There are still many unknowns surrounding COVID-19, the disease caused by SARS-CoV-2, or the duration of persistent symptoms experienced with long COVID.
Researchers in the U.K. recently published a study in The Lancet Respiratory Medicine that followed more than 2,000 hospitalized COVID-19 patients. After having one year to recover following being released from the hospital, roughly only 25% of patients felt like they were completely back to their usual, healthy selves.
Long COVID is the term that describes experiencing COVID-19-related symptoms that last for an extended period of time. Often also called post-COVID syndrome or chronic COVID, people who experience this condition may sometimes be referred to as long-haulers.
According to the Centers for Disease Control and Prevention (CDC), long COVID refers to a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19.
Some symptoms the CDC mentions people with long COVID may experience include:
Long COVID is prevalent enough that it can be recognized as a disability under the Americans with Disabilities Act.
The researchers started with a group of 2,320 participants who were discharged from the hospital between March 7, 2020, and April 18, 2021. All participants were originally hospitalized due to COVID-19-related illnesses.
The participants followed up with their doctors 5 months after being released from the hospital to have their symptoms assessed.
The patients completed questionnaires about anxiety, depression, fatigue, post-traumatic stress disorder (PTSD), and other health issues. Doctors also tested the participants cognitive abilities and pulmonary function.
The researchers assigned participants to four clusters depending on the severity of their physical and mental health symptoms: very severe, severe, moderate, and mild. Half of the participants fell into the very severe and severe clusters.
Of the participants who completed their 5-month follow-up, 807 completed a 1-year follow-up appointment. The majority reported not feeling recovered from COVID-19.
At the 5-month follow-up, 25.5% of the patients reported feeling fully recovered. Of the participants who came back for a 1-year follow-up, 28.9% felt fully recovered, which is an improvement of only roughly 10%.
The researchers found that many of the people who were on mechanical ventilators in the hospital did not feel fully recovered after 1 year.
Additionally, the prevalence of not being back to full health was higher among females and participants with obesity.
The limited recovery from 5 months to 1 year after hospitalization in our study across symptoms, mental health, exercise capacity, organ impairment, and quality-of-life is striking, writes lead author Dr. Rachael Evans, clinical associate professor and honorary consultant respiratory physician at the University of Leicester in the United Kingdom.
She also notes that females and people with obesity may need higher intensity interventions such as supervised rehabilitation.
While the authors write that the mechanisms behind long COVID are unknown, they hypothesize that the hyper inflammation associated with COVID-19 dysregulates the immune system.
Our findings of persistent systemic inflammation, particularly in those in the very severe and moderate with cognitive impairment clusters, suggest that these groups might respond to anti-inflammatory strategies, says Professor Louise Wain, one of the study authors and professor in the Department of Health Sciences at the University of Leicester.
Dr. Ziyad Al-Aly, the director of Clinical Epidemiology at the Washington University School of Medicine in St. Louis, Missouri, spoke about long COVID in a Show Me the Science podcast. Of the issues long COVID patients experienced, Dr. Al-Aly noted, at least one is related to inflammation.
Were starting now to uncover long-term consequences of COVID-19 that literally will last a lifetime, Dr. Al-Aly said.
And then we did work to delve deeper into the cardiovascular manifestationsthats the heart manifestations, mental health disorders, kidney disorders, and now, most recently, diabetes, Dr. Al-Aly commented. Inflammation is a known contributing factor in developing type 2 diabetes.
We think that this is really a consequential problem. Its going to affect millions and millions of people. And our health systems should be equipped to be able to deal with it, continued Dr. Al-Aly.
Dr. Claire Taylor, a physician and neuroscientist who formerly worked for the M.E. Trust in the U.K., spoke with Medical News Today about the study.
We are severely lacking in tests to objectively show that people have not fully recovered and what is driving that, she said.
Additionally, Dr. Taylor said she found the inflammatory issues with long COVID patients concerning. However, she expressed hope that the blood tests performed in this study will open up an avenue for other blood tests to show ongoing inflammation in long COVID patients.
Covid fines should be overturned en masse in light of the prime ministers defence for attending lockdown-breaching events, a lawyer has argued, as it emerged more than 20 penalties imposed on businesses had been struck down in recent months.
Lucinda Nicholls, who successfully represented 23 firms and is still fighting on behalf of seven more, said serious deficiencies in the evidence presented against her clients as well as Boris Johnsons own apparent confusion about how to apply his own rules called every penalty imposed under Covid legislation into question.
Boris Johnson said he found the regulations confusing. Considering they changed about 12 times, it is understandable someone might be confused, she said.
The lawyer, from the firm Nicholls & Nicholls, added: In the context of Partygate, the government should be overhauling all of the Covid fines issued to individuals and businesses.
If the government that brought in the legislation had difficulties with regard to the exemptions and the defences, then that demonstrates that there is clearly going to be confusion among the local authorities and the police in relation to enforcement.
Gainz Fitness & Strength, an independent gym in Bedford, was one of the firms Nicholls represented. Its owner, Alex Lowndes, risked being penalised when he decided to stay open in November 2020. He felt so strongly about the issue that he had campaigned albeit unsuccessfully for the inclusion of a special, blanket lockdown exemption for gyms that same month.
