Coronavirus disease 2019 (COVID-19) is a highly contagious infection caused by the SARS-CoV-2 virus discovered in Wuhan, China, in December 2019 [1]. On March 11, 2020, the World Health Organization (WHO) declared this rapidly spreading illness a global pandemic [2].
The worldwide spread of the virus and its rapid increase in mortality necessitated the expeditious development of a novel vaccine. Early December 2020 marked the beginning of the first mass vaccination program [3]. There are 10 COVID-19 vaccines approved for use by the WHO. These include Oxford-AstraZeneca (AstraZeneca), Johnson and Johnsons Janssen (J&J), Moderna, Pfizer-BioNTech (Pfizer), Sinopharm, Sinovac, COVAXIN, Covovax, Nuvaxovid, and CanSino [4]. Pfizer, Moderna, and J&J have been approved for emergency use by the United States Food and Drug Administration (FDA). The Centers for Disease Control and Prevention (CDC) is currently recommending the primary vaccine series for those aged six months and older and, if eligible, boosters for those five years and older [5].
As of June 17, 2022, the CDConline COVID tracker reported that 78.1% of the United States population had received at least one dose of the COVID-19 vaccine, while 66.8% are considered fully vaccinated. Additionally, 47.2% of those considered fully vaccinated have been administered the first booster dose [5]. While the primary vaccine and boosters aredeemed safe and effective, increased reports of adverse events are inevitable with the execution of mass vaccination.
Clinical and radiologic evidence of transient reactive lymph node enlargement secondary to the COVID-19 vaccinations is well documented in the literature [6-8]. Clinical signs of lymphadenopathy (LAP) following COVID-19 vaccination have been noted to includelymph node swelling and tenderness ipsilateral to the site of injection [9]. Meanwhile, radiologic evidence of LAP following COVID-19 vaccination, observed on various imaging modalities, have been noted to includediffuse and cortical lymph node thickening [10]. The presence of LAPraises the question if this is due to ones immune system reacting to the vaccine versusan underlying malignant process, infection, autoimmune condition, or medication. This article aims to synthesize the available data on COVID-19 vaccine-associated LAP in breast imaging recipients and to reduce the use of unneeded imaging and invasive procedures in these patients.
Selection Criteria and Search Strategies
A comprehensive literature search was performed by three authors(RTA, JR, JD) using scientific databases including PubMed, Google Scholar, and Science Direct. Search strings included COVID-19 AND vaccine AND lymphadenopathy AND mammogramOR "mammography" OR breast imaging OR breast MRI. No MeSH terms were utilized. The following study designs were included in our final review: retrospective, case series, and case reports. Pre-existing literature reviews and systematic reviews were excluded. All articles were reviewed for relevancy by reading the title and abstract. After removing duplicate articles, we included data from 26 studies relevant to our topic. We included retrospective observational studies, case series, and case reports published in English. Many of these articles included patients with breast imaging such as mammography (MMG), breast ultrasounds (US), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT). The table inAppendices comprises a list of articles used in this report and briefly describes each.
Data Collection
Data extraction was completed independently by three authors (RTA, JR, JD).These studies examined characteristics such as age, prior history of breast cancer, malignant findings, and adenopathy location in addition to variables such as imaging type, vaccination type, days since the last COVID-19 vaccination, and whether patients received the first or second dose of the vaccine.
In our literature review, 26 published (11 retrospective studies, eight case reports, and seven case series) articles were included (Tables 1; table in the Appendices). An analysis of these articles can be seen in Table 1.
LAP reports will likely increase as the COVID-19 vaccine reaches a broader patient population.With increasing vaccination rates, side effects from vaccination are expected to become more noticeable, and thus more likely to be reported. The purpose of this literature review was to summarize the available data related to LAP after receiving at least one dose of the COVID-19 vaccine. It is essential to consider time variation, the number of vaccinations received, and personal patient characteristics when LAP is reported on breast imaging.
LAP Characteristics
Across the 26 studies reviewed, a total of 5,162 patients received at least onedose of the COVID-19 vaccine, with 1,906 patients (36.92%) showing signs of post-vaccination LAP [7,11-35]. Axillary LAP was seen across all studies, while supraclavicular, intramammary, and subpectoral LAPwas also noted, though less frequently [7,17,29,32]. LAP was found through various imaging modalities, including MMG, US, MRI, and PET/CT, with and without fluorodeoxyglucose (FDG) tracing.
Timing
Studies that reported the number of days since the last COVID-19 vaccination showed that LAP typically occurs within a month after vaccination. Considering the close timing after vaccine administration, LAP found on breast imaging after COVID-19 vaccination may not merit an aggressive workup. A thorough history and last vaccination date should therefore be taken before an aggressive workup is initiated. A retrospective case series by Robinson et al. found that patients who had received a COVID-19 vaccination within 90 days had a higher incidence of axillary adenopathy present on MMG [19]. The study identified 23 out of 750 cases of axillary adenopathy (3%), much higher than the 0.02-0.04% rate of adenopathy reported in normal MMG, particularly in the first two weeks following vaccination. Additionally, no instances of axillary adenopathy were identified in those who were observed 28 days post-vaccination [19].
Vaccine Type
While vaccinations against HIN1 Influenza, tuberculosis (TB), smallpox, measles, and human papillomavirus (HPV) are associated with regional LAP to varying degrees, post-vaccination LAP is an infrequent adverse effect in the aforementioned vaccinations [9,36-38]. Meanwhile, this effect has been observed with higher frequency in SARS-CoV-2 mRNA vaccine recipients [39].The two mRNA COVID-19 vaccines, Pfizer and Moderna, were the first mRNA vaccines to be granted authorization by the FDA. Most vaccinations work by using a killed or weakened version of a pathogen to trigger the immune system to recognize and respond to it in the future.Messenger RNA (mRNA) vaccines work differently by using genetically engineered mRNA instead of part of an actual bacteria or virus. When mRNA is introduced into the body, it is displayed on antigen-presenting cellsand then travels to regional axillary lymph nodes and initiates a large T- and B-cell response for the development of cellular and humoral immunity. As a result, the mRNA vaccination, unlike previous protein-based vaccinations, elicits a more robust immune response within lymph node germinal centers during antigen presentation [10]. The mRNA vaccinations, Moderna and Pfizer, were the two most frequently administered in the studies included in our review. Studies in which patients were administered AstraZeneca, a viral vector vaccine, and J&J, an adenovector vaccine, wereless frequently mentioned.
