After last year’s heat crisis, Pacific Northwest emergency managers, doctors and even transit systems are using lessons learned to prepare for this summer
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A vaccine-derived version of poliovirus has repeatedly surfaced in London sewage over the past several months, suggesting there may be a cryptic or hidden spread among some unvaccinated people, UK health officials announced Wednesday.
No polio cases have been reported so far, nor any identified cases of paralysis. But sewage sampling in one London treatment plant has repeatedly detected closely related vaccine-derived polioviruses between February and May. This suggests “it is likely there has been some spread between closely-linked individuals in North and East London and that they are now shedding the type 2 poliovirus strain in their feces,” the UK Health Security Agency (UKHSA) said.
Though the current situation raises alarm, the agency notes that it’s otherwise common to see a small number of vaccine-like polioviruses pop up in sewage from time to time, usually from people who have recently been vaccinated out of the country. This is because many countries use oral polio vaccines that include weakened (attenuated) polioviruses, which can still replicate in the intestines and thus be present in stool. They can also spread to others via poor hygiene and sanitation (i.e., unwashed hands and food or water contaminated by sewage), which can become concerning amid poor vaccination rates.
Among adults vaccinated against COVID-19, the odds of developing long COVID amid the omicron wave were about 20 percent to 50 percent lower than during the delta period, with variability based on age and time since vaccination.
The finding comes from a case-control observational study published this week in The Lancet by researchers at Kings College London. The study found that about 4.5 percent of the omicron breakthrough cases resulted in long COVID, while 10.8 percent of delta breakthrough cases resulted in the long-term condition.
While the news may seem a little reassuring to those nursing a breakthrough omicron infection, it’s cold comfort for public health overall since the omicron coronavirus variant is much more transmissible than delta.
A committee of experts advising the Food and Drug Administration voiced unanimous support Wednesday for the authorization of two COVID-19 vaccines for children under the age of 5. If the FDA authorizes the vaccines, it will mark the first time during the more than two-year pandemic that vaccines against COVID-19 will be available for this age group—the last group yet to be eligible for vaccination.
Although children in this young age group have a relatively lower risk of severe disease and death from COVID-19 compared with older groups, they can and do become severely ill and die from the infection. As of last month, 45,000 children under 5 have been hospitalized for COVID-19 during the pandemic; roughly 50 percent of those hospitalizations occurred during the omicron wave. Of the children who land in the hospital, about 63 percent have no underlying medical conditions that put them at greater risk of severe COVID-19. And about a quarter of those hospitalized require intensive care.
So far, 475 children under the age of 5 have died from COVID-19 during the pandemic, making COVID-19 far deadlier than other diseases we routinely vaccinate young children against, including influenza, measles, chickenpox, hepatitis A, and rotavirus.
Late in 2021, the Environmental Protection Agency announced a long-term project that aimed to come to grips with contamination by a class of chemicals called PFAS, for per- and poly-fluoroalkyl substances. Sometimes termed “forever chemicals,” these compounds don’t naturally degrade at an appreciable rate, and they show up in everything from food packaging to drinking water. Lab and epidemiological studies have indicated that they carry potential health risks, and the EPA started a program to evaluate the latest research on them.
On Tuesday, the agency announced some of the first results of this effort and is issuing updated drinking-water health advisories on four of the chemicals, one of which tightens exposure risks by a factor of 10,000. In addition, the EPA announced that it is planning to spend a billion dollars of Infrastructure Bill funding in disadvantaged and small communities to help them monitor and reduce PFAS exposures.
PFAS are hydrocarbons in which some of the hydrogen atoms have been replaced by fluorine. This makes them chemically inert, allowing them to stick around in the environment for a long time without breaking down—hence the term “forever chemicals.” Their stability and tendency to repel water makes them useful for a variety of industrial processes. Their users, however, haven’t always been careful about what happens to the chemicals during use. As a result, PFAS have contaminated both soil and drinking water, among other things.
The World Health Organization will convene its emergency committee of expert advisors Thursday, June 23, to consider whether it should declare the growing, multinational monkeypox outbreak a public health emergency of international concern (PHEIC).
As of Tuesday, June 14, WHO has received reports of more than 1,600 confirmed monkeypox cases and almost 1,500 suspected cases from 39 countries. Those countries include eight in which monkeypox infections were previously known to spill over from animals, and 32 newly affected countries, most of which are in Europe, but also include Australia and countries in the Americas and Eastern Mediterranean.
