indian Reservation that checked attendees’ COVID-19 vaccination status came under scrutiny for potentially violating state law. The case raises the question of whether Montana can enforce its law on the Blackfeet Nation, superseding the tribe’s right to enforce its own ordinances as a sovereign nation within US borders to protect the health of its people. A 1855 treaty allows the Blackfeet tribe to regulate tribal and nontribal members alike on its land. The US CDC has lauded Blackfeet Nation for implementing effective COVID-19 risk mitigation and prevention measures. Relatedly, a separate lawsuit argues that Montana’s law is unconstitutional and prevents hospitals and physicians from protecting disabled patients and employees from exposure to COVID-19.

VACCINE APPROVAL PROCESS IN INDIA India’s national drugs regulator approved a domestically developed vaccine for COVID-19—Covaxin, produced by Bharat Biotech—despite discrepancies in the number of clinical trial participants, questionable changes to trial protocols, and efforts to speed trials along without complete data on safety and efficacy, according to a report from STAT. A lack of transparency surrounding the vaccine’s development efforts, questions over Bharat Biotech’s manufacturing facilities, as well as political and scientific pressure to move testing forward contribute to ongoing concerns over Indian government oversight of and commitment to producing quality medical products. A day after the STAT report’s publication, India’s Health Ministry said any allegations that the government made missteps or rushed Covaxin’s development and testing are “completely misleading, fallacious, and ill-informed,” and Bharat Biotech called the narrative misleading, clarifying that any pressure felt originated within the company. Bharat Biotech also reiterated that Covaxin is safe and effective, having been tested more than any other Indian vaccine and with several million doses administered worldwide.

India’s pharmaceutical industry is one of the world’s largest by volume, exporting medicines to more than 200 countries and contributing a large volume of generic drugs, especially in the US. Last month, the WHO linked an Indian-made cough syrup to the deaths of nearly 70 children in West Africa; India’s drugs regulator disputed the WHO’s findings.

https://covid19.who.int/

[ponchi101]

Agree that Long Covid merits more study. One question that I would like to ask: do people that got Covid BUT WERE VACCINATED, suffer the same range of symptoms and effects as those that were not vaccinated?
We have now two distinct (or even three) populations to study.

[dryrunguy]

Agree that Long Covid merits more study. One question that I would like to ask: do people that got Covid BUT WERE VACCINATED, suffer the same range of symptoms and effects as those that were not vaccinated?
We have now two distinct (or even three) populations to study.

Some evidence suggests that unvaccinated people generally suffer worse health outcomes than partially or fully vaccinated people. This applies to general illness (how badly COVID knocks you off your gourd and for how long), hospitalizations, deaths, AND the incidence and severity of long COVID.

[Suliso]

I have no idea how this will end in China, but not with eradication of covid I'm sure.

https://www.bbc.com/news/world-asia-china-63739617

[ponchi101]

The claim that only 5,200 people have died in China is ludicrous.

[dryrunguy]

I guess I'll put this here. Today's NY Times e-newsletter featured an interesting analysis of data on the impact of remote learning earlier in the pandemic on student math and reading skills in the U.S.

::

Good morning. Remote learning erased students’ progress in math and reading, but it wasn’t the only factor.


Behind the declines
Months into the current school year, most American students are still trying to make up for what they lost during the pandemic. This fall, we saw some of the clearest evidence yet of the extent to which the pandemic — and the school closures that came with it — hurt children’s education.

Nine-year-olds lost the equivalent of two decades of progress in math and reading, according to an authoritative national test. Fourth and eighth graders also recorded sweeping declines, particularly in math, with eighth-grade scores falling in 49 of 50 states.

The data comes from the National Assessment of Educational Progress, a rigorous exam that evaluates thousands of children across the country and is overseen by a research arm of the U.S. Education Department.

Today, I’ll break down the factors that drove these declines and explain an important trend that helps show why these results are so sobering.

Remote learning’s role
First, to address one of the most common questions I hear as an education reporter: To what degree is remote learning responsible for these setbacks? The answer is both simple and complicated.

At a basic level, there is good evidence and a growing consensus that extended remote learning harmed students. Some state test results from 2021 help show the damage. In Ohio, researchers found that districts that stayed fully remote during the 2020-21 school year experienced declines up to three times greater than those of districts that mostly taught students in person.

More recently, the national test results capture both the initial academic declines and any recovery, and they offer some nuance. While there was a notable correlation between remote learning and declines in fourth-grade math, for example, there was little to no correlation in reading. Why the discrepancy? One explanation is that reading skills tend to be more influenced by parents and what happens at home, whereas math is more directly affected by what is taught in school.

So remote learning does not explain the whole story. What else does? In a sophisticated analysis of thousands of public school districts in 29 states, researchers at Harvard and Stanford Universities found that poverty played an even bigger role in academic declines during the pandemic.

“The poverty rate is very predictive of how much you lost,” Sean Reardon, an education professor at Stanford who helped lead the analysis, told me.

Comparing two California school districts, one wealthier and the other poorer, illustrates this point. Cupertino Union, a Silicon Valley school district where about 6 percent of students qualify for free or reduced lunch (a marker that researchers use to estimate poverty), spent nearly half of the 2020-21 school year remote. So did Merced City in the Central Valley, where nearly 80 percent of students are eligible for free or reduced lunch, according to the Harvard-Stanford analysis.

Yet despite spending roughly the same amount of time attending classes remotely, students in the wealthier Cupertino district actually gained ground in math, while students in poorer Merced City fell behind.

High vs. low performers
While the overall declines in student achievement were stark, the averages mask even deeper divergences between student groups. For example, Black and Hispanic students, who had started out behind white and Asian students in fourth-grade math, lost more ground than those groups during the pandemic.

Notably, the gap is also growing between the country’s highest-achieving students and low-performing students who struggle the most.

That gap — driven by declines among lower performers — was most clear for younger students and in reading. (Middle-school math declines were more significant across the board.)

In fourth grade, the average reading score on the national exam fell three points. But results for students in the top 90th percentile did not fall at all, while those for students in the bottom 10th percentile plunged six points, double the overall average.

In other words: The students who had the least ground to lose lost the most.

There may be a twofold explanation. Recent research from NWEA, a nonprofit academic assessment organization, found that students at the bottom of their classes both experienced sharper setbacks at the start of the pandemic and showed less improvement last school year.

I am sometimes asked: If the pandemic affected all students, how much does it matter? Isn’t everyone behind?

What the latest data affirmed is that while the pandemic affected all students, it did not affect all students equally. That was true with remote learning, and it is playing out now in recovery. The students who had the greatest needs coming into the pandemic have the steepest challenge — and will need the most help — in the future.