Updates on New Infectious Disease Threats: What You Need to Know
Information about COVID-19 as well as other infectious diseases is constantly evolving. I am hoping to summarize some of that in these newsletters. New information will be in BOLD. This newsletter will be a bit shorter - for better or for worse! - as we are headed towards the holidays!
COVID-19
General Information
Effective November 1, 2023, the government will no longer pay for treatments for COVID-19: this cost will now be born by commercial insurance companies. This may be important, as the cost to patients for treatments like Paxlovid may rise significantly.
People who have recovered from infection with COVID-19 are at higher risk for developing auto-immune diseases such as psoriasis, vasculitis (inflammation of the vessels), Crohn's disease, ulcerative colitis, rheumatoid arthritis, and sarcoidosis (Jama Netw. Open).
A recent article published in the Annals of Internal Medicine found a surprising result: people with asthma are LESS likely to be hospitalized with COVID-19 and to do poorly in general. Although this finding had been reported previously, it is a bit counter-intuitive (to me, at least) so nice to see it confirmed.
Remember when it seemed that people who took paxlovid had a higher rebound rate than those who didn't? And then that was de-bunked...? Well: bad news: a new study showed that 20% of people whose COVID-19 was treated with paxlovid had a rebound, while only 1.8% of those who did not take paxlovid had rebounds (Annals of Internal Medicine). Now, the people who got the paxlovid were older and had weaker immune systems than those who didn't, so we are comparing apples and oranges a bit. Also, the study looked at only 127 people, so the size is small. Finally, the rebound occurred exclusively in people who started the medications within two days of symptom onset...Nonetheless, this rebound discrepancy is not good news. What to make of all of this? We will need more studies to figure out the best way to treat COVID-19. For now, perhaps we should try to delay using paxlovid until you have had at least 2 (but less than 5) days of symptoms, if you need it at all...
LONG COVID:
An article (JAMA) found that people infected with SARS-Cov-2 had lower levels of serotonin (a chemical produced by our bodies that is important in functions like learning, memory, and mood). It seems that residual SARS-Cov-2 virus in the gut can keep the serotonin precursor chemicals from getting absorbed.
Incidence/ Prevalence:
COVID cases and hospitalizations continue to decrease, though the number of sick are still significant.
The above notwithstanding, about 10% of people checked for COVID-19 in medical settings are found to be positive.
Treatment
We have a new COVID-19 vaccine, this one made by Novavax. It received emergency use authorization on October 3, 2023. The EUA was based on non-clinical data indicating that this vaccine elicits an immune response in Rhesus monkeys. It is NOT an mRNA vaccine: rather, it was made with more traditional protein-based technology and may be appropriate for people who have concerns about the mRNA vaccines.
Do you remember the back-and-forth we have seen in studies on treatment of COVID-19 with blood plasma from people who have recovered from the virus? For years, studies seemed to contradict prior data in advocating for or against this mode of treatment. Well, there is another new study (New England Journal of Medicine) that found that if you had COVID-19 and were on a breathing machine in the ICU with significant lung damage, then transfusion of "convalescent plasma" was indeed helpful in survival.
A new, investigational vaccine that works against COVID-19 as well as the flu has been found (in early testing) to be as effective as getting the two vaccines individually. Such a vaccine, once approved, would not be available until the 2024/2025 flu season (JAMA).
Testing
An at-home COVID-19 test made by Acon laboratories has now been cleared by the FDA. This test had been available previously though emergency-use authorization since 2021, but now has the official blessing of the FDA. The test could correctly identify 89.8% of the people who had COVID-19. Of those that were not infected with the virus, the test gave a correct result 99.3% of the time.
Other Infectious Diseases:
RSV:
RSV is a virus that causes lung diseases in young children and older adults. Most older adults who get seriously ill with RSV live in senior living communities or have multiple other medical problems.
Infection with RSV continues to increase in Northern California, especially among kids. In Northern California, kids younger than 7 who were tested in the clinic were 20% likely to be infected with RSV.
We are also seeing more RSV in people older than 60.
As mentioned previously, people who are over 60 and are at higher risk for infection or live in a communal living environment are encouraged to get vaccinated. Vaccines are available at the major pharmacies. Appointments are usually needed.
INFLUENZA:
You can get the flu shot at our office now. No appointments are necessary, but it may be a good idea to call the office first to let us know you are coming.
Astra Zenica has submitted a new nasal flu vaccine to the FDA for review. If approved, this vaccine would be the first flu vaccine that would be self-administered (without a doctor or nurse present). If approved, this vaccine would be available NEXT flu season, 2024/2025.
Although the worldwide incidence of influenza remains low, we are seeing more cases in Western and Eastern Asia. Rates in the U.S. are low, but rising in Alaska and the Southeast. In the last 2 weeks alone, the positivity rate of tests has risen to 5.5% from 3.2%.
Luckily, the CDC has reported that the match between the circulating flu virus and the vaccine is very good.
If we look to the flu season in Australia 6 months ago, we learn that this year's season was less widespread than in 2022, but more severe.
MALARIA:
The WHO has just authorized a new malaria vaccine. It seems to be about 75% effective and protection can last at least 2 years; a previous malaria vaccine was only 30% effective.
MEASELS:
Measles cases rose 18% world wide between 2021 and 2022. Deaths from the disease were up 40%! This increase seems to be due to decreased vaccination during the pandemic. In 2022, 37 countries had a measles epidemic, while only 22 countries had a measles epidemic in 2021.
OTHER MEDICAL NEWS:
A recent study (Annals of Internal Medicine) provides some hope for the prevention of dementia in patients with "Mild Cognitive Impairment (MCI)," a condition that often precedes dementia. Researchers looked at 318 adults, aged 65 and older, with MCI. About one third of these were tasked to complete "cognitively enhanced tai chi" via video, from the comfort of their homes twice a week. The others participated in other exercises such as stretching. Those with the cognitively-enhanced tai chi group had improvements in memory tests.
Many of you will know that I am a big proponent of hearing aids for people who have decreased hearing: not only do they help with hearing (obviously!) but are also associated with a decreased incidence of dementia....well, another new article (Journal of the American Geriatrics Society) found that people who wore hearing aids consistently were also half as likely to fall compared to those that didn't....interesting!
Our Community and Beyond:
nothing here right now...
About Dr. Sujansky's Life in These Times
I hope all of you have a peaceful, relaxing Thanksgiving holiday. I love Thanksgiving, as it is not nearly as commercialized as other holidays. May you enjoy family, food, comfort, and health this year!
Next newsletter in 2024!