Using US Census Bureau state unemployment insurance data, researchers from Johns Hopkins University documented a significant job turnover among healthcare workers (HCWs) during the COVID-19 pandemic, which suggests long-term implications for the US healthcare sector.
The study was published today in JAMA Health Forum and is based on data collected from January 2018 through December 2021. The researchers assessed job exit and entry data quarterly.
In quarter 1 of 2020, approximately 18.8 million people (14.6 million women [77.6%] and 4.2 million men [22.4%]) were working in the healthcare sector in the study sample.
Arkansas, Mississippi, and Tennessee were not included in the study.
In 2018, the average healthcare worker exit rate per quarter was 5.9 percentage points. In the first quarter of 2020 it climbed to 8.0 percentage points (95% confidence interval [CI], 7.7 to 8.3).
Though quarter 1 of 2020 saw the highest exit rate, the percentage remained high throughout the study period, with an exit rate of 7.7 (95% CI, 7.4 to 7.9) percentage points in quarter 4 of 2021.
Reasons for exiting the healthcare workforce differed across the study period. In quarters 1 and 2 of 2020, most workers exited the job and entered unemployment. By late 2021, the reason was to switch to a different job sector.
In 2020, 5.7 percentage points were attributable to people exiting into nonemployment compared with a baseline mean of 3.2 percentage points per quarter in 2018, a 78% increase, the authors noted.
In quarter 4 of 2021, the last quarter assessed, the exit rate of healthcare workers into unemployment was 4.0 percentage points (95% CI, 3.8 to 4.3), a 25% increase from baseline, and the exit rate into a non-healthcare sector was 3.6 percentage points (95% CI, 3.5 to 3.7), a 38% increase, the authors found.
By the end of 2021, there were an increase in entrants to the healthcare sector. However, the entry into the sector came mostly from unemployed workers, suggesting that healthcare organizations after the pandemic subsided are operating with more staff with less experience than in the prepandemic period, the authors note.
In 2020, states in the Northeast region saw the greatest increases in health care worker exit rates.
The investigators also found geographical differences in exit rates. In the early part of the pandemic, more New England states reported exit due to nonemployment. In 2021, the exit due to unemployment increased in the South and West.
"In 2020, states in the Northeast region saw the greatest increases in health care worker exit rates vs their prepandemic mean values, comprising 8 of the top 10 states with the largest increases in health care worker exit rates," the authors wrote.
Overall, the study findings suggest workforce turnover may pose "substantial costs for both organizations and patients, as it implies potentially disrupted continuity of care and fewer staff with industry- and firm-specific experience," the authors concluded.
Jacqui Wise reports on further evidence from witnesses in Scotland, with experts and the current first minister taking the stand this week
Previously (19 January) the inquiry heard that Jason Leitch, Scotlands national clinical director, had messaged a colleague that, WhatsApp deletion is a pre-bed ritual.1 Giving evidence on 23 January, Leitch said that his message was slightly flippant and an exaggeration.2 He said the record retention policy was that you could use informal messaging systems for Scottish government business but that any advice or decisions should be recorded by email or in a briefing document and then the informal messaging could be deleted. Giving evidence on 25 January, Humza Yousaf, former health secretary and now first minister, told the inquiry he used personal phones rather than a government device for WhatsApp messages during the pandemic.3 He said he deleted messages but was able to recover some from an old handset which he handed over to the inquiry. He confirmed there would be an external review into the use of WhatsApp and non-corporate technology in the Scottish government.
Leitch said as the country reopened there was ambiguity around mask wearing. He said he had the impression that hardly anyone followed the rules about masking when standing up during a meal, at the time when dining was allowed unmasked. He told Yousaf in a message, Officially you should wear a mask but literally no one does. Have a drink in your hand at all times. Then youre exempt. So if someone comes over and you stand, lift your drink. He said he understood the rules but the reality of life suggests this guidance was nuanced rather than entirely right.
Devi Sridhar, chair of global public health at the University of Edinburgh, said the UK had had time to learn from other countries and from what had happened on the Diamond Princess cruise ship but had failed to do so. Giving evidence on 23 January, she said Ebola had caused lockdowns and school closures in West Africa in 2014 so in those countries such measures did not feel like a crazy idea. But Sridhar said that there was a sense of complacency across high income countries: Well, well be fine because we always are, and this is a low income issue and it wont come here. She said, There was a lack of humility in terms of learning from the experience of teams in countries such as Senegal and South Korea who had worked day to day to manage infectious diseases.
Sridhar, who became a member of the Scottish governments covid-19 advisory group in April 2020, told the inquiry she thought the UK had moved too quickly from containment to mitigation. That pivot happened too early, given that other countries were showing that containment was possible. She argued that Britain got stuck because it spent a long time discussing whether testing would make a difference outside of hospitals. There was that feeling that testing was for poor countries. We can treat our way through this. We have a health service. She said the UK was slower than other countries in buying the reagents for testing and setting up testing systems. She also said that borders should have been better controlled, such as in Australia and Norway, to control the influx of cases. Other countries also moved more quickly in adopting face coverings. Sridhar also said the Scientific Advisory Group for Emergencies was incredibly secretive in terms of who was on the committee and what evidence they had. In the case of a pandemic, transparency should have been much better.
Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh and a member of the Scottish governments covid-19 advisory group, told the inquiry that medical advisers were not listening to his warnings in the early months of 2020.4 He had sent an email in January 2020 warning that the health system would become overwhelmed within a year if action was not taken but felt that medical advisers to the government froze when confronted with the data. Giving evidence on 24 January he said he was frustrated that a detailed report into the management of influenza in Scotland in 2009-10 had not been acted on. This had made a series of recommendations including the need for mechanisms of obtaining, sharing, and analysing data which should be ready to go should another pandemic arise. He said the advice not to bother the NHS unless it was absolutely necessary led to thousands of deaths across the UK and probably hundreds in Scotland. Most of the hospitals in Scotland had their quietest time in living memory during the first lockdown because no one else was going to hospital.
The inquiry was shown messages in which Nicola Sturgeon, the former first minister, described Boris Johnsons announcement about a second covid lockdown in England as fucking excruciating.5 In messages to Liz Lloyd, her former chief of staff, Sturgeon said, His utter incompetence in every sense is now offending me on behalf of politicians everywhere. She added, He is a fucking clown. Lloyd was asked if the relationship between Sturgeon and Johnson had broken down and replied, I think broken down overstates what was there to break. She said previously there was politeness between the two leaders but the relationship became much harder during the pandemic. She said there was better communication between the two governments, particularly on health, but that discussions with the prime minister didnt get us anywhere. Sturgeon is to give evidence to the inquiry next week.
by Timothy McQuiston, Vermont Business Magazine COVID-19 cases and hospitalizations fell last week after a long period of edging higher since last summer. Cases and hospitalizations were both down about 20 percent from the week. Hospitalizations are about what they were last winter. Fatalities have not seen a related spike nor decline. There were 6 deaths reported by the Vermont Department of Health last week and 6 the week before, for a pandemic total now of 1,100 as of January 13, 2024 (the most recent data available). Deaths have been running at about that level for several months.
The VDH reported January 17, 2024, that COVID-19 hospitalizations were down 9 last week to a statewide total of 50. COVID-19 activity remains in the "Low" range, according to the VDH. Reported cases last week were 365, down 90 for the week.
VDH reported 15 COVID-related deaths in March, 20 in April, 10 in May, 10 in June (these are fewest since the summer of 2021), 11 in July, 15 in August, 17 in September, 25 in October, 19 in November and 15 in December and 5 so far in January 2024 (there were 33 in October 2022 and 47 in October 2021 and zero in October 2020, which was the last month since the beginning of the pandemic to record no COVID-related fatalities).
Of the total deaths to date, 884 have been of Vermonters 70 or older. There have been 3 deaths of Vermonters under 30 since the beginning of the pandemic.
CDC states that already an estimated 97% of Americans have some level of immunity, from either vaccination or infection or both, which they said will help keep down new transmission and lessen serious outcomes.
New COVID-19 variant JN.1: Experts explain symptoms, how to spot and treat the new strain
(see data below)
Report Timeframe: January 7 to January 13, 2024
The hospitalizations dataset contains day-level data reported from all Vermont hospitals each Tuesday. Reported numbers are subject to correction.
The number of reportable COVID-19 cases is still available in this report, below. Laboratory-confirmed and diagnosed COVID-19 cases and COVID-19 outbreaks must still be reported to the Vermont Department of Health.
There were 3 outbreaks last week, 2 at schools, and 1 at long-term care facilities (LTC). There were 10 outbreaks the week before.
Vermont Department of Health recommendations: Preventing COVID-19 (healthvermont.gov)
Vermont has the second lowest fatality rate in the US (127.3 per 100K; Hawaii 102.2/100K). Mississippi (439/100K) and Oklahoma (436.7/100K) have the highest rates. The US average is 292.8/100K (CDC data).
There has been a total of 1,169,666 COVID-related deaths to date in the US (CDC) and 7,012,986 globally (WHO).
Following an analysis of COVID-19 data, the VDH reported in January 2023 a cumulative 86 additional COVID-associated deaths that occurred over the course of the pandemic but had not been previously reported. Most of those deaths occurred in 2022.
COVID-19 Update for the United States
Early Indicators
Test Positivity
% Test Positivity
11.8%
(January 7 to January 13, 2024)
Trend in % Test Positivity
-1% in most recent week
Emergency Department Visits
% Diagnosed as COVID-19
2.5%
(January 7 to January 13, 2024)
Trend in % Emergency Department Visits
-19% in most recent week
These early indicators represent a portion of national COVID-19 tests and emergency department visits. Wastewater information also provides early indicators of spread.
