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In early 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a highly contagious and pathogenic virus, made its alarming debut and quickly spread worldwide, causing the novel coronavirus (COVID-19) pandemic that threatened human health and public safety.
While the world was brought to a standstill, hospitals and health care systems entered uncharted territory and quickly adapted to the evolving health crisis to care for their community and keep potentially sick patients and health care workers from spreading the virus.
The magnitude of response involved the reinforced universal masking of health care workers and patients at the hospital and regular SARS-CoV-2 testing of all health care workers and patients upon admission, regardless of symptoms, and strict isolation protocols for those infected with the virus.
Approximately four years after the pandemic was declared, researchers at University of California San Diego School of Medicine used high-end technology and an innovative approach to evaluate the effectiveness of those prevention measures implemented in the health care setting during the last three waves of the pandemic.
The study, published in the January 16, 2024, online edition of Clinical Infectious Diseases, was a first of its kind to use information from electronic health and contact tracing records to closely analyze the genetic makeup of the virus combined with the comparison of how the diverse strains were physically being spread among patients and health care workers in the hospital.
Researchers found that the implemented infection prevention parameters in the health care setting, including ventilation standards of at least five clean air changes per hour, combined with universal masking, prevented most SARS-CoV-2 transmissions. In patients who tested positive for the virus, personal protective equipment (PPE) shielded and virtually eliminated health careassociated transmission.
"When the pandemic started, it was scary because initially we did not have rapid diagnostic nor treatments available, and we did not fully understand how the virus was transmitted or if our infection prevention protocols were adequate," said Francesca Torriani, MD, senior author of the study, and program director of Infection Prevention and infectious disease specialist at UC San Diego Health.
"Therefore, the potential implications of the virus and the welfare of our workforce and patients was an utmost concern. I witnessed health care workers fearful of contracting the virus at work and potentially infecting their loved ones at home."
Torriani adds that limiting the spread of infection and blocking the virus at the source became the highest priority.
"In response to the progressing pandemic and with the trust and support from executive leadership at UC San Diego Health, we learned many life-saving lessons and strengthened infection prevention control measures to reduce the risk of transmission between patients and health care workers. The swift adoption and modification of infection prevention protocols in health care were felt to be an opportunity for deeper exploration of the effectiveness of our procedures."
The researchers took an innovative approach never used before to evaluate the different variants of the samples to identify if they were temporarily or physically near one another, suggesting health care transmission.
Electronic health record data of patients, whose identities were protected throughout the study, and metadata about staff access and movement to these records, accompanied by a robust contact tracing program, were used to classify, isolate and assess individuals exposed to specific strains of the virus.
"While the virus strains were very distinguishable in the second and third wave of the pandemic, during the explosive and homogenous omicron wave, we found that we could not rely on genetic data alone," said Christopher Longhurst, MD, co-author of the study, executive director of Jacobs Center for Health Innovation, and chief medical officer and chief digital officer at UC San Diego Health.
"We had to dive deeper into the electronic documentation and social network analysis, such as individuals with similar virus strains, and considering their physical interaction in the hospital, to determine what really happened and how the virus was being spread."
Researchers examined the genetic makeup of SARS-CoV-2 during three consecutive waves and compared how closely a person's genetic variant was related to another's.
The study involved the collection of 12,933 virus samples from 35,666 patients and health care professionals from November 1, 2020 to February 27, 2022.
"Even when hundreds of health care workers were becoming infected every week during the peak of the omicron wave, we found that they were no more likely to acquire the virus in the hospital system," said Joel Wertheim, Ph.D., co-senior author of the study and associate professor at UC San Diego School of Medicine. "The outcomes reveal the hidden patterns of viral transmission."
The results from both the genetic and social networking analysis showed that while universal masking was key to prevent transmissions, airborne negative pressure rooms, universal N95 respirator masks or even closing the door of a patient's room were not essential elements to protect against transmission in the health care setting.
In fact, most transmissions occurred outside of the health care setting, physical contact in the community, between households or when universal masking was not followed in the setting of unrecognized SARS-CoV-2 infection. Viral transmission was more likely to occur in shared spaces, such as break-rooms or lobbies.
"Our analysis really highlights that our health care system, with its safety measures including ventilation standards, robust viral testing, and early implementation of universal masking, was able to protect health care workers and patients during the pandemic," said Shira Abeles, MD, co-author of the study, associate professor in the Department of Medicine at UC San Diego School of Medicine and infectious disease specialist at UC San Diego Health.
Longhurst adds the type of technological approach used can be a model for future studies and a tool deployed for epidemics of highly contagious infectious diseases.
"The pandemic has shown us what's at stake. This novel methodology, combining a digital social network derived from electronic health record data with genomic analysis of viral strains, can be used again in the future to model spread of health care associated infections," said Longhurst.
More information: Clinical Infectious Diseases (2024).
Journal information: Clinical Infectious Diseases
By Caitlin Tilley, Health Reporter For Dailymail.Com 17:59 16 Jan 2024, updated 21:34 16 Jan 2024
Chinese scientists have been experimenting with a mutantcoronavirusstrain that is 100 percent lethal in mice despite concerns such research could spark another pandemic.
Scientists in Beijing who are linked to the Chinese military cloned a Covid-like virus found in pangolins,known asGX_P2V, and used it to infect mice.
The mice had been 'humanized', meaning they were engineered to express a protein found in people, with the goal being to assess how the virus might react in humans.
