Experts have been warning about the potential for a winter resurgence of COVID, and now the first signs are appearing in Europe, which has often served as a bellwether for the U.S. In America, new cases have dropped below 40,000 per day for the first time since April. The FDA and CDC have formally approved giving the new bivalent booster shot to children as young as five years old, but a study from a clinic in San Francisco’s Mission District suggests that the federal government’s current policy requiring five days of COVID isolation may not be long enough.
Biden administration extends public health emergency
The Biden administration said Thursday that the COVID-19 public health emergency will continue through Jan. 11 as officials brace for a spike in cases this winter, the Associated Press reports. The decision comes as the pandemic has faded from the forefront of many people’s minds. Daily deaths and infections are dropping and people — many of them maskless — are returning to schools, work and grocery stores as normal. The public health emergency, first declared in January 2020 and renewed every 90 days since, enabled the emergency authorization of COVID vaccines, testing and treatments for free. It also expanded Medicaid coverage to millions of people, many of whom who will risk losing that coverage once the emergency ends.
Lack of data “blinding” WHO to evolution of virus
World Health Organization officials reiterated that they anticipate another winter coronavirus surge at the U.N. health agency’s quarterly Emergency Committee on COVID-19 meeting Thursday. Some countries are already reporting an increase in infections, hospitalizations, and deaths. “We have never been in a better position to end COVID-19 as a global health emergency,” said Tedros Adhanom Ghebreyesus, the director-general of the organization, in his opening remarks. “But our work is not yet finished.” He noted that most countries no longer have COVID-19 mitigation measures in place to limit the spread of the virus and that they have “drastically” reduced their surveillance, testing and sequencing. “This is blinding us to the evolution of the virus and the impact of current and future variants,” he said.
Large respiratory outbreak under investigation at Southern California high school
Respiratory and flu-like symptoms among a large number of students at a San Diego County high school are under investigation by health authorities, the Association Press reports. The Public Health Services investigation announced Wednesday involves the San Diego Unified School District’s Patrick Henry High School, which has 2,600 students. “Although the County reports daily several hundred COVID-19 cases, and is already seeing a rapid and early start to flu season, it is too early to determine the cause of the suspected outbreak at Patrick Henry High School as test results are pending,” the county communications office said in a statement.
Local hospitals have had a recent increase in emergency room visits due to flu and respiratory syncytial virus (RSV), which usually causes mild, cold-like symptoms. “We are coordinating with local school districts and are checking with other school campuses to try and figure out why so many students have been affected so suddenly,” Dr. Cameron Kaiser, deputy public health officer, said in the statement.
Nationally, doctors have been urging vaccine-weary Americans not to skip flu shots this fall. After the flu hit historically low levels during the COVID-19 pandemic, it may be poised for a comeback. Experts say that Australia just experienced its worst flu season in five years and what happens in Southern Hemisphere winters often foreshadows what Northern countries can expect. In addition, people have largely abandoned masking and distancing precautions that earlier in the pandemic helped prevent the spread of other respiratory bugs.
Pfizer releases first human trial results for bivalent boosters
On Thursday, Pfizer and BioNTech released the initial data from their ongoing study of their bivalent COVID-19 booster shots in humans, saying in a press release that the updated formula demonstrated a “substantial” immune response against the omicron BA.4 and BA.5 subvariants. The companies analyzed blood samples from 80 adults one week after they received the new shots for the preliminary results on the effectiveness of boosters, which were given emergency use authorization by the FDA in August without data from human trials. “While we expect more mature immune response data from the clinical trial of our omicron BA.4/BA.5-adapted bivalent vaccine in the coming weeks, we are pleased to see encouraging responses just one week after vaccination in younger and older adults,” Pfizer CEO Albert Bourla said in a statement. The companies will release additional findings on responses at one month “to support potential full licensure and global registration” of the bivalent vaccine.
UCSF’s Wachter predicts a “modest surge” this winter
Dr. Bob Wachter, UCSF’s chief of medicine and prolific tweeter, this week told Axios that he is not terribly concerned about the emerging coronavirus variants U.S. health officials are tracking even though some are “somewhat more immune evasive than BA.5.” He said, “none of them are super scary (because) all of them come from the BA.5 lineage” and that he expected a “modest surge” this winter if enough people get the updated bivalent booster shots. The new formula targets the original coronavirus strain and the dominant BA.4 and BA.5 omicron versions. But Wachter said the virus is known for throwing curveballs, as it did last December shortly before the biggest surge of the pandemic, so anything is possible. “There was nobody who predicted omicron a month before omicron,” he said.
