A bird flu outbreak in U.S. dairy cows has grown to affect more than two dozen herds in eight states, just weeks after the nations largest egg producer found the virus in its chickens.
Health officials stress that the risk to the public is low and that the U.S. food supply remains safe and stable.
At this time, there continues to be no concern that this circumstance poses a risk to consumer health, or that it affects the safety of the interstate commercial milk supply, the U.S. Food and Drug Administration said in a statement.
Heres what you need to know about bird flu and food:
Which states have found bird flu in dairy cows?
As of Friday, the strain of bird flu that has killed millions of wild birds in recent years has been found in at least 26 dairy herds in eight U.S. states: Idaho, Kansas, Michigan, New Mexico, North Carolina, Ohio, Texas and South Dakota.
The virus, known as Type A H5N1, has been detected in a range of mammals over the last few years, but this is the first time it has been found in cattle, according to federal health and animal agencies. Genetic analysis of the virus does not show that it has changed to spread more easily in people, the U.S. Centers for Disease Control and Prevention said.
How is bird flu affecting food production?
Agriculture officials in at least 17 states have restricted imports of dairy cattle from states where the virus has been detected, but, so far, government agencies say its had little effect on commercial milk production. Officials believe cows likely have been infected by exposure to wild birds, but said cow-to-cow spread cannot be ruled out.
Farmers are testing cows that show symptoms of infection, including sharply reduced milk supply and lethargy. Animals that show signs or test positive for illness are being separated from other animals on the farms. The animals appear to recover within two weeks.
U.S. egg producers are watching the situation closely after bird flu was detected in chickens in Texas and Michigan. Millions of birds have been killed, but the FDA said the risk of affected eggs getting into the retail market or causing infections in humans is low because of federal inspections and other safeguards.
Does pasteurization kill bird flu?
Scientists say theres no evidence to suggest that people can contract the virus by consuming food thats been pasteurized, or heat-treated or properly cooked.
Its not a food safety concern, said Lee-Ann Jaykus, an emeritus food microbiologist and virologist at North Carolina State University.
Two people in U.S. have been infected with bird flu to date. A Texas dairy worker who was in close contact with an infected cow recently developed a mild eye infection and has recovered. In 2022, a prison inmate in a work program caught it while killing infected birds at a Colorado poultry farm. His only symptom was fatigue, and he recovered.
Is grocery store milk safe from bird flu?
Yes, according to food safety experts and government officials.
U.S. producers are barred from selling milk from sick cows and must divert and destroy it. In addition, milk sold across state lines is required to be pasteurized, or heat-treated using a process that kills bacteria and viruses, including influenza.
We firmly believe that pasteurization provides a safe milk supply, Tracey Forfa, director of the FDAs Center for Veterinary Medicine told a webinar audience this week.
Is raw milk safe from bird flu?
The FDA and the CDC are less certain about unpasteurized, or raw, milk sold in many states, saying theres limited information about the possible transmission of the H5N1 virus in such products.
So far, no herds linked to raw milk providers have reported cows infected with bird flu, but the agencies recommend that the industry not make or sell raw milk or raw milk cheese products made with milk from cows that show symptoms or are exposed to infected cows.
U.S. health officials have long warned against the risk of food-borne illness tied to raw milk, which the CDC said caused more than 200 outbreaks that sickened more than 2,600 people between 1998 and 2018.
Still, raw milk proponents like Mark McAfee, owner of Raw Farm USA in Fresno, Calif., said the outbreak of H5N1 in commercial cows appears to have spurred higher sales of the products, despite federal warnings.
Can you catch bird flu from eggs or meat?
Only dairy cows, not beef cattle, have been infected or shown signs of illness to date, agriculture officials said.
The largest egg producer in the U.S. temporarily halted operations on April 2 after finding bird flu in its chickens. Cal-Maine Foods culled about 1.6 million laying hens and another 337,000 pullets, or young hens, after the detection.
The company said there was no risk to eggs in the market and that no eggs had been recalled.
Eggs that are handled properly and cooked thoroughly are safe to eat, said Barbara Kowalcyk, director of the Center for Food Safety and Nutrition Security at George Washington University.
A lot of people like runny eggs. Personally, if I eat an egg, its very well cooked, she said.
Still, Kowalcyk and others cautioned that the situation could change.
This is an emerging issue and clearly this pathogen is evolving and theres a lot that we dont know, she said. I do think that everybody is trying to figure it out as quickly as possible.
CLAIM
As more people got vaccinated for Covid, more people got Covid.
DETAILS
Flawed Reasoning: The post compared differences in vaccine coverage between four countries and differences in the number of reported COVID-19 cases in these countries. However, the claim failed to account for the fact that age distribution and adherence to COVID-19 guidelines also vary between countries and affect how many COVID-19 cases are reported. Factually inaccurate: At no point in time had Vietnam and South Africa around 10% of their population fully vaccinated while exhibiting fewer COVID-19 cases than Iceland and Portugal.
KEY TAKE AWAY
When comparing country-level COVID-19 data, care must be taken when drawing conclusions because such analyses come with a high risk of bias. It is important to account for many factors, such as COVID-19 testing policy, each countrys age distribution, and compliance with COVID-19 preventive measures, because these are all factors that affect COVID-19 outcomes reported in each country.