The BBC, which first reported on the overturning of the 23 penalties, said Lowndes denied breaching lockdown regulations when charged following a raid on his gym. The broadcaster said he faced a 10,000 fixed-penalty notice and was due to stand trial last March. But the council failed to gather sufficient evidence and its request for an adjournment was rejected by magistrates.
Nicholls had argued on Lowndes behalf that his gym should benefit from the exemptions that were eventually included in the rules.
Data released by the National Police Chiefs Council in March showed police in England and Wales issued 877 notices under business regulations such as that given to Lowndes while more than 100,000 were imposed on people over various other allegations. Yet more have been handed out by local councils.
Nicholls said there was no prospect of appeal where the penalty had been paid, since this represented an admission of guilt, and said ministers should act to ensure all were overturned.
Bedford borough council, which gave Lowndes a fixed-penalty notice, said regulations were enforced in line with its duty at the time.
We brought this case because there was ample evidence for a successful prosecution following the non-payment of a fixed-penalty notice and because it was in the public interest, a council spokesperson told the BBC.
It is important that we remember that the threat posed by the virus then was very different to that which we face now.
The pandemic isnt over but the combination of immunity from prior infection, vaccinations and antivirals has made it possible for us to return cautiously to the activities that we love.
In the spring of 2020, as Americans continued to proclaim their excitement for basketball games and parades, an ER doctor named Dylan Smith watched in dismay. Was everyone else ignoring reality? That March, New York City hesitated to close its schools during the citys first COVID wave. Smith was horrified. A major pandemic was arriving, and softening its blow would require closing schools, which he believed was the best way to protect kids. There were a lot of suggestions that kids would be these supercarrier vectors, he says, where they would come home and they would infect Mom and Dad and Grandma and Grandpa, and they would infect teachers at school.
Now, two years later, Smith has changed his mind. He thinks schools shouldve reopened much soonerby early 2021 at the latest. In other words, Smith admits to rethinking one of his positions on COVID-19, an act that sometimes feels as risky as telling 17th-century Florentines that Earth revolves around the sun. Not everyone will agree with Smiths reassessment. But maybe we can learn something from his willingness to do it.
Read: America is about to test how long normal can hold
Smith started having second thoughts about school closures in the fall of 2020. Unlike in the early days, his hospital, by that point, had plenty of tests. Kids didnt seem to be getting very sick from COVID, and they appeared to have no greater risk of spreading it than everyone else. This idea that kids were going to be these crazy vectors was no longer being borne out, he says.
Then, he began to see kids come into the hospital with mental-health emergencies at alarming rates. Kids were having panic attacks and trying to kill themselves; some were saying they were stressed out because they couldnt see their friends. What he saw mirrors national trends: 37 percent of high schoolers have experienced poor mental health during the pandemic, according to a CDC survey.
But as in other parts of the country, pediatric psych wards in Northern Virginia were so full that the kids would remain in the ER for three or four days while the doctors tried to find an open psychiatric bed. They were just sitting in an ER room, Smith told me. A social worker would stop by each day to check on them, and someone would roll a TV console from room to room. In the summer of 2020, he started to see younger and younger kids involved in shootings and stabbings. (Gun violence among kids younger than 17 spiked nationally in 2020.)
Its hard to know what to chalk all of these issues up tothe ennui of Zoom school; less structure and supervision; the pandemic that, in teenage years, has seemed to grind on forever. But Smith noticed that movie theaters and restaurants were opening back up. Schools seemed more important. After vaccines became widely available in 2021, Smith didnt see any further justification for school closures. When people expressed doubts about school reopenings, he made his opinion clear: The science supported it.
Many of us have updated our beliefs about COVID at some point in the past two years, even if we havent said so publicly. Perhaps you started out worried that the coronavirus was easily transmitted via surfaces, then you discarded that fear upon further evidence. Maybe you are a major infectious-disease specialist who at first thought that young, healthy people didnt need boosters, then decided they should get them after all. Maybe you committed the ultimate noble flip-flop: You overcame your skepticism of vaccines and opted to get vaccinated.
Read: Whats really behind global vaccine hesitancy
Confessing that weve changed our opinion is hard, and not only because we dont like feeling stupid, or looking stupid, or being exiled from certain circles of Twitter. If I admit Im wrong, then I have a harder time relying on my own judgment every time I make a decision or have an opinion, says Adam Grant, an organizational psychologist at the University of Pennsylvania and the author, most recently, of Think Again. Im admitting that my convictions about the world are often incorrect, and that that makes the world a little bit scarier to live in.
People get especially rigid in frightening and unpredictable situations. The pandemic has made many of us seize and freeze in order to restore that sense of control, Grant told me. The restaurants that are still using QR codes rather than paper menusostensibly for COVID reasonsare perhaps practicing a little terror management alongside their cost cutting.
Tenelle Porter, a psychologist at UC Davis, studies so-called intellectual humility, or the recognition that we have imperfect information and thus our beliefs might be wrong. Practicing intellectual humility, she says, is harder when youre very active on the internet, or when youre operating in a cutthroat culture. That might be why it pains mea very online person working in the very competitive culture of journalismto say that I was incredibly wrong about COVID at first. In late February 2020, when Smith was sounding the alarm among his co-workers, I had drinks with a colleague who asked me if I was worried about this new coronavirus thing.
No! I said. After all, I had covered swine flu, which blew over quickly and wasnt very deadly.