Patient Characteristics
In this literature review, it appears that thewomen with adenopathy were predominantly between 30 years and 60 years of age. According to the United States Preventive Services Task Force (USPSTF), it is recommended for women 50-74 years old to get MMG every two years [40]. Do clinical professionals have an obligation to pursue aggressive workups if women receive MMG that reveals LAP in the setting of recent vaccination? Before the pandemic, women with LAP on breast imaging were recommended for further evaluation. However, vaccine-associated LAP should be considered to avoid unnecessary workup in this patient population.
Conservative Approach
In our literature review, 21 studies investigated whether patients with LAP following COVID-19 vaccination showed evidence of new malignant findings. As a whole,new malignancy findings were rarely reported. These 21 studies identified 1,172 patients with LAP, 28 of whom (2.4%) showed new malignancies on imaging. More specifically, in Horvat et al., among 104 patients with LAP and COVID-19 vaccinations, only three were newly diagnosed with breast cancer [26]. In the study by Cohen et al., 17 out of 332 women had a new breast cancer diagnosis [32]. A majority of the patients undergoing aggressive workup (e.g., biopsy) in these studies did not have evidence of malignancy. Follow-up US is less invasive than other imaging modalities and also did not reveal evidence of malignancy in most cases.Despite being less invasive, ultrasound is, however, less sensitive than biopsy for diagnosing malignancy. Therefore, it is important to acknowledge that false negatives can occur.
Management and Recommendations
In response to the original guidelines suggested by the Society of Breast Imaging, a large, multidisciplinary team of experts at three of the leading tertiary cancer centers in the United States have come forward with recommendations regarding radiographic imaging and post-vaccination imaging LAP. Their recommendations included the following: whenever possible, cancer-related imaging and screening should be performed before vaccination. As mortality rates due to infection are more significant than the reduction in mortality rates seen from screening, they suggested that patients being screened for cancer who are at increased risk or patients with a known history of cancer should not delay vaccination due to scheduled imaging, as these patients are at higher risk for serious COVID-19 infection and complications. In line with the recommendations by the Society of Breast Imaging in 2021, they suggested that screening MMGshould either be scheduled before a patients first dose or four to six weeks after the second dose of the vaccine. In addition, the team recommended extending this interval to six weeks after the final vaccination dose, stating that it is common for LAP to remain detectable on imaging at four weeks. Imaging should not be delayed in an acute situation [41].
If a patienthas cancer or has a known history of cancer, all vaccinations should be administered contralateralto the affected side, in the same location on the arm [32]. Whenever new-onset LAP follows vaccination, Becker et al. recommend observation for six weeks before a thorough diagnostic workup and consider US follow-up if there is a history of cancer. A tissue biopsy should be performed only if there is a concern for metastatic nodal cancer, where prompt identification and treatment are required [41].
Since their initial recommendations in the winter of 2021, the Society of Breast Imaging updated its guidelines as of February 2022 for managing and screening individuals with post-vaccination LAP. It is no longer recommended to delay screening MMG for four to six weeks after the COVID-19 vaccination. A Breast Imaging Reporting and Data System (BI-RADS) category 1 was previously assigned to patients with unilateral axillary LAP on screening MMG with a recent history of COVID-19 vaccination. The latest guidelines recommend categorizing these patients as BI-RADS category 2 (benign), requiring further routine screening. If given a BI-RADS category 3 (probably benign), previous recommendations suggested a follow-up interval of four to twelve weeks. As post-vaccine LAP may persist for a prolonged period, the guidelines now suggest a follow-up interval of longer than twelve weeks. Patients with persistent axillary LAP were previously considered for biopsy. According to the Society of Breast Imaging, patients with improved axillary LAP should be assigned a BI-RADS category 2, or if the condition remains unchanged, a BI-RADS category 3, which will warrant continued follow-up at six months. A lymph node biopsy should only be considered if adenopathy increases [42].
It is essential to consider tissue sampling and prompt diagnostic evaluation in patients with LAP and associated breast parenchymal abnormalities. This refined approach may prevent delays in diagnosis and treatment for patients with malignancy masked by symptoms from vaccination. A review by Hao et al.highlights an instance in which a patient with ipsilateral LAP and associated breast parenchymal change (breast edema) seen on MMG twelve days post-vaccination was found to have a metastatic invasive lobular carcinoma on biopsy [43]. Hence, clinical judgment and consideration of associated symptoms are essential when determining whether to perform breast imaging.
Limitations
The study's design must be viewed in light of some limitations. A significant limitation is the insufficient sample size for a meaningful statistical analysis. Most of the literature available are case reports and case series. Therefore, we recognize that their findings lack generalization. Furthermore, the minimal cohort studies we found target different variables. This manuscript places all the available literature to date in one article for easy readability. Considerations for future studies with potential for generalizability may include prospective observational studies following patients with post-COVID-19 vaccine LAP over time.
While many Covid-19 restrictions are being, or have already been, relaxed nation-wide, vulnerable people like those living with cancer may be concerned about going back out into the world, especially with so many questions remaining about the virus. If you have cancer, you have a higher risk of developing severe Covid, but it can be hard to follow how many boosters to get, what kind of precautions to keep up, and beyond when it comes to the virus.
For many people who currently have or previously had cancer, current guidelines can be confusing. Should you be getting each vaccine booster? Are masks still a must in all public places? What about available treatments if you do get Covid-19? We consulted experts to come up answers to these important questions when it comes to cancer and Covid-19.
Hematologist/oncologist Dr. Thomas Martin explains why blood cancer patients may be more at risk for severe Covid-19.