Science Feedback previously covered such claims and explained why directly comparing data from different countries can give rise to ill-founded conclusions.
A Facebook post by TV host Sharyl Attkisson published on 1 April 2024 is yet another example of such a claim. In the post, Attkisson claimed that Iceland and Portugal had over 75% of their population fully vaccinated but had more Covid-19 cases per 1 million people than countries such as Vietnam and South Africa that had around 10% of their population fully vaccinated. Attkisson previously propagated misinformation about vaccines and COVID-19, as documented by Science Feedback.
This comparison strongly implied that COVID-19 vaccines are ineffective. However, Attkissons claim is inaccurate. Furthermore, her underlying reasoning is flawed. As we explain below, there are important differences between these countries that make direct comparisons like Attkissons meaningless.
To begin with, Attkissons figures for vaccine coverage in the four countries cited dont represent the latest data available. According to the data aggregator Our World in Data, which cites data from the World Health Organization and national health departments, COVID-19 vaccine coverage was 87% in Vietnam as of 30 June 2023. This figure is the latest data available for this country.
COVID-19 vaccine coverage was 77% in Iceland as of 29 March 2022 and 86% in Portugal as of 29 March 2023. It was lower in South Africa, at 35% as of 24 September 2023 (Figure 1).
Figure 1 Share of fully vaccinated individuals in Vietnam, Portugal, Iceland, and South Africa. Source: Our World in Data.
All these figures predate Attkissons post, which was made on 1 April 2024. Thus, the vaccine coverage in South Africa and Vietnam is now clearly higher than the proportions cited in Attkissons post. In particular, vaccine coverage in Vietnam is comparable with that of Iceland and Portugal.
By examining the data in the past, we noticed that the vaccine coverage in South Africa and Vietnam was only concomitantly around 10% in September 2021. Although this could be consistent with Attkissons claim, the number of COVID-19 cases at the time isnt (Figure 2). The number of COVID-19 cases in September 2021 was higher in South Africa than in Iceland, contrary to the claim.
Figure 2 Number of COVID-19 cases per million inhabitants of each country. Source: Our World in Data.
These inconsistencies alone are enough to invalidate Attkissons implication that COVID-19 vaccines dont work, since this implication hinges on Vietnam and South Africa having much lower vaccine coverage and COVID-19 cases numbers than Iceland and Portugal.
Apart from the numerical inconsistencies in Attkissons post, the logic underlying her implication is flawed. This is because the countries she referenced differ in aspects other than vaccine coverage, which impact the number of reported COVID-19 cases. These are known as confounding factors.
Confounding factors are variables that affect the outcome of an experiment, but arent the variables being studied in the experiment. If these other factors arent taken into account, its not possible to reliably establish whether an observed difference in COVID-19 cases between two countries is due to a difference in vaccine coverage, some of these other factors, or a combination of both.
One important confounding factor is the different population age distribution between countries. Figure 3 shows that the average number of confirmed cases in 2022 is proportional to the share of individuals above 65 in the population.
This is relevant to Attkissons comparison because Iceland, Portugal, Vietnam, and South Africa have different population age structures: the share of people above 65 is higher in Iceland and Portugal than in Vietnam and South Africa (Figure 3).
Figure 3 Correlation between the number of COVID-19 cases and individuals older than 65 in each country, expressed as a percentage of the total population. COVID-19 cases are expressed as the average across 2022 of the cumulative number of confirmed cases since the beginning of the pandemic for the available 180 countries in the dataset#. The colored dots represent the four countries used in Attkissons claim. Orange: South Africa, red: Vietnam, blue: Iceland, green: Portugal. Source: Our World in Data.
Therefore, one can expect to observe more COVID-19 cases in countries with older populations because of the correlation between age and number of COVID-19 cases. If this effect isnt accounted for, any observed difference in the number of COVID-19 cases between countries could be due to the differences in their population age distribution, rather than their vaccine coverage, like Attkisson claimed.
Differences in the age distribution of populations also impact the detection of COVID-19 cases. It is well characterized that COVID-19 disproportionately affects older people, who are more at risk of developing symptomatic and severe COVID-19. For that reason, older people were also among the first to get vaccinated when vaccines became available. By contrast, younger people are more often asymptomatic[4,5].
Without a systematic screening system in place, asymptomatic cases are more likely to go undiagnosed and, therefore, unrecorded in the data. Thus, countries with older populations are more likely to exhibit a higher rate of infection as well as a higher vaccine coverage.
Accurate reporting of COVID-19 cases requires a healthcare system able to provide large-scale population testing and timely recording of positive tests. If a country isnt able to do so, the official number of COVID-19 cases will be lower than the actual number of cases. Therefore, if one country suffers from significantly more underreporting compared to others, this will bias the country-to-country comparison of COVID-19 cases.
According to an article by the New York Times, the lack of COVID-19 testing underestimated the real extent of COVID-19 infections in Africa[6]. While the reported number of cases was low, seroprevalence studies indicated that 65% of the African population had in fact been infected by the third quarter of 2021. Epidemiological modeling studies also concluded that African countries suffered from an underreporting of COVID-19 cases[7,8].
