(Precision Vaccinations)
Vaccine research organizations recently announced a new program in Kenya, Rwanda, and the Democratic Republic of Congo to evaluate the safety and immunogenicity of homologous and heterologous COVID-19 vaccine booster regimens in people living with Human immunodeficiency virus (HIV).
The Coalition for Epidemic Preparedness Innovations (CEPI) and the Kenya-based Victoria Biomedical Research Institute (VIBRI) confirmed on May 11, 2022, that about $12.5 million in funding would be deployed to assess this mix and match booster approach in HIV populations.
This vital research is needed since 38 million people globally live with HIV, and two-thirds of them arein sub-Saharan Africa.
Data on the effectiveness of COVID-19 vaccines in people living with HIV are limited, and many outstanding questions remain, such as:
Dr. Melanie Saville, Executive Director of Vaccine R&D, CEPI, commented in a related media release, To effectively expand access to COVID-19 vaccines around the world, we urgently need to boost clinical research into how well these vaccines work in vulnerable populations, especially in people living with HIV.
For example, people living with HIV could have reduced immune responses to COVID-19 vaccination, increasing the chances of breakthrough infections.
This study will help to gather the data needed to fill this gap in our understanding and inform how governments and COVAX can optimize their vaccination strategies going forwards to better protect this large vulnerable population of people who are potentially immunocompromised.
Participants in this Phase 2B study who have already received homologous COVID-19 vaccination with either Moderna or Pfizer mRNA vaccines or the vaccines produced by Janssen, Sinovac, or Sinopharm will receive a booster of either the Janssen or Novavax vaccines five to seven months after completion of the primary vaccination series.
Each study participantaged 12 to 64 years living with or without HIV infectionwill be followed over an 18-month period. After booster vaccination, investigators will assess the safety and immune response at months 6, 12, and 18.
CEPI is an innovative partnership between public, private, philanthropic, and civil organizations
This is the latest program to be funded in response to a CEPI Call for Proposals launched in January 2021, which aims to address current gaps in our clinical knowledge of vaccine performance both now and in the long term.
Regarding HIV vaccine development, the U.S. National Institute of Allergy and Infectious Diseases (NIAID) recently launched a Phase 1 clinical trial evaluating three experimental HIV vaccines"Finding an HIV vaccine has proven a daunting scientific challenge," commented Anthony S. Fauci, M.D. NIAID director, on March 14, 2022.
"With the success of safe and highly effective COVID-19 vaccines, we have an exciting opportunity to learn whether mRNA technology can achieve similar results against HIV infection."
More information about the HVTN 302 study is available on ClinicalTrials.gov using the identifier NCT05217641.
Additional HIV vaccine development news is posted at PrecisionVaccinations.com/HIV.
PrecisionVaccinations publishes fact-checked research-based vaccine news.
Ledge Light Health District has scheduled free COVID-19 vaccination clinics at senior centers in New London, East Lyme and Groton.
Only the Moderna vaccine will be available for people 18or older who need a first or second dose or are eligible for a first or second booster dose.
The clinics are from noon to 2 p.m. Friday at the New London Senior Center, corner of Brainard and Mercer streets; from 2 to 4 p.m. Monday, May 23 at the East Lyme Senior Center, 37 Society Road, Niantic; and from 1 to 3 p.m. Tuesday, June 7 at the Groton Senior Center, 102 Newtown Road.
Those eligible for a first booster shot include those 18or older who completed a primary series of either the Moderna or Pfizer vaccineat least five months ago, or those 18 or older who had a primary dose of the Janssen (Johnson & Johnson) vaccine at least two months ago.
People50 or older who received a first booster dose of any COVID-19 vaccine at least four months ago are eligible for a second booster shot.
No appointment, insurance or ID is necessary at the clinics. People should bring their CDC vaccination card, if they have one.
The CDC recommends that everyone 5 and older get a primary series of COVID-19 vaccine and that everyone 12 and older also receive a booster. For a complete list of community clinics, including those where vaccinations are available for people younger than 18, visit llhd.org.
People diagnosed with cancer whove received a COVID-19 vaccine have a higher risk of a breakthrough COVID infection than vaccinated people without cancer, according to a study.
The research was published online on April 8, 2022, by the journal JAMA Oncology. Read Breakthrough SARS-CoV-2 Infections, Hospitalizations, and Mortality in Vaccinated Patients With Cancer in the US Between December 2020 and November 2021.
COVID-19 vaccine recommendations are different for people with weakened immune systems (called immunocompromised). Several breast cancer treatments including chemotherapy, certain targeted therapies, and immunotherapy can weaken your immune system. People with moderately to severely compromised immune systems are especially vulnerable to COVID-19, and may not build the same level of immunity to the virus after being fully vaccinated as people who are not immunocompromised.
If youre currently receiving breast cancer treatment, its a good idea to ask your doctor if you should follow these recommendations from the Centers for Disease Control and Prevention (CDC) for moderately to severely immunocompromised people:
If your initial vaccine was Pfizer or Moderna, the CDC recommends you get a third dose of the same vaccine you received initially at least 28 days after your second dose.
After the third dose of either the Pfizer or Moderna vaccine, you should receive a booster dose of either of the two mRNA vaccines at least three months after your third dose.
If your initial vaccine was J&J, the CDC recommends you get a second dose of either the Pfizer or Moderna vaccine at least 28 days after receiving the vaccine. The CDC also recommends a booster dose of either the Pfizer or Moderna vaccine at least two months after your second dose. The FDA has limited emergency use authorization to people ages 18 and older who have had a severe allergy to an mRNA vaccine, are unable to get an mRNA vaccine because these arent available, or strongly prefer the J&J vaccine.