A few days later, my mom called and asked me the same question. People in Italy are staying inside their houses, she pointed out.
Yeah, I said. But SARS and MERS both stayed pretty localized to the regions they originally struck.
Then, a few weeks later, when we were already working from home and buying dried beans, a friend asked me if she should be worried about her wedding, which was scheduled for October 2020.
Are you kidding? I said. They will have figured out a vaccine or something by then. Her wedding finally took place this month.
Smith talks like an ER doctor, giving you just enough information but not so much that it might slow him down. Hes 30 and has one of those apathetic buzz cuts that busy guys get. In our Zoom calls, his cat, Bucky, would periodically yowl in the background.
One thing that allows people like Smith to talk so openly about changing their mind is a loose attachment to their opinions. Dont let your ideas become part of your identity, said Grant, the organizational psychologist.
Charlie Warzel: The bad ideas our brains cant shake
For instance, at one point in our interview, I pointed out to Smith that teen mental health had been declining since before the pandemic. If anything, the pandemic has accelerated a teen-mental-health crisis that was already in motion. So were applying causation where there was already a trend? he asked. Thats a valid point. People are going to choose the interpretation that fits with either their preconceived notions and their priors or is convenient to the position they want to hold. Ultimately, he decided, if global crises and social media were already shredding teen mental health, the pandemic has magnified the salience of those two things.
Here, hes using science-speak: acknowledging the contradicting evidence, evaluating the claim, and coming to the best conclusion you can under the circumstances. His is an attitude born of the emergency room, where you dont always have a patients full test results before you have to treat them. Hes not saying it was wrong to close schools in 2020, just that as we accumulated more evidence and developed vaccines, the evidence pointed in the opposite direction.
According to Grant, the best way to keep an open mind in an unclear situation is to do just this: Think like a scientist. (The other, lesser ways to think are like a preacher, prosecutor, and politician, which are what they sound like.) The writer Julia Galef calls this the scout mindset, as opposed to the soldier mindset. The scout and scientist mindsets are approximately the same thing: The motivation to see things as they are, not as you wish they were, she writes in her eponymous book.
Thinking like a scientist, or a scout, means recognizing that every single one of your opinions is a hypothesis waiting to be tested. And every decision you make is an experiment where you forgot to have a control group, Grant said. The best way to hold opinions or make predictions is to determine what you think given the state of the evidenceand then decide what it would take for you to change your mind. Not only are you committing to staying open-minded; youre committing to the possibility that you might be wrong.
Because the coronavirus has proved volatile and unpredictable, we should evaluate it as a scientist would. We cant hold so tightly to prior beliefs that we allow them to guide our behavior when the facts on the ground change. This might mean that we lose our masks one month and don them again the next, or reschedule an indoor party until after case numbers decrease. It might mean supporting strict lockdowns in the spring of 2020 but not in the spring of 2022. It might even mean closing schools again, if a new variant seems to attack children. We should think of masks and other COVID precautions not as shibboleths but like rain boots and umbrellas, as Ashish Jha, the White House coronavirus-response coordinator, has put it. Theres no sense in being pro- or anti-umbrella. You just take it out when its raining.
Read: Is it time to start masking again?
Understanding when to abandon beliefs and when to recommit to them can help us ride out this pandemic and prepare for the next one. In a pandemic, we need to be continually discovering and learning new things, Porter told me. Still, she added, in a moment of intellectual humility: I dont know that we have hard data on that.
Though people often deride those who change their mind as hypocrites, Grant and others think its a mark of integrity. Its a sign that youre committed to the truth, not committed to an idea.
Smith didnt publicly advocate for schools to reopen for in-person learning. Hes on Twitter, but he has few followers and rarely tweets. The only person who called him on his about-face was his wife. I remember when you said that schools should close down and that people are being idiots for not closing schools down, she told him.
Yeah, he said, evaluating the evidence. Youre right.
When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.
ENFIELD, Conn. (WWLP) The Henry Barnard Elementary School in Enfield is facing a staffing shortage after more than 30 members tested positive with COVID-19.
According to a letter on Monday from Superintendent of Schools Christopher Drezek, more than thirty staff members tested positive for COVID-19 putting a strain on school operations. The school remained open Monday and Tuesday however, staff are instructed to bring home their iPads for remote learning in the event the school does not find additional staff to cover.
Superintendent Drezek says a discussion is being held Tuesday to move staff from other buildings to safely remain open as additional staff awaits test results.
Henry Barnard Elementary School is located on Shaker Road in Enfield with students in Kindergarten, 1st, and 2nd grade. On the staff roster, there are a total of 105 staff members. Those include 8 members in the main office, 8 Kindergarten teachers, 7 teachers for Grade 1, 7 teachers in Grade 2, and forty specialists that include art, music, PE, substitutes, and more. There is 7 staff listed under tutors, 25 para-professionals, and 3 lunch aides.
As of Monday, there are 153 confirmed cases of COVID-19 in Enfield between April 10 and April 23. Enfield is listed color-coded red, meaning there are 15 or more cases of COVID-19 per 100,000 residents. It is recommended that everyone wear a mask in public indoor spaces even if they are fully vaccinated.
Scientists are discovering a surprising bright side for some people with asthma: They are less susceptible to COVID-19.