There are also certain cancer treatments that may make people more vulnerable to Covid infections, even if they are vaccinated. These include patients who:
The Centers for Disease Control and Prevention (CDC) recommends that everyone over 6 months old get the Covid vaccine and that includes most people with cancer and those who were previously treated for the disease. People with an increased risk of developing severe Covid, including cancer patients, should also get booster shots. While it is recommended that all members of the public get one booster shot, those with an increased risk should get two.
Whatever you get, either [Pfizer or Moderna], we encourage people to get their two extra boosters, Dr. John Greene, chair of Moffitt Cancer Centers Infectious Disease Program, tells SurvivorNet.
You may have heard that some people should get a third booster shot, but Dr. Greene explains that this is not needed in most cases.
As far as a third booster, thats very rare and it depends on what their immune system is doing, he explains. Dr. Greene adds that if a patient is interested in getting another booster shot (with the Pfizer and Moderna shots, that would be five shots in total), they can request that, but its not common.
As we all know, there have already been several variants of Covid-19 and immunocompromised people may be worried how safe they are from new strains, even with the vaccine.
The new omicron strains are rapidly mutating and becoming less and less covered by the current vaccine, so the companies are vigorously working on trying to get a new vaccine that covers all the new emerging variants, Dr. Greene explains. The might be out in six months to a year, but until then, we work with what we have.
There are a few situations where a doctor may recommend that a patient with cancer wait to get a vaccine or booster. One of those situations is when a patient has already had a recent Covid infection.
Many of our patients are getting infected with the new variant, Dr. Greene says. And that immunity will give them protection from reinfection for at least 90 days. So after the 90 days are up, they can get a booster.
Another situation is when a patients immune system has been so severely affected by treatment that it would simply not be beneficial to get them the vaccine Because their chance of mounting an immune response is zero to 20 percent, Dr. Greene says. An example Dr. Greene gave was Rituxan (rituximab), which is a monoclonal antibody used to treat some blood cancers. Because this drugs knocks out immune producing cells, it would not make sense to try to mount an immune response to Covid while patients are taking the drug.
If a person with cancer gets sick with a Covid infection, there are a few different treatment approaches doctors can take. Which approach your doctor goes with, and whether Covid treatment is required at all, will depend on several factors.
Drugs that may be used to treat Covid include:
These drugs cannot be given to all patients, and Paxlovid in particular has the potential for interaction with other drugs.
The other drugs are quite safe for most people, except theres a few exceptions for people with severe liver or kidney issues, Dr. Greene says.
When it comes to going about their everyday lives, cancer patients should continue to use caution but also keep in mind that we are in a much different place than we were in spring of 2020.
For now, the National Cancer Institute still recommends people with an increased risk from Covid continue to follow guidelines like:
Cancer patients are one of the safest groups of all [when it comes to Covid precautions], Dr. Greene says. The vast majority of them are ultra-safe no matter what, so theyre going to be pretty strict about not going to crowded areas and if they do, to wear a mask and wash hands frequently and be as distant as possible.
Dr. Greene also pointed out that despite case numbers, current Omicron is a less severe variant than Delta was. Still, its a good idea to continue being cautious as the virus continues to linger.
The CDC also has a tool that lets you check the level of Covid in your community and adjust your Covid precautions as needed.
Learn more about SurvivorNet's rigorous medical review process.
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White House chief medical adviser Dr. Anthony Fauci conceded that COVID-19 vaccines do not protect "overly well" against infection Tuesday on "Your World."
VACCINATED PATIENTS WITH BLOOD CANCERS ARE AT HIGHER RISK OF BREAKTHROUGH COVID THAN OTHER CANCERS, STUDY SAYS
DR. FAUCI: One of the things that's clear from the data [is] that even though vaccines - because of the high degree of transmissibility of this virus - don't protect overly well, as it were, against infection, they protect quite well against severe disease leading to hospitalization and death. And I believe that's the reason, Neil, why at my age, being vaccinated and boosted, even though it didn't protect me against infection, I feel confident that it made a major role in protecting me from progressing to severe disease. And that's very likely why I had a relatively mild course. So my message to people who seem confused because people who are vaccinated get infected - the answer is if you weren't vaccinated, the likelihood [is] you would have had [a] more severe course than you did have when you were vaccinated.
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Once again, Covid-19 seems to be everywhere. If you feel caught off-guard, you arent alone.
After the Omicron tidal wave washed over the United States in January and the smaller rise in cases in the spring caused by the BA.2 subvariant, it might have seemed like the coronavirus could be ignored for a while. After all, the US Centers for Disease Control and Prevention estimated in December that nearly all Americans had been vaccinated or have antibodies from a past infection. Surely all that immunity bought some breathing room.
But suddenly, many people who had recovered from Covid-19 as recently as March or April found themselves exhausted, coughing and staring at two red lines on a rapid test. How could this be happening again and so soon?
The culprit this time is yet another Omicron offshoot, BA.5. It has three key mutations in its spike protein that make it both better at infecting our cells and more adept at slipping past our immune defenses.
In just over two months, BA.5 outcompeted its predecessors to become the dominant cause of Covid-19 in the United States. Last week, this subvariant caused almost 2 out of every 3 new Covid-19 infections in this country, according to the latest data from the CDC.
Lab studies of antibodies from the blood of people whove been vaccinated or recovered from recent Covid-19 infections have looked at how well they stand up to BA.5, and this subvariant can outmaneuver them. So people whove had Covid as recently as winter or even spring may again be vulnerable to the virus.
We do not know about the clinical severity of BA.4 and BA.5 in comparison to our other Omicron subvariants, CDC Director Dr. Rochelle Walensky said at a White House Covid-19 Response Team briefing Tuesday. But we do know it to be more transmissible and more immune-evading. People with prior infection, even with BA.1 and BA.2, are likely still at risk for BA.4 or BA.5.
The result is that were getting sick in droves. As Americans have switched to more rapid at-home tests, official case counts currently hovering around 110,000 new infections a day reflect just a fraction of the true disease burden.
We estimate that for every reported case there are 7 unreported, Ali Mokdad, professor of health metrics sciences at the University of Washingtons Institute for Health Metrics and Evaluation, wrote in an email.
Other experts think the wave could be as much as 10 times higher than whats being reported now.
