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ASPartOfMe
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30 Dec 2022, 7:05 pm

CDC tracking rise of new XBB.1.5 COVID variant, already more than 40% of U.S. cases

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The Centers for Disease Control and Prevention said Friday it is tracking a new variant of concern dubbed XBB.1.5. According to new figures published Friday, it estimates XBB.1.5 makes up 40.5% of new infections across the country. 

XBB.1.5's ascent is overtaking other Omicron variant cousins BQ.1 and BQ.1.1, which had dominated a wave of infections over the fall. Scientists believe its recent growth could be driven by key mutations on top of what was already one of the more immune evasive strains of Omicron to date.

"We're projecting that it's going to be the dominant variant in the Northeast region of the country and that it's going to increase in all regions of the country," said Dr. Barbara Mahon, director of the CDC's proposed Coronavirus and Other Respiratory Viruses Division, in an interview with CBS News.

Mahon said the agency had not listed XBB.1.5 separately in its earlier projections because the strain had not cleared a minimum threshold in the underlying sequences collected by the agency.

The agency's 40.5% figure is only a projection, Mahon stressed, with a probability interval ranging right now from 22.7% to 61.0%.

XBB.1.5's prevalence is largest in the Northeast, the agency estimates. Most of the earliest cases from XBB.1.5 recorded in global databases through early November were sequenced around New York and Massachusetts.

More than 70% of infections in the regions spanning New Jersey through New England are now from XBB.1.5, the agency is projecting.

The ascent of XBB.1.5 comes as COVID-19 hospitalizations have accelerated across the U.S. in recent weeks. The pace of new admissions is now worse than this past summer's peak in several regions, but still lower than at this time last winter.

"There's no suggestion at this point that XBB.1.5 is more severe. But I think it is a really good time for people to do the things that we have been saying for quite a while are the best ways to protect themselves," said Mahon.

This month, the Northeast has recorded some of the worst COVID-19 hospital admission rates out of any region in the country. In New England, the CDC says new hospitalizations among Americans 70 and older have climbed to the highest levels seen since early February.

Around 13% of Americans are currently living in areas of "high" COVID-19 Community Levels, where the agency currently urges masking. Los Angeles, Miami, and New York City rank among the biggest counties now at these levels.

Mahon said XBB.1.5's mutations could be part of driving the increase where XBB had failed to gain a foothold. But she added that other factors, like the higher risk posed by respiratory viruses during the winter holiday season, could also be playing a factor.

Mahon cited the agency's recommendations to seek out updated COVID booster shots, as well as taking other precautions like improving ventilation, testing before gathering, or masking in high COVID areas.

The XBB.1.5 strain is a spinoff of the XBB variant, itself a "recombinant" blend of two prior Omicron strains, which drove a wave of infections overseas earlier this year. 

Earlier this year, the Biden administration had voiced optimism that XBB was unlikely to dominate infections in the country. South Asian nations like Singapore reported that strain appeared to pose a lower risk of hospitalization relative to earlier Omicron variants. 

After it was first spotted in the country, XBB had made up a small fraction of U.S. cases for several weeks despite appearing in a growing share of variants from arriving international travelers. 

Then over the past month, XBB's prevalence began to swell in the CDC's estimates. These figures are released weekly in "Nowcast" projections based on the sequences that authorities have gathered so far. 

Now, the CDC says that increase was driven largely by XBB.1.5. After ungrouping XBB.1.5, the agency estimates all other XBB infections currently make up just 3% of cases nationwide.

Beyond its parent, XBB.1.5 has an additional change called S486P. Chinese scientists have reported the mutation appears to offer a "greatly enhanced" ability to bind to cells, which could be helping drive its spread.

Before evolving into XBB.1.5, XBB had already ranked among the strains with the largest immune-evasion relative to earlier major Omicron strains. Scientists in Japan reported this week that XBB appeared to be "the most profoundly resistant variant" to antibodies from breakthrough infections of any lineage they had tested.

Like BQ.1, XBB is resistant to a roster of monoclonal antibody drugs that doctors had relied on earlier in the pandemic before they were sidelined by new variants.

Data from a team of federally-backed researchers earlier this year found the current batch of updated bivalent boosters appear to offer better "neutralizing activity" Omicron variants, including XBB, when testing antibodies in the blood of people who got the updated booster compared to after only the original vaccines. 

However, antibody responses in that study were also worse for XBB compared to the other strains they studied. 

For antiviral drugs like Pfizer's Paxlovid, data from another team of scientists in Japan suggest they will retain efficacy against XBB.

"With what we know so far, XBB.1.5 has not acquired any new mutations in the viral protein targeted by Paxlovid. The susceptibility of XBB.1.5 against Paxlovid should not change given the current data," the University of Wisconsin-Madison's Peter Halfmann, one of that study's authors, told CBS News in an email.

And for tests, the Food and Drug Administration warned Thursday on its website that one home collection kit — DxTerity's saliva test for the virus — had been discovered to have "significantly reduced sensitivity" to variants with XBB's mutations.


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01 Jan 2023, 7:55 pm

Once-favored Covid drugs ineffective on Omicron may be putting millions at risk

Quote:
The lack of specialized Covid-19 treatments for people with weak immune systems has left millions of Americans with limited options if they get sick as the pandemic heads into an uncertain winter.

Once heralded as game-changers for Covid patients considered at risk for getting seriously ill — one was used to treat then-President Donald Trump in 2020 — monoclonal antibodies are now largely ineffective against current Covid variants. Easier-to-administer antiviral drugs, such as Paxlovid, have largely taken their place but aren’t safe for all immune-compromised people because they interact with many other drugs.

