State virus levels remain ‘low’ as transmission jumps in U.S.

State virus levels remain “low” but U.S. virus transmission levels nearly double

All California counties reported “low” virus community levels for the second week in a row Friday, based on hospitalization and case metrics used by the U.S. Centers for Disease Control and Prevention. The proportion of counties nationwide in the “low” tier remained about the same as last week, with about 78.5% in the category. Another 19.07% were in the “medium” category, while the remaining 2.42% were in “high” — figures that budged little. The agency’s community transmission map, based on a separate metric that tracks the rates of new cases and positive tests, showed 46.68% of U.S. counties in the “high” virus transmission category — nearly double the previous week’s report of 26%. Another 26.27% were in the “substantial” tier and 21.34% had “moderate” transmission. About 5.7% of all counties were considered to have “low” virus transmission, down from 10% the previous week.

Global cases fell by 17% last week

The number of new weekly COVID-19 cases worldwide decreased by 17% last week, compared to the previous week, with more than 2.3 million new cases reported, according to the latest epidemiological update from the World Health Organization. But cases rose by 5% over the same period in the Americas and the Western Pacific and the agency warned, “the true number of incident cases is likely to be underestimated due to a decline in testing globally.” The number of new weekly deaths also decreased overall by 5%, compared to the previous week, but increased in four regions: Africa, the Americas, Southeast Asia, and the Western Pacific. There were 9,300 fatalities reported globally.

Fauci says U.S. is at a “crossroads” as BQ.1 and BQ.1.1 climb

While most Americans have been able to push COVID-19 concerns out of their minds over the past few weeks amid declines in cases and hospitalizations, the nation’s top pandemic advisor warned that newer, immune-evasive coronavirus variants such as XBB, BQ.1, and BQ.1.1 may soon reverse those positive trends. “We’re really at a point that may be a crossroads here. As we’re entering into the cooler months, we are starting to see the emergence of sublineage variants of omicron,” Dr. Anthony Fauci said on the Conversations on Health Care radio show on Thursday. He stressed that the U.S. is averaging about 2,600 virus-related deaths a week — a number that is far too high. “We’re still in the middle of this — it is not over,” Fauci said. “Four hundred deaths per day is not an acceptable level.”

BQ.1 and BQ.1.1 again increased in proportion last week, making up 35.3% of the total coronavirus variants circulating in the United States this week, up from 27.1% in the previous week, according to data published Friday by the U.S. Centers for Disease Control and Protection. The proportion of the dominant omicron BA.5 variant has now receded to less than half the sequenced cases, at 39.2%. BF.7 also continues to grow, making up 9% of the cases, while the newly detected BA.5.2.6 made up 3.1% of the cases, followed by a “variant soup” that includes BA.4.6, BA.2.75, BA.2.75.2, BA.4, BA.1.1.529 and several other lesser strains.

Pandemic sent alcohol death toll skyrocketing, government reports say

The rate of deaths that can be directly attributed to alcohol rose nearly 30% in the U.S. during the first year of the COVID-19 pandemic, according to new government data. The Centers for Disease Control and Prevention had already said the overall number of such deaths rose in 2020 and 2021. Two reports from the CDC this week provided further details on which groups have the highest death rates and which states are seeing the largest numbers, the Associated Press reports. “Alcohol is often overlooked” as a public health problem, said Marissa Esser, who leads the CDC’s alcohol program. “But it is a leading preventable cause of death.”

A report released Friday focused on more than a dozen kinds of “alcohol-induced” deaths that were wholly blamed on drinking. Examples include alcohol-caused liver or pancreas failure, alcohol poisoning, withdrawal and certain other diseases. There were more than 52,000 such deaths last year, up from 39,000 in 2019. In 2020, they rose 26%, to about 13 deaths per 100,000 Americans. That’s the highest rate recorded in at least 40 years, said the study’s lead author, Merianne Spencer. Such deaths are 2 1/2 times more common in men than in women, but rose for both sexes in 2020, the study found. The rate continued to be highest for people ages 55 to 64, but rose dramatically for certain other groups, including jumping 42% among women ages 35 to 44.

Updated booster substantially better than previous, new Pfizer data shows

Updated clinical data for the omicron BA.4/BA.5-adapted bivalent booster show the shots elicited a substantially higher immune response in adults compared to the original COVID-19 vaccine, according to Pfizer and BioNTech. Two small independent studies, from researchers at Columbia and Harvard, had recently questioned whether the boosters offered better protection than the original shots.

Pfizer’s study shows that one month after receiving a booster dose of the bivalent vaccine, neutralizing antibody levels in people 55 and older had jumped 13 times higher than before the extra dose — about four times the response to the original “monovalent” booster. Younger adults saw a 9.5-fold jump in their antibody levels compared to before the booster. It had been about 11 months since the study participants’ previous vaccination.