Every rodent that was infected with the pathogen died within eight days, which the researchers described as 'surprisingly' quick.
The team were also surprised to find high levels of viral load in the mice's brains and eyes - suggesting the virus, despite being related to Covid, multiplies and spreads through the body in a unique way.
Writing in a scientific paper that has not yet been published, they warned the finding 'underscores a spillover risk of GX_P2V into humans'.
Professor Francois Balloux,an infectious disease expert based at University College London, wrote on Twitter (X): 'It's a terrible study, scientifically totally pointless.
'I can see nothing of vague interest that could be learned from force-infecting a weird breed of humanized mice with a random virus. Conversely, I could see how such stuff might go wrong...'
Professor Richard Ebright, a chemist at Rutgers University in New Brunswick, New Jersey, told DailyMail.com he wholeheartedly agreed with Professor Balloux's assessment.
He added: 'The preprint does not specify the biosafety level and biosafety precautions used for the research.
'The absence of this information raises the concerning possibility that part or all of this research, like the research in Wuhan in 2016-2019 that likely caused the Covid-19 pandemic, recklessly was performed without the minimal biosafety containment and practices essential for research with a potential pandemic pathogens.'
A research group whose work is feared to have started the Covid pandemic is being funded by the US Government to do similar experiments in other parts of the world.
According to the study, carried out by theBeijingUniversity of Chemical Technology, the virus was discovered in 2017prior to the Covid outbreak.
It was discovered in Malaysia in pangolins - scaly mammals that are known harborers of coronaviruses andwere heavily speculated to be the intermediate host that passed Covid from bats to humans.
The researcherscloned the virus and stored multiple copes in the Beijing lab, where it continued to evolve.
It is unclear when the newly surfaced study was conducted. But the researchers said it was possible the virus had undergone a 'virulence-enhancing mutation' in storage, which made it more deadly.
For the new research, eight mice were infected with the virus, eight were infected with an inactivated virus and eight were used as a control group.
All mice infected with the virus died. They succumbed to the infection between seven and eight days after being infected.
Symptoms included their eyes turning completely white, rapid weight loss and fatigue.
Researchers found 'significant amounts' of the virus in the rodents' brains, lungs, noses, eyes and windpipes.
By day six, the viral load had 'significantly decreased' in the lungs, but the animals' brains had shrunk and there were 'exceptionally high' virus levels in their brains.
The results suggest that the virus infects via the respiratory system and then migrates to the brain - unlike Covid which causes lower lung infections and pneumonia in severe cases. However, there have been examples of Covid being found in brain tissue of severely sick patients.
'Severe brain infection during the later stages of infection may be the key cause of death in these mice,' the researchers said.
They concluded: 'This is the first report showing that a SARS-CoV-2-related pangolin coronavirus can cause 100 percent mortality in hACE2 mice, suggesting a risk for GX_P2V to spill over into humans.'
However, the original strain of Covid also killed 100 percent in mice in some studies, meaning the new results may not be directly applicable to humans.
Dr Gennadi Glinsky, a retired professor of medicine at Stanford, said on social media: 'This madness must be stopped before [it is] too late.'
DailyMail.com exposed in 2022 how similar research virus-manipulation research was being carried out by Boston University.
Researchers were found to have created a new Covid strain that had an 80 percent death rate among mice.
It sparked nationwide debate about whether the experiments were an illegal form of research known as 'gain of function' - which involves purposefully making viruses more deadly or infectious to study their evolution.
The Biden Administration tightened rules around such research in October 2022, but the definition of gain of function remains contested.
Dr Christina Parks, a molecular biologist from the University of Michigan, said the Chinese study was 'classic gain of function, whether they tell you it is or not.'
One of the Chinese researchers was Dr YigangTong, who trained at the Academy of Military Medical Sciences, a Chinese military medical research institute run by thePeople's Liberation Army.
Dr Tong studied there between 1988 and 1991 for a master of science and then again between 1997 and 2000 for a PhD.
He also co-authored a paper in 2023 with 'bat woman' Zheng-Li Shi, who helps run the Wuhan Institute of Virology (WIV).
The WIV has been designated the most likely source of the Covid pandemic by the FBI and US Department of Energy in what has been dubbed the 'lab leak' theory.
Researchers there, with US Government grants, were performing gain of function experiments on coronaviruses in the months leading up to the Covid outbreak.
The virus first emerged miles away from the WIV, where researchers were known to be working on coronaviruses found in bats.
It comes asDr Peter Daszak, head of the New York based non-profit EcoHealth Alliance, whichfunded controversial experiments inWuhanwhich some fear started the pandemic, presented the discovery of a never-before-seen virus with 'almost' as much potential to infect humans as Covid.
Dr Daszak, a friend of Dr Anthony Fauci, the ex-chief medical advisor to the US President, revealed his team have already found one bat coronavirus of considerable interest.
'We found a lot of SARS-related coronaviruses, but one in particular we found was quite common in bats where people were commonly exposed,' he told the WHO event, attended by MailOnline.
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Heading out on a crowded bus or train? It might be time to wear a mask after a recent surge in COVID cases, according to BU infectious diseases researcher David Hamer. Photo via iStock/sibway
COVID-19
Here we go again. Another winter, another COVID-19 wave. As many Americans try their best to move on from or ignore the coronaviruscalling quits on masking, skipping vaccinations, not bothering to testCOVID-19 is surging in the United States.