The very same immune system proteins that trigger excess mucus production and closing of airways in people with allergic asthma may erect a shield around vulnerable airway cells, researchers report in the April 19 Proceedings of the National Academy of Sciences. The finding helps explain why people with allergic asthma seem to be less susceptible to COVID-19 than those with related lung ailments, and could eventually lead to new treatments for the coronavirus.
Asthma is a breathing disorder characterized by airway inflammation. The result is coughing, wheezing and shortness of breath. About 8 percent of people in the United States have asthma, with about 60 percent of them having allergic asthma. Allergic asthma symptoms are triggered by allergens such as pollen or pet dander. Other types of asthma can be set off by exercise, weather or breathing in irritants such as strong perfumes, cleaning fumes or air pollution.
Usually, asthma is bad news when it comes to colds and flu. At the start of the pandemic, most experts predicted that coronavirus infections and asthma would be a dangerous mix, says Luke Bonser, a cell biologist at the University of California, San Francisco who was not involved in the study. And that is true for people whose asthma is not triggered by allergies and those with related lung disorders like chronic obstructive pulmonary disease, or COPD. Those conditions put people at high risk for severe COVID-19.
But as the pandemic progressed, researchers noticed that people with allergic asthma werent developing severe COVID-19 as often as expected. Heres a look at why that may be.
What sets allergic asthma apart from other types of asthma and COPD is a protein called interleukin-13, or IL-13.
Usually, IL-13 helps the body fight off parasites such as worms. Certain T cells pump out the protein, and the body responds by churning out sticky mucus and constricting airways. This traps the worms, holding them in place until other immune system cells can come in for the kill.
In the case of [allergic] asthma, the body is making a mistake. Its mistaking a harmless substance, like pollen, for a worm, says Burton Dickey, a pulmonologist at M.D. Anderson Cancer Center in Houston who was not involved in the study.
But it wasnt clear how IL-13 was protecting people with allergic asthma from SARS-CoV-2, the coronavirus that causes COVID-19. To find out, pathophysiologist Camille Ehre of the University of North Carolina School of Medicine in Chapel Hill and colleagues grew cells from the lining of the airways from six lung donors. Some of the cells were treated with IL-13 to mimic allergic asthma. Then the researchers infected some of the cells with SARS-CoV-2.
Next on the list of to-dos was to compare how cells that havent been treated with IL-13 behave when healthy and when infected with the coronavirus.
Uninfected cells grew in lawns resembling lush grasslands, where the tufts of waving fronds are actually hairlike protrusions called cilia, which grow from the tops of airway-lining cells, the team confirmed. Cilias motions help move mucus, and anything stuck in the mucus, out of the lungs.
Cells infected with the coronavirus looked much different. The lush lawn was now slathered in mucus, and bald spots appeared as infected cells died. The doomed cells get squeezed out of the lawn of cilia and inflate like a balloon. The inflation happens partly because chambers called vacuoles inside the infected cells get clogged with viruses. Its just filled with viruses, and then it gets kicked out of the club and it blows up and releases all these viruses, Dickey says.
But not all the cells in the infected lawn were affected equally. Looking at the cells from the side, researchers could see that cells sporting cilia were infected with the coronavirus. But mucus-producing cells called goblet cells, which dont have cilia, were rarely infected. That may be because a protein called ACE2 decorates the surface of ciliated cells far more often than it does goblet cells. ACE2 is the protein that the coronavirus uses as a door into cells.
When researchers doused the cells with IL-13 before adding the coronavirus, the results were strikingly different.
The lawn of waving cilia atop the treated cells was mostly intact, with far fewer balloons of dying cells rising above the surface. But the fronds didnt wave as vigorously as in untreated cells. Thats because IL-13 reduces cilia beating, the researchers found. Less active cilia could mean that virus-laden mucus sticks around longer. That can be a double-edged sword inside the lungs because you want to clear the mucus, but you dont want to spread it around, Ehre says.
Counting cells under the microscope, the researchers saw that far fewer of the infected cells treated with IL-3 got the heave-ho. Whereas the untreated cells had ejected about 700 of their own by about four days after infection, only about 100 treated cells had gotten kicked out. The images showed that IL-13 really was protecting cells from infection. But how was still an unanswered question.
One thing that IL-13 does is stimulate airway-lining cells to churn out a type of sticky mucus that can trap viruses before they can infect cells. The team found that untreated cells released a burst of the mucus shortly after being infected with the coronavirus, depleting stores of the sticky stuff. But cells treated with IL-13 were still well-stocked with mucus.
All that extra mucus from the treated cells could ensnare viruses and expel them from the lungs before much damage is done. But people with nonallergic asthma and COPD make plenty of mucus too, and they arent protected from the virus. So Ehre and colleagues stripped away the mucus to see how the airway cells fared without this phlegmy trap.
Even without the mucus, IL-13 was still protective.
Examining patterns of gene activity, the team found that IL-13 was also causing cells to make less ACE2, the protein that SARS-CoV-2 commandeers as a gateway into cells. It makes it much harder for the virus to find its door to enter the cells, Ehre says.
That result agrees with previous findings from Bonser and colleagues. Being able to replicate the same data in several different studies, thats great, he says. And the new study looks more closely into IL-13s protective mechanism than previous research did.
Cells treated with IL-13 also turn down the activity of genes involved in making protein-producing factories called ribosomes, the researchers discovered. That may limit viral replication in cells. But some genes activity was also turned way up. That includes several genes involved in making keratan sulfate, a long, sugar-studded protein that is found in cartilage and the eyes corneas. Its there in the body to make a shield, Ehre says.