By contrast, underreporting is likely to be less of an issue in higher-income countries like Portugal and Iceland. Therefore, its plausible that the lower number of cases officially reported in South Africa is partly a consequence of underreporting and not because it has lower vaccine coverage. But Attkissons post takes all official figures at face value without accounting for this limitation.
Many countries issued guidelines and enforced measures to limit the spread of COVID-19. However, the reactiveness and the nature of those measures, and how well people adhered to those measures, differed greatly between countries[9,10]. Therefore, its possible that differences in COVID-19 casess between countries can be explained in part by differences in how well each population adhered to COVID-19 measures. In other words, adherence to public health measures is yet another important confounding factor that should be considered before comparing countries.
With that in mind, its important to note that Vietnam was able to curb the first wave of COVID-19 thanks to its rapid response and its populations high degree of adherence to COVID-19 measures[11,12].
Therefore, its plausible that the lower number of COVID-19 cases in Vietnam compared to some other countries can be explained in part by better adherence with COVID-19 guidelines. Yet, Attkissons analysis failed to take this factor into account.
Country-to-country comparisons are relatively easy to make because country-level statistics, such as the percentage of vaccinated people or the number of people with COVID-19, are readily available.
However, analyses using such data come with caveats. Specifically, one must pay attention to the existence of confounding factors that also affect the outcome of interestin this case, the number of COVID-19 cases.
Indeed, the age of the population, compliance with physical distancing and hygiene guidelines, and COVID-19 reporting efficiency are all parameters that differ from country to country and impact how many people get the disease. Analyses, like Attkissons, that dont consider these factors are thus flawed and dont provide any insight into the COVID-19 vaccines effectiveness.
By contrast, clinical trials and post-marketing surveillance all show that COVID-19 vaccines are safe and effective at preventing severe disease.
#: The figures for the COVID-19 cases is the average over all 2022 of the cumulative number of COVID-19 cases reported into the Our World in Data dataset. Averaging was preferred over choosing a single point in time to avoid the risk of variability associated with picking one unique time point. The year 2022 was chosen for averaging as its one year after the beginning of vaccination rollout and because data for Iceland, which are relevant to the claim, are lacking in the dataset for 2023.
A view of the Grand Palais ahead of the Paris 2024 Olympic Games in Paris, Monday, April15, 2024. The Grand Palais will host the Fencing and Taekwondo competitions during the Paris 2024 Olympic Games. (Yoan Valat, Pool via AP, File)
NEW YORK (AP) The biggest races, routines and games for many of this generations Olympic athletes were contested in front of mostly empty stands, largely devoid of coaches to help them out or friends and family to cheer them on.
That was three years ago at the COVID-19 Summer Olympics and two years ago at the COVID-19 Winter Olympics. Now that theyre preparing for the Paris Olympics that begin in July and a return to something that feels normal the Americans heading back to the Games know they can never take for granted the screaming fans and a hug from Mom or Dad.
I think its super important to be able to share these massive moments with people you care about, said BMX rider Alise Willoughby, who has been to the last three Olympics.
Willoughby and about 100 other U.S. athletes are doing interviews and photo shoots this week at the Team USA media summit at a hotel in Times Square an event that itself was made impossible in the lead-up to the Tokyo Games in 2021 amid the coronavirus pandemic.
One topic of conversation this week is how grateful the bikers, rowers, gymnasts and the rest are to be past the days of contact tracing, quarantines and daily swabbing or spitting for COVID-19 tests inside the so-called Olympic bubble.
In Paris, there will be celebrations with relatives and one-on-one contact with coaches, most of whom were not allowed into the venues three years ago. The USA House a traditional stop for athletes to wind down and kick back, especially after theyre done competing will be doing brisk business once again.
Mostly, athletes are looking forward to the chance to soak in the feeling from the crowd, an element sorely missing in the cavernous and largely unfilled venues in Tokyo.
Ill be able to see the audiences emotions. I want to build that with them and I can tailor my routines to that, said American rhythmic gymnast Evita Griskenas, who plans French music to accompany one routine and All-American number for another, all with the goal of getting fans caught up in the moment.
Griskenas said she already feels a different vibe. Preparing for the Olympics in Tokyo Games that were initially delayed by a year, then held in an atmosphere nobody quite recognized became a largely solitary, and joyless, affair.
It turned into training in my basement and throwing things outside, she said.
This year, a different experience awaits, and some athletes are even looking forward to a crowd rooting against them because, hey, at least its a crowd.
The boys have been saying, We want to play France in, like, the semifinals, rugby player Perry Baker said. You just visualize how big that can be, and how fun that can be. Their crowd. Our crowd. We live for those moments.
With crowds, naturally, come other issues that were mostly set on the sideline in 2021. On Monday, French President Emmanuel Macron said the much-touted opening ceremony scheduled for the Seine River could be moved to the Stade de France if the security threat is deemed too high.