Were looking at probably close to a million new cases a day, Dr. Peter Hotez said Monday on CNN. This is a full-on BA.5 wave that were experiencing this summer. Its actually looking worse in the Southern states, just like 2020, just like 2021, said Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Houston.
That puts us in the range of cases reported during the first Omicron wave, in January. Remember when it seemed like everyone everywhere got sick at the same time? Thats the situation in the United States again.
It may not seem like a very big deal, because vaccines and better treatments have dramatically cut the risk of death from Covid-19. Still, about 300 to 350 people are dying on average each day from Covid-19, enough to fill a large passenger jet.
That is unacceptable. Its too high, Dr. Ashish Jha, coordinator for the White House Covid-19 Response Team, said at Tuesdays briefing.
Daily hospitalizations are also climbing in the United States. The fraction of patients needing intensive care is up by about 23% over the past two weeks. And other countries are experiencing BA.5 waves, too.
I am concerned that cases of Covid-19 continue to rise, putting further pressure on stretched health systems and health workers. I am also concerned about the increasing trend of deaths, said Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, at a news briefing Tuesday after the agencys decision to maintain its emergency declaration for Covid-19.
The pandemic, he said, is nowhere near over.
There are also more insidious health risks to consider. A recent preprint study that compared the health of people whod been infected one or more times with Covid-19 found that the risk of new and sometimes lasting health problems rose with each subsequent infection, suggesting that reinfections are not necessarily benign.
Although vaccination reduces the risk of getting long Covid, a certain percentage of people have lasting symptoms after a breakthrough infection.
Thats another reason why high numbers of Covid-19 cases are a big deal: Because the virus is still spreading wildly, it has every opportunity to mutate to make even fitter and more infectious versions of itself. Its doing this faster than we can change our vaccines, leaving us stuck in the Covid-rinse-repeat period of the pandemic.
On Tuesday, Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases, pleaded with Americans to use all available tools to stop the spread of the virus, including masking, ventilation and social distancing.
We need to keep the levels of virus to the lowest possible level, and that is our best defense. If a virus is not very robustly replicating and spreading, it gives it less of a chance of a mutation, which gives it less of a chance of the evolving of another variant, Fauci said in a news briefing.
In fact, this is already happening.
Even as the US comes to terms with BA.5, variant hunters around the world are closely watching another Omicron descendant, BA.2.75. Its been detected in about 10 countries, including the United States, and seems to be growing quickly in India.
BA.2.75 has nine changes in its spike region that distinguish it from BA.2 and about 11 changes compared with BA.5, according to Tom Peacock, a virologist at Imperial College London.
Several of the mutations in BA.2.75 are in a region of the spike protein known to be an important place for antibodies to bind to stop the virus, said Ulrich Elling, a scientist at the Austrian Academy of Sciences who monitors coronavirus variants for that country.
Theres little information to go on: Its still not known, for example, how BA.2.75 may compete against BA.5 or whether it causes more severe illness. But experts say it has all the hallmarks of a variant that could go global.
It spread to many different countries already, so we know that it has some sort of staying power, said Shishi Luo, associate director of bioinformatics and infectious disease for Helix Labs, which decodes virus samples for the CDC and other clients.
Because of that, and because of changes in the region of the virus that our antibodies look for to shut it down, we sort of know ahead of time that this one will cause some trouble, Luo said.
Based on what we know now, she expects that this subvariant could drive a fall Covid-19 wave in the United States.
In the meantime, Jha said, people should get boosters that are available to them to keep their immunity as strong as possible. US health officials emphasized that people who are boosted now will still be able to get an updated shot this fall that includes the BA.4 and BA.5 strains.
Jha specifically urged Americans who are 50 and older, if youve not gotten a vaccine shot this year, go get one now. It could save your life, he said.
The West Virginia Department of Health and Human Resources (DHHR) reports as of July 14, 2022, there are currently 2,889 active COVID-19 cases statewide. There were no deaths reported to DHHR over the last 24 hours, and total deaths remain at 7,099 attributed to COVID-19.
CURRENT ACTIVE CASES PER COUNTY: Barbour (17), Berkeley (149), Boone (51), Braxton (14), Brooke (12), Cabell (141), Calhoun (8), Clay (10), Doddridge (11), Fayette (93), Gilmer (13), Grant (17), Greenbrier (53), Hampshire (30), Hancock (40), Hardy (35), Harrison (130), Jackson (36), Jefferson (80), Kanawha (307), Lewis (22), Lincoln (30), Logan (62), Marion (110), Marshall (50), Mason (46), McDowell (56), Mercer (145), Mineral (30), Mingo (43), Monongalia (123), Monroe (22), Morgan (12), Nicholas (46), Ohio (56), Pendleton (4), Pleasants (14), Pocahontas (11), Preston (33), Putnam (106), Raleigh (179), Randolph (24), Ritchie (9), Roane (30), Summers (20), Taylor (25), Tucker (4), Tyler (9), Upshur (48), Wayne (43), Webster (17), Wetzel (18), Wirt (3), Wood (137), Wyoming (55). To find the cumulative cases per county, please visit coronavirus.wv.gov and look on the Cumulative Summary tab which is sortable by county.
West Virginians ages 6 months and older are recommended to get vaccinated against the virus that causes COVID-19. Those 5 years and older should receive a booster shot when due. Second booster shots for those age 50 and over who are 4 months or greater from their first booster are recommended, as well as for younger individuals over 12 years old with serious and chronic health conditions that lead to being considered moderately to severely immunocompromised.
Visit the WV COVID-19 Vaccination Due Date Calculator, a free, online tool that helps individuals figure out when they may be due for a COVID-19 shot, making it easier to stay up-to-date on COVID-19 vaccination. To learn more about COVID-19 vaccines, or to find a vaccine site near you, visit vaccinate.wv.gov or call 1-833-734-0965.
To locate COVID-19 testing near you, please visit https://dhhr.wv.gov/COVID-19/pages/testing.aspx.
WASHINGTON The Biden administration is considering whether to expand second coronavirus booster shots to adults under 50 in an effort to counter the latest, highly contagious variant, which has driven up hospitalization rates and deepened worries about waning immunity among those vaccinated or boosted at least six or so months ago.