That seems to be what it is doing for airway cells too. A thick layer of keratan sulfate developed on top of cells treated with IL-13, armoring them against a coronavirus infection.
Which of these protective mechanisms is most important, or if its a combination of all of them, is one of the many things left to explore, Ehre says. This paper is not the final paper that figures everything out. There is way more work to do.
Knowing even more details about how IL-13 works to protect against the coronavirus could lead to new treatments, Bonser says. But IL-13 itself probably will not be used as a drug because of the inflammation, excess mucus, cough and shortness of breath it triggers.
Unfortunately, the extra protection doesnt mean that people with allergic asthma dont have to be concerned about getting COVID-19, Dickey says. People with asthma have had very bad outcomes. This is not a virus you want to take chances with, he says. But its OK to bask on the bright side a little. Its not fun to have asthma, so you have to be grateful for every rare occasion where it does something useful.
Headlines and summaries of the latest Science News articles, delivered to your inbox
Thank you for signing up!
There was a problem signing you up.
What do available data tell us about COVID-19 vaccine effectiveness against infection, hospitalization, and death, including during the emergence of new variants like Omicron?
All available data show that mRNA COVID-19 vaccines continue to meet their primary goal: prevention of severe outcomes from COVID-19, including hospitalization and death, among children and adults. Protection against severe disease is highest in those who receive a booster dose.[1,2,3]
Although the level of protection against SARS-CoV-2 infection after COVID-19 vaccination has declined in all ages with the emergence of the Omicron variant, vaccination still reduces the risk for infection and COVID-19associated hospitalization and death, especially among people who receive a booster dose.
CDC uses a multilayered approach to understand how well COVID-19 vaccines work in the real world. This approach includes ongoing analyses of surveillance data and studies of vaccine effectiveness. Surveillance data allow us to monitor rates of COVID-19 cases, hospitalizations, and deaths by vaccination status. This information can signal potential changes in vaccine effectiveness that can be further studied through more robust, controlled vaccine effectiveness studies conducted by CDC or our partners. These studies provide vaccine effectiveness estimates that help us better understand how well the vaccines work in different groups of people, against different outcomes, and different variants.
CDC uses the following platforms and methods to collect and analyze surveillance data on COVID-19 cases, hospitalizations, and deaths by vaccination status:
Case surveillance: CDC collaborates with 30 public health jurisdictions that actively link immunization registry and case surveillance data to monitor rates of COVID-19 cases and deaths by vaccination status, including receipt of a booster dose.
COVID-NET: CDC tracks COVID-19 hospitalizations by vaccination status using COVID-NET. COVID-NET is a population-based, sentinel surveillance system that collects reports of laboratory-confirmed COVID-19associated hospitalizations in 99 counties in 14 states.
National Healthcare Safety Network: Infections in long-term care facility residents by vaccination status are reported through a network of approximately 15,000 medical facilities called the National Healthcare Safety Network (NHSN).
Vaccine effectiveness studies build on surveillance data by collecting extra information on cases (eg, individuals with COVID-19) and controls (eg, individuals without COVID-19) in more defined settings, such as specific hospitals, allowing for comparisons of these groups. Information such as a history of previous SARS-CoV-2 infection and underlying conditions (eg, cancer, diabetes) collected as part of these studies helps CDC gain more precise estimates and a better understanding of how well vaccines are working. Vaccines were initially prioritized for healthcare providers who were at higher risk for exposure to SARS-CoV-2, as well as older adults. Vaccine effectiveness studies allow us to compare differences among people who are vaccinated and those who are not vaccinated to ensure we account for how differences such as age or risk for exposure affect, or bias, estimates of vaccine effectiveness. This is why we often present vaccine effectiveness data by age group or by specific populations, such as healthcare personnel.
CDC works with partners to study COVID-19 vaccine effectiveness using several data collection platforms and study designs. Vaccine effectiveness studies vary on the basis of outcome (eg, infection, hospitalization), population (eg, focusing on residents of long-term care facilities), and study design. For example, CDC partners with the VISION Network, which includes 306 emergency department and urgent care clinics and 164 hospitals in 10 states, to study how well vaccines protect against COVID-19associated emergency department/urgent care visits and hospitalizations in children and adults. Another study platform, Overcoming COVID, monitors vaccine effectiveness in children aged 18 years or younger who are hospitalized with symptoms of COVID-19. Results from these ongoing studies are regularly published in CDC's MMWR , as well as other scientific journals.[4] The Overcoming COVID platform can also evaluate vaccine effectiveness in children younger than 5 years, should COVID-19 vaccines become available for this younger age group.
For more information on the current and planned vaccine effectiveness studies that CDC is currently conducting with partners, visit COVID-19 Vaccine Effectiveness Research.
CDC uses multiple important sources for data. No single study or surveillance system can provide all the information needed to understand how well COVID-19 vaccines work in real-world conditions over time, which is why this multilayered approach is so important.
CDC's multijurisdictional surveillance data, which tracks rates of COVID-19 cases and associated deaths by vaccination status, is extensive, covering more than 65% of the US population. The volume of this data allows for analysis of outcomes over time, such as COVID-19associated deaths. However, although these data signal potential changes in vaccine effectiveness, they cannot control for all factors that may affect the rates being tracked for example, prior infection.
