On Sunday, India reported the highest number of COVID cases in a day in the past 227 days or over seven months.
The Union Health Ministry on Monday said that India has reported 636 new COVID-19 cases, bringing the total active cases to 4,394. In the last 24 hours, three new fatalities - two from Kerala and one from Tamil Nadu - have been recorded.
On Sunday, India reported the highest number of COVID cases in a day in the past 227 days or over seven months.
Daily case numbers, which had dropped to double digits until December 5, have risen again following the emergence of a new variant and cold weather conditions. India reported a total of 145 cases of COVID-19 subvariant JN.1 till December 28.
The World Health Organisation (WHO) classified JN.1 as a variant of interest and as distinct from its parent lineage, BA.2.86.
At the height of the pandemic, daily figures were in lakhs. Since the pandemic's onset in early 2020, over 4.5 crore people have been infected and more than 5.3 lakh lives have been lostnationwide.
On Sunday, Maharashtra recorded 131 fresh COVID-19 cases after testing 12,405 samples at a positivity rate of 1.05 per cent, the state health department said. No fatalities are reported.
A day earlier, the state had logged 172 COVID-19 infections.
Out of 8,76,33,748 laboratory samples tested until Sunday (since the beginning of the pandemic in March 2020), 81,72,836 have tested positive for COVID-19, as per the health department.
Maharashtra has so far reported 29 cases of JN.1 sub-variant of Omicron till Sunday. District-wise distribution is Pune 15, Thane 5, Beed 3, Chhatrapati Sambhajinagar 2 and one each in Kolhapur, Akola, Sindhudurg and Nashik.
Maharashtra has seen 137 COVID-19 fatalities since January 1, 2023. While 70.80 per cent of these deaths have occurred in individuals above 60 years of age, 84 per cent of the deceased had comorbidities, and 16 per cent didn't have any comorbidity.
On the other hand, Kerala reported 2,282 new COVID cases during last week, marking a 24% decrease from the week before when the tally of reported cases was 3,018. This suggests that the surge may have already peaked after lasting for around four weeks.
While Karnataka recorded 922 new COVID cases, alomost a three-fold jump from the 309 cases reported from the week earlier.
The other states where JN.1 cases have been detected are -- 36 in Gujarat, four each in Rajasthan and Tamil Nadu, two from Telangana and one from Delhi.
Also read:WHO warns of co-circulation of influenza and SARS-CoV-2 viruses. Should India worry?
Also read:Was SARS-CoV-2 virus that causes COVID-19 engineered as a bio weapon? Here's what Indian scientists say
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The costs of our lack of understanding are vast, Beaudoin and others say, creating a huge new burden on the health-care system, as people report limitations in their daily activities including being able to work.
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How is long COVID diagnosed?
This is where some of the most intriguing scientific advances lie.
Doctors typically diagnose long COVID through a process of elimination, ruling out other causes for the lingering symptoms reported by patients who have had a bout of COVID.
But in September, the journal Nature published a study showing that people with long COVID have distinct blood biomarkers - a finding that could lead to the development of diagnostic blood tests.
"This is really exciting," said Ziyad Al-Aly, chief of research at VA St. Louis Health Care System and clinical epidemiologist at Washington University in St. Louis, who studies long COVID. "It provides objective evidence to legitimize the disease and show it is not made up in people's heads. And it provides clues as to the mechanism."
The study, conducted by researchers at the Icahn School of Medicine at Mount Sinai in New York and Yale School of Medicine, first appeared in preprint form more than a year ago. It showed patients' personal stories typically matched the scientific evidence of long COVID, reinforcing the notion that patients have a clear understanding of what's happening to their bodies.
There's an important message in that for doctors, said David Putrino, the study's lead author and director of the Abilities Research Center at the Mount Sinai Health System: Believe your patient!
What is long COVID, anyway?
Patients who shared their stories on social media brought long COVID to public attention early in the pandemic. But not even the name - or definition - for the clusters of as many as 200 different symptoms is settled.
Long COVID is also known as PASC, for post-acute sequelae of COVID, and PCC, for post-COVID conditions, the term favored by the CDC for the wide range of health effects that can be present four or more weeks after infection with SARS-CoV-2 and can last weeks, months or even years.
Several theories exist for what causes long COVID, including inflammation, a form of autoimmunity triggered by the virus, lasting damage to tissue and the persistence of the virus. Many researchers find that last theory particularly intriguing.