Severity Indicators
Hospitalizations
Hospital Admissions
32,861
(January 7 to January 13, 2024)
Trend in Hospital Admissions
-9.6% in most recent week
Deaths
% of All Deaths in U.S. Due to COVID-19
4.3%
(January 7 to January 13, 2024)
Trend in % COVID-19 Deaths
+10.3% in most recent week
Total Hospitalizations
6,727,163
CDC | Test Positivity data through: January 13, 2024; Emergency Department Visit data through: January 13, 2024; Hospitalization data through: January 13, 2024; Death data through: January 13, 2024. Posted: January 22, 2024 3:33 PM ET
The Delta variant took off in August 2021, which resulted in the heaviest number of deaths before vaccines and their boosters helped alleviate serious COVID cases. Multiple Omicron variants are now circulating and appear more virulent than previous variants, but perhaps not more dangerous, according to the CDC.
AP April 5, 2023: WHO downgrades COVID pandemic, says it's no longer a global health emergency
Walk-in vaccination clinics run by the state closed on January 31, 2023. Learn more
Vermonters are reminded that all state COVID testing sites were closed as of June 25, 2022. PCR and take-home tests are available through doctors' offices, pharmacies and via mail from the federal government. The federal government officially ended its pandemic response as of May 11, 2023. See more information BELOW or here: https://www.healthvermont.gov/covid-19/testing.
Starting May 11, 2023, the CDC and Vermont Department of Health will no longer use the COVID-19 Community Level to measure COVID-19 activity in the U.S. and Vermont. Instead, Vermont's statewide COVID-19 level will be measured by the rate of COVID-19 in people being admitted to the hospital, per 100,000 residents.
Focusing on hospitalization data is a better estimate of how COVID-19 is impacting the community now that reported COVID-19 cases represent a smaller proportion of actual infections. This also allows us to compare Vermonts hospitalization levels with other parts of the country.
The Delta variant caused a surge in COVID-related fatalities last fall and into the winter.
The highest concentration of deaths was from September 2021 through February 2022. Overall, December 2020 and January 2022 were the worst months with 72 fatalities each.
The US confirmed its first case of COVID-19 on January 20, 2020.
Vermonters ages 6 months and older are eligible for COVID-19 vaccines. Getting vaccinated against COVID-19 is the safer way to build protection from serious illnesseven for those who have already had COVID-19. Learn more about COVID-19 vaccines (CDC)
COVID-19 vaccines are free and widely available. Anyone can get vaccinated in Vermont, including those who live in another state, are non-U.S. citizens, or who have no insurance. See Vermont's current vaccine rates
Know your rights when getting free vaccines.
You are considered up-to-date if you are over the age of 6 years old and have received a bivalent (updated) COVID-19 vaccine.Learn more about kid vaccines
If you are unable or choose not to get a recommended bivalent mRNA vaccine, you will be up to date if you received the Novavax COVID-19 vaccine doses approved for your age group.
Find more on recommended doses from CDC
COVID Vaccine Information for Health Care Professionals
More on COVID-19 Vaccines (CDC)
Recommended COVID Vaccine Doses (CDC)
Find a COVID-19 vaccine near you.
Image
Use Vaccines.gov to find a location near you, then call or visit the location's website to make an appointment.
Vaccines.gov
Everyone 6 months of age and older is eligible to get a COVID-19 vaccination.Most children are also now eligible for a bivalent dose that offers increased protection against the original strain and omicron variants.
See more on recommended vaccine doses by age group (CDC)
Resources for parents and caregivers
https://www.vermontfamilynetwork.org/ccfk/
Tips for Helping Kids Feel Ready for Any Vaccine (Vermont Family Network)
#factsheet
What Families with Children Should Know About COVID-19 Vaccines (translated)
https://www.youtube.com/watch?v=lWcqHOgQIVg&t=5s
Conversations About COVID-19 Vaccines for Children with Vermont Pediatricians (American Academy of Pediatrics)
If you cannot get vaccines through any of the options above, our local health offices
offer immunization clinics by appointment.
Need a ride? If you do not have transportation to get a free COVID-19 vaccine or booster, please contact your local public transportation provider or callVermont Public Transportation Association (VPTA)
at 833-387-7200.
English language learners, or immigrant or refugee community members, who would like to learn about more about vaccine clinics can contact theAssociation of Africans Living in Vermont
(AALV) at 802-985-3106.
If you lost your vaccine card or your information is wrong:
Recommendations for keeping your vaccination card and record up to date
Find more COVID-19 translations
COVID-19 resources for people who are deaf and hard of hearing
Report your COVID-19 test results
In a recent study published in Nature Cardiovascular Research, researchers review the cardiovascular effects of long coronavirus disease 2019 (COVID-19).
Post-COVID-19, which is also referred to as long COVID and post-acute sequelae of COVID-19 (PASC), is a novel condition affecting 10-60% of COVID-19 survivors, which amounts to 70-420 million individuals throughout the world. Long COVID is characterized by the persistence or, in some cases, development of novel symptoms following recovery from COVID-19.
The World Health Organization (WHO) and United States Centers for Disease Control and Prevention (CDC) estimate that long COVID symptoms can persist for months or even years following initial infection recovery, thereby resulting in significant loss of quality of life (QoL) for affected individuals.