Asked what she thought of that possibility, Nicole Deal, the chief of security for the U.S. Olympic and Paralympic Committee, said other than her main goal athlete safety she wants to provide the best experience for the athletes.
Security is an underpinning and a foundation. Were not the main show, Deal said.
With two of the next five Olympics set to come to the U.S. Los Angeles hosts in 2028 and Salt Lake City is a virtual lock for the Winter Games in 2034 Olympic leaders know theres a lot riding on Paris. This return to normal, they hope, will bring more Americans back to watching the Olympics in person, online and on TV.
Prime-time ratings in Tokyo were 42% lower than the previous Summer Games, in Rio de Janeiro in 2016, and 50% below the Games before that, in London in 2012. There were a number of reasons for that including the increasingly fragmented viewing audience, the rise of streaming services and the 13-hour time difference between New York and Japan.
But also: COVID-19.
Even for those who were back home, it wasnt the most important thing going on for us at that time, USOPC CEO Sarah Hirshland said of the renewed possibilities presented by the first COVID-19-free Games since 2018. This is about an opportunity to really focus on this incredible thing called Olympic and Paralympic sport. It brings us together almost like nothing else.
The way things went in Tokyo took some of the luster away from what was nearly a perfect experience for indoor volleyball player Jordyn Poulter. Yes, she won a gold medal in her first Olympics, three years ago. Yes, it was a once-in-a-lifetime type of triumph. Still, there was something missing.
Not being able to relish in that moment with friends and family in that immediate time its something that Im looking forward to in this next one, she said.
___
AP Summer Olympics: https://apnews.com/hub/2024-paris-olympic-games
The Associated Press
NEW YORK The biggest races, routines and games for many of this generations Olympic athletes were contested in front of mostly empty stands, largely devoid of coaches to help them out or friends and family to cheer them on.
That was three years ago at the COVID-19 Summer Olympics and two years ago at the COVID-19 Winter Olympics. Now that theyre preparing for the Paris Olympics that begin in July and a return to something that feels normal the Americans heading back to the Games know they can never take for granted the screaming fans and a hug from Mom or Dad.
I think its super important to be able to share these massive moments with people you care about, said BMX rider Alise Willoughby, who has been to the last three Olympics.
Willoughby and about 100 other U.S. athletes are doing interviews and photo shoots this week at the Team USA media summit at a hotel in Times Square an event that itself was made impossible in the lead-up to the Tokyo Games in 2021 amid the coronavirus pandemic.
One topic of conversation this week is how grateful the bikers, rowers, gymnasts and the rest are to be past the days of contact tracing, quarantines and daily swabbing or spitting for COVID-19 tests inside the so-called Olympic bubble.
In Paris, there will be celebrations with relatives and one-on-one contact with coaches, most of whom were not allowed into the venues three years ago. The USA House a traditional stop for athletes to wind down and kick back, especially after theyre done competing will be doing brisk business once again.
Mostly, athletes are looking forward to the chance to soak in the feeling from the crowd, an element sorely missing in the cavernous and largely unfilled venues in Tokyo.
Ill be able to see the audiences emotions. I want to build that with them and I can tailor my routines to that, said American rhythmic gymnast Evita Griskenas, who plans French music to accompany one routine and All-American number for another, all with the goal of getting fans caught up in the moment.
Griskenas said she already feels a different vibe. Preparing for the Olympics in Tokyo Games that were initially delayed by a year, then held in an atmosphere nobody quite recognized became a largely solitary, and joyless, affair.
It turned into training in my basement and throwing things outside, she said.
This year, a different experience awaits, and some athletes are even looking forward to a crowd rooting against them because, hey, at least its a crowd.
The boys have been saying, We want to play France in, like, the semifinals, rugby player Perry Baker said. You just visualize how big that can be, and how fun that can be. Their crowd. Our crowd. We live for those moments.
With crowds, naturally, come other issues that were mostly set on the sideline in 2021. On Monday, French President Emmanuel Macron said the much-touted opening ceremony scheduled for the Seine River could be moved to the Stade de France if the security threat is deemed too high.
Asked what she thought of that possibility, Nicole Deal, the chief of security for the U.S. Olympic and Paralympic Committee, said other than her main goal athlete safety she wants to provide the best experience for the athletes.
Security is an underpinning and a foundation. Were not the main show, Deal said.
With two of the next five Olympics set to come to the U.S. Los Angeles hosts in 2028 and Salt Lake City is a virtual lock for the Winter Games in 2034 Olympic leaders know theres a lot riding on Paris. This return to normal, they hope, will bring more Americans back to watching the Olympics in person, online and on TV.
Prime-time ratings in Tokyo were 42% lower than the previous Summer Games, in Rio de Janeiro in 2016, and 50% below the Games before that, in London in 2012. There were a number of reasons for that including the increasingly fragmented viewing audience, the rise of streaming services and the 13-hour time difference between New York and Japan.
But also: COVID-19.
Even for those who were back home, it wasnt the most important thing going on for us at that time, USOPC CEO Sarah Hirshland said of the renewed possibilities presented by the first COVID-19-free Games since 2018. This is about an opportunity to really focus on this incredible thing called Olympic and Paralympic sport. It brings us together almost like nothing else.