Conversely, the smaller study populations included in vaccine effectiveness studies allow us to control for some of these variables. However, sometimes the small number of outcomes observed within certain age and vaccination categories reduce the precision of vaccine effectiveness estimates. Although this isn't ideal from a data analysis standpoint, it can sometimes be a good thing from a public health perspective. For example, when there are so few hospitalizations among vaccinated children in a study population that researchers can't calculate statistically significant vaccine effectiveness estimates, we can take that as an indication that these vaccines are likely succeeding at what they were designed to do keeping children from getting sick enough to need hospitalization.
CDC's multilayered approach to monitoring has also allowed us to quickly identify how different variants affect vaccine effectiveness, including during the Omicron wave. Researchers can stratify analyses by variant period, allowing CDC to compare vaccine effectiveness estimates or rates of cases and hospitalizations by vaccination status during different variant periods. Some vaccine effectiveness studies have also used whole-genome sequencing to confirm which variants are associated with the different COVID-19 outcomes being studied.
Studies show that, in general, mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) provide higher levels of protection against all outcomes than the J&J/Janssen COVID-19 vaccine.[5] Although analyses of jurisdictional surveillance data may appear to suggest that protection has recently increased among people who received the Janssen vaccine to similar levels as in those who received an mRNA vaccine, many Janssen vaccine recipients have received a booster dose of an mRNA vaccine or have received additional protection through infection with COVID-19 which could potentially bias surveillance results.
A separate vaccine effectiveness study[5] found that people who received the J&J/Janssen COVID-19 vaccine as both their first dose and booster dose had lower levels of protection against COVID-19associated emergency department and urgent care visits during Omicron compared with those who received an mRNA booster dose. In addition, people who received an mRNA primary series and booster had the most protection against COVID-19associated hospitalization.
CDC recommends mRNA COVID-19 vaccines over the Janssen vaccine for primary and booster vaccination for all eligible people in most situations. However, offering the Janssen COVID-19 vaccine is preferable to not providing any COVID-19 vaccine.
At this point, most of your patients have either heard about or experienced SARS-CoV-2 "breakthrough" infections with the highly contagious Omicron variant, which can understandably weaken confidence in the effectiveness of vaccination. Helping them understand the difference between preventing infection and preventing severe disease which can cause hospitalization and death is a good way to start to frame the conversation when people question vaccine effectiveness.
Although people frequently consult family members, friends, and webpages for information on vaccines, doctors are consistently ranked as the most trusted source for vaccine information. With this unique position, your strong recommendation is critical for patient education and vaccine acceptance.
COVID-19 vaccines are continuing to meet their primary goal: keeping people out of emergency rooms, hospitals, and intensive care units, as well as preventing death. Although people who are vaccinated may still get infected, they are much less likely to get severely ill compared with unvaccinated people.[6]
Make sure you and your eligible family members stay up-to-date on COVID-19 vaccines. Staying up-to-date protects you and your eligible children from severe outcomes related to COVID-19, including hospitalization and death.
It also helps your family and your community directly. Hospitals need to have the ability to treat and manage all kinds of diseases. If they are overwhelmed with patients with COVID-19, it can jeopardize healthcare for anyone who needs intensive care or has a medical emergency like a heart attack.
Boosters work. We know that, for adults, booster doses do exactly what it sounds like "boost" the immune system's protection against serious illness. We don't have enough data yet to know whether kids aged 5-11 years will need boosters, but as your healthcare provider, I encourage you and your family to stay up-to-date on your COVID-19 vaccines.
Vaccine and masking recommendations can change when we get new data, especially with a new disease like COVID-19 and when new variants arise. When CDC and scientists learn that people might need booster doses, or new variants emerge, they look very carefully at the data to make or change vaccine recommendations. I feel strongly that staying up-to-date on your COVID-19 vaccines, including getting boosters when they are recommended, is one of the best ways to protect you and your family from severe COVID-19.
CDC COVID Data Tracker: Rates of COVID-19 Cases and Deaths by Vaccination Status
CDC COVID Data Tracker: Rates of Laboratory-Confirmed COVID-19 Hospitalizations by Vaccination Status
CDC COVID Data Tracker: COVID-19 Vaccine Effectiveness
COVID-19 Vaccine Breakthrough Case Investigation and Reporting
The Possibility of COVID-19 after Vaccination: Breakthrough Infections
Benefits of Getting a COVID-19 Vaccine
COVID-19 Vaccines Work
It might not look like much a plastic box that fits in the hand, with tiny tubes jutting out the top and bottom. Too simple to be cutting edge. Too humble to save so many lives.
But for 20 years, researchers in Robert Prudhommes lab have fine-tuned this little box that has revolutionized drug manufacturing, enabling everything from mRNA-based COVID-19 vaccines to malaria drugs. The life-saving molecules that treat those diseases are fragile, and they must survive an epic voyage from a lab bench, through the supply chain, into a blood cell. Encapsulation gives them a secure vehicle and a final heading. Its a delicate craft backed by complex mathematics, and over the arc of his career, Prudhomme has become a master craftsman.
From mRNA vaccines to antimalarial drugs, vast global health initiatives depend on nanoparticle technologies to deliver key molecules to target cells. For 20 years, Robert K. Prudhomme has led a team of Princeton University researchers in developing a simple way to formulate these medicines in a precise, scalable process called flash nanoprecipitation.