But the federal government funding that drove drug development in the early days of the pandemic has dried up, and lawmakers have rebuffed the Biden administration’s pleas for more. Without that, there’s little incentive for drugmakers to work on new antibody treatments that could be more effective.

And without a government program like Operation Warp Speed to develop second-generation vaccines and treatments, at-risk patients could be in danger of developing severe cases of Covid and flooding hospitals when the U.S. health care system is already strained, thanks to an influx of patients with an array of respiratory illnesses, including flu and RSV.

“Just because we have exited the emergency phase of the pandemic does not mean that Covid is over or that it no longer poses a danger,” said Leana Wen, a public health professor at George Washington University and former Baltimore health commissioner. “There are millions of Americans who are vulnerable to severe illness.”

The FDA pulled authorizations for four antibody treatments in 2022 as Omicron and its myriad subvariants wiped out their effectiveness. The treatments were geared toward adult and pediatric patients with mild-to-moderate Covid who were considered at risk of developing severe disease and ending up hospitalized.

While antiviral pills are plentiful and remain an option for some with weak immune systems, they won’t work for everyone — Pfizer’s Paxlovid interacts with many widely prescribed drugs.

Monoclonal antibodies — which have been made by companies like Regeneron, Eli Lilly and Vir — are lab-created molecules designed to block a virus’ entry into human cells. But they must bind to the virus’ spike protein to neutralize it, and the coronavirus’ many mutations since its 2019 emergence have gradually rendered the available products ineffective.

“It’s a bit risky to develop this,” said Arturo Casadevall of the Johns Hopkins Bloomberg School of Public Health, pointing to how quickly some Covid variants have surfaced before quickly receding.

A massive spending bill that lawmakers passed before Christmas left out the administration’s $9 billion request for more money to fight the pandemic, meaning there are fewer dollars to be spread around to address emerging Covid needs.

“Due to congressional inaction and a lack of funding, HHS does not have the resources it needs to fund the development of new treatments, and we could find ourselves with a very limited medicine cabinet at a time when we need more tools to combat Covid-19,” a department spokesperson told POLITICO, adding that HHS is working with providers and other groups “to ensure that Americans are able to take advantage of all available treatment options.”

The Biden administration has strongly promoted oral antiviral regimens like Paxlovid, which debuted a year ago and marked a turning point in managing the virus for most Americans.

A CDC alert issued Dec. 20 to clinicians and public health professionals warned of the lack of viable monoclonal antibody treatments — including the diminished efficacy of a prophylactic antibody, Evusheld — and the availability of the antiviral options that to date have seen lackluster uptake. The agency urged providers to consult the National Institutes of Health’s Covid treatment guidelines for ways to potentially manage drug interactions with Paxlovid, such as temporary pauses or reductions in dosage.

Remdesivir, an antiviral administered intravenously, is another treatment option for the immunocompromised, but it requires infusions over three days in either hospital or outpatient settings.

Covid convalescent plasma remains an option for immunocompromised people who contract the virus, but its availability is scattershot across the country, Casadevall said.

Still, Casadevall said, the main issue is educational because its use has changed since the pandemic’s early days, when treatments were scarce. Some hospital systems, like Hopkins, use it routinely, while some doctors don’t know plasma is still an option, he said.

Casadevall, who leads the Covid-19 Convalescent Plasma Project, says NIH’s stance on plasma is inconsistent with its previous recommendations of monoclonal antibodies, which were made without clinical efficacy data, since Covid antibodies are the active component in both therapies. He led a petition earlier this month — signed by several doctors, including past and current presidents of the Infectious Diseases Society of America — asking NIH to change its recommendations.

Handal’s group also has asked the NIH and the White House to convene a meeting with scientists on the issue.

“To just not be having a dialogue about it is infuriating to us,” Handal said. “People are dying while people are just going through this bureaucratic dance.”

Still, pharmaceutical companies may be more inclined — both financially and practically — to pursue developing better antiviral pills that pose fewer drug interactions and are easier to administer, said Jason Gallagher, a clinical pharmacy specialist in infectious diseases at Temple University Hospital. Antivirals also hold up better against an ever-changing virus, he added.

“There’s way more money in Paxlovid than there is in any monoclonal” antibody treatment, Gallagher said, and it may take incentives to drugmakers to encourage their development. “They’re not going to make anyone really rich.”




At-home swabbing still works just fine, but we can’t seem to escape false negatives. What gives?
Quote:
Max Hamilton found out that his roommate had been exposed to the coronavirus shortly after Thanksgiving. The dread set in, and then, so did her symptoms. Wanting to be cautious, she tested continuously, remaining masked in all common areas at home. But after three negative rapid tests in a row, she and Hamilton felt like the worst had passed. At the very least, they could chat safely across the kitchen table, right?

Wrong. More than a week later, another test finally sprouted a second line: bright, pink, positive. Five days after that, Hamilton was testing positive as well. This was his second bout of COVID since the start of the pandemic, and he wasn’t feeling so great. Congestion and fatigue aside, he was “just very frustrated,” he told me. He felt like they had done everything right. “If we have no idea if someone has COVID, how are we supposed to avoid it?” Now he has a different take on rapid tests: They aren’t guarantees. When he and his roommate return from their Christmas and New Year’s holidays, he said, they’ll steer clear of friends who show any symptoms whatsoever.