The way things went in Tokyo took some of the luster away from what was nearly a perfect experience for indoor volleyball player Jordyn Poulter. Yes, she won a gold medal in her first Olympics, three years ago. Yes, it was a once-in-a-lifetime type of triumph. Still, there was something missing.
Not being able to relish in that moment with friends and family in that immediate time its something that Im looking forward to in this next one, she said.
Study design and oversight
The United Kingdom Obstetric Surveillance System (UKOSS) has a source population of all women giving birth or being admitted for obstetric specialist care to one of the 194 consultant-led maternity units in England, Northern Ireland, Scotland and Wales, ~720,000 maternities annually1,19,20,21. A protocol for active surveillance of pregnant women admitted to hospital with viral infection was planned in 2012, approved by the ethical review board (HRA NRES Committee East Midlands), Nottingham 1 (Ref. Number: 12/EM/0365) and hibernated (https://doi.org/10.1186/ISRCTN40092247). The protocol was activated for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) from March 1, 2020, and concluded on March 31, 2022. Routines were in place to ensure complete reporting (online supplementary)3, and follow-up information about birth outcomes up to December 31, 2022, were retrieved from clinical records until April 24, 2023. Maternal and perinatal deaths were cross-checked with the MBRRACE-UK mortality surveillance. (https://www.npeu.ox.ac.uk/mbrrace-uk). The corresponding author vouches for the accuracy and completeness of the data and reporting. Patients and public were part of the UKOSS steering committee and involved in study design, oversight, reporting and dissemination of study findings but not in the conduct of the study. The funder played no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; nor in the decision to submit the paper for publication.
Pregnant women were included if admitted to hospital with a positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (PCR) test within 7days of admission, during admission or up to 2days after giving birth. Women were further classified according to their SARS-CoV-2 symptoms (symptomatic/asymptomatic); severity of infection (mild/moderate to severe); and the dominant viral variant in UK at the time of the PCR test (wild-type March 1 to November 30, 2020; alpha December 1, 2020, to May 15 2021; delta May 16 to December 14, 2021; omicron (BA.1 and BA.2 variant) December 15, 2021, to March 31 2022)36.
Moderate to severe maternal COVID-19 was defined according to modified WHO criteria as maternal death, maternal intensive care admission, peripheral oxygen saturation below 95% at admission, pneumonia on radiological imaging or need for respiratory support (either oxygen supplementation, non-invasive ventilation (high flow nasal oxygen or continuous positive airway pressure), mechanical ventilation or extracorporeal membrane oxygenation (ECMO))37.
The sociodemographic characteristics and medical risk factors recorded were maternal age, maternal body mass index (kg/m2), employment, ethnic background, smoking, pre-existing medical conditions (no medical conditions (reference) vs asthma, hypertension, cardiac disease or diabetes), preeclampsia, gestational diabetes, parity, plurality and gestational age at admission (categorised by completed weeks into <22, 22 to 27, 28-33, 3436 and 37weeks). Vaccination status was recorded from January 2021 after vaccination was recommended for pregnant women in risk groups in the UK from December 22, 202038,39,40.
Pregnancy outcomes examined were pregnancy loss (<24weeks gestation)41, gestational age at birth, expedited birth due to COVID-19, and mode of birth (spontaneous vaginal, operative vaginal, caesarean section prior to or during labour). The perinatal outcomes were stillbirth at 24weeks gestation41, preterm birth (<34weeks and 34+0 to 36+6 weeks gestation), neonatal unit admission, and neonatal death within 7days after birth.
Percentages and frequencies were computed by symptom group, and for symptomatic women by severity of infection, dominant variant, and vaccination status. Where data were missing, percentages are presented as the proportion of cases known.
Risk ratios (RR) with 95% confidence intervals (CI) for stillbirth, preterm birth and admission to neonatal unit for births to symptomatic women were computed using symptomatic mild infection during the wild-type period as the reference category with the lowest absolute risk. Since severity and variant were known risk factors, we included a preplanned interaction analysis to assess the combined effect of these factors2,4. Several models were run: models with dominant variant only (crude RR), disease severity only (crude RR), and severity and variant along with an interaction term for both (interaction without covariates (model 1)); adjusted for selected covariates without vaccination status (model 2); and adjusted for selected covariates and vaccination status using mild infection during the alpha period as reference (model 3). The covariates were selected based on availability of information and evidence from the literature3,42,43.
Multilevel Poisson or multinomial regression model as appropriate was used with random intercept to account for clustering effect among multiple births. The multivariable model for stillbirth was adjusted for maternal age, ethnicity, employment status, body mass index, plurality, smoking, parity, medical conditions prior to or during pregnancy and gestational age at admission. The preterm birth model included the above except gestational age at admission, and the model for neonatal unit admission was adjusted for gestational age at birth, parity, and medical conditions. Statistical analyses were performed using STATA version 18 (Statacorp, TX, USA).
Study registration number: (https://doi.org/10.1186/ISRCTN40092247)
Ethics approval: HRA NRES Committee East MidlandsNottingham 1 (Ref. Number: 12/EM/0365). Information about ethnicity was self-determined according to the UK standard census categories (List of ethnic groups)GOV.UK (ethnicity-facts-figures.service.gov.uk).