The U.S. Food and Drug Administration (FDA) granted emergency use authorization to Evusheld (chemical name: tixagevimab combined with cilgavimab), an antibody therapy used to prevent COVID-19 in people age 12 and older who have moderately to severely compromised immune systems or cannot get a COVID-19 vaccine because of a severe allergic reaction to its ingredients. Evusheld works differently from a vaccine, and may be an option for immunocompromised people who may not develop enough immunity after a COVID-19 vaccine.
Even though being vaccinated helps protect you from serious illness, its still possible to get whats called a breakthrough COVID-19 infection. People diagnosed with cancer may have lower COVID-19 antibody levels after being vaccinated. The researchers wanted to know how many people in the United States diagnosed with cancer whod received a COVID-19 vaccine had a breakthrough infection. The researchers also wanted to see the outcomes of these breakthrough infections.
For this study, the researchers looked at the records of 45,253 people who had been diagnosed with at least one of 12 types of cancer and 591,212 people who had not been diagnosed with cancer. All the people had received a COVID-19 vaccine between December 2020 and November 2021 and hadnt been diagnosed with COVID-19 before being vaccinated. The records came from 66 healthcare organizations from all 50 states.
People diagnosed with cancer were older and more likely than people without cancer to have other health problems.
Breast cancer was the most common cancer among people in the study:
13,032 were diagnosed with breast cancer
11,421 were diagnosed with prostate cancer
6,962 were diagnosed with hematologic cancer, including leukemia, lymphoma, and multiple myeloma
3,094 were diagnosed with colorectal cancer
2,926 were diagnosed with skin cancer
2,849 were diagnosed with lung cancer
9,833 were diagnosed with bladder, endometrial, kidney, liver, pancreatic, or thyroid cancer
These numbers total more than 45,253 because some people were diagnosed with more than one type of cancer.
The researchers measured the monthly rate of breakthrough COVID-19 infection as the number of new cases in every 1,000 people. The rate was higher in people with cancer than in people without cancer:
From February to March 2021, the rate was 19.6 in people with cancer versus 4.9 in people without cancer.
From April to May 2021, the rate was 43.1 in people with cancer versus 13.8 in people without cancer.
From June to July 2021, the rate was 30.6 in people with cancer versus 17.4 in people without cancer.
From August to September, the rate was 51.7 in people with cancer versus 41.3 in people without cancer.
From October to November 2021, the rate was 52.1 in people with cancer versus 46.9 in people without cancer.
The rate differences were statistically significant, which means they were likely because of the cancer diagnosis and not just due to chance.
Among the people diagnosed with cancer, the risk of a breakthrough infection was 13.6% during the study period. The risk among people not diagnosed with cancer was 4.9%.
People diagnosed with pancreatic cancer had the highest risk, and people diagnosed with thyroid cancer had the lowest risk. Breakthrough infection risk was:
24.7% for people diagnosed with pancreatic cancer
22.8% for people diagnosed with liver cancer
20.4% for people diagnosed with lung cancer
17.5% for people diagnosed with colorectal cancer
17.4% for people diagnosed with bladder cancer
16.0% for people diagnosed with kidney cancer
14.9% for people diagnosed with hematologic cancer
12.5% for people diagnosed with skin cancer
12.8% for people diagnosed with prostate cancer
11.9% for people diagnosed with endometrial cancer
11.9% for people diagnosed with breast cancer
10.3% for people diagnosed with thyroid cancer
Among the people diagnosed with cancer, people who visited a doctor because of certain cancers between November 2020 and November 2021 had a higher risk of a breakthrough infection than people who didnt visit a doctor because of cancer. This finding suggests that people who were actively being treated for certain cancers had a higher risk of a breakthrough infection than people whod completed treatment. Higher risk was seen in people diagnosed with:
breast cancer
hematologic cancer
colorectal cancer
bladder cancer
pancreatic cancer
The researchers then matched people with and without cancer on the basis of:
age, ethnicity, and other demographics
vaccine type
other medical conditions
People with cancer still had a higher risk of breakthrough infection than people without cancer.
The researchers also compared breakthrough infection outcomes in people with and without cancer:
The risk of hospitalization was 31.6% in people diagnosed with cancer and 25.9% in people without cancer.
The risk of dying was 6.7% in people diagnosed with cancer and 2.7% in people without cancer.
These results emphasize the need for patients with cancer to maintain mitigation practice, especially with the emergence of different virus variants and the waning immunity of vaccines, the researchers wrote.
This studys results are concerning for people whove been diagnosed with cancer especially for people who are actively receiving breast cancer treatment.
Other research strongly suggests that people diagnosed with cancer have a higher risk of getting COVID-19 than people who have not been diagnosed with cancer. This risk is higher for people who have been recently diagnosed with cancer.
But knowing you have a higher risk of getting a COVID-19 breakthrough infection and having serious complications and worse outcomes can be motivation to stay vigilant about your safety. This awareness also can encourage you to keep following COVID-19 precautions, even if the rest of the world isnt. Its extremely important that you:
practice physical distancing
wear a face mask that fits snugly when you go out of the house
wash your hands frequently and use hand sanitizer when you cant wash your hands
avoid crowds and poorly ventilated spaces
clean and disinfect surfaces you touch frequently, including doorknobs, light switches, phones, keyboards, handles, and faucets
be alert for any COVID-19 symptoms, including loss of smell or taste, as well as fever, cough, and shortness of breath
talk to your doctor about COVID-19 vaccines and boosters, and get fully vaccinated as soon as you can if its recommended for you
Learn more about Coronavirus (COVID-19): What People With Breast Cancer Need to Know.
To talk with others about COVID-19 and breast cancer, join the conversation on All things COVID-19 or coronavirus in our community.
Written by: Jamie DePolo, senior editor
Nuvaxovid is a protein-based vaccine engineered from the genetic sequence of the first strain of SARS-CoV-2, the virus that causes COVID-19.
The vaccine was found to be about 90 per cent effective at preventing symptomatic COVID-19 and 100 per cent effective in preventing severe infection in trials.