Current data suggests virus levels in Massachusetts recently hit peaks unseen since the Omicron variant burst onto the scene two years ago. According to the latest numbers from Massachusetts Department of Public Health, COVID-19 cases in the state jumped from around 2,000 a week in early November to nearly 6,000 a week by the end of December. Local physicians reported a continued rise in cases into January. The upswing has been driven by a new highly transmissible coronavirus variant, JN.1an Omicron offshoot thats now the dominant strain of the virus in the US.
Throw in flu and RSV, plus the usual wintry sniffles from colds, and we have all the ingredients for a lousy, laid-up winter. Just 18 percent of Massachusetts residents are up-to-date with their COVID vaccinations; 37 percent have had a flu shot.
To get the latest on the surge, whether we all need to dig out those masks again, and how to tell whether its COVID, the flu, or a cold causing that runny nose and sore throat, The Brink spoke with Boston University infectious diseases expert David Hamer. A BU School of Public Health and Chobanian & Avedisian School of Medicine professor of global health and medicine, Hamer is also a core director and researcher at BUs Center on Emerging Infectious Diseases.
Hamer: We are seeing more COVID cases nationwide, but its complicated. Part of the problem is the quality of the data that feeds into this. It used to be when everybody was doing active testing and using PCR tests, all that data fed into the public health systems. But now lots of people are doing home tests, and those dont end up being captured, so the data arent as good as they were two years ago at the heart of the pandemic.
But, that said, theres definitely a substantial increase of reported cases in Massachusetts, and the wastewater data had been creeping up, as well, so a lot of signs that theres more transmission. This has been the biggest spike weve had since Omicron. And compounding that, theres more flu being transmitted also. I think were looking at sort of a syndemic of multiple diseases. What to me is really interesting is that we havent had a big surge in COVID for a whileis it now starting to settle into more of a respiratory season pattern?
Hamer: Yes, is the short answer. Many hospitals in the Northeast, including Boston Medical Center [BUs primary teaching hospital], have gone back to masks. I have a clinic todayI had not been using a mask consistently, but I think its advisable [now], because theres a higher risk.
And then public transportation, less than 5 percent of people wear masks in my experience, but I started masking more about a month ago because I was watching the numbers, thinking I dont want to get COVIDor other respiratory viruses, for that matter. In crowded places where theres likely to be inadequate ventilation, right now is a good time to think about having a mask.
Hamer: The level of boosting is really pretty woeful relative to what it should be. The JN.1 variant has been on the risethe CDC estimated that almost two-thirds of COVID cases in the US now are due to this subvariant. The bivalent vaccine, the modified vaccine that we have available, was designed for other Omicron subvariants, but it cross-protects against this. People really should be thinking about having a booster if they havent had it.
Hamer: Its really hard to tell. Between more immunity among individuals due to COVID vaccines or having had natural COVID infections, possibly the evolution of the virus toward a milder [disease], causing more upper respiratory symptoms, theres so much overlap between the common cold, COVID, RSV, andsomewhatinfluenza. Usually, you have a fever with influenza, but not always now with COVID. A lot of patients Ive seen will only have a stuffy or runny nose, a little bit of a cough. They may not necessarily have a fever, severe fatigue, and other symptoms that would be more suggestive of COVID, or loss of sense of smell, which were not seeing as commonly anymore.
Any respiratory symptoms should trigger testing, because SARS-CoV-2 is so easily transmissible. You dont want your coworkers, your family members, to become sick, so its important to know.
Hamer: They should spend five days in relative isolationat home, if they canbefore they resurface. And then when they start going back out in public, or if they go back to work, they should ideally wear a mask with all external contacts for the next five days. This goes back to studies we did here at BU among studentsbut also in studies that colleagues of ours did at Mass General with an older population. On average, young healthy BU students would shed virus and, by day five, many of them had gotten down to levels where they had undetectable or very low levels of viral load. But some were still shedding virus out to day seven, eight, nine, or even 10. Usually, it was around seven or eight that they finished up. So, people are still infected for at least five to seven or eight days after an episode. And thats in young, healthy students; in an older population, the duration of viral shedding is more prolonged.
Hamer: There are still people who have long COVID. Theres a lot of evidence that suggests vaccination and treatments like Paxlovid may help reduce the likelihood of long COVID developing. The flip side of that is theres a lot of evidence that people arent accessing the treatments, theyre not using them. Theyre not for everybody, but for those who are older, have underlying diseases or certain risk factors, they should be used.
Hamer: Yeah, unfortunately, its not over. A lot of people I knew that were very, very careful for three years, when it seemed like everything was good, they started going back to their usual liveshaving more social interactions, not wearing masks in public placesand many people that had never become infected had their first infection. And Im one of them.
Hamer: Theres still a fair amount of COVID circulating. Theres also a rising risk of influenza, as well as other regular respiratory viruses, and people should be thinking about doing things that help reduce their risk. So, vaccination. If they become infected, testing; if they test positive, isolating. Also, if theyre at higher risk, speaking with their physician about having oral treatment. The public health service message is if you have cold symptoms, you should, if at all possible, try not to come to work or go to school.
This interview has been edited for length and clarity.
Need a COVID-19 rapid test? BUs City Convenience is now offering two rapid antigen tests for $9.99. Need a flu shot? Student Health Services will be hosting immunization clinics on January 24, 25, and 26check its website for details.