There have been 72 monkeypox deaths reported this year from African countries that have long been affected by limited spillovers. So far, there are no confirmed deaths among cases in newly affected countries, but WHO is seeking verification of a reported monkeypox-related death in Brazil.
Omicron subvariants BA.4 and BA.5 are on the rise in the European Union, spurring officials there to warn that a surge of COVID-19 cases will likely follow in the coming weeks.
In an alert Monday, the European Center for Disease Prevention and Control cautioned that various factors would influence how bad the expected BA.4/BA.5 wave will be. Those factors include the extent of vaccination and past infection in the population, as well as timing since those events because protection from both wanes over time.
BA.4 and BA.5 are clumped together because they share the same mutations in the genetic coding for their spike proteins, though they have differing mutations elsewhere in their genome. Both have a transmission advantage over the initial omicron subvariant, BA.1, as well as subvariants BA.2 and BA.2.12.1.
With pandemic funding running out, the Biden administration is repurposing $10 billion to buy next-generation COVID-19 booster doses for the fall, as well as treatments, including the anti-viral Paxlovid and monoclonal antibodies.
The funding will be pilfered from federal programs that support COVID-19 test availability and domestic production, as well as stockpiles of essential resources, such as personal protective equipment (PPE) and ventilators. Funding for research on coronavirus vaccines and new treatments will also take a hit.
“These were incredibly painful decisions,” White House COVID-19 Response Coordinator Ashish Jha said in a press briefing Thursday.
A committee of independent, expert advisors for the Food and Drug Administration voted overwhelmingly to authorize the two-dose Novavax COVID-19 vaccine Tuesday, with 21 of 22 committee members voting in favor of the vaccine and one member abstaining.
The endorsement is only for a two-dose primary series in adults, not for boosters. The FDA is not obligated to follow the advice of its committee—the Vaccines and Related Biological Products Advisory Committee (VRBPAC)—but the agency typically heeds its advice. If the FDA authorizes the vaccine, the Centers for Disease Control and Prevention will need to sign off on use before it becomes available.
The decision regarding the Novavax vaccine, which is already authorized in dozens of other countries, is not a straightforward one in the US. The vaccine has some advantages over currently approved vaccines but has several strikes against it.
Omicron subvariant BA.2.12.1 has overtaken BA.2 as the dominant version of the pandemic coronavirus in the US, now accounting for an estimated 59 percent of cases nationwide. But BA.2.12.1’s reign may end as quickly as it began, with yet another batch of omicron subvariants gaining ground—BA.4 and BA.5—and threatening to cause more breakthrough infections.
BA.2.12.1 has a transmission advantage over BA.2, which itself has an edge over the initial omicron subvariant, BA.1, that caused a towering surge of US cases in mid-January. BA.2 peaked in mid-April, accounting for 76 percent of US cases at its height. But then came BA.2.12.1, which is named for being the 12th lineage stemming from BA.2 and the first branch of that BA.2.12 lineage.
When BA.2 peaked in mid-April, BA.2.12.1 accounted for about 18 percent of cases. It reached about 43 percent prevalence by mid-May and has since overtaken BA.2, which currently accounts for only about 35 percent of cases. BA.2.12.1 is dominant in every region of the country, except for the Northwest, according to the Centers for Disease Control and Prevention.
The multinational monkeypox outbreak continues to pose a low risk to the general public, and, for now, it seems unlikely that cases will mushroom into a global pandemic, according to the World Health Organization and the US Centers for Disease Control and Prevention.
But, experts are concerned that the virus could continue to spread and that transmission may escape containment without an urgent and thorough public health response.
The outbreak tally continues to increase rapidly, with hundreds of cases now reported across at least 23 countries. In an update released Sunday, May 29, WHO reported 257 confirmed cases and around 120 suspected cases from 23 countries. Those figures are already significantly outdated. As of Monday, Our World in Data reported 555 confirmed cases worldwide. On Tuesday, the United Kingdom reported 190 cases, up from the 106 that WHO reported Sunday. Likewise, the US total has increased to 15 cases, up from 10 reported last week.
Monkeypox is presumed to have spread within the US, and nine cases have now been identified in seven states, according to the director of the Centers for Disease Control and Prevention, Rochelle Walensky.
In a press briefing Thursday, Walensky said the nine cases were from Massachusetts, New York, Florida, Utah, Washington, California, and Virginia. Most of the nine cases had recent international travel to areas with active monkeypox cases, but not all.
“We need to presume that there is some community spread,” Walensky said. “But there is active contact tracing that is happening right now to understand whether and how these cases might have been in contact with each other or with others in other countries.”