Rema Ramakrishnan, Hilde M Engjom, Nicola Vousden and Marian Knight analysed the data.
The study protocol was published at the study start and is available on the UKOSS website https://www.npeu.ox.ac.uk/ukoss/completed-surveillance/covid-19-in-pregnancy.
Further information on research design is available in theNature Portfolio Reporting Summary linked to this article.
Welcome to Long COVID Dispatches. In this blog, our goal is to keep you informed of the best and newest information on Long COVID. My name is Dr. Lisa Sanders, and Im an internist on the faculty of the Yale School of Medicine and the medical director of Yale New Haven Healths Multidisciplinary Long COVID Care Center.
I have the pleasure of working with a super-smart group of Yale MD/PhD students who will be writing many of the blog posts youll read here. They are fascinated by the science that continues to emerge from the study of this strange and often devastating post-infectious syndrome we call Long COVID. Our goal is to share with you the newest science, studies, treatments, and thinking about this illness, which is so often left in the wake of COVID-19. I edit this blog and will offer my insights at the end of each post.
From the earliest days of the pandemic, it was clear that COVID-19 was more than just an infectious disease that delivered all manner of suffering but then moved on, allowing those in its path to fully recover. Many people, once infected, remained ill long after any signs of the acute infection had resolved. It was for these individuals that this clinic was started.
The clinics true origins date back to the days when the first cases of Long COVID declared themselves. The Yale New Haven Health physicians who cared for patients with acute COVID-19 represented three subspecialtiespulmonology, cardiology, and neurology. They were the first to see that recovery for many patients was unexpectedly long and slow. Each medical group developed their own approach to helping these patients manage their symptoms. One year ago, I was brought in to help diagnose and treat the influx of patients now struggling with Long COVID symptoms.
Our patients and their wide range of symptoms are what drive us to learn as much as we can about the illnesses appearing after COVID-19. And seeing how quickly knowledge was accumulating about Long COVID, we were asked frequently by patients, How can we stay up to date? How can we know what is new and may be useful? So these patients were the stimulus for creating this blog.
We hope to post updates here every couple of weeks. If some dramatic news about Long COVID breaks, well also try to get a jump on it here. If you learn of some exciting news about Long COVID, please feel free to share it with us, and we will look into it and try to help spread the word. Send it to us here: LongCovidDispatches@yale.edu.
We are also interested in your stories. Tell us how COVID-19 affected you. Share how you are dealing with your Long COVID. We will post stories (using pseudonyms) that provide new insights or manifestations of this many-faceted, multidimensional disorder. (Send your stories here: LongCovidDispatches@yale.edu.)
As it turns out, Long COVID has lessons for us all. Working together to share our experiences, our knowledge, and our discoveries is one way to manage this unexpected remnant of the COVID-19 pandemic.
Read the first blog post.
Individuals with a history of COVID-19 infection had an increased risk for incident autoimmune inflammatory rheumatic disease (AIRD) compared with those without prior COVID-19 infection or with influenza infection, according to one study.
COVID-19 diagnostic test-Ralf-stock.adobe.com.jpeg
Findings from this binational, population-based study from South Korea and Japan were published in Annals of Internal Medicine.
We found increased risk for incident AIRD up to 12 months after COVID-19 diagnosis compared with influenza-infected and uninfected control patients, wrote the researchers of the study. Greater severity of acute COVID-19 was associated with higher risk for incident AIRD. Among modifiable factors, SARS-CoV-2infected patients who had prior vaccination against COVID-19 did not show increased risk for AIRD, with the exception of patients with severe COVID-19.
In this study, the researchers aimed to investigate the long-term risk for incident AIRD after COVID-19 infection over various follow-up periods. The researchers based their findings from 2 national, large-scale, population-based cohort studies from Korea (n = 10,027,506) and Japan (n = 12,218,680). Both studies included patients 20 years and older who had COVID-19 between January 1, 2020, and December 31, 2021.
Additionally, the researchers randomly selected uninfected individuals or patients with influenza, which has been associated with increased risk for autoimmunity and inflammation, between 2020 and 2021.
Patients with missing data on socioeconomic status, coinfection or reinfection with COVID-19 and influenza, or a history of AIRD were excluded from the study.
The primary outcome was AIRD, identified by at least 2 claims beyond the first 30 days after infection, at 1, 6, and 12 months after COVID-19 or influenza. Secondary outcomes included incident inflammatory arthritis, connective tissue disease, untreated AIRD, and treated AIRD after 30 days of COVID-19 or influenza infection.
The study revealed that between 2020 and 2021, 394,274 (3.9%) and 98,596 (0.98%) of South Koreans had a history of COVID-19 or influenza, respectively. The mean (SD) age of these individuals was 48.4 (13.4) years, and 50.1% were male. Among the Japanese participants, 1,002,525 (8.2%) and 121,543 (0.99%) had COVID-19 or influenza, respectively. They had a
Propensity score matching showed that beyond the first 30 days after infection, South Korean individuals with COVID-19 were at increased risk of AIRD compared with uninfected patients (adjusted HR, 1.25; 95% CI, 1.18-1.31) and influenza-infected patients (adjusted HR, 1.30; 95% CI, 1.02-1.59). Among individuals with moderate to severe COVID-19 events (n = 375), the risk was increased (HR, 1.42; 95% CI, 1.27-1.59).