Produced by Orangebox Pictures and Princeton Universitys School of Engineering and Applied Science
In a 2003 paper, Prudhomme, professor of chemical and biological engineering, and Brian Johnson, a 2003 Ph.D. alumnus, described a technique called "flash nanoprecipitation" that mixes liquids to create precise solids perfectly sized, perfectly shaped, perfectly layered polymer grains, one million times smaller than a grain of table salt. To accomplish it, the researchers created a device called a confined impinging jet mixer that takes in two unlike liquids, mixes them in a flash of turbulent swirling, and pumps out a stream of bespoke nanoparticles. Each particle contains an active ingredient such as a drug molecule, a strand of RNA, or a protein wrapped in a package that delivers the payload to its target, whether blood cells, liver cells, or a metastasizing tumor.
The secret to this mixing, said Prudhomme, lies in empty space.
You need a confined volume where the turbulence can evolve, he said. Think of stirring cream into a coffee cup. That stretching, swirling process is how turbulence does the mixing.
Other methods either take the coffee cup analogy too literally, stirring the solutions in vessels, or use a T-shaped geometry to flow two streams together and sluice them out the bottom. The vessel approach limits production to single batches at a time and fails when applied to large volumes. The T-mixer gets clogged easily at both large and very small scales. Both approaches, while fine for research, produce inconsistent and unstable particles when used at large commercial scales.
The confined impinging jet mixer avoids the limitations of either approach to produce precision medicines at global scales. It allows the continuous flow of large volumes for long periods of time, while avoiding clogging by engineering a cavity where the two liquid jets strike each other in the middle of the open space, away from the walls. The particles form and drop out of the device in less than 50 milliseconds hence the "flash" in "flash nanoprecipitation."
The real innovation was in how to make small particles in large volumes, said Rodney Fox, a leading fluid-dynamics expert and professor at Iowa State University. Fox headed a team that later simulated the process in molecular detail and proved how it worked computationally. He said the rapid timing put Prudhommes technique in a class by itself. If mixing doesnt happen fast enough, particles clump together. But with flash nanoprecipitation, the complex particles form before they can clump. Prudhomme had figured out how to combine materials that normally refuse to combine: by mixing them so fast they dont have time to react otherwise.
What people had generally used to generate these types of particles were less sophisticated mixing systems, said Marian Gindy, a 2008 Ph.D. alumna and an executive at pharmaceutical giant Merck who worked with Prudhomme at Princeton. Where before you couldn't necessarily make the small molecule drugs and get them to stabilize in this nanoscale form, you now can. That tiny size is a big advantage when trying to get drugs to the right part of the body, she said.
The method has led to its widespread adoption. Since 2016, the Gates Foundation has sponsored workin the Prudhomme laboratory to produce low-cost and highly effective drugs for use in global health applications. They have demonstrated production of highly stable treatments for malaria, diarrhea and tuberculosis. One of the worlds largest contract research organizations, WuXi AppTec, is building a manufacturing capability based on this technology. Merck has also adopted for its work with RNA cancer therapies.
Mike McDermott, Pfizers chief of global supply, has described the impingement jet mixer as the heart of this whole machine producing the COVID-19 vaccine.
While scientists and engineers around the world have continued the development of this technology, it originated in Prudhommes lab, Fox said. Hes the father of this idea."
Carsten Losch, chief executive of KNAUER Wissenschaftliche Gerte GmbH, the Berlin-based company that encapsulated the COVID mRNA vaccines, said his firm had invested a lot of effort perfecting the devices to meet the exacting specifications of the pharmaceutical industry.
The basic research of Professor Prudhomme resulted years later in a technology that manufacturers of lipid nanoparticles use in a similar way today, Losch said.
Prudhomme also co-founded a startup company called Optimeoswith Shahram Hejazi, a lecturer at Princeton's Keller Center for Innovation in Engineering Education. Optimeos focuses on bringing next-generation RNA-based therapies to market to treat cancer, diabetes and other fatal diseases using the technology developed in Prudhommes lab.
It is incredibly rewarding to be a part of the path from fundamental academic research to major advances in public health, Prud'homme said.
Editors note: This article first appeared on pages 10-11 of the Spring 2022 E-Quad News
MONDAY 5/2/2022, 1:53 p.m.
The Wisconsin Department of Health Services has reported 1,419,124 total positive coronavirus test results in the state and 12,884 total COVID-19 deaths.
The number of known cases per variant is no longer tracked as The Wisconsin Department of Health Services has updated its website, deleting that section.
Unable to view the tables below?Click here.
The DHS announced an attempt to verify and ensure statistics are accurate, some numbers may be subject to change. The DHS is combing through current and past data to ensure accuracy.
Wisconsins hospitals are reporting, that the 7-day moving average of COVID-19 patients hospitalized was 213 patients. Of those,29 are in an ICU. ICU patients made up 14.4%of hospitalized COVID-19 patients.
The Wisconsin Department of Health Services reports that 9,467,692 vaccine doses and 2,010,368 booster doses have been administered in Wisconsin as of May 2.
Unable to view the tables below?Click here.
The Wisconsin Department of Health Services is using a new module to measure COVID-19 activity levels. They are now using the Center for Disease Control and Preventions (CDC) COVID-19 Community Levels. The map is measured by the impact of COVID-19 illness on health and health care systems in the communities.