A universal coronavirus vaccine that would be ready in the case of a future outbreak could save millions of lives and billions of dollars while a strain-specific vaccine is developed, new research published in the journal eCLinicalMedicine found.1
"COVID-19 was the third major and serious coronavirus epidemic or pandemic following SARS in 2002 and MERS in 2012, thus, we should anticipate a fourth coronavirus outbreak within the next decade or so, Peter J. Hotez, an author on the study, said in a release.2 A universal vaccine is cost-effective and cost-saving and a priority for advancement."
Investigators from the City University of New York Graduate School of Public Health and Health Policy conducted a study to evaluate different types of universal and strain-specific coronavirus vaccines. Researchers created a computational simulation model to represent the spread and impact of a novel coronavirus in the United States.
The simulation model employed data from the CDC and observational studies conducted during the COVID-19 pandemic to examine both clinical and economic outcomes on the US population, including hospitalizations, deaths, quality-adjusted life years (QALYs) lost, direct medical costs, productivity losses, and total societal costs.
The aim of the study was to offer potential funders, researchers, and manufacturers guidance on the potential value of such a vaccine and how this value may change with differing vaccine and vaccination characteristics.
Investigators found that a universal coronavirus vaccine would be cost saving by itself as long as it had an efficacy and coverage of 10% or more. For every 1% increase in efficacy up to 50%, the vaccine could prevent 395000 additional infections and save around $1 billion in societal costs, including $45.3 million in productivity losses and $1.1 billion in direct medical costs.
Additionally, as long as a strain-specific coronavirus vaccine took 2 to 3 months to develop, test, and bring to market, the universal vaccine would still be cost saving.
Researchers noted that future studies should explore the impact of different variants that could emerge during the course of an epidemic, as it could provide additional opportunities on how a universal coronavirus vaccine could be useful.
"Our study shows the importance of giving as many people as possible in a population at least some degree of immune protection as soon as possible," Bruce Y. Lee, an author on the study, said in a release.2 "Having a universal vaccine developed, stockpiled, and ready to go in the event of a pandemic could be a game-changer even if a more specific vaccine could be developed3 to 4 months later."
It's easy to be complacent about COVID-19. Most people experience only mild issues fever and coughing, maybe congestion and shortness of breath.
But the coronavirus is capable of causing much more than a simple respiratory illness, affecting organs throughout the body, experts say.
"We see people have symptoms from almost head to toe in terms of how they feel, how they function and what they can do," said Dr. Adrian Hernandez, a cardiologist who is director of the Duke Clinical Research Institute in Durham, North Carolina.
The new year started with an increase in COVID-19 hospitalizations in the U.S., prompting Hernandez and other experts to advise caution, especially for those at high risk.
While the short-term effects of COVID-19 can be flu-like, even mild cases can lead to long COVID a constellation of problems that can persist for weeks or months. More than 200 symptoms have been linked to long COVID, said Hernandez, who has overseen many COVID-19 studies.
Because COVID-19 typically affects breathing and can lead to problems such as pneumonia, many people may think it's primarily a lung disease. It's not that simple, said Dr. Nisha Viswanathan, director of the long COVID program at the David Geffen School of Medicine at the University of California, Los Angeles.
"I would argue that COVID-19 is not a disease of the lungs at all," she said. "It seems most likely that it is what we call a vascular and neurologic infection, affecting both nerve endings and our cardiovascular system."
It's no surprise that experts say SARS-CoV-2 the name of the virus that causes COVID-19 is complex, with many of its pathways just beginning to be understood. But some things are becoming clear. One of the best reviews of long COVID symptoms, Viswanathan said, appeared last January in Nature Reviews Microbiology. It detailed the disease's effects throughout the body, including the pancreas, blood vessels and reproductive system.
"SARS-CoV-2 is excellent at triggering your immune system to go from zero to 100," said Dr. Lindsay McAlpine, a neurologist who is director of the Yale NeuroCovid Clinic in New Haven, Connecticut. That revving of the immune response leads to both a "wide swath of inflammation" and excessive blood clotting, she said.
"Perhaps the viral replication is going on in the lungs and nasopharynx (the area at the top of the throat that connects the nose to the respiratory system). But the inflammation that the virus triggers is systemic," McAlpine said.
Here are some parts of the body significantly affected by COVID-19.
The brain and nervous system
"The virus and the immune response can have several different effects on the brain," said McAlpine, lead author of a 2021 study looking at strokes in people with COVID-19, published in the journal Stroke. She is researching issues related to COVID-19 and brain fog, which she called "a very common symptom."
The exact causes of brain-related issues are not clear, but she said it does not appear that the virus is directly attacking brain tissue. Rather, it seems that the ramped-up immune response leads to clots that could cause brain problems.
"A lot of patients have described it as feeling like they have a concussion," McAlpine said. "And it can persist for several months after COVID," even if the initial case was mild.
"In addition to the cognitive impairment, we see worsening or new-onset migraines," she said. "We see new neuropathy in the legs and the arms numbness, tingling, difficulty walking because of the neuropathy."
COVID-19 might also be unmasking other neurodegenerative conditions, such as Parkinson's disease, she said. McAlpine has diagnosed new cases of Alzheimer's disease in people who, before COVID-19, were functioning fine, then developed symptoms. "We don't know why," she said.