More than one in five adults in the US who have recovered from COVID-19 may end up developing a long-term condition linked to the viral infection, according to a study published this week by the Centers for Disease Control and Prevention.
The post-COVID conditions span heart, lung, kidney, cardiovascular, gastrointestinal, neurological, and mental health conditions. Overall, COVID survivors had nearly twice the risk of developing respiratory and lung conditions, including pulmonary embolisms, compared with uninfected controls. The most common post-COVID conditions were respiratory conditions and musculoskeletal pain.
Among COVID survivors, people ages 18 to 64 were more likely than older survivors to develop cardiac dysrhythmia and musculoskeletal pain. The risks for survivors 65 and up were greater for kidney failure, blood clots, cerebrovascular disease, muscle disorders, neurological conditions, and mental health conditions.
The US Centers for Disease Control and Prevention today provided an update on the monkeypox situation in the US, which is connected to a growing multinational outbreak. It also used the time to address open questions and calm some unfounded fears.
To date, there are five confirmed and probable cases in the US. The one confirmed case of monkeypox in the US was identified last week in a Massachusetts man who had recently traveled to Canada. The four probable cases include one in New York City, one in Florida, and two in Utah.
Those four cases are probable because they all tested positive for an orthopoxvirus, the family of viruses that includes monkeypox and smallpox. They are considered presumptive monkeypox cases and are being treated as such while the CDC carries out secondary testing to confirm monkeypox.
A sixth child has died in the United States from puzzling liver inflammation—aka hepatitis—and the number of unexplained cases has risen to 180 across 36 states, according to the Centers for Disease Control and Prevention.
The latest death was announced in a press briefing Friday, led by CDC Deputy Director for Infectious Diseases Jay Butler, who said it was reported to the agency Thursday. He did not indicate in which state the death occurred.
In addition to the deaths, 15 of the 180 cases required liver transplants, Butler reported. The cases all occurred in children under the age of 10 but skewed to preschool-age children, with the median age being around 2 years.
A growing outbreak of monkeypox cases has spread across several countries, including the US, suggesting that the animal-transmitted disease that occurs in forested areas of Central and West Africa has been quietly spreading undetected.
So far, the US has reported one case in a Massachusetts man who had recently traveled to Canada, which, as of Thursday, reported 17 suspected cases in Montreal. The United Kingdom has identified nine cases, one of which is connected to recent travel to Nigeria, where monkeypox is endemic. But the other cases appear to have been infected within the UK and are all not linked to the travel-related case by contact or timing. Portugal is investigating more than 20 cases, Spain is reportedly investigating 23 cases, and Italy and Sweden have each reported at least one case.
Monkeypox is a relative of smallpox and produces similar symptoms, but it causes a milder disease than that of the eradicated virus. There are two clades of monkeypox: the West African clade and the Congo Basin clade. The West African clade, which is what has been detected in the UK, is the milder of the two. It is usually a self-limiting infection, though it can cause severe disease in some cases. The case fatality rate has been estimated at about 1 percent. The Congo Basin clade, meanwhile, has an estimated fatality rate of as high as 10 percent. For both clades, children are among those at high risk of severe disease, and infection can be particularly dangerous during pregnancy, causing complications, congenital conditions, and stillbirth.
At least six people in North Korea have died and more than 350,000 have contracted an unusual fever since late April in an outbreak that “explosively spread nationwide,” North Korean state media said Friday.
On Thursday, 18,000 new cases were reported, 187,800 people were in quarantine, and 162,200 had reportedly recovered. The cases are being defined by “a fever whose cause couldn’t be identified,” according to The New York Times.
The numbers come just a day after the authoritarian country acknowledged for the first time during the pandemic that the coronavirus was spreading within its borders.
North Korea instituted a nationwide lockdown Thursday after reporting an omicron coronavirus variant outbreak in its capital, Pyongyang. The report marks the first time during the pandemic that the secretive, authoritarian country has acknowledged coronavirus cases within its borders, though outside experts have doubted the country’s previous claims of zero infections.
Acknowledging omicron cases in Pyongyang raises questions over whether the admission is a sign of deteriorating public health conditions and/or a signal that the country is willing to accept pandemic aid, including vaccines.
So far, North Korea’s government has rejected offers of COVID-19 vaccine supplies from the United Nation’s global vaccination effort, COVAX, and China’s domestically produced vaccines. North Korea is one of the few countries that has not run a public vaccination effort, and its 26 million people are believed to be largely unvaccinated.