Since 2020, over 23,000 publications on long COVID have been released. Despite the increased focus on the prevalence and definition of the condition, some studies have aimed to understand the pathophysiology and underlying mechanisms of the disease, with the shared aim of discovering a cure.
Significant progress notwithstanding, a targeted treatment for long COVID remains elusive. Thus, synthesizing the rapid scientific progress in post-COVID-19 research will both highlight recent advances and underscore critical gaps in the literature.
Despite being a predominantly respiratory condition, a growing body of evidence reports the systemic effects of COVID-19. This feature is shared by long COVID, with over 20 symptoms identified to date across respiratory, cardiovascular, neurological, gastrointestinal, and endocrine systems. Common nonspecific complaints include dizziness, fatigue, and memory loss.
Due in part to the novelty of the condition, clinical diagnostic tests for post-COVID-19 syndrome remain theoretical. As a result, the National Institutes of Health Researching COVID to Enhance Recovery (RECOVER) Initiative 12-symptom checklist is the current gold standard in long COVID diagnosis.
Recent cardiovascular-focused research has devised cardiovascular-centric guidelines, including the American College of Cardiology practice guideline document.
Although the cardiovascular complications of the post-COVID-19 condition are highly publicized, the sequelae from this virus are not particularly unique. Cardiovascular effects including myocarditis have been long described following other viral illnesses such as influenza and Epstein-Barr virus. However, the mortality rate and incidence of vascular complications is far greater in COVID-19."
Long COVID is confirmed through various clinical tests including complete blood counts, basic metabolic panel, troponin, C-reactive protein, and pro-brain natriuretic peptide levels, electrocardiograms (ECGs), and echocardiograms. In severe cases, magnetic resonance imaging (MRI) and chest X-rays may be used.
Long COVID-associated cardiovascular pathophysiology can be classified as immune dysregulation and inflammation, endothelial dysfunction, microvascular injury, and neurological signaling dysfunction. Two main long COVID phenotypes have been identified, of which include overt cardiovascular disease after COVID-19 (PASC-CVD) and those with cardiovascular symptoms despite lacking clear disease markers (PASC-CVS).
PASC-CVD patients are often older and are at an increased risk of endothelial dysfunction, inflammation, and microvascular injury. Comparatively, PASC-CVS patients are typically younger and at a greater risk of neurological signal dysfunction and immune dysregulation.
The mechanisms responsible for the cardiovascular effects of long-COVID can be immediate through direct cytotoxic injury or delayed, which is attributed to a cascade of immune-overstimulation-mediated responses.
Postural orthostatic tachycardia syndrome (POTS) is one of the most commonly researched cardiovascular symptoms and is characterized by a sudden increase in one's heart rate when transitioning between sitting, lying down, and standing. POTS was identified at the beginning of the COVID-19 pandemic, with the highest prevalence in the PASC-CVS phenotype.
The most common test for POTS is a head-up tilt-table test (HUTT); however, several studies have found that many POTS patients remain undetected by HUTT. As a result, POTS prevalence estimates may be severe underestimates.
Myocardial injury is another common characteristic of post-COVID-19, which, unlike POTS, has clear biomarker evidence of its prevalence through the troponin test. Myocardial injury is also much better characterized, as it arises both from general critical illness outcomes of acute COVID-19 like hypoxemia and shock, as well as from cardiac structural pathology.
Recent studies have elucidated the role of COVID-19 in causing myocardial injury through hypercoagulability. Subsequently, myocardial injury increases the risk of heart failure and myocarditis.
Arrhythmias, or irregular heartbeat, have been identified through their comorbidities, including inflammatory cytokine release, myocardial scarring and fibrosis, persistent immune dysfunction, and potential gap junction dysfunction.
While no curative therapies for long COVID have been identified, long COVID cardiovascular symptoms can be managed on a symptom-by-symptom basis. These interventions are often based on routine cardiovascular care with generally beneficial outcomes.
Advances in post-COVID-19 diagnostic tests, which are currently under development, must be fine-tuned to better inform policymakers and clinicians. Additional progress is also needed to identify long COVID-associated cardiovascular risk factors. The development of novel therapeutic interventions to treat the entire condition of long COVID is also crucial, rather than managing each of its numerous symptoms individually.
Large-scale longitudinal studies are needed to better understand the medium-term and long-term implications of the post-COVID-19 condition."
Journal reference:
January 23, 2024
2 min read
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Risks for adverse outcomes associated with COVID-19 at delivery stayed high during the omicron variant window, despite possible immunity from previous SARS-CoV-2 infection, vaccination or testing differences, researchers reported.
If you are pregnant or planning pregnancy, it is important to stay up to date with COVID-19 vaccinations to reduce the risk of getting very sick and experiencing problems from COVID-19 and to protect the health of your baby, Jeffrey Carlson, PhD, an epidemiologist at the CDCs National Center on Birth Defects and Developmental Disabilities, told Healio. Although studies have suggested less severe outcomes during omicron compared to prior variant periods, the risk of complications for pregnant women with COVID-19 remained elevated during the omicron period compared with pregnant women without COVID-19.