Expanding eligibility for a fourth dose of vaccine to younger adults would require regulatory approval; more discussions with officials from the Food and Drug Administration and the Centers for Disease Control and Prevention are expected in the coming days, according to people familiar with the situation.
The administration decided in March to offer second booster doses to everyone 50 or older, along with some younger individuals who have immune deficiencies. Dr. Anthony S. Fauci, a leading infectious disease expert and the chief medical adviser to the White House, has forcefully argued for broadening eligibility to all younger adults.
Two federal officials said that Dr. Ashish K. Jha, the White House coordinator for the pandemic response, also favors that approach. The discussions were reported earlier by The Washington Post.
In an interview on Monday, Dr. Fauci said there was not enough clinical data to strongly recommend that those under 50 get a second booster shot. But he said many in that age group received their last shot in November or December, so their protection against the virus is waning.
Although it is up to the F.D.A. and the C.D.C. to decide, Dr. Fauci said, I think there should be flexibility and permissiveness in at least allowing a second booster for younger adults.
Other federal officials seem more skeptical and anxious to see more data to justify the decision. Some have argued that the administration should be trying harder to persuade Americans to accept the initial round of Covid vaccines, rather than pursuing diminishing benefits with those who are already at least somewhat protected.
There are also concerns that by promoting second boosters for all adults now, the administration could weaken its argument for reformulated booster shots in the fall, when it hopes to offer boosters that better combat the latest versions of the virus. The F.D.A. recently recommended that the vaccines be redesigned to better combat the fast-spreading Omicron variants of BA.4 and BA.5.
The June 30 decision came just two days after the agencys committee of independent vaccine experts overwhelmingly voted for regulators to pursue more advanced vaccines tailored to forms of Omicron, an acknowledgment that the current shots may no longer be as protective by the time a possible fall or winter surge arrives.
The two most recent Omicron subvariants have driven up rates of hospitalization and death, though both remain far lower than at the height of the winter Omicron wave. The same subvariants have sent hospital admissions climbing in Britain, France, Portugal, Belgium and Israel.
The White House has scheduled a news briefing for Tuesday on the state of the pandemic and the threats posed by the latest Omicron subvariants.
To put the COVID-19 pandemic in the rearview mirror and prevent other coronaviruses from causing havoc, the world needs an arsenal of measures to prevent and treat these infections. To develop new medications, researchers are working to target one protein, nsp13, that these viruses need to replicate. In a study in ACS Infectious Diseases, one team describes a new approach to identifying molecules that interfere with this protein, a step toward development of pan-coronavirus antivirals.
While vaccines prepare the immune system to fight off the virus, antiviral medications treat infections that have already begun by interfering with an essential part of the viral machinery. Some antivirals, including remdesivir, molnupiravir and nirmatrelvir, are already available for COVID-19 patients; however, health authorities want additional options that disrupt infection in different ways. Researchers have identified a promising new target within SARS-CoV-2 and other coronaviruses, a protein called nsp13. It is an enzyme that works with other viral proteins to help copy the pathogen's genetic code by unwinding its double-stranded viral RNA. Nsp13 fuels this work by breaking bonds between phosphate groups, including those in the energy-storing molecule known as adenosine triphosphate (ATP). Nsp13 is also involved in capping the viral RNA, which protects it from the human immune system. To speed up the search for drugs that block nsp13, Masoud Vedadi and colleagues developed a new way to screen large numbers of molecules to identify those with the most potent activity.
Because nsp13's energy-releasing activity increases in the presence of single-stranded nucleic acids, the team devised tests that focus on this activity in the presence and absence of single-stranded DNA. In both cases, the tests glow more brightly when less ATP is broken down, which occurs when something is interfering with nsp13. They used one of these tests to screen a library of 5,000 small molecules, turning up 17 promising results. Additional work, including performing the second test, narrowed the field to only six compounds -; potential starting points for the development of future, more-potent nsp13 inhibitors, according to the researchers. The new tests, meanwhile, could be used to efficiently screen large numbers of small molecules for activity against nsp13, or to confirm results from other approaches, they say.
The authors acknowledge funding from the University of Toronto (Toronto COVID-19 Action Initiative-2020) and support of the Structural Genomics Consortium, University of Toronto site.
Source:
American Chemical Society
Journal reference:
Mike Stucka USA TODAY NETWORK| Montgomery Advertiser
New coronavirus cases leaped in Alabama in the week ending Sunday, rising 14.5% as 14,633 cases were reported. The previous week had 12,783 new cases of the virus that causes COVID-19.
Alabama ranked fifth among the states where coronavirus was spreading the fastest on a per-person basis, a USA TODAY Network analysis of Johns Hopkins University data shows. In the latest week coronavirus cases in the United States decreased 4.6% from the week before, with 750,600 cases reported. With 1.47% of the country's population, Alabama had 1.95% of the country's cases in the last week. Across the country, 24 states had more cases in the latest week than they did in the week before.
The Fourth of July holiday disrupted who got tested, when people got tested and when both test results and deaths were reported. This may significantly skew week-to-week comparisons.
Montgomery County reported 1,219 cases and one death in the latest week. A week earlier, it had reported 701 cases and zero deaths. Throughout the pandemic it has reported 59,645 cases and 958 deaths.
Elmore County reported 340 cases and zero deaths in the latest week. A week earlier, it had reported 274 cases and one death. Throughout the pandemic it has reported 24,794 cases and 350 deaths.
Autauga County reported 239 cases and zero deaths in the latest week. A week earlier, it had reported 162 cases and zero deaths. Throughout the pandemic it has reported 16,801 cases and 217 deaths.
Butler County reported 78 cases and zero deaths in the latest week. A week earlier, it had reported 53 cases and zero deaths. Throughout the pandemic it has reported 5,333 cases and 129 deaths.
Lowndes County reported 52 cases and zero deaths in the latest week. A week earlier, it had reported 16 cases and zero deaths. Throughout the pandemic it has reported 2,775 cases and 77 deaths.