The heart and blood vessels
Research shows COVID-19 infection can increase the risk for heart-related problems such as myocarditis, a rare inflammation of the heart, and an irregular heartbeat known as atrial fibrillation.
The risk of dangerous clotting including deep vein thrombosis (clots in large veins) and pulmonary embolisms (clots in the lungs) is small but stays elevated for up to a year after the infection, according to research done before vaccines were available.
Many factors might be playing into COVID-related heart problems, Viswanathan said, including microclots tiny blood clots or an autoimmune response targeting heart muscle cells. A recent study in Nature Cardiovascular Research shows the virus may infect coronary arteries, causing plaque buildup to become inflamed and break off, which can lead to a heart attack. Gastrointestinal system
"Interestingly, the GI system's mechanism may be a little different than what impacts the heart," Viswanathan said. One theory suggests that the virus finds a hiding place while the rest of the body fights it off. "And we have found now in multiple studies that COVID can remain in our GI tract for weeks and months after it has resolved in the rest of the body."
The exact place where the virus might hide is up for debate, Viswanathan said. But Hernandez said gastrointestinal symptoms are clear: "People can have nausea, vomiting, diarrhea."
A large study of veterans published last year in Nature Communications found people with COVID-19 had a higher risk of gastroesophageal reflux disease, irritable bowel syndrome and other gastrointestinal problems more than 30 days after infection compared to people without COVID-19. The risk was elevated even among people who had mild cases of the disease.
Kidneys
Kidney problems were common in a 2023 study published in The Lancet Respiratory Medicine that looked at organ damage after COVID-19 infection.
Researchers don't necessarily know whether kidney problems stem from people getting sick with high fevers and taking in less fluid or because "with a virus that can go anywhere and cause inflammation anywhere, you can have all sorts of problems," Hernandez said.
What to do
Not everyone who gets COVID-19 will have these problems, Viswanathan said. But people experiencing symptoms can reach out to their primary care physician or a long COVID clinic.
What everyone can do, she said, is take steps to protect themselves and those around them.
The first step is to be cautious if COVID-19 is surging in your area. Consider wearing a mask in crowded public places. "A lot of people have COVID now, and it may take a while for them to test positive," Viswanathan said.
"The second thing is get vaccinated," she said. "It really does seem to be highly protective." The Centers for Disease Control and Prevention recommends everyone ages 5 and older get the updated COVID-19 vaccine to avoid getting seriously ill from the virus.
"The third thing is controlling your cardiovascular risk factors," she said. That means getting high blood pressure, diabetes or other chronic medical conditions under control. "It will all decrease your risk."
McAlpine added that if you have COVID-19 symptoms, stay away from other people to avoid putting them at risk.
Hernandez emphasized the importance of vaccinations in general for people with heart or lung disease, cancer or suppressed immune systems. "For people who have other health conditions, you don't need another one," he said. "And if you could avoid an illness like COVID or the flu why wouldn't you?"
02:04 (IST), Jan 15
Pakistan: 3 passengers test positive for JN.1 Covid-19 variant at Karachi airport
Three travellers who landed at Jinnah International Airport in Karachi tested positive for JN.1 sub-variant of coronavirus, ARY News reported on Sunday. The antigen tests that were performed at Jinnah International Airport on three individuals yielded positive results, according to the Sindh Health Department.
Jan 11
Please try again
A whole host of winter respiratory viruses is circulating in the first weeks of 2024 which means you probably know several people who are sick right now. And for a fourth January running, we still have to worry about COVID-19.
At this stage in the pandemic, worrying that your sore throat, cough or congestion might, in fact, be COVID-19 is a natural thought, especially as the Bay Area is experiencing another wave of infections fueled by the new JN.1 strain.
But while testing negative on an at-home antigen test can bring some relief, unfortunately, you may no longer be able to trust that initial result in the way you could earlier in the pandemic.
Keep reading for what you need to know about COVID-19 incubation periods in 2024, why an early negative test could be a false result, and what to do if youre caught in a Wait, so do I have COVID or not? testing limbo.
Some medical experts say theyve noticed that at this stage of the pandemic, its often taking much longer for people to get a positive test result on an at-home COVID-19 antigen test. In other words, theyre observing that people with COVID-19 symptoms are taking an antigen test and getting a negative result only to get a positive result on a different test several days later.
This means that many people could wrongly assume they dont have COVID-19 after that first negative test and then inadvertently spread the virus to friends and family.
Dr. Peter Chin-Hong, an infectious disease expert at UCSF, said he and his colleagues are now seeing people take longer to get a positive test even though they have COVID-19 symptoms. Dr. Elizabeth Hudson, regional chief of infectious diseases at Kaiser Permanente Southern California, told the Los Angeles Times that shes also noticed this delay and that a patient might not get a positive test result up until the fourth day after the start of their symptoms.
But theres a confusing additional aspect to this too: Paradoxically, said Chin-Hong, incubation times for the virus have gotten shorter throughout the pandemic. This means people have tested positive for COVID-19 more quickly than in 2020, when the average incubation period was five days because the incubation period has changed with each new variant. Chin-Hongs advice in the last year has been that if youre having COVID-19 symptoms, it now makes sense to take a test as early as two days after exposure.
So how do shorter incubation times square with this newly observed delay on positive COVID-19 tests?
