The flu and colds have returned with a vengeance
A Scrabble Message: Covid-19 Antiviral Drugs for Prevalence of Influenza in the Early Universe and in Europe
First, a programming note: This is my last newsletter before starting a book leave. I will be back in late January. Until then, other Times journalists will be writing The Morning, and I look forward to reading their work along with all of you.
If these antibodies stop working against the virus, the United States will still have Covid-19 antiviral drugs like Paxlovid, molnupiravir and remedsivir to help those at risk of severe complications.
In the United States, they are BQ.1 and B Q.1.2. In other countries, the recombinant variant XBB has been rising quickly and appears to be fueling a new wave of cases in Singapore. Cases are rising in Europe and the UK, where these have taken hold.
Dr. Peter Hotez says that they all use the letters Q, X and B, which make them a variation of Scrabble.
Why is the COVID-19 surge kickin in the kicking in now? Analysis of the New Variants and Predictions for the Northern Hemisphere
COVID-19 restrictions were lifted last year. So why is the surge kicking in only now? Hensley was worried that flu andRSV would come back. But the influenza season overall was mild in the Northern Hemisphere. Although the number of infections increased, the peak was lower than it has been in previous years, which may have helped to limit the spread of the virus. Virginia Pitzer is an epidemiologist at the Yale school of public health in New Haven, Connecticut, and she says that factors such as temperature and humidity affect the transmission of the virus.
It’s not clear whether this gang of new variants will continue to run around together, each sharing a piece of the Covid-19 infection pie, or whether one will rise to outcompete the others, as has happened in previous surges.
Antibodies are not a great idea for companies since they cost millions of dollars to make and could only be effective for a short period of time.
The Omicron family tree has two different branches, but they are each descended from the same line of trees called convergent evolution.
The experts believe that this convergence means we are in the middle of a new phase of evolution, one that will result in several different strains circulating at the same time.
“What is likely to happen is that we have several co-circulating, semi-dominate lineages going into the winter season,” said Nathan Grubaugh, an associate professor of epidemiology at the Yale School of Public Health.
“That’s because with convergent evolution, perhaps several different lineages can independently obtain similar transmissibility levels versus a single new variant taking over.
“This is what predominantly happens for most pathogens, such as the flu and RSV,” Grubaugh wrote in an email. “Now that the virus has adapted pretty well to human transmission, most of what is circulating has high fitness.”
The large mix of new variant was becoming more difficult to assess due to countries scaling back on their surveillance according to Maria Van Kerkhove.
The study authors say these findings call for continued efforts to prevent Covid-19 infections and enhanced health monitoring of individuals after an infection.
For now, the Omicron subvariant BA.5 still holds the top spot in the US. It caused almost two thirds of new infections in the US last week and is quickly being outmatched by other sublineages.
Fauci told CNN that most people think that BA.5 will be the dominant variant, and that most people think it will happen at the middle of November.
These variants are different from BA.4 and BA.5, but they’re descended from those viruses, the result of genetic drift. They have parts of their genomes with that virus.
Their changes aren’t on the scale of what happened when the original Omicron arrived on the scene in November 2021. That strain of the virus, which is now long gone, came out of genetic left field, leaving researchers and public health officials scrambling to catch up.
“It isn’t that different from BA.5 that it would completely escape the protection that you would get from vaccine” – if people would just get the shot, Fauci said.
The bivalent booster vaccine, authorized in September, protects against the original strain of the coronavirus as well as the BA.4 and BA.5 subvariants.
In the United States, 15% of eligible people have received a two-strain jab. Many people have received a mixture of vaccines, which has led to confusion over which type of booster they should get and when.
Covid-19 is not going to be bigger than the BA.5 wave, but it will be better than the B.A.5 and the Omicron wave
“It’s probably going to be significantly bigger than the BA.5 wave, at least that’s what I expect,” said Mark Zeller, a project scientist who monitors variants at the Scripps Research Institute. But Zeller says he doesn’t expect this winter’s surge to reach heights of January’s Omicron wave.
People who aren’t getting an updated booster for their vaccine may be at increased risk for recontamination and serious infections, because the genetic changes these variants share seem to help them escape immunity.
People with immune function that has been weakened by drugs, disease or age are particularly important for antibody therapies. These are the people who don’t respond well to vaccines.
“So even if we got money today, it would take us many months to bring a monoclonal into the marketplace, and we don’t have the money today anyway,” Jha told CNN.
The administration has been thinking about ways to commercialize some parts of the Covid-19 response – to get out of the business of buying vaccines and therapies – ultimately passing the costs on to consumers and insurers. But Jha says the process has to be guided by “the needs on the ground and the realities of the virus.”
He says current realities require that the government continue to incentivize the production of new therapies, and he expects that the Biden administration will again try to ask Congress to pass more funding to do that.
Seasonal Influence on the Respiratory Syncytial Viral Disease: Why Does Vaccination Surge Now? Why Does It Happen Now? How Did It Happen?