Additionally, sex, age group, income level, history of respiratory infections, Charlson Comorbidity Index score, body mass index, smoking status, alcohol consumption, and aerobic physical activity also showed consistent results for the association between AIRD and Covid infection. Similar findings were observed for both the South Korea and Japan cohorts.
However, the researchers acknowledged some limitations to the study. Since the results were derived from an Asian population during the period before the arrival of the Omicron variant, the findings may not be generalizable to more recent variants or among different ethnic groups. Additionally, some AIRD outcomes were uncommon and may have led to imprecise estimates. Lastly, the researchers noted that scrutiny of patients with COVID-19 may have resulted in increased referrals and detection rates for AIRD compared with uninfected patients.
Despite these limitations, the researchers believe the study showed an increased risk for incident AIRD up to 12 months after infection.
Care strategies for patients who survive COVID-19 should pay close attention to manifestations of AIRD, particularly after severe COVID-19, wrote the researchers. COVID-19 vaccination was associated with reduced risk for incident AIRD after SARS-CoV-2 infection, except among those who had severe COVID-19 despite vaccination.
Reference
Kim MS, Lee H, Lee SW, et al. Long-term autoimmune inflammatory rheumatic outcomes of COVID-19. Ann Intern Med. 2024;177(3):291-302. doi:10.7326/m23-1831
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Researchers from the University of Liverpool and the University of Edinburgh have found evidence that shows that people with cancer face a higher risk of mortality from COVID-19 compared with those without cancer.
In a paper published in The Lancet Oncology, researchers show that during the pandemic, patients aged under 50 undergoing cancer treatment had the highest risk of in-hospital death compared to patients of the same age without cancer. Led by Professor Carlo Palmieri and Professor Lance Turtle, the study's findings show continued action is needed to mitigate the poor outcomes in patients with cancer.
One of the largest studies of its kind, it compared more than 6,500 cancer patients receiving treatment with more than 177,000 non-cancer patients. In all, 31.7% of cancer treatment patients died at 30 days, significantly more than for non-cancer patients, where 18% died 30 days after contracting COVID-19.
Significantly, the evidence shows that younger patients (<50 years) have the highest risk of mortality when compared to a non-cancer group of the same age. This higher risk of death is despite this age group being treated in the same way as other patients. For example, cancer patients aged under 50 were admitted to intensive care and ventilated just as often as patients without cancer of the same age.
The study set out to determine how various factors that influence the risk of death from COVID-19 might differently affect patients undergoing cancer treatment. The investigators found that the number of other heath conditions did not affect the risk of death from COVID in cancer patients, unlike patients without cancer.
Patients who were frail, on the other hand, were more likely to die from COVID if they were also having cancer treatment. Measures that hospitals routinely record to determine how sick patients are, were similar between patients with cancer and non-cancer patients, but despite this the cancer patients were still more likely to die.
The study also examined changes in hospital mortality during the first two years of the COVID-19 pandemic in the U.K. The death rate of patients in hospital fell in both cancer and non-cancer patients over this period. However, the rate of fall was not constant, and the situation for cancer patients improved more slowly overall.
The study found that deaths were always higher in cancer patients receiving treatment compared to patients without cancer. While deaths decreased in cancer patients over the pandemic they never reached the levels seen for patients without cancer. In addition, there were two periods when the difference in mortality between patients with and without cancer increased before decreasing.
Professor Carlo Palmieri, from the University of Liverpool and Clatterbridge Cancer Center NHS Foundation Trust said, "Cancer patients are at greater risk of death from COVID-19 than many other patient groups. However, how this risk has evolved during the pandemic remains unclear. This large-scale study helps us better understand these risks and illustrates that more action is neededfor example through optimizing vaccination, long-acting passive immunization, and early access to therapeutics.
"Further work is also now required to understand the differences seen between cancer patients receiving treatment and non-cancer patients, and how age, cancer type and treatment may have impacted on mortality or escalation of care, as well as the possible influence of vaccination and socio-economic factors."
Professor Lance Turtle, of the University of Liverpool, said, "This study underlines the fact that, while COVID-19 has become much less of a risk for most people, there are groups who are much more vulnerable to the effects of COVID-19. While the situation has improved for these groups, their risk has probably not gone back down to what it was pre-pandemic.
"For patients and doctors contemplating cancer treatment, or other treatments that suppress the immune system, the risk of COVID-19 remains a concern."
More information: Lance Turtle et al, Changes in hospital mortality in patients with cancer during the COVID-19 pandemic (ISARIC-CCP-UK): a prospective, multicentre cohort study, The Lancet Oncology (2024). DOI: 10.1016/S1470-2045(24)00107-4
Journal information: Lancet Oncology
An infection with the SAR-COV-2 virus does not increase the risk of asthma development in pediatric patients, according to data published in the journal Pediatrics.1 The study authors noted that the research could be useful in the prognosis and treatment of long-term respiratory effects of COVID-19 in children.