Right now, experts arent 100% sure why antigen tests are taking longer to return a positive COVID-19 result. But Chin-Hong said that the hypothesis that makes sense to him is less about the efficacy of the antigen tests themselves and way more about how much quicker someone with COVID-19 might develop symptoms in 2024 than they would have done in 2020.
As a reminder, those symptoms are the sign that your bodys immune system is mounting a response to an invading virus and back at the start of the pandemic, by the time you developed COVID-19 symptoms and took a test it would probably already be positive, Chin-Hong said.
But at this stage of the pandemic, most of us now have a lot of immune experience with COVID-19, Chin-Hong said and the average persons immune system is increasingly on guard and activated more than in 2020, he said. So when your body detects a burgeoning coronavirus infection now, your whole immune system just gets agitated and active, and you begin to get sick sooner, but you actually dont have as much virus in your blood yet, Chin-Hong said.
Dr. Abraar Karan, an infectious disease physician and researcher at Stanford University, also put it this way for NPR: With our immune systems primed, the bodys response [now] comes much more quickly than it would have back in 2020 when SARS-CoV-2 was a novel pathogen.
And because many of us take a COVID-19 test when we start to feel sick, we might be testing way too early at that time for an at-home antigen kit to successfully detect enough virus inside us. This mismatch between when your symptoms start and when youve enough virus present in your body to result in a positive COVID-19 test was started to be observed in early omicron, but I think it just seems more accentuated now, Chin-Hong said.
However, Hudson of Kaiser Permanente Southern California told the L.A. Times that for her, this delay in positive tests might be attributable to peoples accumulated immunity from COVID-19over the years either from getting infected or getting vaccinated.
Its actually pushing back the time that peoples COVID tests are coming up positive, Hudson said.
The bottom line is: If youre testing because youve started feeling unwell, its unwise to assume in 2024 that a negative result automatically means you dont have COVID-19, because you might just be testing too early.
Experiencing the onset of symptoms that feel like COVID-19 is unpleasant and worrying enough. And now, this new possible delay around even knowing if you have COVID-19 adds another element of frustration and uncertainty to whats already a stressful situation. Even if youve been able to find free COVID-19 tests being given away or by order from the U.S. government via USPS, one COVID-19 scare in a family can run through that stockpile pretty fast and the cost of purchasing new COVID-19 antigen kits can really add up.
If youre in the limbo of not knowing whether you actually have COVID-19 yet, heres what to do:
If your first test is negative for COVID-19, test again later
If you have symptoms but have tested negative, dont assume it means youre COVID-free. The CDC recommends that you take another antigen test 48 hours laterand then test again after another 48 hours.
Chin-Hong advises that you can also seek out a PCR test, which is more sensitive.
While youre unsure, play it safe
If you have symptoms and dont know why yet for sure, stay home as much as you can. If you truly cant stay indoors and away from others, wear a well-fitted mask to protect your community and try to ensure youre in well-ventilated spaces.
Be especially careful not to spread any virus around folks who are at higher risk for serious illness or hospitalization from COVID-19, which includes older people, immunocompromised and disabled people.
Remember: Just because its not COVID-19 doesnt mean youre not still sick
Even if you turn out not to have COVID-19 after several days of testing but youre still experiencing symptoms, you might still be infected with one of the other highly infectious winter respiratory viruses out there like flu, RSV or a bad cold. And if youre sick, you could easily infect your friends, family or colleagues with whatever youre suffering from.
Give yourself permission not to trust a friends negative test, too
What if its a friend whos experiencing COVID-19 symptoms, and theyre insisting that theyre safe to meet with you because they took a test and its negative?
Knowing what you know that it can sometimes take folks longer to get a positive COVID-19 test in 2024 you should feel free to compassionately tell your friend that while you trust them, you cant trust an early negative test right now. Theres a good chance that they have no idea that positive tests can be increasingly delayed and will be relieved to know that by staying home, they havent accidentally spread an infectious disease to you or other loved ones.
And if they disagree and insist theyre still safe to meet up? You should feel free to decline, even if it feels awkward. Remember, its not weird to not want to get COVID-19.
Stock up on free COVID-19 tests
Finding a quick, free COVID-19 test whether an at-home antigen test or a PCR test has gotten progressively harder at this stage of the pandemic as more sites and services have shuttered. The federal government has, at least, restarted its free at-home COVID-test-ordering service through USPS, meaning you can once again order another four free antigen tests to be delivered to your door for a future time.
Read more about where to find free or low-cost COVID-19 tests this winter.
but make sure your COVID-19 tests havent expired
Many of the COVID-19 tests being made available right now (for example, at your local public library) may be approaching their expiration date if they havent already passed it. And an expired test could give you an unreliable result.
You can check the FDAs list of antigen test types to see whether the box youre holding has had its shelf life extended by the manufacturer. The FDA said that if a tests shelf life has been extended, its because the manufacturer has given the agency enough data showing that the shelf-life is longer than was known when the test was first authorized. (In other words, its still OK to use that test.)
At KQED News, we know that it can sometimes be hard to track down the answers to navigate life in the Bay Area. Weve published clear, practical explainers and guides about COVID-19, how to cope with intense winter weather, and how to exercise your right to protest safely.
So tell us: What do you need to know more about? Tell us, and you could see your question answered online or on social media. What you submit will make our reporting stronger and help us decide what to cover here on our site and on KQED Public Radio, too.