Carlson and colleagues conducted a cross-sectional observational study assessing data from 2,990,973 U.S. women with delivery hospitalizations from the Premier Healthcare Database from February 2020 to August 2023. Researchers categorized February 2020 to June 2021 as the pre-delta period, July to December 2021 as the delta period and January 2022 to August 2023 as the omicron period. COVID-19 exposure was identified via diagnostic code during delivery hospitalization.
Overall, 1.9% of women in the study had COVID-19 at delivery hospital admission discharge. Of these, 20,031 women had COVID-19 at delivery during the pre-delta period, 10,534 during the delta period and 26,053 during the omicron period.
Compared with pregnant women without COVID-19, those with COVID-19 had significantly higher prevalence of adverse maternal and pregnancy outcomes during delivery across all variant periods, according to researchers.
Women with COVID-19 at delivery during the omicron period had significantly increased risks for maternal sepsis (0.4% vs. 0.1%; adjusted prevalence ratio = 3.32; 95% CI, 2.7-4.08), acute respiratory distress syndrome (0.6% vs. 0.1%; aPR = 6.19; 95% CI, 5.26-7.29), shock (0.2% vs. 0.1%; aPR = 2.14; 95% CI, 1.62-2.84), renal failure (0.5% vs. 0.2%; aPR = 2.08; 95% CI, 1.73-2.49), ICU admission (2.7% vs. 1.7%; aPR = 1.64; 95% CI, 1.52-1.77), mechanical ventilation (0.3% vs. 0.1%; aPR = 3.15; 95% CI, 2.52-3.93), in-hospital mortality (0.03% vs. 0.01%; aPR = 5; 95% CI, 2.3-10.9), stillbirth (0.7% vs. 0.6%; aPR = 1.17; 95% CI, 1.01-1.36) and preterm delivery (12.3% vs. 9.6%; aPR = 1.28; 95% CI, 1.24-1.33) in adjusted models compared with women without COVID-19.
These data only included COVID-19 infections at delivery, so more information is needed about the potential impacts of COVID-19 infections earlier in pregnancy, Carlson said. These findings underscore the importance of continued surveillance, research and monitoring of maternal, pregnancy and infant outcomes as new variants emerge.
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Disclosures: Carlson reports having previously owned Moderna stock. Please see the study for all other authors relevant financial disclosures.
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Over the past month, global COVID-19 cases rose slightly, with a steady drop in deaths from the virus, the World Health Organization (WHO) said in its latest monthly update.
However, the group cautioned about interpreting the data, given that less than half of countries reported their COVID metrics during the latest reporting period, which covers December 11, 2023, to January 7.
"According to estimates obtained from wastewater surveillance, clinical detection of cases underestimates the real burden from 2 to 19-fold," the WHO said.
In the final week of 2023, the JN.1 variant made up 65.5% of sequences, up sharply from 24.8% the month before.
In its analysis of regional trends, the WHO said cases rose in two regions. Numbers were up sharply in the South East Asia region, with a more modest increase in the Western Pacific region. In South East Asia, countries reporting some of the highest increases were India and Indonesia. JN.1, part of the BA.2.86 family, became dominant in India in the first week of January.
Meanwhile, in the Western Pacific region, Malaysia and Singapore reported the biggest case rises. Information on Malaysia's health ministry website show that cases in the current wave peaked just before Christmas and are declining steadily. Singapore's health ministry data show a similar pattern.
Deaths declined or remained stable across five of WHO's regions, with only South East Asia reporting a rise, which was sharp. The region's highest numbers were from India, Indonesia, and Thailand.
The WHO closely monitors hospitalizations and intensive care unit (ICU) indicators to look for any changes in illness severity. Very few countries regularly report their hospitalizations and ICU admissions for COVID. Of 22 countries that do, 36% saw a 20% or more rise in hospitalizations over the past month, which included Indonesia, Malta, Brunei Darussalam, Malaysia, Greece, Singapore, the United States, and Ireland.
And of 18 countries regularly reporting ICU data, 44% reflected a rise of 20% or more in admissions for COVID. They include Indonesia, Malaysia, Singapore, Estonia, Ireland, the Netherlands, Greece, and the Czech Republic.
As part of severity monitoring, the group also tracks ICU-to-hospitalization and death-to-hospitalization ratios, which it said are still subject to the same incomplete reporting constraints. The WHO said ICU-to-hospitalization ratios have been decreasing since the peak in July 2021, with a stable trend in recent weeks.
The death-to-hospitalization ratio has also been declining since July 2021, and since January 2023 has remained under 0.15. "This is an encouraging trend indicating a lower mortality risk among hospitalized individuals," the WHO said. It said multiple factors may be responsible, including infection- or vaccine-derived immunity, earlier diagnosis and treatment, and reduced strain on health systems.
Also, the WHO included a caveat that it's not possible to saybased on ratio tracking-if the newer SARS-CoV-2 variants are less virulent.