State virus trends stall for the third consecutive week
California’s COVID-19 numbers made little progress in the past week. The state is tracking about 8.2 new daily cases per 100,000 residents as of Thursday, down from 8.3 per 100,000 a week ago, according to health department data. The statewide test-positive rate also remains unchanged at 4.7%. But the case numbers may be misleading with the number of coronavirus tests performed across the state falling steeply, with the official sites administering fewer than 30,000 tests daily — the lowest number since April 2020. By comparison, in January, state sites administered more than 834,000 coronavirus tests per day. California is still tallying a death toll of 19 people each day due to the virus, and there are 1,746 patients hospitalized with COVID-19, a modest decrease from the 1,800 admissions recorded at the beginning of the month.
Long COVID to blame for shorter workouts, UCSF study finds
Researchers at UCSF have found another persistent effect of a coronavirus infection to add to the familiar list of long COVID ailments such as brain fog, fatigue and headache: reduced exercise capacity. In a report published in JAMA Network on Oct. 12, the researchers found evidence that some people who suffer with “long haulers” symptoms may have “reduced oxygen extraction in the muscles, irregular breathing patterns, and a lesser ability to increase heart rate during exercise to match cardiac output.” They also found evidence of deconditioning.
To get their results, the UCSF scientists conducted a systematic review and meta-analysis of 38 previous studies that tracked the exercise performance of more than 2,000 participants who had recovered from COVID-19, then zeroed in on 9 studies in which the exercise performance of 359 participants who had recovered from the virus was compared to that of 464 participants who had symptoms consistent with long COVID. The average age of the participants ranged from 39 to 56 and the average body mass index from 26 to 30.
According to first author Matthew S. Durstenfeld, of the UCSF Department of Medicine and of the Division of Cardiology at Zuckerberg San Francisco General Hospital, the changes seen were equivalent to 1.4 metabolic equivalent of tasks (METs), a measure of energy consumed during physical activities. “This decline in oxygen peak rate would roughly translate to a 40-year-old woman with an expected exercise capacity of 9.5 METs, dropping to 8.1 METs, the approximate expected exercise capacity for a 50-year-old woman,” he said in a statement.
In simpler terms, he said that a doubles tennis player might need to transition to playing golf with a cart or stretching exercises, and those who swim laps may find that low-impact aerobics is a better match. “But it’s important to note that this is an average,” he said. “Some individuals experience a profound decrease in energy capacity and many others experience no decrease.”
Daily cases fall below 40,000 for the first time since April
The seven-day rolling average of daily COVID-19 cases in the U.S. fell below 40,000 for the first time since mid-April on Tuesday, marking a 75% decline since last month, according to data from the Centers for Disease Control and Prevention. At the peak of the summer BA.5 surge, the moving average reached about 130,000 cases per day. But health officials say case counts are no longer a reliable indicator of pandemic trends and last week the CDC stopped updating its daily numbers due to a lack of reporting data from states and jurisdictions. The White House on Tuesday warned of a “challenging” virus season ahead, as temperatures cool down and the holidays approach. More than 330 people die on average each day of COVID-19, according to CDC data, with the U.S. death toll standing at over 1.05 million.
Florida governor under investigation for using pandemic funds in migrant stunt
The Treasury Department’s internal watchdog is investigating whether Florida Gov. Ron DeSantis improperly used federal pandemic aid to fly migrants to Martha’s Vineyard as part of his effort to “transport illegal immigrants to sanctuary destinations,” the Associated Press reports. At issue is whether millions of dollars in interest earned on State and Local Fiscal Recovery Funds, disbursed through the American Rescue Plan, were used to facilitate the transport of about 50 Venezuelans from Texas to Massachusetts in mid-September, with a stopover in Florida on the way. “The use of federal COVID relief funds in this manner runs contrary to congressional intent and appears to violate federal law,” Sen. Ed Markey and six other Massachusetts lawmakers wrote in a Sept. 17 letter to Treasury Deputy Inspector General Richard K. Delmar. Markey said DeSantis was “effectively using COVID-19 relief to score political points by exploiting vulnerable immigrants.” The White House has called the trip to Martha’s Vineyard a “cruel, premeditated political stunt.”
Europe entering another wave, says WHO
Europe is getting hit with another wave of infections as cases and hospitalizations rise sharply across the region, the World Health Organization and European Centre for Disease Prevention and Control (ECDC) said Wednesday. “Although we are not where we were one year ago, it is clear that the COVID-19 pandemic is still not over,” said WHO’s Europe director, Hans Kluge, and ECDC’s director, Andrea Ammon, said in a joint statement. “We are unfortunately seeing indicators rising again in Europe, suggesting that another wave of infections has begun.” Cases are up and vaccine uptake is down, which opens up the potential for another devastating winter, the agencies said. “The potential co-circulation of COVID-19 and seasonal influenza will put vulnerable people at increased risk of severe illness and death, with the likelihood of increased pressure on both hospitals and healthcare workers, already exhausted from almost three years on the frontlines of the pandemic,” they said.