The FDA had cleared the updated boosters without first requiring testing in people, basing the decision on studies of a similarly tweaked vaccine — against an earlier omicron strain — rather than on the exact updated recipe.

“As we head into the holiday season, we hope these updated data will encourage people to seek out a COVID-19 bivalent booster as soon as they are eligible in order to maintain high levels of protection against the widely circulating omicron BA.4 and BA.5 sublineages,” said Albert Bourla, chief executive officer of Pfizer. “These updated data also provide confidence in the adaptability of our mRNA platform and our ability to rapidly update the vaccine to match the most prevalent strains each season.”

About 26.3 million Americans have gotten an updated booster since they rolled out in early September, according to the Centers for Disease Control and Prevention. That represents about 8.3% of the population eligible for the new vaccines — up from 7.3% a week ago. Pfizer’s shot is available for anyone 5 or older. Moderna’s version of the updated booster is for those 6 and older.

Wachter says new subvariants aren’t “massively scary” but winter is coming

Dr. Bob Wachter says that the emerging coronavirus subvariants aren’t “massively scary” but will likely drive another COVID-19 surge. “I think we’ve got to humble,” UCSF’s chair of medicine said at a virtual town hall hosted by state Senator Nancy Skinner (D-Berkeley) on Tuesday. “Winter will drive people inside. There are these new variants that are coming out that are at least somewhat immune evasive.”

Wachter said that people are underestimating the ongoing risks of the virus due to pandemic fatigue and may not act quickly if cases start sticking back up in the Bay Area. “Unfortunately, in the old days, if you started to see a surge, people immediately started being more careful and putting masks on,” said Wachter, who was joined by California State Epidemiologist Dr. Erica Pan. “I’m not confident that will happen, at least to the same degree that it used to happen.”

Pan added that one-way masking is still an effective mitigation measure. “If you can have a good seal and well-filtered mask, then you are very well protected… even if you are the only one in the room.”

The health experts also said that long COVID is becoming an increasing source of anxiety for them. “For my own family, that is still what concerns me the most,” Pan said. Wachter said the primary reason he still masks in crowded indoor spaces and does everything he can to avoid infection is his worry over the persistent, complex symptoms that can linger after infection — even in those who previously had a mild case of COVID-19. “It’s not right to say COVID is not an issue. It’s still an issue. You still don’t want to get it,” he said.

They added that while 11.4% of eligible Californians over 5 years old have received the new bivalent booster, according to the state dashboard, is better than the national level of 7.3%, it’s too low. “There is absolutely no question that the benefits exceed the risk,” Wachter said. “It continues to work incredibly well in preventing severe cases of COVID.”

People who were previously infected likeliest to experience adverse reactions to vaccines

The risk of experiencing an adverse reaction after receiving an mRNA coronavirus vaccination may be greater among people who were previously infected with COVID-19, according to a study published Tuesday in Vaccine. Researchers from the U.S. Centers for Disease Control and Prevention used v-safe vaccine surveillance data and online follow-up surveys from 3,862 adults who reported severe systemic adverse events after receiving their first vaccine dose from Dec. 2020 to May 2021, comparing the results to a vaccinated control group with three times as many individuals. Among those who previously tested positive for COVID-19, the odds of experiencing a severe reaction were 2.4 times higher among those who received the Moderna vaccine and 1.5 times higher among Pfizer recipients compared to those with no history of infection. Most participants did not require medical attention, with 0.5% of all study participants reporting visiting an emergency department or being hospitalized after the second dose. “Vaccine providers can use these findings to counsel patients who had pre-vaccination SARS-CoV-2 infection histories, experienced severe systemic AEs following dose 1, and are delaying or considering not receiving additional mRNA COVID-19 vaccine doses,” the authors wrote.

State epidemiologist “optimistic” about the winter, recommends masks for all viruses

California health officials are seeing an uptick of omicron COVID-19 subvariants, such as BQ.1 and XBB, in the state but are not yet concerned they will cause a substantial spike in cases and hospitalizations this winter. Erica Pan, the state epidemiologist, told The Chronicle on Thursday that California is not anticipating a new surge of the sort that can stress the health care system, comparable to what has occurred in some other parts of the world. She added that the emerging subvariants “don’t seem to be causing more serious clinical impact.” Pan did not offer a threshold for possibly reinstating a statewide mask mandate or any other mitigation measures if cases start to increase but instead encouraged Californians to get the updated bivalent booster to help blunt the impact of viruses currently in circulation. She did recommend voluntary masking in crowded indoor settings to help prevent the spread not just of the coronavirus but also other airborne pathogens, such as RSV and influenza.