A SARS-CoV-2 infection does not increase asthma development risk in pediatric patients. / Microgen - stock.adobe.com
Respiratory virus infectionssuch as COVID-19are known to increase the risk of asthma development in children. Prior research has found that children who were hospitalized with COVID-19 had a higher incidence of chronic cough and asthma-like symptoms. However, there is currently a lack of data on the incidence of an asthma diagnosis in pediatric patients after a COVID-19 infection.
Investigators from the Childrens Hospital of Philadelphia conducted a retrospective cohort study to determine whether an infection with SARS-CoV-2 modified pediatric incident asthma risk. The study was funded by the National Institutes of Health and the Childrens Hospital of Philadelphia Research Institute.
During the early days of the pandemic, we could isolate the effects of COVID-19 from other viruses and follow these patients long enough to observe the onset of asthma, James P. Senter, MD, MPH, first author on the study, said in a release.2 We were also testing so frequently that we had a built-in control group to compare asthma symptoms and whether COVID-19 was a critical factor.
READ MORE: Novavax COVID-19 Vaccine Shows Lasting Protection Against Delta Variant
Data for the study was gathered from electronic health records from the Childrens Hospital of Philadelphia Care Network. The study cohort included 27423 patients aged between 1 and 16 who received a polymerase chain reaction (PCR) test for SARS-CoV-2 between March 1, 2020, and February 28, 2021. Study participants were required to have at least 1 ambulatory well child visit in the year prior to the PCR test and at least 1 visit any time during 18-months of follow-up after the first positive or last negative PCR test.
Of the study participants, 3146 were in the SARS-CoV-2 positive group and 24276 were in the negative group. Patients who tested positive were more likely to be older, Black, have a higher BMI, be insured by Medicaid, and were among lower childhood opportunity index quintiles. SARS-CoV-2 positive patients were also less likely to have food allergies but more likely to have allergic rhinitis.
Investigators found that 573 patients received an asthma diagnosis in the 18-month follow-up period. Of patients who tested positive for SARS-CoV-2, 1.81% were subsequently diagnosed with asthma, compared to 2.13% of SARS-CoV-2 negative patients. For most of the follow-up, patients with SARS-CoV-2 had a lower incidence of new asthma diagnosis compared to SARS-CoV-2 negative patients.
During the 18-month follow-up, a positive PCR test was not associated with an increased risk of new asthma diagnosis. Additionally, Black race, comorbid food allergy, and allergic rhinitis were associated with a significantly increased risk of new asthma diagnosis during the study period.
Study limitations included the use of data from only 1 institution, a reliance upon SARS-CoV-2 PCR test results for a 1-year exposure window, and using an exposure window that came before new variants of SARS-CoV-2. The investigators said that future studies should consider COVID-19 infection severity which may modify incident asthma risk in pediatric patients.
This well-powered study reaffirms risk factors we know contribute to asthma development and provides clinically useful information to pediatricians and providers on the absence of risk of developing asthma as a result of COVID-19, David A. Hill, MD, PhD, senior author on the study, said in a release.2 We are hopeful that this study will put to rest an outstanding question on the minds of many their families.
READ MORE: Infectious Disease Resource Center
The activist hedge fund Shah Capital blasted the leadership of Novavax for not leveraging concerns some people have about mRNA vaccines to boost sales of its own traditional, protein-based COVID-19 vaccine.
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The fund, founded and led by Himanshu H. Shah, called for an urgent shake-up of the companys board and suggested that the vaccine maker directly market its product to people who are unwilling to take mRNA vaccinesspecifically people over 60 and who live in southern U.S. states.
While there continues to be an elevated level of debate as to the root cause of these adverse mRNA reactions, a sizeable portion of our population has become afraid and is unfortunately making the decision to forego receiving a Covid vaccine, Shah Capital said in the letter, obtained by MarketWatch.
A survey of 1,500 Americans from the Annenberg Public Policy Center (APPC) at the University of Pennsylvania found that vaccine misinformation is on the rise.
In November, about 12% of respondents falsely believed that the mRNA COVID-19 vaccines cause cancer, up from 9% in January of that year.
For its part, Novavax said in a statement emailed to Quartz, We are confident that the actions we are taking are the right ones to drive long-term sustainable growth and create value for all our stakeholders. We welcome the perspectives of our shareholders and value their input on our strategy.
The U.S. Food and Drug Administration approved the use of Novavaxs COVID-19 vaccine in 2022, a year after approving Moderna and Pfizers mRNA shots.
Novavax sales and stock have tumbled in the years since. The companys revenue in 2023 fell 65% to $531 million, down from $1.5 billion in 2022. Its stock has dropped 55% over the past 12 months.
Limited COVID-19 vaccine usage has been dragging down other vaccine makers as well. In the U.S., only 14% of adults have received an updated 2023-2024 COVID-19 vaccine, according to the Centers for Disease Control and Prevention.
Moderna stock is down 27% over the past 12 months, while Pfizer stock fell 36% during the same period.