Within Alabama, the worst weekly outbreaks on a per-person basis were in Wilcox County with 588 cases per 100,000 per week; Bullock County with 545; and Montgomery County with 538. The Centers for Disease Control says high levels of community transmission begin at 100 cases per 100,000 per week.
Adding the most new cases overall were Jefferson County, with 2,284 cases; Montgomery County, with 1,219 cases; and Mobile County, with 1,053. Weekly case counts rose in 42 counties from the previous week. The worst increases from the prior week's pace were in Montgomery, Jefferson and Shelby counties.
>> See how your community has fared with recent coronavirus cases
Across Alabama, cases fell in 23 counties, with the best declines in Tuscaloosa County, with 420 cases from 519 a week earlier; in Colbert County, with 190 cases from 233; and in Russell County, with 121 cases from 162.
In Alabama, 27 people were reported dead of COVID-19 in the week ending Sunday. In the week before that, 30 people were reported dead.
A total of 1,373,684 people in Alabama have tested positive for the coronavirus since the pandemic began, and 19,786 people have died from the disease, Johns Hopkins University data shows. In the United States 88,593,875 people have tested positive and 1,020,861 people have died.
>> Track coronavirus cases across the United States
USA TODAY analyzed federal hospital data as of Sunday, July 10. Likely COVID patients admitted in the state:
Likely COVID patients admitted in the nation:
Hospitals in 39 states reported more COVID-19 patients than a week earlier, while hospitals in 35 states had more COVID-19 patients in intensive-care beds. Hospitals in 42 states admitted more COVID-19 patients in the latest week than a week prior, the USA TODAY analysis of U.S. Health and Human Services data shows.
The USA TODAY Network is publishing localized versions of this story on its news sites across the country, generated with data from Johns Hopkins University and the Centers for Disease Control. If you have questions about the data or the story, contact Mike Stucka at mstucka@gannett.com.
Good evening. Im Karen Kaplan, and its Tuesday, July 12. Heres the latest on whats happening with the coronavirus in California and beyond.
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Whos looking forward to a third consecutive winter surge that causes hospitals to fill with COVID-19 patients and sends the death toll spiraling?
Not me. And neither are the good folks at the Food and Drug Administration.
Theyre looking to head off another disastrous winter by tweaking the formula for the nations COVID-19 booster shots.
The vaccines and boosters currently available in the U.S. were designed with a particular strain of SARS-CoV-2 in mind one that left China way back in January 2020. Since then, the World Health Organization has recognized five major variants of concern and eight additional variants of interest. According to the Centers for Disease Control and Prevention, all of the coronaviruses now circulating in the United States are some version of the Omicron variant.
In other words, the coronavirus has changed, but our shots havent.
So last month, the FDA convened a meeting of its vaccine advisory committee to get advice on how to proceed. Dr. Peter Marks, the FDAs vaccine chief, told the panel that all options entail some degree of risk.
If the agency decided to update the formula, the new shots would become available without being subjected to the extensive clinical trials used to vet the original vaccines. The agency decided long ago that modifications to COVID-19 vaccines it had already authorized or approved would be evaluated using a streamlined process. In the unlikely event that an update created a safety problem, it would be up to the FDAs surveillance systems to detect it in a timely manner.
On the other hand, Marks warned, if no changes are made, Americans who are fully vaccinated and boosted could find themselves with significantly less protection than they have had in years past. One study found that three doses of mRNA vaccine offered half as much protection against Omicron as they did against Delta, the variant that preceded it.
The Alex Theatre in Glendale.
(Chris Pizzello / Associated Press)
If new vaccines are warranted, theres the non-trivial matter of deciding which strain (or strains) should replace the original. This is a lot trickier than it may sound.
Lets say you pick BA.5, currently the countrys dominant Omicron subvariant. As of Tuesday, 65% of the coronaviruses spreading in the U.S. were of the BA.5 variety. But a month ago, BA.5 accounted for just 17% of the viruses in circulation, and BA.2.12.1 had a 57% market share. Given how quickly things change, whos to say whether BA.5 will still be a factor by the time a fall booster campaign gets underway?
Getting a timely and accurate fix on all this is truly a challenge, and it is science at its hardest, Marks said.
It sounded more like black magic to Dr. Arnold Monto, the chair of the vaccine advisory committee. Were being asked, essentially, to have a crystal ball, he groused.
A version of this goes on twice a year, when the World Health Organization decides on the composition of the influenza vaccine for the coming flu season. Like the coronavirus, the flu virus changes from year to year, and experts take those changes into account when deciding which strains the flu shot should target.
They dont always come up with an accurate forecast and the consequences can be serious. During the 2014-15 season, bad guesses about the influenza A viruses expected to show up in North America diminished the shots effectiveness, contributing to 758,000 flu hospitalizations among the elderly and 148 deaths among children, my colleague Melissa Healy reports.
After the advisory committee adjourned its meeting, FDA officials announced their choice: New COVID-19 boosters should prime the immune system to recognize both the original coronavirus strain and the BA.4 and BA.5 subvariants, which share the same spike protein.
The choice has its detractors. Dr. Paul Offit, a committee member from the University of Pennsylvania, said there was insufficient evidence that redesigned boosters would prevent serious illnesses and death more effectively than the current versions, whose safety is well established. Exposing Americans to the risks of a tweaked vaccine is not OK when those benefits arent clear, he told Healy.
In the long run, the solution is to devise a vaccine that keeps working even as the coronavirus evolves. Ideally, a universal vaccine would target some part of the SARS-CoV-2 virus that doesnt mutate the way the spike protein does, but thats a lot easier said than done.
Scientists around the world have been pursuing this goal for well over a year. One research group thats trying to make this happen announced last week that it was making plans to test its candidate vaccine in humans in a Phase I clinical trial.
The team members, from Caltech and Oxford University, created a nanoparticle adorned with pieces of SARS-CoV-2, along with seven related coronaviruses. Mice and monkeys inoculated with the vaccine were protected against a range of viruses, including ones that the shot hadnt introduced to their immune systems.
Weve had three pandemics or epidemics in the past 20 years: first SARS, then MERS, then SARS-CoV-2, Caltech biochemist Pamela Bjorkman told my colleague Corinne Purtill. More outbreaks sparked by spillover events are inevitable, she said, and we want to protect now against the future spillover.