"It's not so unusual for viruses to persist," said E. John Wherry, director of the Institute for Immunology at the University of Pennsylvania's Perelman School of Medicine. In the case of SARS-CoV-2, researchers have looked hard for viral persistence. "There is a lot of information out there, but we still haven't found a direct causal link between the virus persisting in the body and symptoms of long COVID."
The study published in Nature in September found that long COVID also appears to reactivate some common viruses, including Epstein-Barr and mononucleosis.
Many researchers believe not all long COVID cases fit under a single umbrella.
A large study conducted by the National Institutes of Health's RECOVER Initiative and published in May in JAMA has helped to define long COVID through a symptom-based scoring system. Study participants reported more than 30 symptoms affecting different organ systems and parts of the body, out of which analysts were able to identify the 12 most common among those with long COVID. They included fatigue, dizziness, gastrointestinal symptoms, heart palpitations and issues with sexual desire.
Who gets it?
Anyone, regardless of their age or severity of their original symptoms, according to the World Health Organization.
Data published in September by the CDC's National Center for Health Statistics found that in 2022, 6.9 percent - or about 18 million - U.S. adults reported having had long COVID while 3.4 percent - or 8.8 million - said they currently had the condition.
Nearly twice as many women - 4.4 percent - said they currently had long COVID compared with 2.3 percent of men.
Adults between 35 and 49 were the most likely age group to report having had long COVID.
If you have had COVID-19 once without developing long COVID, that doesn't mean you won't get it the future. One 2022 study co-authored by Al-Aly suggested that repeat infections with the virus increases the chances of developing long COVID.
An analysis of nearly 5 million U.S. patients who had COVID, based on a collaboration between The Washington Post and research partners, showed that people infected with the coronavirus's omicron variant are less likely to develop symptoms typical of long COVID than those who had COVID earlier in the pandemic. Patients exposed to the coronavirus during the first wave of pandemic illness - from early 2020 to late spring 2021 - were most prone to develop long COVID, with 1 in 12 suffering persistent symptoms, the study showed.
Can I stop myself from getting long COVID?
Yes! By not getting COVID in the first place. That means getting vaccinated, wearing a well-fitting mask, washing your hands and avoiding crowded, poorly ventilated indoor spaces.
And if that sounds like a tall order these days, you are right. Many people have given up on prevention, and COVID cases are increasing according to the CDC, with a rising test positivity rate of 11.7 percent and a 6.6 percent increase in emergency department visits for COVID in the past week.
The Food and Drug Administration has not approved any drug for preventing long COVID, but reducing the severity of the initial infection through vaccination probably also reduces the risk of long COVID, experts said.
For the increasing number of us who get infected, there is evidence that taking an antiviral such as Paxlovid may lower your risk of later developing long-COVID symptoms.
The evidence comes from observational studies, in which researchers collect and study data from a sample group of patients rather than setting up clinical trials with controls. The RECOVER program, which was awarded $1.15 billion by Congress in 2021 to study long COVID, has embarked on clinical trials of Paxlovid and other potential interventions.
The diabetes drug metformin may also be preventive. In one study, it was associated with a risk reduction of more than 40 percent.
What treatment is available?
There also are no approved drugs for treatment. Instead, doctors largely rely on managing their patients' symptoms, which often resemble other familiar conditions, using standard pulmonary rehabilitation, for example, to treat respiratory problems. They also adapt strategies used with concussion patients to treat brain fog and other common cognitive complaints. Some doctors are prescribing low-dose naltrexone, a generic drug typically used to treat alcohol and opioid addiction.
"It's a whack-a-mole approach," Beaudoin said. "There is not a clear algorithm to follow."
Patient advocacy groups continue to trade information about treatments on social media. But there are worrisome trends in the medical world, according to Harlan Krumholz, a cardiologist and long-COVID researcher at Yale University: Long-COVID clinics are shuttering their doors, and ambitious young physicians aren't drawn to an intractable problem like long COVID but are instead choosing specialties such as neurology and oncology with greater opportunities for breakthroughs.
Whats my chance of recovery?
Beaudoin and others counsel patience.
Most people do recover, they say, but the length of time varies. In general, more severe cases of acute illness are associated with more severe cases of long COVID.
In addition to getting professional help from a primary care physician or at a long-COVID clinic, some patients say they benefit from relaxation techniques and counseling to help with depression and anxiety that can come with suffering a long-term and poorly understood condition.
What more do you need to know?
Research is moving ahead across the country at institutions such as Mount Sinai, Stanford and Yale, and through the government-funded RECOVER program, which offers opportunities for people to enroll in clinical trials. The clinicaltrials.gov website offers sign-up possibilities for research underway around the world.