As of May 12, 92 per cent of Singapores population have completed their primary vaccination series, while 75 per cent have received their booster doses.
With good vaccination coverage and the majority of our total population well-protected, we will be progressively stepping down the number of vaccination centres from end-May 2022, as previously announced on Apr 22, said MOH.
The first tranche of five Joint Testing and Vaccination Centres will open on May 24, as part of efforts to ensure that COVID-19 testing and vaccination services remain accessible to the general public, it added.
"These centres are designed with the ability to scale up operations in the event of an emerging variant of concern in future."
Another five centres will open progressively across the island from end-June.
To enable the medical service providers to better manage vaccine preparation and reduce any unnecessary wastage, the public is strongly encouraged to book an appointment via the National Appointment System before proceeding to the JTVCs, said MOH.
The centres are as follows:
In the past few weeks, everyone from late night hosts to country stars to comedians to many at the White House, including Vice President Kamala Harris, has contracted Covid. The uptick in boldfaced names testing positive is not a coincidence.
Centers for Disease Control and Prevention data released today shows BA.2.12.1, thought to be 30% more infectious than BA.2, is poised to become the dominant variant in the United States.
Seven weeks ago, Americans got the news of what was then the latest in several waves of new Omicron variants, each more infectious than the rest. BA.2.12.1 is actually a subvariant of BA.2, which was at that point pushing out the original Omicron. Before March 19, BA.2.12.1 and sister subvariant BA.2.12.2 made up only 1.5% of newly-sequenced positive tests.
By last week, BA.2.12.1 had beaten out its sister sublineage for a 36.5% share of all newly-sequenced positive Covid tests. This week, that number has jumped to 42.6%, making it very likely that BA.2.12.1 will become the dominant variant in the country in the next 7-10 days.
In the region comprised of New York, New Jersey and Connecticut, where the subvariant was first identified, it is already tied to 66% of new cases sequenced. As of the past weekend, hospitalizations and deaths in New York were up 38% and 24%, respectively.
Its important to note that BA.2 had already begun sending those numbers up before BA.2.12.1 took hold, but the new variant seems to be supercharging the increases in those important categories.
Across Pennsylvania, West Virginia and Virginia, BA.2.12.1 makes up 48% of new cases. The Southeast is close behind, with 45% of new infections now associated with the subvariant. See map below for a regional look at the U.S. updated today by the Centers for Disease Control and Prevention.
If there is good news in the new data, its that the next wave of Omicron variants called BA.4 and BA.5 and thought to be even more transmissible than BA.2.12.1 have not seen the same rate of spread in the U.S. since their arrival here on March 19. Their share remains minuscule, with only 19 cases detected Stateside since March 19.
Data source
We administered a cross-sectional survey. To evaluate the publics health behaviour responses to COVID-19, we conducted an anonymous online survey. To increase the representativeness of the sample, a proportional stratified sampling that reflected age, gender, and population region in the sample quota ratios was used. The number of participants was set based on the composition of the registered resident population announced by Statistics South Korea in February 2020. A total of 1406 patients visited the online survey between April 14 and April 20, 2020.
In South Korea, the first confirmed COVID-19 cases occurred on 4 January 2020, which prompted the Korea Disease Control and Prevention Agency to implement the New Normal Level and strengthen their surveillance [17]. When the fourth confirmed case occurred on 28 January 2020, the KCDC scaled up the alert level and conducted publicity campaigns about taking preventive behaviours against infectious disease. During the month of February, the number of confirmed cases increased radically as the new infectious disease rapidly spread nationwide, even at the local community level. During this period, the health authorities conducted various campaigns on personal preventive behaviours through posters, digital images, and text messages. In particular, they suggested specific health behaviours according to place and time in order to induce people to adhere to health behaviours.
To evaluate the publics health behaviour responses to COVID-19, we developed a questionnaire made up of 26 questions (5 sociodemographic questions; 5 health behaviour questions; 9 Health Belief Model questions and 7 questions about cues to take action), and we conducted online research using a research panel. An online research panel is a sample of persons who have already agreed to take surveys on websites. Since these individuals have already agreed to provide their sociodemographic information, it is easy for researchers to maintain an appropriate balance across age, gender, and population region. Additionally, based on a privacy policy, specific personal information about the respondents such as their name and address are not permitted to be exposed to the researchers.
The data for the analysis were collected by an online research company named TRUIS, which maintains 420,000 online panels [18]. According to the composition of the registration population announced by the National Statistics Office in February 2020, we set gender, age group, and regional quota ratios. Before beginning the survey, TRUIS set gender, age group, and regional quota ratios based on registration population data for impartial analysis. At first, 1406 people had accessed the online survey. A total of 102 participants exceeded the quota ratio, so we excluded them from the survey. For example, assuming that 1406 subjects were subject to the survey, 165 people were allocated to the quota when applying the ratio of the number of men in their 20s. Thus, if 200 men in their 20s answered the questions, then the results of the survey could be biased. This means that, in this example, 35 respondents would need to be excluded from the sample. Ultimately, a total of 1304 respondents completed the questionnaire; however, among them, 66 respondents did not complete the survey, and 31 respondents did not provide consistent responses. Therefore, we concluded that 1207 respondents were credible based on the quota ratios, which resulted in a response rate of 92.5%.
The final sample size was 1207, with a considerable margin error of 2.82% and a 95% confidence interval. Since this study analysed peoples autonomous actions or responses to COVID-19, which means that they needed to be able to decide their actions on their own, it was important to choose adults as the respondents. For this reason, the survey decided to provide comprehensive information about the adult population in the age bracket of 2059years. Prior to the survey, participants agreed to the provision that the contents and purpose of this study were understood and that they were willing to participate in the study. Anonymous participation was strongly mandated, and no identifiable information was collected from the respondents.