The US Food and Drug Administration limited the use of the Johnson & Johnson (Janssen) COVID-19 vaccine late Thursday, citing the risk of a very rare but severe clotting disorder called thrombosis with thrombocytopenia syndrome (TTS).
From now on, the J&J vaccine is only to be used in people ages 18 and up who are unable or unwilling to receive an alternative COVID-19 vaccine. That includes people who have had a life-threatening allergic reaction (anaphylaxis) to an mRNA COVID-19 vaccine, people who have personal concerns about mRNA COVID-19 vaccines and would otherwise not get vaccinated, and people who don’t have access to mRNA COVID-19 vaccines.
The limitation comes as the FDA and the Centers for Disease Control and Prevention have been closely monitoring people who received J&J COVID-19 vaccinations for TTS. To date, the agencies have identified and confirmed 60 cases of TTS linked to the vaccine, including nine deaths. That represents a rate of 3.23 TTS cases per million doses of J&J vaccine administered, and a rate of 0.48 TTS deaths per million doses of vaccine administered, the FDA said Thursday.
An estimated 14.91 million people worldwide died in 2020 and 2021 due to the COVID-19 pandemic, according to an analysis of global excess deaths released Thursday by the World Health Organization.
The estimate—with a 95 percent confidence interval of 13.3 million to 16.6 million—is significantly larger than the number of reported deaths directly caused by COVID-19 during that time, which was around 5.42 million by official counts. But, estimates of excess death try to capture the true toll of the pandemic—direct and indirect deaths. The estimate is done by comparing the number of deaths that occurred during a time period to those expected to occur in that period based on historical mortality data and modeling. Such modeling also accounts for historical differences, such as fewer traffic and influenza deaths during the pandemic due to movement and health restrictions.
Thus, excess death estimates aim to capture not only reported COVID-19 deaths, but unreported COVID-19 deaths, and deaths indirectly caused by COVID-19. Those can include people dying of preventable, non-COVID conditions because they delayed or avoided health care in fear of becoming infected, or because their healthcare system was overburdened with COVID-19 patients and unable to provide optimal care.
The pandemic coronavirus will likely become a seasonal respiratory virus, much like influenza, requiring annual booster shots each fall, according to three top officials at the US Food and Drug Administration.
In a commentary piece published this week in the medical journal JAMA, the officials make a case for seasonal shots and caution that preparation for this winter’s potential surge needs to begin no later than next month.
“The timeframe to determine the composition of the COVID-19 vaccine for the 2022-2023 season, to use alongside the seasonal influenza vaccine for administration in the Northern Hemisphere beginning in about October, is compressed because of the time required for manufacturing the necessary doses,” the officials write. “A decision on composition will need to be made in the US by June 2022.”
The omicron subvariant BA.2.12.1 is poised to become dominant in the US, currently accounting for an estimated 36.5 percent of all US SARS-CoV-2 cases, according to the latest estimates released Tuesday by the Centers for Disease Control and Prevention.
The subvariant’s ascent is the latest rapid succession of omicron subvariants, from the sky-scraping peak of cases from the initial omicron subvariant BA.1 in January, to the current bump driven by the subvariant BA.2, which achieved dominance in March. As before, the reason for the viral usurping is that omicron subvariants continue to evolve advantages: BA.2.12.1 has a transmission advantage over BA.2, which had a transmission advantage over BA.1, which had a significant advantage over delta.
The imminent reign of BA.2.12.1 raises concern for yet another wave of infections and poses questions about how effective future omicron-specific vaccines could be against symptomatic infections.
Enduring an initial omicron infection may not spare you from omicron’s subvariants, according to preliminary data from South Africa.
The country is currently at the start of a new wave of infections, primarily driven by two omicron coronavirus subvariants, BA.4 and BA.5. Despite a towering wave of cases from the initial BA.1 omicron variant in December that infected a large chunk of the country, new omicron cases increased 259 percent in the last two weeks, according to data tracking by The New York Times. Hospitalizations are also up, and deaths have increased by 18 percent.
Preliminary data posted online last week helps explain why cases are once again surging—the BA.4 and BA.5 omicron subvariants can evade neutralizing antibodies generated by infections from BA.1. For the study, led by virologist Alex Sigal of the Africa Health Research Institute, researchers pitted neutralization antibodies from people infected with BA.1 up against BA.4 and BA.5 in a lab. They had samples from 24 unvaccinated people infected with BA.1 and 15 vaccinated people who had also had a BA.1 infection (eight people were vaccinated with the Pfizer/BioNTech vaccine, and seven had the Johnson & Johnson vaccine).