Hamilton and his roommate are just two of many who have been wronged by the rapid. Since the onset of Omicron, for one reason or another, false negatives seem to be popping up with greater frequency. That leaves people stuck trying to figure out when, and if, to bank on the simplest, easiest way to check one’s COVID status. At this point, even people who work in health care are throwing up their hands. Alex Meshkin, the CEO of the medical laboratory Flow Health, told me that he spent the first two years of the pandemic carefully masking in social situations and asking others to get tested before meeting with him. Then he came down with COVID shortly after visiting a friend who didn’t think that she was sick. Turns out, she’d only taken a rapid test. “That’s my wonderful personal experience,” Meshkin told me. His takeaway? “I don’t trust the antigen test at all.”

That might be a bit extreme. Rapid antigen tests still work, and we’ve known about the problem of delayed positivity for ages. In fact, the tests are about as good at picking up the SARS-CoV-2 virus now as they’ve ever been, Susan Butler-Wu, a clinical microbiologist at the University of Southern California’s Keck School of Medicine, told me. Their limit of detection––the lowest quantity of viral antigen that will register reliably as a positive result––didn’t really change as new variants emerged. At the same time, the Omicron variant and its offshoots seem to take longer, after the onset of infection, to accumulate that amount of virus in the nose, says Wilbur Lam, a professor of pediatrics and biomedical engineering at Emory University who is also one of the lead investigators assessing COVID diagnostic tests for the federal government.

That problem isn’t likely to be solved anytime soon. The same basic technology behind COVID rapid tests, called “lateral flow,” has been around for years; it’s even used for standard pregnancy tests, Emily Landon, an infectious-disease physician at the University of Chicago, told me. Oliver Keppler, a virology researcher at the Ludwig Maximilian University of Munich who was involved in a study comparing the performance of rapid tests between variants, says there isn’t really a way to tweak the tests so that they’ll be any more sensitive to newer variants.

Of course, Hamilton (and his roommate) would point out that the tests can fail even several days after symptoms start. That’s why he and others are feeling hesitant to trust them again. “It’s not just about the utility or accuracy of the test. It’s also about the willingness to even do the test,” Ng Qin Xiang, a resident in preventative medicine at Singapore General Hospital who was involved in a study examining the performance of rapid antigen tests, told me. “Even within my circle of friends, a lot of people, when they have respiratory symptoms, just stay home and rest,” he said. They just don’t see the point of testing.


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02 Jan 2023, 12:15 pm

There are two sides to every coin. In this case
How contagious is this new variant?
How deadly is this new variant?

One article on the internet states: Omicron XBB 1.5 Variant is very dangerous as compared to earlier variants and is highly transmissible.

Another article states: The XBB 1.5 variant is a type of Omicron and is said to be more infectious as it spreads quickly and appears to evade people's vaccine protection.

Another article states: A new Covid-19 variant is spreading throughout the US, according to the Centers for Disease Control and Prevention (CDC). The strain, known as XBB.1.5, is said to be the cause of 41% of Covid cases that have been formally confirmed nationwide, according to their statistics. From only 21% seven days prior, the CDC discovered that the mutation had considerably grown during the past week.

---------------------------

But the other part of the issue is HOW MUCH MORE DEADLY IS THIS VARIANT?

One recent article states it this way:

"We are not experiencing that kind of surge phenomena that we experienced last year, which really, really was impactful across all of health care and across our entire population," Martin said. "The funny thing is, of course, is that COVID has not exactly gone away, right? We still have quite a bit of it, in our community and in our hospitals. But it's been fairly stable. It's been a little bit more predictable. And from that standpoint, (it's) made it a little bit easier to manage."

Martin thinks two big reasons explain the difference.

First, COVID's omicron variants last winter were far more virulent and dangerous.

"We've seen a virus that seems to be a little less virulent than some of its predecessors, meaning it doesn't seem to be causing as severe disease," he said. "Now, that's not to say it's totally benign, right? There are still plenty of people who are very susceptible to it, the elderly, people with severe lung, heart problems and people who have problems with their immune systems for various medical reasons. And so we still do, of course, see people die from COVID."

The other reason: The population has developed immunity through plenty of vaccinations and catching COVID, Martin said.

"So we certainly don't have anything like what you might think of as traditional herd immunity. But thanks to vaccination and prior infection, we see that people who have a certain degree of immune response, even if it's not enough ... to prevent them from getting infected, we see that the consequences of the infection are now much less than they used to be," he said.

Source: COVID-19 still spreading, but less deadly than last year


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02 Jan 2023, 6:12 pm

School Mental Health Days
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Quote:
Sometimes, Derik Bazemore says, he needs a day off from school to unwind, especially after three years of pandemic worries and hassles, not to mention the everyday stress of being an eighth-grader.

"Kids, myself included, have suffered from the COVID pandemic. It has affected our mental health," said Bazemore, 14, who attends Dodd Middle School in Freeport.

School districts offering "mental health days" to schoolchildren has been a controversial issue nationwide, but legislation is expected to go before New York State's lawmakers when they reconvene this month. A dozen states already have passed laws allowing mental health days in schools, several since 2020, when the COVID-19 pandemic forced districts across the country to move to remote learning.

Supporters say "mental health days" would allow students to hit pause and recalibrate when they feel overwhelmed. Those who oppose them say students have enough days off during the school year, and that such days could just be a pass to play hooky.

Long Island's students, for their part, have dealt with the fallout of nearly three rocky years of remote learning, isolation, learning loss, masking, social distancing, and more. Districts this school year — with studies showing a rise in student anxiety and depression — have sharpened their focus on mental health issues.