The Center for Disease Control and Prevention (CDC) reports two counties in Wisconsin are experiencing high COVID-19 community levels. none of them are in northeast Wisconsin.
Five counties in Wisconsin are experiencing medium COVID-19 community levels, including Green Lake in northeast Wisconsin.
Every other county in Wisconsin is experiencing low COVID-19 community levels.
For more information on how the data is collected, visit the CDCs COVID-19 Community Levels data page.
For many of those who are vaccinated or were previously infected, learning of a close contact with the disease is less frightening than frustrating.
Testing is more and more normal. Masks are less and less visible.
There is an uptick in cases in the US and hospitalizations are up 10% since last week. Hopefully the rate of deaths continues to fall.
Most Americans have had Covid-19
The data comes from an ongoing study of blood samples sent to commercial laboratories across the US.
At the beginning of December, an estimated 34% of Americans had antibodies, which suggests the Omicron variant infected a quarter of the population.
We can assume Covid-19 will surge back
During an appearance on CBS News on Sunday, Birx pointed to a new rise in Covid-19 cases in South Africa.
"Each of these surges are about four to six months apart. That tells me that natural immunity wanes enough in the general population after four to six months -- that a significant surge is going to occur again," Birx said.
Public health officials need to prepare the public, she said, and make sure everyone knows that immunity, from infection or vaccination, wanes over time.
You have to go beyond 'fully vaccinated' to be 'up to date'
Even as public health officials push most people to get booster shots months after vaccination, they have not updated the definition of "fully vaccinated" to include a booster.
While more than three-quarters of the country has received at least one dose of a Covid-19 vaccine, less than one-third has received a booster.
For this reason, officials have moved away from that term -- "fully vaccinated" -- and instead encourage people to stay "up to date," which means getting a booster when eligible.
The most durable immunity comes for people who are up to date on their vaccines and have been previously infected.
Many doctors still say to stay up to date on vaccines as they are authorized by the US Food and Drug Administration.
"We still need to push forward getting those vaccines done to give the highest level of protection we possibly can," Dr. Anand Swaminathan, an emergency medicine physician, said on CNN over the weekend.
He argued that we still don't know a lot about the disease and that cases of long Covid are worth trying to avoid.
What exactly is long Covid?
Her case of long Covid pushed her into an early retirement and to move closer to family -- and 20 months later, she still has debilitating symptoms.
Howard also talked to Nick Guthe, whose wife, Heidi Ferrer, died by suicide after long Covid made life excruciating.
It's misunderstood and hard to diagnose, but symptoms can drag on for months.
Transitioning to what?
In the same report, McPhillips noted the US is transitioning from the pandemic phase of the Covid-19 era, but there's disagreement on what the US is transitioning to.
She wrote: The rise of the BA.2 subvariant and the general unpredictability of the coronavirus leave the future of the pandemic -- and the resources needed to fight it -- largely unknown.
"Things are not stable right now," said William Hanage, an epidemiologist and associate professor at the Harvard T.H. Chan School of Public Health. "Even if I don't reckon we are going to see [another] large surge, weekly reporting means that if I am wrong, we would learn about it later and so be able to do less about it."
"We're not over the pandemic. Don't let anybody get the misinterpretation that the pandemic is over, but what we are in is a different phase of the pandemic," Fauci said. "A phase that's a transition phase, hopefully headed toward more of a control where you can actually get back to some form of normality without total disruption of society, economically, socially, school-wise, etc."
May 2, 2022 A method for delivering genetic material to the body is being tested as a way to repair damaged heart muscle after a heart attack. The ground-breaking research was presented at Frontiers in CardioVascular Biomedicine 2022, a scientific congress of the European Society of Cardiology (ESC).
The COVID-19 messenger RNA (mRNA) vaccines use lipid nanoparticles (tiny fat droplets) to deliver mRNA to the bodys cells. This mRNA instructs the cells to manufacture a dummy spike protein on their surface to mimic the protein on the virus causing COVID-19. The body then mounts an immune response by creating antibodies which can be used if the individual becomes infected with the virus.
A similar method for mRNA delivery was used in the current study. However, instead of aiming for an immune response, the researchers ultimate goal is to instruct the hearts cells to repair themselves after a heart attack.
This preliminary study was conducted to determine whether mRNA could be successfully delivered to the heart muscle in lipid nanoparticles. The researchers injected different formulations into the left ventricular wall of mouse hearts during open chest surgery under general anaesthesia. Twenty-four hours after administration, the mice were sacrificed and the location of mRNA translation was examined.
The researchers found that mRNA successfully reached the heart cells 24 hours after injection. However, despite injection into the heart, the highest levels of mRNA translation were found in cells of the liver and spleen.
Study author Dr. Clara Labonia of the University Medical Center Utrecht, the Netherlands said: High expression was expected in the liver, since it metabolises the lipid nanoparticles. Nonetheless, it was encouraging to see that there was mRNA translation in the heart tissue which means that lipid nanoparticles could work as delivery systems for mRNA therapy.
She concluded: The next step of this research is to test more formulations and choose the one which most efficiently targets the heart tissue. We will then assess whether delivery of mRNA to mice with ischaemic hearts (resembling a heart attack) has any therapeutic effect.