To evaluate the degree of the respondents adherence to COVID-19 preventive behaviours, we analysed their responses to the personal preventive measures recommended by the World Health Organization (WHO). The WHO developed a comprehensive strategy to control COVID-19 that is made up of a list of actions recommended for individuals, communities, governments, and international bodies to suppress the spread of the SARS-CoV-2 virus [19]. Of these actions, we focused on the individual aspects of the preventive measures to assess the respondents beliefs and perceptions concerning preventive behaviours regarding COVID-19. Consequently, we used five items, namely, frequent hand hygiene, respiratory etiquette, wearing a mask, environmental cleaning at home, and self-quarantine. The answers were rated on a 7-point scale ranging from 1=strongly disagree to 7=strongly agree. The total value of the precautionary behaviours was calculated by averaging the scores of each of the questions. To measure internal consistency, a reliability analysis was carried out on the preventive behaviours scale comprising 5 items. The Cronbachs alpha value for the survey was .75, which indicated an acceptable level of reliability.
By building upon the HBM from previous literature, we developed a total of eight categories of determinants that influenced the preventive behaviours taken towards preventing COVID-19. The structured variables covered sociodemographic information, perceived susceptibility, perceived severity, perceived benefit, perceived barrier, self-efficacy of preventive behaviours, and cues to take action. In particular, the sociodemographic characteristics of the survey participants included gender, age, education level, monthly household income, and marital status.
The second part of this study was based on the HBM. The study participants were asked to provide their opinions on specific statements. Perceived susceptibility, severity, benefits, and barriers were each evaluated. To measure the HBM factors, except for self-efficacy, the respondents are asked to answer the two separate questions. The final scores from each factor were obtained by averaging each score. If the final score was above the average score, this was considered indicative of each factor being at a high level. Perceived susceptibility refers to ones belief regarding the possibility of being infected (e.g., If I do not take precautions, I think I will be more likely to be infected with COVID-19). Perceived severity refers to ones belief in the seriousness of the infection (e.g., If I am infected with the SARS-CoV-2 virus, it will impact me severely) [20]. Perceived benefits refer to the efficacy of preventive behaviours in reducing the risk of being infected by the SARS-CoV-2 virus (e.g., If I follow the preventive behaviours, doing so will reduce the risk of getting infected with COVID-19). In contrast, perceived barriers represent the obstacles that inhibit the implementation of preventive behaviours (e.g., It is annoying and uncomfortable to follow preventive behaviours) [21]. The answers were scored on a scale ranging from 1 to 7 (1=strongly disagree, 7=strongly agree).
Self-efficacy refers to an individuals confidence in successfully carrying out preventive health behaviours for the prevention of COVID-19 (e.g., I am able to follow the preventive behaviours) [22]. The survey participants were asked to assess their self-efficacy through a question, and they were asked to indicate their level of agreement using a 7-point Likert scale.
Finally, the HBM assumes that people are set in motion through cues to take action. These cues to take action trigger individuals to take action by using various sources [23]. We chose seven items to evaluate the survey participants trust cues that could affect their preventive behaviours. The respondents were asked to indicate how much they trusted the following sources of information with regard to the information provided about COVID-19: printed media, radio, television, health care providers, official government website, social networks, and family and friends. The answers were scored from 1 (do not trust at all) to 7 (trust completely). The scores were obtained by averaging the scores of the seven questions. To measure internal consistency reliability, we calculated the Cronbachs alpha coefficient on items of the Health Belief Model and cues to take action. The Health Belief Model subscale consisted of 9 items and =.71, while the cues to take action subscale consisted of 7 items and =.79. Each of the Cronbachs alpha values showed that the questions reached acceptable levels of reliability.
A descriptive analysis was conducted to illustrate the general characteristics of the study sample using the frequencies and percentages of the categorical variables. We conducted single and multiple linear regression analyses to identify the factors that affected the respondents health behaviours towards COVID-19 prevention. The data were analysed using IBM SPSS software version 22.
Infectious Diseases
Updated on February 24, 2022
Coronaviruses are a type of virus. There are many different kinds, and some cause disease. A coronavirus identified in 2019, SARS-CoV-2, has caused a pandemic of respiratory illness, called COVID-19.
As of now, researchers know that the coronavirus is spread through droplets and virus particles released into the air when an infected person breathes, talks, laughs, sings, coughs or sneezes. Larger droplets may fall to the ground in a few seconds, but tiny infectious particles can linger in the air and accumulate in indoor places, especially where many people are gathered and there is poor ventilation. This is why mask-wearing, hand hygiene and physical distancing are essential to preventing COVID-19.
The first case of COVID-19 was reported Dec. 1, 2019, and the cause was a then-new coronavirus later named SARS-CoV-2. SARS-CoV-2 may have originated in an animal and changed (mutated) so it could cause illness in humans. In the past, several infectious disease outbreaks have been traced to viruses originating in birds, pigs, bats and other animals that mutated to become dangerous to humans. Research continues, and more study may reveal how and why the coronavirus evolved to cause pandemic disease.
Symptoms show up in people within two to 14 days of exposure to the virus. A person infected with the coronavirus is contagious to others for up to two days before symptoms appear, and they remain contagious to others for 10 to 20 days, depending upon their immune system and the severity of their illness.
Infectious disease expert Lisa Maragakis explains the advances in COVID-19 treatments and how knowledge of COVID-19 can assist in preventing further spread of the virus.
COVID-19 symptoms include:
Some people infected with the coronavirus have mild COVID-19 illness, and others have no symptoms at all. In some cases, however, COVID-19 can lead to respiratory failure, lastinglungandheart muscle damage,nervous system problems,kidney failureor death.
If you have a fever or any of the symptoms listed above, call your doctor or a health care provider and explain your symptoms over the phone before going to the doctors office, urgent care facility or emergency room. Here are suggestionsif you feel sick and are concerned you might have COVID-19.
CALL 911 if you have a medical emergency such as severe shortness of breath or difficulty breathing.