Some 74% of parents nationally believe schools should offer students days off for their mental and behavioral needs, according to a recent poll by Verywell Mind and Parents, which have websites focusing on wellness and parenting. The poll found that 56% of parents already let their kids take them.

At least one Long Island school — Plainview-Old Bethpage John F. Kennedy High School — is already allowing students excused absences for mental health, Principal James Murray said.

When school started in September 2021, Murray said he could see students were anxious as they worked their way back into their routines after more than a year of pandemic disruptions. So he asked Superintendent Mary O'Meara if he could allow them to take days to recharge their emotional battery, and she agreed.

"The pandemic affected many students in ways we could not always measure — the pressure for some was great," O'Meara said.

Students appreciated the district's empathy, and parents liked it because they didn't want to lie if their child needed a day off, he said.

Murray said the school still allows these days and plans to extend them down the line. Parents need to call in their child's absence and follow up with a note. Students are required to make up any work they missed. He put no limit on the number of mental health days, but if a student's days add up, an assistant principal follows up with the family, he said.

"We did have a few instances of that with students. Some [students] we knew were having problems," he said. But no student abused the practice, he said.

Murray said that a student who takes an excused absence on a test day can make it up. A student taking an unexcused absence might be able to take the test but risks a penalty being assessed on their grade, he said.

Some Long Island school administrators don't feel comfortable adding mental health days to their educational tool kit.

"How would giving them a day off fix the situation?" Baldwin Superintendent Shari Camhi said. "The student may just spend the day at the mall or on social media. How does that address the issue?"

Camhi added that there's no shortage of days off during the school year. "What is the stress? Let's fix that," she said.

Some worry that providing such time off could be counterproductive.

In the National Review, Daniel Buck, editor-in-chief of the education newsletter Chalkboard Review, wrote last year that mental health days could teach students to avoid, rather than confront, their troubles.

“What if we built resilience back into our schools? What if we trained students in the stoicism of Marcus Aurelius and habits of virtue in Aristotle such that they can face the inevitable difficulties of life?" he said.

Since the pandemic came to dominate school life, Long Island schools have put in place extra counselors and psychologists, formed partnerships with local mental health clinics, and even set up special rooms for students to take a break.

Before the pandemic, the rates of children's depression and anxiety were estimated to be 8.5% and 11.6%, respectively, according to a review of 29 studies across the world published in JAMA Pediatrics in August 2021. Since the pandemic, the study reported that one in four children was reporting depression and one in five was reporting anxiety.

Among high schoolers, more than a third (37%) nationally reported they experienced poor mental health during the pandemic, and 44% reported they persistently felt sad or hopeless, according to a March 2022 report by the Centers for Disease Control and Prevention.

States that allow days off for mental health include Washington, California, Illinois, Maine, Virginia, Colorado, Oregon, Connecticut, Arizona, Nevada, Utah and Kentucky. Policies vary from state to state. California does not have a limit on the number of permitted days, while Connecticut allows students two days per year.

Allowing a student a day to reset emotions sends a message that "our mental health is as important as physical health," said Teresa Grella-Hillebrand, director of the Counseling and Mental Health Professions Clinic at Hofstra University.

Parents need to play a role in these days, she said, inquiring but not prying into what's bothering their child. Done right, this could spur an important conversation about why they are feeling this way, she said.

"It's not about shaming the child, telling them they can't hack it," Grella-Hillebrand said. "You don't want to make them feel defective in some way. … We want to normalize talking about mental health for kids, so they're prepared to deal with it when they're adults

I hated school, dealt with bullying, and never took a day off, so my first inclination is to agree with Danial Buck. But I never had to deal with lockdowns, all-day masking, and unpredictability after unpredictability that these kids have to deal with. And unlike today's kids, I never had to deal with anything like cyberbullying which is 24/7. Once I was home it was done.


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05 Jan 2023, 12:57 pm

WHO sounds the alarm: New COVID variant is most transmissible yet

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The World Health Organization is warning that a new omicron subvariant known as XBB.1.5 is the most transmissible strain to date.

As COVID-19 hospitalizations rise in some parts of the Northeast -- where the subvariant makes up about 75% of new cases, according to data from the Centers for Disease Control and Prevention -- so are concerns about how to mitigate a potential surge following large holiday gatherings.

In the past few years, the post-holiday rise in COVID numbers was typically attributed to large gatherings and the colder weather bringing people indoors. Experts said it remains to be seen how much XBB.1.5 may be contributing to the most recent rise in hospitalizations.

"We don't fully know what this variant is doing in the population, especially since every time a new variant emerges it's not happening in a bubble … so it's very difficult to tease apart what might be driving, for instance, increases in hospitalizations," said Dr. John Brownstein, an ABC News contributor and chief innovation officer at Boston Children's Hospital.

Very little is known about this new subvariant, but some preliminary research indicates that it may be more immune evasive and contagious than previous omicron variants.

"We are concerned about [XBB.1.5's] growth advantage" in Europe and the U.S. Northeast, said Maria Van Kerkhove, the World Health Organization's COVID-19 technical lead, in a press conference Wednesday. XBB.1.5 had rapidly replaced other circulating variants in those areas, she added.

Scientists still do not know if the subvariant causes more severe illness or leads to more adverse outcomes like long COVID.

Researchers are also still studying how well vaccines will hold up against XBB.1.5. They say the updated bivalent booster shot remains the best way to protect yourself.

"Towards the end of last year, the CDC came out with data showing that those who got vaccinated and boosted with the bivalent had an almost 20-fold decreased risk of dying and severe illness," Dr. Peter Hotez, co-director of Texas Children's Hospital Center for Vaccine Development and dean of the National School of Tropical Medicine at Baylor College of Medicine, told ABC News. "The problem is that was all before XBB.1.5."