Long COVID can be a disability under the Americans With Disabilities Act. People may qualify for benefits and exemptions if the condition limits their ability to perform major life activities such as working, sleeping or preparing food.
There are numerous resources for patients, some, such as the Patient Led Research Collaborative, run by fellow sufferers, while other programs operate out of medical institutions, including Johns Hopkins and the Mayo Clinic.
To end on a note of optimism, if you get COVID today, you are less likely to develop long COVID than in the past. Thats what Beaudoin and other researchers say, though they cannot yet explain why. We suspect the virus is provoking less of an immune response, Beaudoin said.
COVID-positive numbers in the daily official communique may be in single digit, but the new virus strain JN.1 has clearly transmitted to a majority of population in the twin cities, as per an analysis from the waste water sampling being conducted by scientists of the CSIR-Centre for Cellular & Molecular Biology (CCMB), CSIR-Indian Institute of Chemical Technology (IICT) and Tata Institute for Genetics & Society (TIGS-Bengaluru).
This new strain, a close relative of Omicron variant, is an interesting and peculiar one evading the immunity obtained through previous infections or vaccines infecting people. It is spreading silently as most cases are asymptomatic or even mild where an infected person may not even know. But, it has not shown any major illness in clinical context, says TIGS director Rakesh Mishra, also former CCMB director.
In an exclusive interaction, the top scientist points out that the number of hospitalisations is very low but waste water sampling being conducted across cities of Hyderabad (18 open drains), Bengaluru (26 sewage treatment plants that cover most of the city), Vijayawada, Pune and others, have been showing increasing trend in virus being discharged through the toilets into the drains in all the municipal areas since the beginning of last month.
The virus load has been climbing rapidly since the past few weeks and soon, we will know if the trend of infections is increasing or beginning to decrease, by constantly checking the wastewater samples. The peak is generally reached within six to eight weeks of the initiation across the population, he explains.
Since the wave is silent with little or no usual symptoms of cold or throat pain, headache or mild fever (or all three), it is imperative for the medical and health authorities to conduct molecular testing of the hospitalised cases to understand the nature of the infection and variant in case of SARS-CoV-2.
The 65-plus age group and those with co-morbidities having chronic illnesses should exercise caution by using masks, avoiding crowded places and maintaining hand hygiene as even if largely mild or asymptomatic, it could harm them. Available diagnostic kits are able to detect the current variant so it is always better to get tested when symptoms surface, as it is similar to flu, cautions Mr.Mishra.
Even otherwise, it is advisable to mask up (surgical mask or N-95) at crowded places to minimise the chances of getting infected since unchecked and higher level of infections will allow the virus to circulate further and, thereby, enhance probability of it to evolve into variants which could compromise the bodys immunity, worse clinical symptoms and cause more problems.
The senior scientist advocates a heterologous booster dose (having a vaccine different from the previous two/three doses), with clinical consultations, including the available indigenously made mRNA vaccine from Genova Biopharmaceuticals Gemcovac-OM, for the senior citizens and those constantly exposed to the virus.
It is an approved sophisticated, self-replicating mRNA vaccine and could help because the even the third dose after few months may not prevent infection as the antibody levels go down gradually. Cellular immunity though has long-lasting memory that kicks in when the virus enters the body, and prevent severe disease conditions he says.
Mr.Mishra reiterates his call for a more robust sewage and environmental surveillance system to be in place in the cities to keep constant watch on the emerging viruses or pathogens so that an advance warning can be given to minimise deleterious effects. Such system will enable civic bodies to be prepared for future and pre-empt the number of emergency situations.
This virus is not worrisome, but constant monitoring is needed to avoid surprises. Environmental surveillance is a powerful smart technology tool to be proactive with minimum fuss and maximum benefit with less cost, he adds.
Data on this page is reported by the Centers for Disease Control and Prevention. Population and demographic data is from the U.S. Census Bureau. Hospitalization data is reported by individual hospitals to the U.S. Department of Health and Human Services, and it includes confirmed and suspected adult and pediatric patients. The C.D.C. does not provide complete vaccinations data for some counties and caps its vaccination rate figures at 95 percent.
The C.D.C. may make historical updates as more data is reported.
The C.D.C. stopped reporting data on Covid cases in May 2023.
ODonnell said that before the pandemic, flu cases would typically increase in December and peak in January.
Main Line Health has also seen a lot more patients who are sick with flu, said Chief Medical Officer Jonathan Stallkamp.