Learn more about COVID-19 symptoms.
COVID-19 is diagnosed through a test. Diagnosis by examination alone is difficult since many COVID-19 signs and symptoms can be caused by other illnesses. Some people with the coronavirus do not have symptoms at all.Learn more about COVID-19 testing.
Treatment for COVID-19 depends on the severity of the infection. For milder illness, resting at home and taking medicine to reduce fever is often sufficient. More severe cases may require hospitalization, with treatment that might include intravenous medications, supplemental oxygen, assisted ventilation and other supportive measures
Two COVID-19 vaccines Pfizer and Moderna - have been fully approved by the FDA and recommended by the CDC as highly effective in preventing serious disease, hospitalization and death from COVID-19.
The CDC notes that in most situations the two mRNA vaccines from Pfizer and Moderna are preferred over the Johnson & Johnson vaccine due to a risk of serious adverse events. The J&J vaccine may be available for those who yet prefer it and for use in certain circumstances.
It is also important to receive a booster when you are eligible. You can get any of these three authorized or approved vaccines, but the CDC explains that Pfizer and Moderna are preferred in most situations.
In addition, it helps to keep up with other safety precautions, such as following testing guidelines, wearing a mask, washing your hands and practicing physical distancing.
Yes, severe COVID-19 can be fatal. For updates of coronavirus infections, deaths and vaccinations worldwide, see theCoronavirus COVID-19 Global Casesmap developed by the Johns Hopkins Center for Systems Science and Engineering.
Two COVID-19 vaccines Pfizer and Moderna - have been fully approved by the FDA and recommended by the CDC as highly effective in preventing serious disease, hospitalization and death from COVID-19.
The CDC notes that in most situations the two mRNA vaccines from Pfizer and Moderna are preferred over the Johnson & Johnson vaccine due to a risk of serious adverse events. The J&J vaccine may be available for those who yet prefer it and for use in certain circumstances.
It is also important to receive a booster when eligible. You can get any of these three authorized or approved vaccines, but the CDC explains that Pfizer and Moderna are preferred in most situations.
Coronaviruses are named for their appearance: corona means crown. The viruss outer layers are covered with spike proteins that surround them like a crown.
SARSstands for severe acute respiratory syndrome. In 2003, an outbreak of SARS affected people in several countries before ending in 2004. The coronavirus that causes COVID-19 is similar to the one that caused the 2003 SARS outbreak.
Since the 2019 coronavirus is related to the original coronavirus that caused SARS and can also cause severe acute respiratory syndrome, there is SARS in its name: SARS-CoV-2. Much is still unknown about these viruses, but SARS-CoV-2 spreads faster and farther than the 2003 SARS-CoV-1 virus. This is likely because of how easily it is transmitted person to person, even from asymptomatic carriers of the virus.
Yes, there are different variants of this coronavirus. Like other viruses, the coronavirus that causes COVID-19 can change (mutate). Mutations may enable the coronavirus to spread faster from person to person as in the case of the delta and omicron variants. More infections can result in more people getting very sick and also create more opportunity for the virus to develop further mutations. Read more aboutcoronavirus variants.
If you are concerned that you may have COVID-19, follow these steps to help protect your health and the health of others.
What you need to know from Johns Hopkins Medicine.
Is COVID endemic? Here's what health experts are saying.
How soon could we see COVID-19 go from pandemic to endemic? Here's what we know now.
Just the FAQs, USA TODAY
The U.S. Centers for Disease Control and Prevention now recommends that people in 16 Michigan counties wear masks again in indoor, public places as the coronavirus surges and hospitalizations climb.
The CDCupdated its map Thursday evening that detailscommunity risk from COVID-19, showing all of metro Detroit now in the high-risk category as well as many counties in the northwestern lower peninsula.
They are: Washtenaw, Wayne, Oakland, Macomb, Livingston, St. Clair, Chippewa, Mackinac, Emmet, Cheboygan, Antrim, Kalkaska, Grand Traverse, Benzie, Manistee and Calhoun.
In those 16 high-risk counties, the CDC recommends:
More: Michigan is facing 'unique moment' of COVID-19 history, expert says, as cases rise
More: Got a positive COVID-19 test? New treatments can help keep you out of the hospital
Even though masks are recommended yet again in large swaths of the state,public health officials in Wayne, Oakland, Washtenaw and Macomb counties andthe city of Detroit told the Free Press on Fridaythey aren't going tomandatethem at this stage.
"We are not planning to issue orders at this point," said Susan Ringler Cerniglia, a spokesperson for the Washtenaw County Health Department."Based on our guidance, we expect some entities, especially our higher-risk or group settings, to require it again while were at a high community level. This would include schools, public agencies, shelters, etc. if theyre not currently requiring universal masking indoors."
As the omicron subvariants BA.2 and BA.2.12.1 gain prevalence, the virus is spreading quickly in other parts of the state as well.
Twenty-eightMichigan counties now have moderate levels of transmission, according to the CDC.
They are: Gogebic, Ontonagon, Marquette, Presque Isle, Alpena, Montmorency, Otsego, Alcona, Crawford, Charlevoix, Leelanau, Kent, Barry, Kalamazoo, Eaton, Clinton, Gratiot, Isabella, Ingham, Shiawassee, Saginaw, Midland, Bay, Genesee, Sanilac, Monroe, Lenawee, Jackson.
[ Want moreupdates on COVID-19 in Michigan? Download our app for the latest ]
In thosecounties, the CDC recommends:
The state health department reported 901 people were hospitalized with confirmed cases ofcoronavirus Friday more than double the number hospitalizeda month ago, when 429people with the virus were getting hospital care.
It's still nowhere near the levels of COVID-19 hospitalization Michigan saw in January, when the state hit pandemic peaks with more than 4,600 people hospitalized.
The state reached a seven-day average of 3,958 new daily cases on Wednesday the highest point since February, when Michigan was coming down from the initial omicron surge.