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11 Jan 2023, 10:39 pm

Are Our Immune Systems Stuck in 2020?

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In the two-plus years that COVID vaccines have been available in America, the basic recipe has changed just once. The virus, meanwhile, has belched out five variants concerning enough to earn their own Greek-letter names, followed by a menagerie of weirdly monikered Omicron subvariants, each seeming to spread faster than the last. Vaccines, which take months to reformulate, just can’t keep up with a virus that seems to reinvent itself by the week.

But SARS-CoV-2’s evolutionary sprint might not be the only reason that immunity can get bogged down in the past. The body seems to fixate on the first version of the virus that it encountered, either through injection or infection—a preoccupation with the past that researchers call “original antigenic sin,” and that may leave us with defenses that are poorly tailored to circulating variants. In recent months, some experts have begun to worry that this “sin” might now be undermining updated vaccines. At an extreme, the thinking goes, people may not get much protection from a COVID shot that is a perfect match for the viral variant du jour.

Recent data hint at this possibility. Past brushes with the virus or the original vaccine seem to mold, or even muffle, people’s reactions to bivalent shots—“I have no doubt about that,” Jenna Guthmiller, an immunologist at the University of Colorado School of Medicine, told me. The immune system just doesn’t make Omicron-focused antibodies in the quantity or quality it probably would have had it seen the updated jabs first. But there’s also an upside to this stubbornness that we could not live without, says Katelyn Gostic, an immunologist and infectious-disease modeler who has studied the phenomenon with flu. Original antigenic sin is the reason repeat infections, on average, get milder over time, and the oomph that enables vaccines to work as well as they do. “It’s a fundamental part,” Gostic told me, “of being able to create immunological memory.”

This is not just basic biology. The body’s powerful first impressions of this coronavirus can and should influence how, when, and how often we revaccinate against it, and with what. Better understanding of the degree to which these impressions linger could also help scientists figure out why people are (or are not) fighting off the latest variants—and how their defenses will fare against the virus as it continues to change.

In scenarios like these, original antigenic sin may sound like the molecular equivalent of a lovesick teen pining over an ex, or a student who never graduates out of immunological grade school. But from the immune system’s point of view, never forgetting your first is logically sound. New encounters with a pathogen catch the body off guard—and tend to be the most severe. A deep-rooted defensive reaction, then, is practical: It ups the chances that the next time the same invader shows up, it will be swiftly identified and dispatched. “Having good memory and being able to boost it very quickly is sometimes a very good thing,” Victora told me. It’s the body’s way of ensuring that it won’t get fooled twice.

These old grudges come with clear advantages even when microbes morph into new forms, as flu viruses and coronaviruses often do. Pathogens don’t remake themselves all at once, so immune cells that home in on familiar snippets of a virus can still in many cases snuff out enough invaders to prevent an infection’s worst effects. That’s why even flu shots that aren’t perfectly matched to the season’s most prominent strains are usually still quite good at keeping people out of hospitals and morgues. “There’s a lot of leniency in how much the virus can change before we really lose protection,” Guthmiller told me. The wiggle room should be even bigger, she said, with SARS-CoV-2, whose subvariants tend to be far more similar to one another than, say, different flu strains are.

With all the positives that immune memory can offer, many immunologists tend to roll their eyes at the negative and bizarrely moralizing implications of the phrase original antigenic sin. “I really, really hate that term,” says Deepta Bhattacharya, an immunologist at the University of Arizona. Instead, Bhattacharya and others prefer to use more neutral words such as imprinting, evocative of a duckling latching onto the first maternal figure it spots. “This is not some strange immunological phenomenon,” says Rafi Ahmed, an immunologist at Emory University. It’s more a textbook example of what an adaptable, high-functioning immune system does, and one that can have positive or negative effects, depending on context. Recent flu outbreaks have showcased a little bit of each: During the 2009 H1N1 pandemic, many elderly people, normally more susceptible to flu viruses, fared better than expected against the late-aughts strain, because they’d banked exposures to a similar-looking H1N1—a derivative of the culprit behind the 1918 pandemic—in their youth. But in some seasons that followed, H1N1 disproportionately sickened middle-aged adults whose early-life flu indoctrinations may have tilted them away from a protective response.

The backward-gazing immune systems of those adults may have done more than preferentially amplify defensive responses to a less relevant viral strain. They might have also actively suppressed the formation of a response to the new one. Part of that is sheer kinetics: Veteran immune cells, trained up on past variants and strains, tend to be quicker on the draw than fresh recruits, says Scott Hensley, an immunologist at the Perelman School of Medicine at the University of Pennsylvania. And the greater the number of experienced soldiers, the more likely they are to crowd out rookie fighters—depriving them of battlefield experience they might otherwise accrue. Should the newer viral strain eventually return for a repeat infection, those less experienced immune cells may not be adequately prepared—leaving people more vulnerable, perhaps, than they might otherwise have been.

Some researchers think that form of imprinting might now be playing out with the bivalent COVID vaccines. Several studies have found that the BA.5-focused shots are, at best, moderately more effective at producing an Omicron-targeted antibody response than the original-recipe jab—not the knockout results that some might have hoped for. Recent work in mice from Victora’s lab backs up that idea: B cells, the manufacturers of antibodies, do seem to have trouble moving past the impressions of SARS-CoV-2’s spike protein that they got from first exposure. But the findings don’t really trouble Victora, who gladly received his own bivalent COVID shot. (He’ll take the next update, too, whenever it’s ready.) A blunted response to a new vaccine, he told me, is not a nonexistent one—and the more foreign a second shot recipe is compared with the first, the more novice fighters should be expected to participate in the fight. “You’re still adding new responses,” he said, that will rev back up when they become relevant. The coronavirus is a fast evolver. But the immune system also adapts. Which means that people who receive the bivalent shot can still expect to be better protected against Omicron variants than those who don’t.