Study links virus surges to rise in heart attacks

Deaths from heart attacks rose significantly during pandemic surges, including the COVID-19 omicron surges, reversing a pre-pandemic decline in cardiac events, according to new data analysis from the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles. The study, published in the peer-reviewed Journal of Medical Virology, shows heart attack death rates increased for all age groups during the pandemic — most significantly among individuals ages 25 to 44, who are not usually considered at high risk for heart attack. “The dramatic rise in heart attacks during the pandemic has reversed what was a prior decade-long steady improvement in cardiac deaths,” said Yee Hui Yeo, first author of the study and a Cedars-Sinai physician-scientist, in a statement. “We are still learning the many ways by which COVID-19 affects the body, regardless of age, gender, ethnicity or race.”

Yeo said researchers do not have a clear understanding of why there was such a rapid rise in cardiac deaths in patients with COVID-19, but one explanation may by that the virus can trigger or accelerate the presentation of preexisting coronary artery disease, even in younger adults. Acute or chronic stress could also play a role.

In the year prior to the pandemic, there were 143,787 heart attack deaths in the U.S. In 2020, that number increased by 14% to 164,096. By 2021, the rates of heart attack death had increased by 29.9% for adults ages 25 to 44, by 19.6% for adults ages 45 to 64, and by 13.7% for adults ages 65 and older. “There is something very different about how this virus affects the cardiac risks,” said Susan Cheng, senior and co-corresponding author of the study. “The difference is likely due to a combination of stress and inflammation, arising from predisposing factors and the way this virus biologically interacts with the cardiovascular system.”

Four vaccine doses provide low neutralization against BQ.1.1 and XBB.1, study suggests

Newer omicron COVID-19 subvariants such as BQ.1.1 and XBB.1 have accumulated additional spike mutations that impact the efficacy of available vaccines, according to a pre-print study published Thursday by University of Texas Medical Branch. Researchers collected three human serum panels from individuals 1-3 months after their fourth dose of the original formula mRNA vaccine or one month after a bivalent booster dose. What they found is that while the updated bivalent booster elicits better neutralization against the newly emergent omicron strains than the original vaccine, both regimens offer low neutralization against BA.2.75.2, BQ.1.1, and XBB.1, “suggesting the potential of these new sublineages to dethrone BA.5 as the dominant lineage in circulation.” People who were infected with COVID-19 before receiving their bivalent booster developed higher and broader neutralization against the sublineages after the shot. “The results suggest that previous infection significantly increases the magnitude and breadth of neutralization for (the) BA.5-bivalent-booster and among the tested omicron sublineages, XBB.1 exhibits the highest level of immune evasion,” the authors wrote.

Coronavirus cases in state plateau while hospitalizations rise

California is averaging 6.1 new daily COVID-19 cases per 100,000 residents as of Thursday, the same number reported in the previous week, according to health department data. The statewide coronavirus test-positive rate increased slightly to 4.5%. Hospitalizations due to confirmed COVID-19 cases are up to 1,700, marking a 4% increase from the previous day’s total. There were 153 fewer intensive care unit beds available over the same period due to a 7.2% increase in ICU patients. The state is reporting 14 deaths per day due to the virus.

Pfizer starts trial for a combined flu and COVID vaccine

Pfizer and its German partner, BioNTech, announced Thursday that they have launched a study of a combined flu and COVID-19 vaccine. The Phase 1 trial for the mRNA-based combination vaccine candidate will evaluate the shot for safety, tolerability, and immunogenicity. It uses the updated bivalent coronavirus vaccine formula. “The flexibility and manufacturing speed of the mRNA technology has demonstrated that it is well-suited for other respiratory diseases. Pfizer is deeply proud of our continued work to explore its potential to protect against influenza and COVID-19 in one combination vaccine, which we think could simplify immunization practices against these two respiratory pathogens, potentially leading to better vaccine uptake for both diseases,” said Annaliesa Anderson, senior vice president of Pfizer. Moderna and Novavax are also developing combined COVID-19 and flu vaccine candidates.

Santa Clara County health officer warns of “grandchildren of omicron”

Wastewater data shows that COVID-19 transmission levels are higher than official case counts indicate in Santa Clara County, health officials told the board of supervisors Tuesday. “It looks to the casual observer that we’re in pretty good shape because we’re between waves and it’s gone lower,” said Dr. Sara Cody, the county health officer, but added that data from the sewer sheds covering 75% of the population showed substantially higher virus levels in circulation. “We don’t know what’s just around the corner, but we think that the grandchildren of omicron are probably around the corner,” Cody said. “These are the children of BA.5. There’s a few variants that are emerging now. We’ve detected a handful in our county, but they’ve not yet taken off.”

She said that while 16% of eligible residents in the county have received the bivalent booster, compared to about 11% statewide, she would like to see better uptake ahead of the holiday season, especially with flu and RSV circulating. “One of the things that worries me most about how we still have a lot of COVID circulating is, I just worry that the pandemic is going to have a very long tail because there are a lot of people in our community who have long COVID,” Cody said. “Some have mild cases and some are quite severe and they’re not able to work or get back to their regular activities.”