The latest wave of infections comes as the nation marked its 1 millionth death from the virus and U.S. flags across the country are lowered to half-staff to honor the dead.
More: Death of Grosse Pointe Woods man haunted Oprah Winfrey, inspired documentary
What it means: COVID-19 cases in Michigan expected to climb through May
Even though few pandemic restrictions remain in place, people can still choose to take steps to protect themselves by getting vaccinated, boosted and using some tried-and-true mitigation measures, according to Emily Martin, associate professor of epidemiology for the University of Michigan School of Public Health.
"Even though the political landscape has changed and sort of the recommendation landscape has changed, the same things work now that worked a few months ago," Martinsaid in a Twitter Space chat discussing the future of COVID-19.
"Masks still work, and higher-quality masks still provide a higher level of protection. Being outdoors is still better than being indoors and being in less crowded spaces is still ... better than being in crowded spaces."
Treatments like the antiviral drug Paxlovid are available now that can reduce the risk of hospitalization or death from the virus. Monoclonal antibody therapy is an option, too, for people who are vulnerable.
"And the sooner you test, the sooner you can access treatment and the sooner ... you use them, the better they work," Martin said. "There are things that we can do with a positive result to make you feel better. And so it's important to test so that you know that you're positive so then you can seek the treatment."
That the state is in the throes of yet another COVID-19 surge is frustrating to LaurenMetiva, 42, of Wyandotte.
A home health nurse, Metiva is fully vaccinated and two of her three children are, too. But her youngest daughter, 4-year-old Annabelle, is still not eligible because none of the COVID-19 vaccines have won emergency-use authorization for kids under the age of 5.
Metiva said she bristles when public health leaders talk about personal responsibility in getting vaccinated because that isn't an option for her daughter.
"Idon't think I've ever heard from any of the health officials or expertsthe caveat of 'Well, we're sorry. We recognize that this still isn't available for a certain amount of the population.' It's just frustrating to read it over and over and over again get vaccinated and I cannot get her vaccinated," she said.
Though a U.S. Food and Drug Administration'sadvisory committee is scheduled in early June to discuss applications from Pfizer and Moderna to use their vaccines in kids as young as 6 months old, it feels to Metiva like young children have been left out for too long.
"I just have seen firsthand how devastating COVID can be to healthy individuals," she said. "I'm worried about COVID. I'm worried about the inflammatory disease they've seen in children. I'm worried about long COVID. I'm worried about all the opportunities to do things that I've kept her from.
"I've kept her out of preschool. We did do swim lessons, but when she's doing swim lessonsthere is a lot of anxiety. It's gone on for so long that I feel like I'm constantlycalculating risk about where it'sbetter to take her and where it's better to pass. It's been a really long time and I'm very frustrated."
Contact Kristen Jordan Shamus: kshamus@freepress.com. Follow her on Twitter @kristenshamus.
Follow her on Twitter @kristenshamus.
As the rest of the world learns to live with Covid-19, Chinas top leader, Xi Jinping, wants his country to keep striving to live without it no matter the cost.
China won a battle against its first outbreak in Wuhan, Mr. Xi said last week, and we will certainly be able to win the battle to defend Shanghai, he added, referring to the epicenter of the current outbreak in China.
But pressure is mounting for a change to the zero-Covid strategy that has left Shanghai at a standstill since March, kept hundreds of millions of Chinese citizens under lockdown nationwide and is now threatening to bring Beijing to a halt.
This week, the World Health Organization called Chinas current pandemic strategy unsustainable. An economist summarized it as zero movement, zero G.D.P. Multinational companies have grown wary of further investments in the country.
For more than two years, China kept its Covid numbers enviably low by doggedly reacting to signs of an outbreak with testing and snap lockdowns. The success allowed the Communist Party to boast that it had prioritized life over death in the pandemic, unlike Western democracies where deaths from the virus soared.
More transmissible variants like Omicron threaten to dent that success, posing a dilemma for Mr. Xi and the Chinese Communist Party. Harsher lockdowns have been imposed to keep infections from spreading, stifling economic activity and threatening millions of jobs. Chinese citizens have grown restless, pushing back against being forced to stay home or to move into grim, government-run isolation facilities.
Yet abandoning the strategy risks a surge in deaths, especially among the countrys tens of millions of unvaccinated older people. Researchers this week warned of a tsunami of deaths if the virus surged unchecked, leaving Chinas fragile national hospital system overwhelmed and raising the possibility of social unrest.
Fearing any dissent during a politically important year for Mr. Xi, Chinas censors have moved quickly to muffle calls for a change in course on Covid-19. The head of the World Health Organization, whose recommendations China once held up as a model, was silenced this week when he called on the country to rethink its strategy.
Photographs and references to Tedros Adhanom Ghebreyesus, the director general of the W.H.O., were promptly scrubbed from the Chinese internet after the statement. The foreign ministry responded by calling Mr. Tedross remarks irresponsible, and accusing the W.H.O. of not having a proper understanding of the facts.
Chinas state-controlled media has also glossed over the draconian measures officials have deployed to deal with outbreaks. This week, as some authorities in Shanghai erected new fences around quarantine zones, boarded up more homes and asked residents not to leave their apartments, state media painted a picture of a city slowly returning to normal.
One article described the hustle and bustle of city life returning, while another focused on statistics for how many stores had reopened.
But rosy state media reports cannot hide a looming challenge facing Mr. Xi.
To date, the coronavirus has claimed 569 lives and infected about 777,565 people since March 1, according to official statistics. If unchecked, the outbreak could lead to 112 million infections and nearly 1.6 million deaths between now and July, according to a study from researchers at Fudan University in Shanghai and Indiana University in the United States.
The situation is pretty grim, and the study shows clearly the huge importance in vaccinating and boosting the elderly, said Marco Ajelli, an infectious disease modeler at Indiana Universitys School of Public Health, who contributed to the study.