Respiratory virus activity continues to remain elevated across the United States but there may be some signs that a peak has been reached for at least one virus, newly updated federal data shows.
As of Friday, "high" or "very high" levels of respiratory illness activity -- defined as people visiting a health care provider with symptoms including cough and fever -- were seen in 35 states in addition to New York City and the District of Columbia, according to the Centers for Disease Control and Prevention, down from 38 earlier this week.
Emergency department visits with diagnosed influenza, COVID-19 and RSV remain high, but all three conditions saw a decrease over the last week. The CDC, however, said this is may due to "holiday-related healthcare seeking behavior and will be monitored."
For the week ending Jan. 6, weekly COVID hospitalizations rose to 35,801. This marks the ninth straight week of increases, but remains lower than hospitalizations recorded at the same time last year.
Nearly 40% of all counties in the U.S. are in the medium category for hospital admission levels, meaning hospitals are seeing 10.0 to 19.9 new admissions for COVID-19 per 100,000 people in the past week.
Those aged 65 and older have the highest rate of weekly COVID hospitalizations by age group followed by those between ages 50 and 64, according to the CDC.
The rise of COVID-19 hospitalizations may be partly due to the spread of the JN.1 variant, which makes up an estimated 61.6% of cases in the U.S. as of Jan. 6.
JN.1 has mutations that may make it either more transmissible or more likely to evade the immune system, the CDC says, but there is no evidence that it causes different symptoms or more severe cases.
Nationally, COVID-19 wastewater viral activity levels are very high, typically an early sign of an increase in cases. There are indications, however, that wastewater activity levels may be slowing in the Midwest and Northeast, the CDC says.
Although influenza activity remains high and key indicators have been increasing for several weeks, the number of weekly new hospital admissions slightly decreased to 18,506, according to CDC data.
"CDC will continue to monitor for a second period of increased influenza activity that often occurs after the winter holidays," the federal health agency wrote on its website.
The CDC estimates that there have been at least 14 million illnesses, 150,000 hospitalizations and 9,400 deaths from flu so far this season. Adults over 65 have the highest rates of flu hospitalizations.
Meanwhile RSV hospitalizations appear to be remaining stable, with a very slight increase in the weekly hospitalization rate from 3.6 per 100,000 the week ending Dec. 16 to 3.7 per 100,000 for the week ending Dec. 23, the last week of complete CDC data.
Unlike with COVID and flu, RSV hospitalizations are highest among children aged 4 and younger followed by adults aged 65 and older.
Vaccines are available for COVID, flu and RSV, but the CDC says "the percent of the population reporting receipt of COVID-19, influenza, and RSV vaccines remains low for adults."
As of Friday, just 21.4% of adults aged 18 and older and have received the updated COVID vaccine, CDC data shows. Additionally, 46.8% of adults have received the flu vaccine. Meanwhile, just 20.1% of adults aged 60 and older have received the RSV vaccine, which was rolled out for the first time this season.
You probably know a lot of sick people right now. Most parts of the U.S. are getting pummeled by respiratory illness, with 7% of all outpatient health care visits recorded during the week ending Dec. 30 related to these sicknesses, according to the U.S. Centers for Disease Control and Prevention (CDC).
Many people are sick with flu, while others have RSV or other routine winter viruses. But COVID-19 is also tearing through the population, thanks largely to the highly contagious JN.1 variant. Just like every year since 2021, this one is starting with a COVID-19 surgeand Americans are getting a good glimpse of what their new normal may look like, says Katelyn Jetelina, the epidemiologist who writes the Your Local Epidemiologist newsletter.
Unfortunately, she says, signs are pointing to this [being] the level of disruption and disease were going to be faced with in years to come.
The CDC no longer tracks COVID-19 case counts, which makes it harder than it once was to say exactly how widely the virus is spreading. Monitoring the amount of virus detected in wastewater, while not a perfect proxy for case counts, is probably the best real-time signal currently availableand right now, that signal is a screaming red siren. According to some analyses, wastewater data suggest the current surge is second in size only to the monstrous first wave of Omicron, which peaked in early 2022. By some estimates, more than a million people in the U.S. may be newly infected every single day at the peak of this wave.
Wastewater isnt the only sign that things are bad. Almost 35,000 people in the U.S. were hospitalized with COVID-19 during the week ending Dec. 30far fewer than were admitted at the height of the first Omicron wave, but a 20% increase over the prior week in 2023. Deaths tend to lag a few weeks behind hospitalizations, but already, about 1,000 people in the U.S. are dying each week from COVID-19.
Yet even as the trends veer in the wrong direction, people are still working in offices, going to school, eating in restaurants, and sitting shoulder-to-shoulder in movie theaters, largely unmasked. It can be hard to know how to feel about that reality. Viewed through a 2020 lens, many people would consider it catastrophically concerning that people are living normally even as COVID-19 sickens the equivalent of an entire citys population every single day. But is it as worrisome in 2024, when the pandemic is over on paper, if not in practice?
Not according to Dr. Ashish Jha, dean of the Brown University School of Public Health and the Biden Administrations former COVID-19 response coordinator. Almost all of the U.S. population has some immunity from previous infections or vaccinations; treatments like the antiviral Paxlovid are available for people at risk of severe disease; and most people know the basics of masking, testing, and other mitigation measures. All of these factors, Jha says, mean COVID-19 is becoming less of a threat over time. Some groups of people, including the elderly and immunocompromised, are still at greater risk than others, and Long COVIDthe name for potentially debilitating chronic symptoms that sometimes follow a case of COVID-19remains a possibility for everyone. But Jha maintains that vaccines and treatments should make everyone feel safer.