The spread of other respiratory illnesses was counteracted by the restrictions on COVID-19. The seasonal flu and respiratory syncytial virus can cause mild cold-like symptoms, but it can be dangerous for young children or older adults and is not usually seen in 2020. Now, in the Northern Hemisphere, RSV is surging, and the hospitalization rate for flu in the United States is higher for this time of year than it has been since 2010. Why exactly are these surges happening now? And what’s in store for future winters?
“We understand the seasonality of flu, and know exactly when to vaccinate for optimal effect,” says Luciana Borio, a former FDA acting chief scientist, who is now a global-health specialist at the Council on Foreign Relations in New York City. But “we simply do not know whether people need to be vaccinated every year or less frequently to be protected from severe COVID”.
Some scientists have also posited on social media that the surge in RSV hospitalizations might be the result of SARS-CoV-2 infection causing immune deficiencies that leave people more susceptible to other infections. But Miller says hasn’t seen any evidence for that either, and the surge in hospitalizations could be explained by the large number of people who missed exposures in the past few years. “There’s a slightly bigger naive population, all of whom are at risk. So you’ve got more numbers going into the system.”
In August 2021, researchers in France coined the term ‘immunity debt’ to describe this reduction in population-level immunity. On Twitter, the term has taken on a life of its own. Matthew Miller is an immunelogist at McMaster University and he calls the idea that a lack of exposure has irrevocably damaged the immune systemnonsense.
There is also a lot that researchers still don’t understand about seasonal viruses. For example, COVID-19 restrictions seemed to have little impact on one type of seasonal virus, rhinoviruses — which are the most common cause of colds — for reasons that aren’t entirely understood. That might be a result of their hardyness, Miller says. They can persist in the environment for a long time.
There are many questions about how these viruses compete and interfere with one another. It is possible that one virus can raise a strong innate immune response, preventing another from being infections. Last year’s first wave of flu declined quickly after the Omicron surge began. Omicron might have had some short-lived protection against flu. Or maybe the Omicron surge simply convinced people to mask up and keep their distance.
Implications for Vaccine Composition and Formulation in the Light of the P.C. Epidemic and the Winter Flux
The peaks and valleys of next year might look a bit like those before the P.C. epidemic. She is not placing any bets. But she says: “I do expect that this winter is probably going to be the last unusual winter.”
Megan is a physician and public-health specialist at Brown University in Rhode Island. “If we’re going to sustain our ability to vaccinate the country, we have to move toward a more standardized schedule, from a behavioural-science point of view.” The proposal to adopt a single vaccine composition for the entire series would alleviate some of the confusion, and it may boost vaccine intake because jabs could be offered alongside annual influenza vaccines, she says. “These changes make a lot of sense.”
Peter Marks, a head of the FDA’s Center for Biologicals Evaluation and Research, said that administering the jab before the winter surge would reduce the number of hospitalizations. In winter, clinics are swamped with people infected with influenza and respiratory syncytial virus (RSV), which led to some US hospitals nearing capacity this season.
Some meeting panellists had concerns about the decision to use a bivalent formulation, rather than an updated single-strain one, in future vaccines. Scientists noted that there are few data on the effectiveness of bivalent vaccines when given as a primary series — particularly in young children, who make up a large proportion of the people now receiving a primary series in the United States. Studies have shown that including ancestral strains might make the vaccine less effective against Omicron.
Long COVID can be prevented with antiviral treatment: A study of the U.S. trial of ensitrelvir
Those with long Covid were also roughly two times more likely to experience cardiovascular events including arrhythmias, stroke, heart failure and coronary artery disease. It was also common for pulmonary conditions to occur. The risk of having a lung embolism more than doubled while the risk of having COPD and moderate or severe asthma nearly doubled for people with long Covid.
The study shows that it is not possible to get Covid from the first time, or if you don’t develop long-term Covid, if you don’t get acutely ill.
The antiviral ensitrelvir, which is not approved in the United States, shortens symptoms in people with mild COVID and might reduce risk of long COVID — but more data are needed.
Organizers of the ensitrelvir trial investigated roughly 1,200 people, with the main goal of determining whether the drug could accelerate recovery. The results show that people who took 125-milliGram ensitrelvir tablets recovered from five symptoms earlier than people who didn’t.
The people who took a 125-milligram dose tested negative for the disease 29 hours earlier than the people who took a placebo. The study was the first to show a statistically significant reduction in the time it took to reach a negative test result.
Danny Altmann at Imperial College London says the best way to investigate if antivirals prevent long COVID would be to only include people who have been affected by SARS-CoV-2. If scientists don’t separate out such people from those whose symptoms don’t have the same cause, trials could yield “murky answers,” Altmann says.
Shionogi have made public data that supports the idea that antivirals protect against long COVID, at some point when there’s residual virus involved in causing symptoms.
There is no consensus on what causes long COVID. “It’s entirely possible that the virus has nothing to do with long COVID,” says Edward Mills, a health researcher at McMaster University in Hamilton, Canada. Long COVID might be caused, for example, by the immune response to the virus, he notes.