January 26, 2024
By Audrey Smith
Ralph S. Baric, PhD, began studying coronaviruses decades before the COVID-19 pandemic hit. There is still much to learn about this family of viruses, and the Baric Lab remains among the worlds leaders in coronavirus research, exploring questions like Where did COVID-19 originate? and developing treatments for future coronaviruses.
Baric, who is the William R. Kenan, Jr. Distinguished Professor of epidemiology at the UNC Gillings School of Global Public Health, was senior author on two recent coronavirus research papers. The first, published in the journal Nature Microbiology, investigated a pangolin SARS-CoV-2-like virus, including its biological capabilities, ability to elicit an immune response and ability to transmit between species. The second, published in the journal Science Translational Medicine, sought to identify broad therapeutics that can treat future outbreaks of MERS-CoV (the coronavirus that causes Middle East respiratory syndrome) and other similar coronaviruses.
Our understanding of the way that animal coronaviruses spill into human populations is incomplete and only partially understood. Some researchers have always argued that the SARS-CoV-2 virus which causes COVID-19 began in bats and then was transmitted to a key intermediate host species, where strains of the virus circulate and mutate, allowing it to be transmitted to humans. In this theory, the intermediate reservoir host species, in which the virus circulated freely and evolved, was critical to explaining how viruses spread into human populations. Yet, a reservoir species with a circulating virus has not been discovered.
Baric and team, however, believed that some zoonotic SARS-like viruses have the intrinsic properties necessary to replicate and transmit easily between multiple mammalian host species, eliminating the need for a reservoir species.
In the paper recently published in Nature Microbiology, Baric and team examined whether the SARS-like coronavirus found in pangolins, small mammals that are often called scaly anteaters, carries these intrinsic properties. The pangolin coronavirus is closely related to SARS-CoV-2, but it has never infected people.
Dr. Ralph Baric
We want to understand how viruses move between species because this information helps to establish research priorities that are designed to protect global health, Baric said. For example, this information can identify hosts and environments that inadvertently promote virus jumping between species, providing us with the knowledge to identify and regulate high-risk environments, like open markets in dense population centers. The information helps to minimize the threat potential by informing the development and testing of diagnostics that can find early cases, and identifying broadly acting countermeasures that are effective. As a consequence, both the public health and medical communities will be positioned to rapidly implement intervention and treatment strategies in an emerging outbreak setting, saving lives.
The team reconstructed the pangolin coronavirus using the genome length sequences for pangolin coronaviruses that had been reported in previous studies. The studies were performed under stringent containment conditions in the laboratory, and the pangolin virus was found to efficiently use the same receptor protein from more than 20 species of mammals, including pangolins, humans, mice and hamsters. They also found that the virus grew at similar numbers as SARS-CoV-2, it could naturally be transmitted between hamsters, and it was killed by the existing monoclonal antibodies, antiviral drugs and vaccines that target the original SARS-CoV-2 strain.
As the virus could transmit between non-reservoir hosts, the data argues that a reservoir species is unnecessary and that some SARS-like animal viruses have the intrinsic capabilities to infect and transmit naturally across multiple species without setting up a large reservoir. SARS-CoV-2 also readily transmitted between deer, mink and humans. This intrinsic capability to transmit across species potentially explains how SARS-CoV-2 emerged to cause the COVID-19 pandemic and why researchers have yet to identify this hypothetical reservoir host.
Most United States citizens think that the COVID-19 pandemic is over and done, but we disagree, said Baric. Our data suggests that zoonotic coronavirus emergence events will accelerate throughout this century and that we need to remain aware and prepared with things like state-of-the-art diagnostic tests, global surveillance systems in place to catch these events early, and a supply of broadly effective antiviral drugs and vaccines to protect the public.
Over 1 million people died before the first countermeasure was available to treat COVID-19. To save lives during future coronavirus outbreaks, broad-based drugs and vaccines capable of providing an immediately available treatment are needed for global health preparedness.
In a paper recently published in Science Translational Medicine, Baric and team were the first to study the bat coronavirus BtCoV-422, which is similar to MERS-CoV. MERS-CoV is a coronavirus that emerged in 2012, causes Middle East respiratory syndrome, has a 35% mortality rate in humans and is still circulating at low levels in the Middle East and East Africa.
The team investigated whether antibodies that neutralize MERS-CoV and antivirals that inhibit SARS-CoV-2 would provide effective treatment strategies against this important group of MERS-like viruses.
The team analyzed the potential range of hosts that the MERS-like BtCoV-422 virus could infect by investigating its ability to use DPP4 entry receptors from multiple species, including humans, and its reliance on external proteases. The MERS-like virus was found to have broad host range potential, and BtCoV-422 replicated efficiently in multiple primary human cells, including airway epithelia, lung fibroblasts and lung endothelial cells. The data also indicated that BtCoV-422 has crossed multiple barriers that typically impede coronavirus emergence potential in humans, such as infectivity in human cells and the efficient use of human entry receptors. However, the virus has reduced growth potential in the human upper respiratory tract, which suggests that further mutations would be required for this virus to threaten human populations.