Original antigenic sin might not be a crisis, but its existence does suggest ways to optimize our vaccination strategies with past biases in mind. Sometimes, those preferences might need to be avoided; in other instances, they should be actively embraced.

For that to happen, though, immunologists would need to fill in some holes in their knowledge of imprinting: how often it occurs, the rules by which it operates, what can entrench or alleviate it.

It does seem intuitive that multiple doses of a vaccine could exacerbate an early bias, Ahmed told me. But if that’s the case, then the same principle might also work the other way: Maybe multiple exposures to a new version of the virus could help break an old habit, and nudge the immune system to move on. Recent evidence has hinted that people previously infected with an early Omicron subvariant responded more enthusiastically to a bivalent BA.1-focused vaccine—available in the United Kingdom—than those who’d never encountered the lineage before. Hensley, at the University of Pennsylvania, is now trying to figure out if the same is true for Americans who got the BA.5-based bivalent shot after getting sick with one of the many Omicron subvariants.

Ahmed thinks that giving people two updated shots—a safer approach, he points out, than adding an infection to the mix—could untether the body from old imprints too. A few years ago, he and his colleagues showed that a second dose of a particular flu vaccine could help shift the ratio of people’s immune responses. A second dose of the fall’s bivalent vaccine might not be practical or palatable for most people, especially now that BA.5 is on its way out. But if next autumn’s recipe overlaps with BA.5 in ways that it doesn’t with the original variant—as it likely will to at least some degree, given the Omicron lineage’s continuing reign—a later, slightly different shot could still be a boon.

Keeping vaccine doses relatively spaced out—on an annual basis, say, à la flu shots—will likely help too, Bhattacharya said. His recent studies, not yet published, hint that the body might “forget” old variants, as it were, if it’s simply given more time.

Even Thomas Francis Jr. did not consider original antigenic sin to be a total negative, Hensley told me. According to Francis, the true issue with the “sin” was that humans were missing out on the chance to imprint on multiple strains at once in childhood, when the immune system is still a blank slate—something that modern researchers could soon accomplish with the development of universal vaccines. Our reliance on first impressions can be a drawback. But the same phenomenon can be an opportunity to acquaint the body with diversity early on—to give it a richer narrative, and memories of many threats to come.


Data Doesn’t Support New COVID-19 Booster Shots for Most, Says Vaccine Expert
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n a perspective published Jan. 11 in the New England Journal of Medicine, vaccine expert Dr. Paul Offit says it’s time to rethink booster recommendations.

In the third year of the pandemic, the population’s immune situation is vastly different from what it was in 2019 when SARS-CoV-2 emerged. Now, most people have been vaccinated against the virus, been infected with it (once or multiple times), or both. And the latest data show that the newest booster shot, which targets the Omicron BA.4/5 strain and original virus variants in a bivalent formulation, isn’t that much more effective in generating virus-fighting antibodies than the original vaccine when used as a booster.

“The experience of the past year has taught us that chasing these Omicron variants with a bivalent vaccine is a losing game,” says Offit, director of the vaccine education center at the Children’s Hospital of Philadelphia and a member of the U.S. Food and Drug Administration’s vaccine advisory committee. Offit also developed the rotavirus vaccine.

n his perspective piece, Offit cites data from two leading virologists—Dr. David Ho, director of the Aaron Diamond AIDS Research Center at Columbia University, and Dr. Dan Barouch at Harvard Medical School—who reported that when serum from people boosted with the bivalent Omicron booster was compared to that from people boosted with a dose of the original vaccine, their levels of neutralizing antibodies against BA.4/5 were comparable. Ho’s work also showed that the bivalent booster did not produce appreciably different antibody responses against newer Omicron variants, such as BQ.1, BQ.1.1, XBB, and now XBB.1.5, which together account for 83% of new infections in the U.S. as of the first week of January.

So why are these infections occurring if the bivalent vaccine was supposed to zero in on the BA.4/5 variant better than the original booster?

The reason has to do with how the immune system is trained against new viruses. Similar to the way newborn animals of some species imprint to recognize their mothers, immune cells dedicate energy and resources to recognizing and familiarizing themselves to any new agents they encounter. Most of the resulting defensive activity is geared toward this original invader, in a phenomenon virus experts call original antigenic sin, in which these immune cells continue to generate virus-fighting antibodies against the original pathogen even if more recent variants of the viruses vary from that template.

The important end result, says Offit, is that as the studies found, chasing variants of the virus with new boosters may not always produce appreciably better responses in the form of a barrage of antibodies. And it’s not just the bivalent BA.4/5 booster that resulted in this pattern. An earlier bivalent shot, aimed at another Omicron variant, BA.1, produced levels of BA.1-neutralizing antibodies that were just under two times those generated by a dose of the original shot.

Now, boosting everyone with an Omicron shot is “trying to prevent, in otherwise healthy people, mild illness for a few months,” says Offit, until the next variant comes along to replace it. “That doesn’t make sense.”

It was reasonable to think that a bivalent booster targeting BA.4/5 would produce more robust levels of antibodies against BA.4/5, but it turns out that’s not necessarily the case, and that the protection is only slightly better when compared to the original booster. “[The bivalent booster] was sold as better, and better at preventing mild disease and transmission,” says Offit, “when there was no evidence for that.”