California cases and deaths as of 6:10 p.m. on Tuesday:
Track Californias coronavirus spread and vaccination efforts including the latest numbers and how they break down with our graphics.
Amid all the talk about Paxlovid, molnupiravir and monoclonal antibodies, theres one COVID-19 remedy that doesnt get the respect it deserves.
Its safe, free and abundant to those who are willing to take advantage of its healing properties.
Im talking about rest.
Doctors told my colleague Emily Alpert Reyes they were dismayed to see so many COVID-19 patients discount or dismiss their need to rest.
Sleep equals immunity, said Dr. Susan Cheng, a cardiologist and researcher at Cedars-Sinai Medical Center. You want to have your immune system not distracted by anything else while its trying to rid your body of the coronavirus. That includes distractions caused by work.
You really want your body to recover, she added. Give it as much rest as possible, to recover as fully as possible.
Lest you dismiss Cheng as an outlier, listen to what Dr. Caitlin McAuley, a family medicine specialist at USCs Keck School of Medicine, had to say.
Getting adequate sleep lets the immune system rebalance, she said. In any acute illness and COVID especially we know that rest is important.
That definitely includes taking a break from work, she added: At a minimum, you really should unplug for three to five days.
And if youre still not convinced, heres some advice from Dr. Timothy Brewer, an infectious diseases specialist at UCLA.
Your body is pretty good at telling you what it needs, he said. So if youre feeling tired and youre sick with COVID, thats probably your body saying, Get back in bed.
Sometimes this is easier said than done. Many hourly workers cant afford to take time off because clocking in is the only way to get paid. Surveys by the Kaiser Family Foundation found that roughly 1 in 10 workers had gone to their jobs after theyd been exposed to the coronavirus or had developed COVID-19 symptoms because they needed the money. People from households with less than $40,000 in annual income were far more likely than their higher-income peers to go to work after an exposure, by a margin of 29% to 6%.
Thats not necessarily unique to COVID-19. Researchers with the Shift Project at the Harvard Kennedy School reported that two-thirds of service workers said theyd worked while ill because they needed to hold on to their jobs. It wasnt just the income to be gained by powering through a few miserable shifts; it was the fear of being reprimanded or fired if they called in sick.
(This ought to be less of a problem in California thanks to a law that guarantees 80 hours of paid sick leave to workers trying to recover from COVID-19. The benefit is available to people who work in companies with at least 26 employees.)
White-collar employees are guilty of working while sick with COVID-19 too. Its tempting because the pandemic has made working from home a normal part of life.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, testifies virtually during a Senate hearing on the federal response to COVID-19.
(Manuel Balce Ceneta / Associated Press)
Dr. Anthony Fauci assured the nation that he would continue working from his Washington, D.C., home when he contracted a mild case of COVID-19 last month. The following week, while still isolated at home, he donned a suit jacket and tie to join a Senate hearing on the governments pandemic response via video.
He wasnt the only government official to prioritize work over rest. Secretary of Transportation Pete Buttigieg pledged to work remotely when he came down with COVID-19. San Francisco Mayor London Breed conducted meetings from home when she tested positive. And when a spokesman for Sen. Chuck Schumer announced Sunday night that his boss had a mild case of COVID-19, he said the majority leader would continue with his robust schedule and remain in near constant contact with his colleagues.
Workaholics like these are setting a bad example by encouraging others to think, If I have the virus, I can just push through it, said David Putrino, director of rehabilitation innovation for the Mount Sinai Health System in New York.
If you must work while sick, its infinitely better to work from home. But youd be much better off not working at all. Mental exertion uses energy, and even a partial workload can strain your immune system and hamper your recovery.
It might even make you sicker. Cheng pointed to studies of mice that were infected with run-of-the-mill viruses. Some were forced to swim; others were not. The swimmers fared much worse than their counterparts who were able to rest.
See the latest on Californias vaccination progress with our tracker.
As noted earlier, BA.5 is the big fish in the pond right now. People who managed to dodge the coronavirus before are getting caught in its clutches. The experts who track everything COVID are piecing together a picture of why this subvariant has, ahem, gone viral.
One reason is that the BA.5 strain is able to produce far more copies of itself than its predecessors. And it looks like its able to do that because its much more effective at getting inside of cells. Thats a key advantage, because once inside, it hijacks the cells machinery to pump out copies of itself. Those copies then go on to infect new cells.
This cycle may help explain why this version of the virus has caused a lot of trouble, more than other Omicron subvariants, Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla, explained in a blog post.
Another factor is the speed with which new strains overtake older ones. Back in the day, variants like Alpha and Delta climbed to the top of the CDCs Nowcast chart and stayed there for weeks or months. But in the 14 weeks represented in the chart right now, three distinct strains BA.2, BA.2.12.1 and BA.5 have all been dominant, with BA.5 rising the fastest.
With such rapid turnover, the immunity gained by an infection has a shorter shelf life. People whove been infected can be reinfected sooner. And many have been.
California reported about 10,400 coronavirus reinfections per week between mid-May and mid-June, a period when BA.5 and its close cousin BA.4 began circulating widely. For the sake of comparison, the state had about 2,300 weekly reinfections between early March and early May.
Overall, California had 278 official cases per 100,000 residents in the week that ended Thursday. Thats down more than 10% from the prior week, but reporting delays over the long Fourth of July weekend might explain the drop.
In Los Angeles County, the official case rate is up to 323 per 100,000 residents per week. (Both figures are surely lowballs, since the results of at-home tests arent always reported to health officials.)
More ominously, statewide hospitalizations of coronavirus-positive patients hit 4,277 Tuesday, the highest single-day total since late February. In L.A. County, the coronavirus-positive patient census was 1,153 as of Tuesday, up 54.4% in the past two weeks. The county is averaging 13 deaths per day over the past week nearly double the rate from two weeks ago.
L.A. County Public Health Director Barbara Ferrer said it looks like well once again have a high COVID-19 community level by the end of the month. The statistic thats likely to seal our fate is the number of new coronavirus-positive patients admitted to county hospitals. Right now, the CDC says that number is 9.7 patients per 100,000 residents per week. Thats only slightly below the threshold of 10 patients per 100,000 per week.
