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.
COVID-19
General Information
According to new guidelines from the California Department of Public Health, people who have COVID-19 and are feeling better (and don't have a fever) no longer need to isolate AT ALL, regardless of whether they test negative or 5 days have passed. However, people with COVID-19 still should wear a mask for 10 days. Now, I'm not sure I am comfortable with this recommendation myself. I would also encourage you to isolate from people whose health is fragile, if you yourself are infected with SARS-Cov-2.
Indeed, the CDC has likewise loosened its isolation guidelines: people who test positive for COVID-19 no longer need to stay home from work or school, as long as they don't have a fever and are feeling better. The government still needs to "sign off" on these CDC guidelines, which is expected to happen in April.
The CDC has recommended that all Americans aged 65 and older should receive an additional dose of the latest COVID vaccine this spring. This recommendations is based on past COVID-19 experience, where there is both a winter and summer surge of disease. However people aged 65 and older should wait at least four months for getting an additional COVID-19 vaccine from the time of prior vaccination
Some people were uncomfortable with the latest round of COVID-19 vaccines and felt they were "rushed through" and untested. Luckily, a recent study published in JAMA looked at 28 possible different adverse events that could be associated with the most recent COVID shot (in over one million people). No serious adverse events were identified.
Meanwhile, studies show that the latest COVID vaccine decreases the risk of symptomatic COVID-19 by 50% (compared to non-vaccinated people).
The currently circulating coronavirus strain "JN.1" seems to be more contagious, but less aggressive and dangerous than prior versions.
A study in the Annals of Internal Medicine found that Covid-19 increased the risk of "autoimmune inflammatory rheumatic disease" by 25% (in South Korea) and 79% (in Japan).
A recent article published in Morbidity And Mortality Weekly Report showed that cases of MIS-C were still occurring in 2023. This is the multi-system inflammatory syndrome seen in children, a rare but serious condition where multiple organs become inflamed. Of note, 82% of the children with MIS-C were unvaccinated. In addition, of the 20 patients who had been vaccinated and still became ill with this syndrome, 60% had been vaccinated over 12 months previously. The take-home? We need to continue to be diligent in vaccinating our children regularly.
LONG COVID:
Research is ongoing on the chemical changes that have occurred in people with Long COVID: proteins in the blood that are part of the "complement system," (which is part of the way the body's immune system works) remain abnormally elevated. It is as if the body is still working under the assumption that the virus is present and needs to be eradicated, although the infection is long gone (Science).
A study published in JAMA found that a novel online (virtual) program that included group exercise as well as psychological support sessions helped people with Long Covid: patients found that they were less fatigued and had an improved quality of life.
Incidence/ Prevalence:
Although the COVID-19 virus is not going away, hospitalization rates are stable and lower than a year ago.
Treatment
There soon may be a new treatment available for COVID-19: researchers have found that the oral medication "simnotrelvir/ ritonavir" given to vaccinated people with mild to moderate COVID-19 reduced symptoms by about one and a half days. (New England Journal of Medicine). This medication is currently only available in China, however, so stay tuned!
There is another new medication to treat mild to moderate COVID-19 in clinical trials: "ensitrelvir." This one seemed to reduce the symptoms by 24 hours. Currently, this medication has emergency use status in Japan. The FDA is reviewing it right now.
A recent study published in the journal JAMA Network Open showed that the rebound rate of people suffering from mild to moderate COVID-19 who had taken Paxlovid was approximately 25%. What do we take from this data? Well, perhaps if you have a mild case of COVID-19, and are concerned that the disease will be of longer duration than desirable, you should forego Paxlovid and the possible associated rebound. Of course, if you have severe COVID-19, Paxlovid is an excellent option.
Testing
Nothing new here, folks.
Other Infectious Diseases:
RSV:
The RSV season seems to be nearing its end for this year!!
Pfizer has announced that its RSV vaccine should be active and effective for two years at least!
Data submitted to the FDA suggests that at least one RSV vaccine may be approved for people aged 50 to 59 in time for the 2024 season.
INFLUENZA:
The number of people infected with the flu seems to be declining.
MEASLES:
Measles was eliminated in the U.S. in 2000, but now is seeing a resurgence. Since the beginning of 2024, over 41 cases of measles have been reported. In all of 2023, there were only 58 cases...Experts believe we are seeing a resurgence due to several reasons:
- We are seeing a re-introduction of measles from foreign countries.
- Some people believe the measles vaccine is unsafe and won't vaccinate their kids (this notion has been thoroughly disproven, by the way...)
- a lot of kids did not get their regular measles shots early in the pandemic, when people weren't going out.
Currently, the foreign countries with the most measles are Yemen, Azerbaijan, Kazakhstan, India, Ethiopia, and Russia.
Adults living in the U.S. (and born after 1957) are recommended to get one measles booster. You can get the booster at most pharmacies (no doctor's prescription required!)
If you do get a measles shot at the pharmacy, please call the office or send me an email to let me know, so I can add that to your chart!
OTHER MEDICAL NEWS:
A study (Nature Medicine) found that eating either a keto based (high fat/ low carbohydrate ketogenic) diet or a Vegan diet helped re-wire and boost the immune system in as little as two weeks! Each of these diets helped the immune system in different ways. This is the latest study that confirms that our diet has a huge effect on how healthy we are and how likely we are to get sick.
Speaking of diet, a recent review (BMJ) found that there is a direct association with eating ultra-processed foods and the incidence of over 30 diseases:
- a 50% increase in heart disease
- a 48-53 increased incidence of anxiety and other common mental disorders
- a 12% increase of diabetes
- a 21% increased risk of death of any cause.
About Dr. Sujansky's Life in These Times
Those of you who have seen me in the office in recent weeks will have noticed a new fashion accessory I have a cast on my right hand and arm. I was jogging approximately 10 days ago, fell, and broke my hand. Luckily I do not have a lot of pain. However it has been annoying, to say the least, to be a right-handed person who is now little able to use their right hand. Luckily, I am still able to see people in the office for their medical issues. However I've had to postpone patients' physical exams until my cast comes off in another three weeks or so. I apologize for this inconvenience for those of you who have been effected.
I'm trying to face this new temporary handicap with equanimity:
I am learning to be ambidextrous.
I will not be cooking for the next month.
I am learning how to use dictation software in my medical practice.
It builds character?!
And, of course, this is all only temporary!
On an entirely different note, I realized just now that today is the Ides of March. This is the day in the middle of March that was marked in the Roman calendar. It is also the day that Julius Caesar was assassinated. So use the opportunity to have some Caesar salad and to dine on Italian food! Buon Appetito!