Now that there’s evidence showing that the bivalent booster isn’t necessarily more effective, the question becomes who should be getting it and why. The bivalent booster is still important for people at highest risk of getting severely ill, such as the elderly and immunocompromised, whose immune systems may not produce as strong of an immune response—even the small increase in additional antibodies could be important for them.

But for the rest of the population, it may be time to consider whether the bivalent booster is necessary, or if continuing to boost with the original vaccine would be sufficient. “I think the [U.S. Centers for Disease Control and Prevention] needs to answer that question,” says Offit. And to do that, Offit is calling on the CDC to provide more detailed data on who is being hospitalized for COVID-19 (not just people who are hospitalized and incidentally test positive for the infection), their age, whether they have immune-compromising conditions, whether they have other health issues, and their vaccination and booster status. “Give us those data, and we can then figure out who really needs to be boosted,” says Offit. “Initially, everybody benefited from getting vaccinated and boosted. But we need to learn who benefits now.”


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12 Jan 2023, 7:17 pm

No one can ever wake up with a stuffy nose and sore throat and think , “Oh, it’s just the sniffles,” in the post Covid world.
Relative gave me a cold.I woke up sick and the first thought was Covid.
I did four home tests spaced out over a week and all negative.Still dodging it.
I’m also mad at the relative that gave me this pesky cold.I haven’t been sick in years.
Asshat.


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12 Jan 2023, 9:23 pm

Long COVID symptoms may ease within a year: research

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Long COVID, a condition with a wide range of persisting symptoms that occur following a COVID-19 infection, is still not well understood, but Israeli researchers have recently completed a study indicating the ailment may resolve relatively quickly.

The study, published in the peer-reviewed medical journal The BMJ, looked at the health outcomes of nearly 2 million COVID-19 patients who developed mild illness after being infected. These patients tested positive for COVID-19 between March of 2020 and October of 2021 and included both vaccinated and unvaccinated individuals.

Common health conditions that the researchers found associated with COVID-19 cases included the well-documented loss of smell, breathing issues, and impacts on concentration and memory. While the definition of long COVID is still not universally agreed upon, the researchers defined the condition as symptoms that were present four weeks after a positive COVID-19 diagnosis.

The majority of the reported health conditions, such as hair loss, heart palpitations, chest pain and memory impairment, resolved or fell back to baseline levels within a year.

“Although the long covid phenomenon has been feared and discussed since the beginning of the pandemic, we observed that most health outcomes arising after a mild disease course remained for several months and returned to normal within the first year,” the researchers wrote.

“This nationwide dataset of patients with mild covid-19 suggests that mild disease does not lead to serious or chronic long term morbidity in the vast majority of patients and adds a small continuous burden on healthcare providers,” they continued.

However, some other conditions were noted to persist more than one year after a patient’s initial coronavirus diagnosis. Loss of smell and changes in the patients’ abilities to taste were found to still be significantly higher than in uninfected people a year after the patients initially tested positive for COVID-19.

Across age ranges, people between the ages of 41 and 60 were found to have the highest number of post-COVID health issues, researchers noted.

The analysis determined that vaccinated individuals were at a lower risk of developing prolonged difficulty breathing. They found that “the risk for all the other long term health outcomes was comparable” between the vaccinated and unvaccinated groups.


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13 Jan 2023, 8:43 am

The SARS-CoV-2 virus, which causes COVID-19, is threatening to surge again. In the past few weeks alone, a recent version, XBB.1.5, the most infectious subvariant yet discovered, has quickly spread in the United States. As of the most recent data from the Centers for Disease Control, this variant makes up about three-quarters of all cases in the Northeast and 27.6% nationwide.

The most striking thing about XBB.1.5 is that it didn’t simply arise as the result of point mutations in the RNA; rather it is the result of a recombination of two descendants of the BA.2 variant.

The important takeaway: For the recombination event to have occurred, the two parental viruses must both have infected a person and have been present in the same cell simultaneously for enzymes to have broken and reattached portions of the two genomes.

Source: XBB.1.5 Spreading Rapidly Through the US: Why the Coronavirus Continues to Confound Scientists and Public Health Officials


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13 Jan 2023, 9:29 am

ASPartOfMe wrote:
Quote:
Long COVID, a condition with a wide range of persisting symptoms that occur following a COVID-19 infection, is still not well understood, but Israeli researchers have recently completed a study indicating the ailment may resolve relatively quickly.

...

The majority of the reported health conditions, such as hair loss, heart palpitations, chest pain and memory impairment, resolved or fell back to baseline levels within a year.

Not sure I agree with this study, or at least the article that is reporting on it.
Some symptoms do go away, some are lessened, some you just learn to live with and you stop noticing they are there. New symptoms are always popping up.

I would say the examples they list are much less disabling than some of the more common ones that are not going away, like ME/CFS, PEM, POTS, MCAS, etc.

We are on the verge of three years with Long Covid. I can't say I see a lot of people in the support groups talking about how they're "back to baseline levels".


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14 Jan 2023, 2:36 am

SabbraCadabra wrote:
ASPartOfMe wrote:
Quote:
Long COVID, a condition with a wide range of persisting symptoms that occur following a COVID-19 infection, is still not well understood, but Israeli researchers have recently completed a study indicating the ailment may resolve relatively quickly.

...

The majority of the reported health conditions, such as hair loss, heart palpitations, chest pain and memory impairment, resolved or fell back to baseline levels within a year.