Less than half of people aged 70 or older in Shanghai have received two jabs, according to the study. Across China, the number is 72 percent, a figure that health experts say should be 95 percent or higher. In dozens of cities where there have been outbreaks or partial lockdowns in anticipation of rising cases, resources have been devoted to stamping out the virus rather than to vaccinations.
Currently the vaccines available in China are also not as potent as foreign ones available in other countries. Chinese vaccines use traditional technology that has been shown to be less effective than breakthrough mRNA technology. China said last year that it was close to approving BioNTech, a German mRNA shot made in partnership with Pfizer, but that has not happened. Several Chinese companies are in the testing phase of a homegrown mRNA option, and China also recently approved for emergency use a Covid-19 antiviral pill made by Pfizer called Paxlovid.
Administering three vaccine shots, using antiviral therapies and offering more effective vaccines could help China find a path out of zero Covid, Mr. Ajelli said.
Investors and business leaders worry that Chinas rigid adherence to its zero-Covid policy could send the economy into free fall. It is high time for the government to change its strategy, said Fred Hu, a prominent Chinese investor. The benefits of zero Covid no longer outweigh the economic costs, he added. Sticking to the zero-Covid strategy would decimate its economy and undermine public confidence.
An uncertain harvest. Chinese officials are issuing warnings that, after heavy rainfalls last autumn, a disappointing winter wheat harvestin June could drive food prices already high because of the war in Ukraine and bad weather in Asia and the United States further up, compounding hunger in the worlds poorest countries.
A pause on wealth redistribution. For much of last year, Chinas top leader, Xi Jinping, waged a fierce campaign to narrow social inequalitiesand usher in a new era of common prosperity. Now, as the economic outlook is increasingly clouded, the Communist Party is putting its campaign on the back burner.
By one estimate, nearly 400 million people in 45 cities have been under some form of lockdown in China in the past month, accounting for $7.2 trillion in annual gross domestic product. Economists are concerned that the lockdowns will have a major impact on growth; one economist has warned that if lockdown measures remain in place for another month, China could enter into a recession.
European and American multinational companies have said they are discussing ways to shift some of their operations out of China. Big companies that increasingly depend on Chinas consumer market for growth are also sounding the alarm. Apple said it could see a $4 billion to $8 billion hit to its sales because of the lockdowns.
Howard Schultz, the interim chief executive of Starbucks, said the company has virtually no ability to predict our performance in China.
Foreign investments have nearly dried up, and some projects have been on hold for more than two years because pandemic restrictions have made it essentially impossible for foreign executives to visit China. When executives at multinational companies appeal to senior Chinese officials, their calls are met with silence, said Michael Hart, the president of the American Chamber of Commerce in China.
China has been very steadfast in its views that it has the right strategy and it doesnt want people to criticize it, Mr. Hart said.
Some of Chinas top leaders have also started to share concerns about the economy. Chinas premier, Li Keqiang, described the employment situation as complicated and grave as migrant workers and college students struggle to find and keep jobs during lockdowns.
Even as daily virus cases in Shanghai are steadily dropping, authorities have tightened measures in recent days following Mr. Xis call last week to double down. Officials also began to force entire residential buildings into government isolation if just one resident tested positive.
The new measures are harsher than those early on in the pandemic and have been met with pockets of unrest, previously rare in China where citizens have mostly supported the countrys pandemic policies.
In one video widely circulated online before it was taken down by censors, an exasperated woman shouts as officials in white hazmat suits smash her door down to take her away to an isolation facility. She protests and asks them to give her evidence that she has tested positive. Eventually she takes her phone to call the police.
If you called the police, one of the men replies, Id still be the one coming.
Isabelle Qian contributed reporting, and Claire Fu contributed research.
Last October, a young girl with severe and unusual liver failure was admitted to a hospital in Birmingham, Alabama. Her symptoms were typical: skin and eyes yellow with jaundice, markers of liver damage off the charts. But she tested negative for all the usual suspects behind liver disease. Her only positive test was, surprisingly, for adenovirusa common virus best known for causing mild colds, pink eye, or stomach flu. In rare cases, its linked to hepatitis, or inflammation of the liver, in immunocompromised patients. But this girl had been healthy.
Then it happened again. A second kid came in, about the same age, with all the same symptoms, and again positive for adenovirus. One patient is a fluke; two is a pattern, says Markus Buchfellner, a pediatric infectious-diseases doctor at the University of Alabama at Birmingham (UAB). Two quickly became three and then four. Alarmed, the hospitals doctors alerted local health authorities and the CDC, whose investigation ultimately found nine such cases of unusual hepatitis in kids in Alabama. Two needed liver transplants.
Buchfellner originally thought that whatever was happening was local to Alabama. But this spring, investigators in the U.K. began independently puzzling over their own mysterious uptick in hepatitis among kids. They have since identified more than 150 such cases in the U.K. This prompted the CDC to cast a wider net, bringing the number of suspected cases across the U.S. to 109. Fifteen of the kids have needed liver transplants, and five have died. Worldwide, probable cases now total 348 spread across 20 countries.
The early evidence continues to point to a link with adenovirusan unexpected correlation that is too strong to dismiss and not strong enough to close the case. Seventy percent of the probable cases globally have tested positive for adenovirus, according to the World Health Organization. But although biopsies have been conducted in a small fraction of those cases, they have failed to find adenovirus in the kids livers. At the same time, we definitely know that a different virus infected a massive number of kids recently: SARS-CoV-2, of course. Yet the correlation here is even less clear; only 18 percent of the probable cases tested positive for COVID.
Adenovirus and coronavirus arent necessarily mutually exclusive explanations. The leading hypotheses now suggest an interaction between adenovirus and the pandemiceither because social distancing changed the patterns of adenovirus immunity, allowing for more severe or simply more adenovirus infections, or because previous infection or co-infection with the coronavirus triggers an unusual response to adenovirus. Alternatively, did the adenovirus itself recently change, evolving to more readily damage the liver?