The researchers then tested current therapeutic countermeasures, including drugs, monoclonal antibodies (mAbs) and vaccine-elicited murine serum, and structurally characterized a group 2c CoV (also known as betacoronavirus) broadly cross-reactive epitope, all with the hope of informing future coronavirus global health preparedness strategies. Importantly, several SARS-CoV-2 drugs approved by the Food and Drug Administration (FDA) and one highly potent MERS-CoV human monoclonal antibody, JC57-11, potently neutralized BtCoV-422, providing ready countermeasures for future use. The virus replication was also potently inhibited by antivirals such as remdesivir and nirmatrelvir. This means that multiple therapeutics that have already been approved for use against SARS-CoV-2 by the FDA are ready for immediate testing against MERS-related viruses, providing several different and immediate treatment strategies for patients in an outbreak setting.
The teams findings also support the hypothesis that these drugs should be evaluated in the context of early treatments for MERS-CoV infection. If approved, these drugs would be valuable tools to treat people experiencing new SARS- and MERS-like coronavirus infections.
Its vitally important that we have broad therapeutics immediately available to treat new emerging viruses, said Baric. We had done extensive studies that had shown that both remdesivir and molnupiravir were highly potent broad-spectrum coronavirus drugs, years prior to the emergence of COVID-19. In fact, thats why these drugs were so quickly approved for human use. We know that there will be other zoonotic coronaviruses that infect and emerge to cause serious diseases in human populations and we need multiple broad-based drugs that can be accessed immediately if were going to protect the health of future populations. We also need effective policies that control ecologic settings for zoonotic virus emergence, like closing open markets and preventing the illegal trade of wildlife.
Importantly, MERS-422 and the pangolin SARS-like coronavirus are being used to demonstrate the performance and breadth of broadly protective vaccines that protect against zoonotic, epidemic and pandemic SARS and MERS-related viruses that threaten human populations. The teams ongoing studies have already contributed to the development of pan-coronavirus vaccine products that are moving toward human clinical research studies.
Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.
Get the latest COVID-19 news from infectious diseases expert Mark Rupp, MD, including COVID-19 case rates, types of variants circulating and vaccine updates.
There are currently more than 20,361 patients hospitalized in the United States per week, with 14% of those being ICU patients. The most recent data on the test positivity rate is from the week ending January 13, which was 11.8%. When test positivity is above 5%, transmission is considered uncontrolled.
Since many are using home tests that are not reported through public health or are not testing at all, the official case counts underestimate the actual prevalence of COVID-19.
Currently, the dominant variant nationwide is JN.1, with 61.6% of cases, followed by HV.1, with 14.8% of cases, and JD.1.1, with 4.1% of cases. "The original omicron variant is gone now," says Dr. Rupp. "Currently subvariants of omicron are circulating, including EG.5, XBB.1.16.6, and FL.1.5.1."
In the week ending January 13, 2024, there were 6,638 COVID-19 tests performed in Nebraska, with 767 positive results. This is a 11.6% positivity rate, down 2% from the week prior.
When you receive a COVID-19 test, you won't find out which variant caused your infection. That's because COVID-19 tests only detect the presence of the virus they don't determine the variant.
Genomic sequencing looks at the genetic code of the virus to determine which variant caused the infection.Sequencing results are used by public health experts to understand variant trends in the community.
The best way to prevent new variants is to slow the spread of the virus. The great news is that these proven public health strategies continue to work against new variants as well.
"We have a lot of disease out there. People should continue to be careful," Dr. Rupp says. "Get the bivalent booster, try to avoid high-risk settings. If you can't, then I think you should wear a mask."
The U.S. Centers for Disease Control and Prevention recommends everyone 6 months and older get updated COVID-19 vaccines this fall.Vaccination remains the best protection against COVID-19-related hospitalization and death.
Our pharmacies offer COVID-19 vaccines on a walk-in basis. View which vaccines are available at each location.
Covid-19 and influenza cases are rising in Chicago and around the country, causing some strain on local hospitals.
At the University of Chicago Medical Center, "We've seen a progressive rise over the past two months, with ever increasing cases, both in the clinics, in our employees and in hospitalized patients, said Dr. Emily Landon, the centers executive medical director for infection prevention and control. It was similar to what we were seeing at the peak of last year.
That, plus the patients with flu, its just really rough right now, added Landon, who currently has Covid-19. Landon came down with the sickness despite taking extra precautions for her rheumatoid arthritis, an autoimmune disease.
According to data from the Chicago Department of Public Health (CDPH), as expected, test positivity cases began to increase in the fall, from about 6% positivity throughout October to a peak of 12% positivity by the end of December. That same week, about 1,013 people were admitted to the hospital for Covid-19 complications an increase of about 700 people from October.
In the midst of cold and flu season, Covid-19 is leading hospital admissions for respiratory viruses, according to the Centers for Disease Control and Prevention (CDC).