However, Ferrer said the CDC combines hospitalization numbers for L.A. and Orange counties, and if you break them apart, you see that the actual figure in the O.C. is around 13, while the one for L.A. is 8.4. Given the discrepancy, Ferrer said she would use the countys statistics to determine when L.A. has a high COVID-19 community level.
After that happens, if L.A. County remains in the high zone for two consecutive weeks, the indoor mask mandate will return, Ferrer said.
Masks are required at Malibu City Hall after four of the 85 people who work there became infected in the span of two weeks. Those infections qualified as a worksite case cluster, which prompted county health officials to impose a mask rule. It will remain in effect until at least two weeks after the last case.
A spokesman for Malibu said none of the infected people caught the coronavirus at work, nor did they spread it to coworkers.
With so many Americans coming down with COVID-19, the FDA announced a new policy last week thats intended to make it easier to get a prescription for Paxlovid. Now pharmacists can prescribe the antiviral pill, which was previously available only from a doctor.
Since Paxlovid must be taken within five days after symptoms begin, authorizing state-licensed pharmacists to prescribe Paxlovid could expand access to timely treatment, said FDA drug center director Patrizia Cavazzoni.
In the early months of the pandemic, before there were COVID-specific medications, doctors frequently prescribed antibiotics to hospitalized COVID-19 patients. Antibiotics dont treat viral infections, but the hope was that they would ward off bacterial infections that might hinder a patients recovery.
A new report from the CDC suggests that practice might have fueled a 15% increase in drug-resistant superbug infections in 2020. Prior to the pandemic, superbug infections had been on the decline, and deaths fell 18% between 2012 and 2017.
Antibiotic use dropped in 2021, and CDC experts expressed hope that when the data come in, theyll see that the number of superbug infections followed suit.
And finally, a new version of Omicron has emerged in India, and scientists are concerned that its rapid growth and quick spread to other countries could make it the successor to BA.5.
The new subvariant, BA.2.75, appears able to dodge immunity from vaccines and past infections, just like its Omicron cousins. Its too soon to say whether it makes people sicker.
At least three cases involving BA.2.75 have been identified in the U.S., including two on the West Coast.
Its still really early on for us to draw too many conclusions, said Matthew Binnicker, director of clinical virology at the Mayo Clinic in Rochester, Minn. But it does look like, especially in India, the rates of transmission are showing kind of that exponential increase.
Todays question comes from readers who want to know: How can I protect myself against the super-contagious BA.5 subvariant?
Compared to other versions of the coronavirus and even other versions of Omicron BA.5 seems particularly difficult to evade. Its spike protein has changed enough that prior coronavirus infections dont offer much in the immunity department, which explains why so many people are experiencing back-to-back illnesses.
COVID-19 vaccines are also less effective at blocking infections with BA.5, though theyre holding up when it comes to preventing severe illness and death.
BA.5 is a different beast, Dr. Robert Wachter, chair of UC San Franciscos Department of Medicine, wrote on Twitter last week.
The virus might be different, but the measures you can take against it are the same as for other versions of SARS-CoV-2.
Get vaccinated and boosted. Staying up-to-date on your vaccinations is essential, especially considering evidence that being fully vaccinated but not boosted offers little protection against Omicron strains. Only 58% of Californians who completed their primary vaccination series have received their first booster shot, according to the state Department of Public Health. Nationwide, just 48% of Americans eligible for their first booster have received it.
Wear a mask. Face coverings are required in Los Angeles County if youre on a bus, train, ride-share vehicle or other form of public transit. The same goes for transportation hubs like airports and train stations. For now, mask use is voluntary in most other settings statewide, but if you opt to wear one, itll be easier to keep BA.5 out of your airways. Bonus: Youll be protecting the people around you too. Your best bet is a high-quality mask with a good seal around your nose and mouth.
Be careful at gatherings. If your summer just isnt complete without barbecues and beach outings, there are things you can do to minimize your risk. Spending time outdoors is safer than being indoors. If you do go inside, wear a mask and make sure the space is well ventilated by opening doors and windows. Avoid dining indoors since you cant eat with your mask on. Asking everyone to take a rapid coronavirus test before your gathering will make it less likely to become a superspreader event.
We want to hear from you. Email us your coronavirus questions, and well do our best to answer them. Wondering if your questions already been answered? Check out our archive here.
(Julia Nikhinson / Associated Press)
This is not a scene from a mass wedding of Moonies. The folks in the photo above were part of a do-over for couples whose marriage ceremonies became casualties of the COVID-19 pandemic.
Five hundred couples took part in the multicultural event Sunday at New York Citys Lincoln Center. The weddings werent legally binding, but they did feature bouquets, a procession, music, dancing and kissing just like the real thing.
A reverend, an imam and a rabbi offered words of inspiration, and New York City Mayor Eric Adams addressed the happy couples. The hourlong ceremony ended with a unity ritual. Then the group reception got underway. It was a symbolic second chance to reclaim what the coronavirus had taken.
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Need a vaccine? Heres where to go: City of Los Angeles | Los Angeles County | Kern County | Orange County | Riverside County | San Bernardino County | San Diego County | San Luis Obispo County | Santa Barbara County | Ventura County
Practice social distancing using these tips, and wear a mask or two.
Watch for symptoms such as fever, cough, shortness of breath, chills, shaking with chills, muscle pain, headache, sore throat and loss of taste or smell. Heres what to look for and when.
Need to get a test? Testing in California is free, and you can find a site online or call (833) 422-4255.
Americans are hurting in various ways. We have advice for helping kids cope, as well as resources for people experiencing domestic abuse.
Weve answered hundreds of readers questions. Explore them in our archive here.
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Patient deaths: 1,021,306
Total vaccine doses distributed: 774,307,105
Patients whove received the first dose: 260,327,743
Patients whove received the second dose: 222,455,652
% of population fully vaccinated (both doses, not including boosters): 67%
% tied to Omicron variant: 100%
% tied to Other: 0%