The straight facts are: COVID is not gone, its not irrelevant, but its not the risk it was four years ago, or even two years ago, Jha says. Its totally reasonable for people to go back to living their lives.
The big challenge now, says Dr. Robert Wachter, chair of medicine at the University of California, San Francisco, is wrapping our heads around that change. Weve got to somehow reprogram our minds to think about this as a threat that is just not as profound as it was for a couple years, Wachter says. When your minds have been pickled in terror for a couple of years, its very hard to do."
In the earlier days of the pandemic, Wachter closely watched the COVID-19 data and used exact numbers and percentages to decide what he felt comfortable doing. Now, with fewer of those precise numbers and more disease-fighting tools available, he goes by trends.
During COVID-19 lulls, Im living my life about as normally as I did in 2019, Wachter says. Once indicators like COVID-19 hospitalizations and wastewater surveillance data start to suggest the virus is on the upswing, he wears a KN95 mask in crowded places like airports and theaters, where theres little downside to masking. And in a full-blown surge, like now, Wachter masks almost everywhere and avoids some places he cant, such as restaurants.
Those decisions feel right to Wachter, based on his personal risk tolerance and vulnerability to severe disease. Hes up-to-date on vaccines, which slashes his chances of being hospitalized or dying if he gets infectedbut, at 66, those outcomes are still likelier for him than for his 30-year-old children. Other people might make different choices, Wachter says. And there are going to be people who say, This is a lot of mental energy...screw it.
With hard numbers scarcer than they once were and lots of people no longer willing or able to make detailed risk assessments, Jetelina instead recommends letting your objectives shape your behavior. Want to avoid infecting your grandmother before a visit? Maybe skip having dinner in a crowded restaurant a few days before and test before you go to her house. Want to minimize your risk of getting very sick if you do get infected? Stay up-to-date on boostersas far too few people do, says Dr. Peter Hotez, co-director of the Texas Childrens Hospital Center for Vaccine Development.
The biggest failing right now in our response to COVID, Hotez says, is that only about 20% of U.S. adults got the latest vaccine, which was updated to target newer viral variants. That should be the number-one priority, he says, since vaccination is the best way to prevent complications like hospitalization, death, and, to some degree, Long COVID.
Even with boosters, Jetelina says Long COVID is a hard risk to plan around. The only tried-and-true way to avoid it is to avoid infection entirely; staying up-to-date on vaccines reduces the risk by up to 70%, according to recent research, but people can and do develop it even if theyre healthy, fully vaccinated, and have had previous infections without incident. With variants as contagious as JN.1 running rampant, doing almost anything in public opens up the possibility of getting sick.
But there are plenty of choices between ignoring the virus entirely and completely locking down at home, says Hannah Davis, one of the leaders of the Patient-Led Research Collaborative for Long COVID. She recommends wearing good-quality masks in public, socializing outside or using open windows and air filters to improve ventilation inside, asking people to test before gatherings, and avoiding especially crowded places during surges. I wish more of those were normalized, because they do at least decrease the chance of getting infected and causing long-term harm and disability to yourself or other people, she says.
But, Davis says, all responsibility shouldnt fall on individuals. She says its a huge injustice that the government hasnt done more to warn the public that people can still get Long COVID, and that reinfections can lead to serious health issues. She also feels the data support policy measures like ventilation requirements for public places and mask mandates on public transportation.
Some mask mandates in health care facilities and nursing homes have been reinstated during this surge. But Jha says widespread mandates are unlikely to come backand in his view, they shouldnt. There was a role for mandates in the early days of the pandemicwhen we had no other tools, no way of protecting people, he says. Mandates four years in, when we have plenty of tests, plenty of vaccines, plenty of treatments, plenty of masks, are not as crucial, he says.
Jetelina says she wouldnt be surprised if 2024 brings a further relaxation of COVID-19 guidance rather than increased mitigation measures. She speculates that the CDC may change its isolation guidelines, for example.
The threat [of COVID-19] will get baked into the other threats people have in their background that arent front of mind, Wachter predicts, similar to the ever-present risk of getting sick with other illnesses or getting into a car accident. And, as long as the virus doesnt shape-shift its way into laughing at our immune status, he says thats not such a bad thing. People will continue to reach different conclusions about the level of risk-taking they can stomach and behave accordingly, just as they do in other areas of life.
Its natural for guidance and behavior to change once a public-health menace begins to transition from emergency to endemic, Jha says. But that doesnt mean we should turn a blind eye toward COVID-19 or the numerous other pathogens swirling around.
"For a lot of people it's been about, 'How do we go back to 2019, to life before the pandemic?'" he says. But, in his view, that's not the right goal: "We actually want to look forward."
Jha says hes hopeful that lessons learned during the COVID-19 pandemic will spark a reimagining of how we deal with respiratory diseases in general. Such an approach wouldnt necessarily single out COVID-19, as much of the public-health messaging has done since 2020. Instead, Jha says, it could standardize and broaden guidance around all infectious diseases, hammering home the importance of things like vaccines, masks, ventilation, and sick-leave policies that allow people to stay home when they have any diseasenot just the one that has dominated our collective consciousness for the past four years.