He added that the flu usually kills tens of thousands of people in the U.S. per year, so it is not a disease to be taken lightly.
If youve ever had flu, it is like getting hit by a truck, he said. You feel horrible. It is not like your typical nose cold where youre blowing your nose for a couple days and maybe Ill just be better the next day. You can be out for days.
Fortunately, so far, the situation is not as bad as it was last winter, when there were record numbers of COVID-19, RSV or respiratory syncytial virus, and flu patients at the same time, said Dr. Ericka Hayes, senior medical director of infection, prevention, and control at the Childrens Hospital of Philadelphia.
COVID-19 remains an unpredictable wild card, she said. It may do nothing or we may see a surge in January not unlike what we saw in January of 22 with the omicron surge. So I think the thing that worries and concerns me the most is the fact that we cant know.
Hayes said the number of RSV cases at CHOP peaked in late November, and is starting to decrease. While the CDC alerted health care providers about low vaccination rates for COVID-19, flu, and RSV, she noted that there was also an issue with the supply of RSV vaccines earlier this year.
So far, the biggest concern is that the number of flu and COVID-19 patients in hospitals could peak at around the same time and strain capacity, said Dr. Cheryl Bettigole, Philadelphias health commissioner.
The newer variants that are circulating dont appear to be worse. They dont appear to be more likely to put people in the hospital, she said. But you get enough virus circulating, youre going to see large enough numbers that hospitalization rates could go up. And staffing for hospitals can be a challenge as these viruses circulate because the hospital personnel cant work if they themselves are sick.
Vaccines help boost the production of antibodies, providing effective protection against serious illness and death, Mona Hyster Fenstad says.
She is a senior consultant at the blood bank at St. Olavs Hospital in Central Norway.
The Covid-19 virus is rife all over Norway. The Norwegian Institute of Public Health recommends people in risk groups to get vaccinated.
They point out that elderly people in particular will be vulnerable to serious illness if they are infected with Covid-19. However, since the vast majority of us have already had Covid-19 at least once, do we really need to think about getting vaccinated?
Yes, the scientists say.
The saying what doesnt kill you makes you stronger is not true in this context. The inflammation that occurs in the body during infections such as influenza, Covid-19, and pneumonia can be harmful. Especially for people with heart or lung disease, or where other risk factors are involved, Fenstad says.
Fenstand and her international colleagues have recently published a study that looked at the effect of vaccination on people who became ill with Covid-19 before vaccines were available. This work has been closely linked to the search for antibodies that can be used as medicine against Covid-19.
At the beginning of 2020, the World Health Organization (WHO) asked scientists and therapists around the world to look for treatments for Covid-19. Among the treatments proposed was convalescent plasma therapy, which uses plasma from blood donors who have recovered from the illness," Fenstad says.
Along with NTNU colleagues, the researchers chose to take a closer look at how the antibodies in this plasma were able to neutralise new virus variants that emerged.
While big pharmaceutical companies were working hard to develop vaccines and medicines, researchers had already begun to look at the use of blood plasma from Covid-19 patients as a possible treatment.
Many of these patients had large amounts of antibodies in their blood. Plasma containing these antibodies was therefore given to seriously ill patients to help them fight the virus. It turned out that convalescent plasma therapy was primarily effective in patients who had immunodeficiencies, Fenstad says.
We were looking for so-called super-neutralisers, people who develop specific antibodies that effectively neutralise different variants of SARS-CoV-2, Denis Kainov says. He is a professor in NTNUs Department of Clinical and Molecular Medicine, and was part of the research team.
These antibodies were eventually cultivated and cloned, and then turned into medicines used to fight Covid-19.
In Norway, the first Covid-19 outbreak occurred in February 2020. The first Alpha variant was quickly followed by new, mutated variants named Beta and Delta. Omicron, which is currently the prevailing variant, was first reported in late 2021.
By April 2020, blood banks across Norway had begun collecting blood plasma from patients who had recovered from Covid-19. At St. Olavs Hospital, 72 patients were selected for a more detailed study of the antibodies in their blood plasma.
It turned out that half of these patients had serum containing antibodies that effectively neutralised the Beta variant, Kainov says.
Kainov has been searching for active substances to use in the treatment of Covid-19 and other viral diseases.
He is now looking for antibodies that could provide wider protection, including against new Covid-19 variants that might emerge.
They noticed that four patients had antibodies that effectively neutralised the Covid-19 variant that was dominant in Trondheim, Central Norway, at the time.