Severe liver failure in kids is very rare, says Helena Gutierrez, the medical director for pediatric liver transplants at UAB and Childrens of Alabama. But when it does happen, a significant proportion of cases even in normal times remains entirely mysterious. No identifiable cause is ever found in almost half of kids with liver failure so severe that they might need a transplant. Ultimately, understanding the recent pattern of unexplained liver-failure cases in kids may shed light on previously mysterious cases that were once too infrequent to attract much attention.
Read: A human liver can be cooled to -4 degrees C and survive
But why is there an increase right now? The only culprit that can be conclusively ruled out is COVID vaccines, because kids under 5, who make up the bulk of the hepatitis cases, cannot yet be vaccinated. In the weeks ahead, experts will be looking at three key pieces of data to parse the remaining hypotheses.
The first and perhaps most obvious set of data to gather is: Have these kids had COVID before? The overwhelming majority of the kids with hepatitis tested negative for the coronavirus, but investigators are now collecting antibody data to see if any of them had COVID in the past. I dont think its directly related to the virus itself, says Buchfellner, but perhaps a COVID infection could have predisposed a kid to liver failure once something elsesay, an adenovirus infectioncame along. And although multisystem inflammatory syndrome, or MIS-C, following coronavirus infection can affect the liver, the hepatitis patients did not exhibit the other hallmark signs of that condition, such as high inflammatory markers and heart damage.
When the COVID antibody data do come out, a lot of the kids will be positivesimply because a lot of kids in general have had COVID recently. Experts will want to go one step further to determine whether the coronavirus is really playing a role. If so, theyd expect that kids with hepatitis are more likely to have COVID antibodies than a control group of kids who did not have hepatitis.
Read: COVID-19s effect on kids is even stranger than we thought
A second key piece of data is about the adenovirus itself. Adenoviruses are very common, so could all the positive tests simply reflect incidental infections unrelated to liver failure? Here, too, investigators will want to see if kids hospitalized with hepatitis are more likely to test positive for adenovirus than those hospitalized for other reasons. If they are, the link to adenovirus becomes stronger. The U.K. is analyzing these exact data and is expected to have results in the next week.
Exactly how many kids test positive for adenovirus sounds like a simple statistic, but it can be messy early on, when investigators are dealing with mostly retrospective data. Different doctors in different hospitals might think to order different tests. UAB happened to test for adenovirus, but its so low on the list of hepatitis culprits that the test is not necessarily routine. And how tests are done can affect whether they come back positive, says Benjamin Lee, a pediatric infectious-diseases doctor at the University of Vermont. Is the virus able to be detected in the blood at the time the patient presents for care? Are there other sites that need to be tested? he asks. What about the nose and throat? Or stool? And indeed, U.K. investigators have had to make sense of a mlange of blood, stool, and respiratory samples, with varying positivity rates.
A third prong of the investigation will focus on the adenoviruses found in these samples. Sequencing their genomes can determine whether the viruses recently acquired new mutations that can explain the link to liver failure. Adenovirus variants have popped up before, and this type of virus is especially apt at reshuffling its genome. Whole genome sequencing is in the works, though scientists in the U.K. originally had trouble getting enough virus out of early samples. And scientists dont have a big database of old adenovirus samples of this kind to compare with the new ones. We take that for granted out with SARS-CoV-2, says James Platts-Mills, an infectious-diseases doctor at the University of Virginia. So the initial progress may be slow.
Partial sequencing of the viral genome, though, has already pinpointed one particular type of adenovirus that predominates in the hepatitis cases: adenovirus 41, also known as 41F. (There are more than 100 types of adenovirus. F refers to the species; the number reflects the order in which the types were discovered.) Adenovirus 41 infects the GI tract. Platts-Mills has studied adenovirus 41 in developing countries, where it is a leading cause of hospitalizations for diarrhea in children. It circulates in wealthy countries, too, but in the U.S. it doesnt cause enough trouble to justify active surveillance. Potentially, Platts-Mills says, the hepatitis cases are only the tip of the iceberg of a large number of undocumented mild adenovirus 41 cases. The invisible surge, if there is one, could be due to either new viral mutations or many young children getting infected at once, with COVID restrictions relaxing.
Still, its surprising to see adenovirus 41 specifically as a suspect in these hepatitis cases, adenovirus experts told me. Although adenovirus has been linked to severe liver failure, its not been adenovirus 41 but types 1, 2, 3, 5, and 7. Plus, these cases almost always happen in patients with suppressed immune systems. In those immunocompromised kids, you could see it in the liver. When we made slides, you could see the viral particles, says Kurt Schaberg, a pathologist at UC Davis who has studied adenovirus hepatitis. The dark centers of the infected liver cells become big and swollen. Its all quite obvious. Biopsies didnt find any of these patterns in the livers of the non-immunocompromised kids. If adenovirus plays a role, it is probably more indirect. Perhaps it somehow triggers the immune system to start attacking the liver, either by itself or in combination with another virus, toxin, or environmental factor. And this might continue even after the virus itself is cleared, so tests for adenovirus could turn up negative.
All of this means that figuring out the answer to these hepatitis cases in kids wont be straightforward. If we found virus in the liver, we would be done, says Buchfellner, in Alabama. The fact we cant find that means its much harder to prove. Instead of a single direct cause, investigators are probably looking for an indirect one or multiple indirect ones. In the weeks ahead, nailing down three key questionswhether these kids have also been infected with COVID, whether their adenovirus infections are incidental, and whether their viruses have mutatedwill at least narrow down the list of plausible hypotheses.
Meanwhile, the nine kids in Alabama are all recovering. Whatever the cause, doctors stressed to me, the risk of severe hepatitis for healthy kids is still very, very small.