Meanwhile, test positivity for Covid-19 cases sits at 8.3% as of Jan. 26. After remaining relatively stable at about 6%, throughout October (up from 2% to 4% over the summer), it started to increase in November. The rate of positive tests peaked the week of Dec. 29, with 12% positivity. (Landon noted that test positivity rate can be unreliable, given that only patients exhibiting respiratory symptoms are tested.)
Regarding patients symptoms, Landon said the hospital is seeing a lot of congestion, lots of sore throats, a lot of co-infection with group A strep, as well as influenza cases.
Were also seeing people who arent testing positive for any of those, and who have just some other virus, making people feel pretty sick and miserable, she added.
According to CDC data, the most prevalent strain of the virus for most of the Midwest is JN.1, a subvariant of Omicron first detected by the World Health Organization in August. It is not said to be any more severe than previous iterations of the virus.
Nearby, Provident Hospital is seeing a similar surge in Covid-19 and flu cases.
This year is the first year in the past few where weve had a true influenza season, said Dr. Jonathan Martin, an infectious disease physician with Cook County Health. Influenza cases have been going up after the holidays.
He added that Provident is also seeing people present with exacerbations of a chronic condition, like asthma or kidney disease.
Per the citys most recent Influenza and Respiratory Virus Weekly Surveillance Report, for the week ending Jan. 13, Chicagos test positivity rate was 9.9%.
Per city reports, more than 20 cases of influenza-associated ICU hospitalizations occurred every week for the last four weeks. Thats more than half of the 174 influenza-associated ICU hospitalizations that have been reported since Oct. 1.
This latest surge, health officials say, is due in part to the low number of vaccinated Americans. Per city data, only 13.8% of Chicagoans have received the most recent booster, which arrived at local pharmacies in September.
The most recent boosters from Pfizer-BioNTech, Moderna and Novavax are all expected to help lower the chances of serious illness and hospitalization from JN.1.
CDPH still recommends vaccination as the best way to protect against infection, and encourages all Chicagoans six months and older to get their annual influenza shot and the updated Covid-19 booster.
Landon said that going forward, people should expect to get a new Covid-19 vaccine yearly, like the influenza vaccine.
As for RSV, though the CDPH reports that activity is decreasing, the CDC recommends RSV vaccines for adults ages 60 and older and people who are 32 to 26 weeks pregnant. An RSV-preventative antibody is also recommended for infants and some young children.
Health officials are also urging masking.
I would recommend wearing a mask in public right now for almost anybody, especially if youre a high-risk person, said Landon.
In September, the U. of C. Medicine re-implemented its mask requirement for all health care workers any time theyre interacting with a patient. Its also screening people when they enter the hospital and tracking exposures within the hospital.
Provident is requiring masking of patients and visitors when they enter an exam room or are waiting to be seen by a provider.
"I would recommend if anyone has any questions or concerns if they do have Covid, to go get tested, to wear a mask if they're on their way to be tested and to stay home from work until you feel better, Martin said.
When SARS-CoV-2 enters the human body, the virus spike protein binds to a cell, allowing the virus to infiltrate and begin replicating.
A new study from Tulane University, conducted in partnership with Florida International University and published in Protein Science, has identified a protein that may be the glue that helps COVIDs spike protein stick.
The study found that a small piece of a proteoglycan called perlecan LG3 a protein most commonly found in blood vessels and the brain readily formed a stable bond with the COVID spike protein and perhaps enhanced the virus ability to bind with cells.
Recent studies have identified proteoglycans as potential key factors in COVID infections. By identifying key interactions between perlecan LG3 and SARS-CoV-2, this study may open the door for new forms of treatment, said co-corresponding author Dr. Gregory Bix, director of Tulane University School of Medicines Clinical Neuroscience Research Center.
The takeaway is this major extracellular matrix proteoglycan found in blood vessels throughout the body most likely plays a significant role in how the virus sticks to and infects cells, said Bix, who has studied perlecan for 25 years as a treatment for cerebrovascular diseases such as stroke and dementia. Perhaps this explains COVIDs impact on the vascular system and the brain, but LG3 seems to act as a sort of bridge for the virus.
Using molecular modeling simulations, the study found that LG3 displayed a high affinity stable interaction with the COVID spike proteins receptor-binding domain, the area that attaches to host cells. This attraction was confirmed using surface plasmon resonance instruments, which use electrons to measure interactions and affinity between molecules.
One prominent type of hydrogen bond found between the COVID spike protein and a host cell only appeared in the study when LG3 was present, suggesting that LG3 may enhance COVIDs ability to bind to a cell.
Further studies are needed to determine if these binding interactions can be affected by mutations in various strains of COVID.
Bix also hopes these findings can lead to new forms of COVID prevention or treatment.
Can decoy pieces of perlecan prevent the virus from binding to cells? Can antibodies block this interaction between LG3 and the spike protein? Theres still so many theories and so much we dont know, Bix said. Continuing to understand how the virus infects cells is critical, especially when you have an ever-evolving virus.