Mission District study finds CDC’s 5-day isolation period may be “totally inadequate”
A new study conducted at a San Francisco walk-up COVID-19 testing clinic has cast doubt on a federal policy requiring people with confirmed or suspected cases of COVID to isolate for just five days. The study, published this week on JAMA Network Open, found that four in five people remain positive for COVID five days after their symptoms appear. The findings indicate that a negative test, not an arbitrary number of days, should be used “to inform the length of the isolation period,” the authors write. Current Centers for Disease Control and Prevention rules require people with COVID to isolate for five days, a policy the federal body has characterized as a realistic concession to what Americans are willing to tolerate nearly three years into the pandemic. The study, conducted on more than 63,000 people, many Latino, who visited the Unidos en Salud testing and vaccine site in the Mission District of San Francisco earlier this year, shows that the CDC’s isolation period of 5 days is “totally inadequate for most people,” said Dr. Eric Topol, a California-based doctor and researcher who was not involved in the study.
Large long COVID study finds many do not recover
One of the most comprehensive studies looking into long COVID found that between six and 18 months after an initial coronavirus infection, one in 20 people had not recovered and 42% reported a partial recovery with “poorer quality of life and wide-ranging impairment of their daily activities which could not be explained by confounding.” The results of the ongoing Long-CISS (Covid in Scotland Study), published Wednesday in Nature Communications, included 100,000 participants and measured 26 common symptoms associated with so-called long haulers. Those include shortness of breath, palpitations, chest pain, brain fog, and insomnia. “Between 6 and 18 months following symptomatic SARS-CoV-2 infection, almost half of those infected reported no, or incomplete, recovery,” the authors wrote. “Whilst recovery status remained constant over follow-up for most, 13% reported improvement over time and 11% deterioration.” There was some good news. The scientists found that vaccination was associated with a reduced risk of at least seven symptoms, and those with asymptomatic infections were less likely to experience long COVID.
CDC green-lights boosters for elementary school-age kids
Following the U.S. Food and Drug Administration’s clearance of updated booster doses for elementary school-age kids— one made by Pfizer for 5- to 11-year-olds, and a version from rival Moderna for those as young as 6 — the Centers for Disease Control and Prevention has also given the vaccines its recommendation, clearing their way to the public. The agency gave the updated shots, which contain half the recipe that targeted the original coronavirus strain and half protection against the dominant BA.4 and BA.5 omicron versions, the green light without requiring another meeting of its vaccine advisers. “I just recommended expanding updated COVID-19 vaccines to children 5-11 years,” said Dr. Rochelle Walensky, head of the CDC. “This is a critical step in our fight against COVID-19. An updated vaccine can help bolster protection for our children this winter.” In a separate press release, Moderna said it is also working to finalize its EUA application for its vaccine for children ages 6 months to 5 years old, which is “expected to be completed later this year.”
New Canadian premier calls unvaccinated “most discriminated against group”
On her first day in office, Alberta’s new premier, Danielle Smith, described individuals who have chosen not to get vaccinated against COVID-19 as the “most discriminated against group” of people in her lifetime and vowed to protect unvaccinated people under the Alberta Human Rights Act, reports the Toronto Star. Smith also said she would replace the province’s chief medical officer of health, Dr. Deena Hinshaw, and restructure the public health department with a team that considers COVID-19 to be an endemic disease that can be treated like influenza, even though a majority of infectious disease experts say it is too soon to label it that way. “I don’t think I’ve ever experienced a situation in my lifetime where a person was fired from their job, or not allowed to watch their kids play hockey, or are not allowed to go visit a loved one in long-term care or hospital, or not allowed to go get on a plane to either go across the country to see family or even travel across the border,” Smith, the leader of the United Conservative Party, told reporters Tuesday.
She also brushed aside a question from a reporter asking why she considered vaccine choice to be a bigger societal disadvantage than race, sexuality, or gender identity. “I don’t take away any of the discrimination that I’ve seen in those other groups that you mentioned,” said Smith, a former radio show host. “But this has been an extraordinary time in the last year in particular and I want people to know that I find that unacceptable, that we are not going to create a segregated society on the basis of a medical choice.” Smith and her party have drawn criticism from Alberta’s former premier Jason Kenney, who told a reporter that “a conservative party or government that is focused on a campaign of recrimination over COVID, politicizing science, entertaining conspiracy theories, campaigning with QAnon, is a party that can’t form government and shouldn’t.”