We followed up by taking new samples from these patients and found that their antibodies also neutralised other Covid-19 variants. In fact, they were also effective on new virus variants, Kainov says.
The conclusion is thus that it is a good idea to get vaccinated even if you have already had Covid-19 and even if the virus has mutated since the vaccine was made.
Out of the four patients, the researchers picked the one whose antibodies had been least effective against the Omicron variant. This patient had received their first vaccine dose four months after recovering from Covid-19. The efficacy of the vaccine was striking.
The vaccine boosted the production of immune cells and antibodies against all tested variants of the virus, including Omicron, Kainov says.
Kainovs colleagues in Estonia could then proceed with blood plasma from the patient, cloning and cultivating antibodies that neutralised Covid-19 viruses on a wide scale.
The results have also provided the scientists with useful knowledge about the effect of the vaccine on convalescents.
When it comes to vaccines, it is always a race. The virus is always one step ahead, and the vaccines and medicines will never be completely up to date, Fenstad says.
Their study is an in-depth study of just one patient, and it constitutes only a tiny piece of research in this field.
"However, large studies in other countries confirm our findings. Vaccines boost the production of antibodies that are also effective against new variants of the virus, she says.
The finding demonstrate that it is a good idea to get vaccinated even if you have already had Covid-19 and even if the virus has mutated since the vaccine was made. It may not prevent you from being reinfected, but it will provide protection against serious illness and death.
When you get sick with Covid-19, you develop antibodies, but the effects of these diminish and are gone after six to nine months. This is why people can get infected again and again by new variants of SARS-CoV-2. The virus mutates to avoid the immune response we have developed through previous infections or vaccines, Kainov says.
That is why vaccination is important now that it is winter.
The studies we have conducted here on Covid-19 patients are extremely important, because there will be new outbreaks of the virus. Almost seven million people have died from Covid-19. We must avoid getting into the same situation again, Kainov says.
Reference:
Fenstad et al. Boosted production of antibodies that neutralized different SARS-CoV-2 variants in a COVID-19 convalescent following messenger RNA vaccination a case study, International Journal of Infectious Diseases,2023.
With the holiday season coming to a close, flu cases are taking off and COVID-19 continues to be a looming threat.
When asked if COVID has become more dangerous, Ann Weiss, Clinical Director at Primary Health, replied, "I really don't think we know. Especially with the component of long COVID thrown in there. It's really significant for a lot of people. I don't see COVID just becoming flu any time soon."
Covid continues to mutate and change, but Weiss, clinical director at Primary Health says the latest boosters seem to be effective against it. Even still, some are reluctant to get their booster shots.
Idaho resident John Nargiel says, "The only reason I got it was I was taking a trip to the Philippines and I wouldn't have been able to go on the trip without it."
If you do get sick, doctors advise that you stay at home except to see a doctor who can quickly determine if you have the flu. Tests for COVID-19, however, take much longer because the viral load has to build up over several days.
According to the CDC, there are still concerns that some hospitals across the country could be overwhelmed by the combination of COVID and a spike in flu cases but so far, Idaho is keeping up.
Weiss says, "We're nowhere near where we were with hospitalizations two years ago so I think we're ready to handle it.
It's still not too late to get your flu vaccine or your COVID booster, though keep in mind that both vaccines take around 2 weeks to reach their maximum effectiveness in the body.
Theres some good news and bad news in the world of vaccines. Most nursing home residents in Arizona still havent gotten their COVID-19 booster. And for the first time, vaccines are available to protect against four respiratory illnesses.
Only 16% of nursing home residents have been vaccinated with the new COVID booster and slightly more than 3% of staff have gotten the jab. Thats according to the most recent data from the Centers for Medicare and Medicaid.
Will Humble is the executive director of the Arizona Public Health Association. In many of the states that have higher vaccination rates for people in assisted living in skilled nursing facilities, it's because those state health departments are requiring that the facilities offer the vaccine, they don't compel anyone to get the vaccine,he said.
He says thats not the case in Arizona.
At first you might think, well, it's a red state-blue state thing. Well, no, because North and South Dakota, which are by all accounts, really conservative states, have terrific vaccination rates for COVID-19 in assisted living and skilled nursing facilities.
They also have much higher RSV vaccination rates.
As for the good news: The big four respiratory illnesses influenza, RSV, COVID-19 and pneumococcal disease are all now vaccine preventable. Unfortunately, he says, it's just disappointing to see the uptake rate for some of these vaccines being so low.