Not sure I agree with this study, or at least the article that is reporting on it.
Some symptoms do go away, some are lessened, some you just learn to live with and you stop noticing they are there. New symptoms are always popping up.

I would say the examples they list are much less disabling than some of the more common ones that are not going away, like ME/CFS, PEM, POTS, MCAS, etc.

We are on the verge of three years with Long Covid. I can't say I see a lot of people in the support groups talking about how they're "back to baseline levels".


The study surprised me also. The study goes against what I have been posting about since Long Covid was first recognized about mild cases leading to debilitating Long Covid. But those were antidotal accounts this is a study of 2 million people. We will see what further studies find. Even if true it is taking a whole lot of people partially or totally out of action for months. People making their mitigation decisions should take that into account.


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14 Jan 2023, 2:41 am

jimmy m wrote:
The SARS-CoV-2 virus, which causes COVID-19, is threatening to surge again. In the past few weeks alone, a recent version, XBB.1.5, the most infectious subvariant yet discovered, has quickly spread in the United States. As of the most recent data from the Centers for Disease Control, this variant makes up about three-quarters of all cases in the Northeast and 27.6% nationwide.

The most striking thing about XBB.1.5 is that it didn’t simply arise as the result of point mutations in the RNA; rather it is the result of a recombination of two descendants of the BA.2 variant.

The important takeaway: For the recombination event to have occurred, the two parental viruses must both have infected a person and have been present in the same cell simultaneously for enzymes to have broken and reattached portions of the two genomes.

Source: XBB.1.5 Spreading Rapidly Through the US: Why the Coronavirus Continues to Confound Scientists and Public Health Officials


Locally our wave is finally noticeably receding. It was not as nearly as widespread as other spikes but lasted for months. It is still at moderate levels.


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14 Jan 2023, 8:50 am

There are two sides to every coin. In this case the two sides are HOW CONTAGIOUS and HOW DEADLY.

A recent article posted:

A new COVID-19 subvariant is spreading across the United States and parts of Europe. Nicknamed the “Kraken variant”, the new strain appears to be more contagious than the previous strains. However, it has been noted the new variant does not affect people’s immune systems adversely thus far. The WHO said on January 4, 2023, that the latest Omicron sublineage XBB1.5 is the “most transmissible subvariant that has been detected yet”, and the variant has been detected in at least 29 countries so far.

Source: What is the new COVID-19 variant XBB1.5, and should we be concerned?


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14 Jan 2023, 9:30 pm

ASPartOfMe wrote:
But those were antidotal accounts this is a study of 2 million people. We will see what further studies find.

I think they're cherry picking at the data to make Long Covid sound less scary. We can't have people afraid of Covid. That would be bad.

Like I said, a lot of those symptoms that they listed do seem to go away (or at least they get to a point where you don't notice them as much), but they are MILD compared to the symptoms that stick with you; all of the neurological damage.

My brain fog is a lot better than it was a couple years ago, but I can't picture myself ever being able to run and jump and climb things again. Just thinking about it makes me feel exhausted.


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16 Jan 2023, 9:04 am

I read another article about LONG COVID.

The most common long COVID symptoms are fatigue, fever, cough, and difficulty breathing or shortness of breath. Less common problems are “brain fog,” headache, stroke, sleep problems, loss of smell and taste, depression or anxiety, joint or muscle pain; cardiovascular symptoms such as chest pain or palpitations; digestive symptoms, and blood clots in various organs.

Long COVID occurs in around five percent of those who have been infected, depending on exactly how it is defined. It causes prolonged pain and suffering in millions of Americans and symptoms so severe that perhaps a million are unable to work.


Source: COVID’s Toll Continues to Rise, But Americans Aren't Taking It Seriously


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19 Jan 2023, 11:47 am

As we transition into the depths of winter in the U.S., this is how the numbers are changing:

As we approach the winter, a new set of numbers is being given by the CDC for the U.S. This is the latest estimate as of
November 5, 2022

BA.5 ----- 39.2 %
BQ.1 ----- 16.5 %
BQ.1.1 --- 18.8 %
BA.4.6 ---- 9.5 %
BF.7 -------- 9.0 %
BA.5.2.6 -- 3.1 %
BA.2.75 --- 2.3 %
BA.2.75.2 - 1.3 %

And this is where we stood in December 4-10, 2022.

BQ.1.1 --- 36.8 %
BQ.1 ----- 31.1 %
BA.5 ----- 11.5 %
BF.7 -------- 5.7 %
XBB -------- 4.7%
BN.1 ------- 4.3 %
BA.5.2.6 --- 1.7 %
BA.4.6 ----- 1.6 %
BF.11 ------- 0.8 %
BA.2 ---------0.7 %
BA.2.75 ---- 0.6 %
BA.2.75.2 -- 0.4 %

And this is where we stand now as of January 8-14, 2023.

XBB.1.5 ----- 43.0%
BQ.1.1 ------ 28.8 %
BQ.1 -------- 15.9 %
XBB ----------- 3.9 %
BA.5 ---------- 2.6 %
BN.1 ---------- 2.1 %
BF.7 ---------- 1.4 %
BA.2.75 ------ 1.3 %
BA.5.2.6 ------ 0.5 %
BA.2 -----------0.2 %
BF.11 --------- 0.2 %
BA.4.6 -------- 0.1 %
BA.2.75.2 ---- 0.1 %

Source: What COVID-19 variants are going around in January 2023?

On the other side of the coin. The number of COVID cases in the U.S. and the number of deaths are way down compared to a year ago.


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