The number of Arizonans admitted to the hospital recently for COVID-19 is about 30% lower than it was at this time last year,according to the Centers for Disease Control and Prevention. But cases are on the rise in the state.
With Thanksgiving and other holiday gatherings approaching, Dr. Kirin Raman with the Arizona Department of Health Services said Arizonans should take precautions as COVID-19 and other seasonal respiratory infections spread.
"Staying home when you're sick from work or from school, covering your coughs and sneezes, washing your hands frequently, and disinfecting those high-touch surfaces," Raman said.
Raman also pointed out anyone can order free COVID-19 test kits online atCOVIDtests.gov.
"If they havent signed up using their address for this fall season, they are eligible for eight sets of tests. If they have already, then those same individuals at those addresses can get another four sets to make sure that they have enough ahead of this holiday season," Raman said.
Raman said the best way to protect yourself and those around you this holiday season is to get an updated COVID-19 vaccine. Vaccine providers nationwide are listed atvaccines.gov.
The Department of Health announced a new website where people 18 years or older can review vaccination records.
The website, known as the SMART Health Card, is a digital record of patients vaccinations. Their health care providers must submit the records to the Hawaii Immunization Registry.
Through the website, patients can generate a QR code for their COVID-19 vaccinations. This will allow them to save their COVID-19 vaccinations to their smartphones digital wallet.
The SMART Health Card website uses ID.me to verify the identity of a patient. ID.me requires a patient to share their social security number or individual taxpayer number, but DOH does not receive this information. Instead, DOH receives information necessary to find a patients immunization record, including patient name, date of birth, address, email address and phone number.
In order to access the SMART Health Card website, click here. For more information, visit the Frequently Asked Questions on the bottom of the website.
Anyone who is under 18 years old must contact the Immunization Registry directly to receive their vaccination record. The Immunization Registry may be contacted by calling (808) 586-4665 for Oahu or 1-888-447-1023 for neighbor islands or by emailing registryhelp@doh.hawaii.gov.
Philadelphia health officials are urging people gathering for Thanksgiving to take safety precautions against the respiratory viruses that proliferate when people spend more time indoors.
While this years sick season may be less severe in Philadelphia than in previous years, its still important for people to test for COVID, especially those planning to have dinner with people more vulnerable to the virus. Health officials also encourage people to get vaccinated.
Shara Epstein, the medical director of the division of disease control at the city health department, said she expects a more typical flu and RSV season than weve seen in the past. COVID cases will likely rise again, but to much more manageable levels, she said.
In Pennsylvania, cases of respiratory syncytial virus, or RSV, and the flu have been increasing in recent weeks, though not near the levels reported during last years tripledemic, when a large spike in respiratory diseases, including COVID, flooded emergency rooms.
As of last week, COVID hospitalizations statewide had also seen a slight uptick, but have been mostly stable since cases began to rise in late summer. Those numbers, too, are well below the increase in cases seen during the tripledemic and other large COVID waves in late 2020 and early 2022.
In late October, the Centers for Disease Control and Prevention predicted that the winter sick season could see a moderate COVID-19 wave, with about as many hospitalizations at the peak of the season as the agency saw last year. Similarly, flu hospitalizations should be on par with recent years, though vaccine uptake will affect how many people need advanced care.
RSV infections are in line with normal seasonal patterns prior to COVID, the CDC said.
During the first couple years of COVID, we did so much that affected the transmissions of these viruses distancing, staying home, masking pretty much everywhere. We didnt see RSV and flu, really, in the first year, Epstein said. Then RSV came back last year and we saw a huge wave there were a lot of kids who hadnt gotten it in previous years. But were starting to see an evening out of all of these viruses.
Local and national health officials have urged travelers to get vaccinated for respiratory diseases before they attend a Thanksgiving event. This is the first year that vaccines are available for flu, RSV, and COVID, the CDC wrote in a press release.
The CDC recommends that everyone older than 6 months should get flu and COVID vaccines. Supply chain issues and insurance snafus with the latest COVID-19 vaccines, which are effective against the most common variants circulating, have been resolved, CDC director Mandy Cohen said during a visit to Philadelphia last month.
In Philadelphia, Epstein said that health officials havent seen huge uptake of the latest COVID-19 vaccine. But, she stressed, its important that as many people as possible get both COVID and flu vaccines.
Theres been some vaccine fatigue people have gotten so many in the last few years, she said.
People over 60 should talk to their doctors about getting an RSV vaccine. Pregnant parents should get an RSV vaccine between their 32nd and 36th weeks of pregnancy, and infants under eight months should get a preventive RSV antibody treatment.
Epstein said that supply issues have made the antibody treatments for infants harder to find this season, but that pregnant people and people over 60 should have less trouble accessing a vaccine.
In Philadelphia, the health department is also recommending residents test for COVID-19 before going to Thanksgiving dinner. Residents can pick up free COVID tests at four resource hubs around the city. The hubs locations and hours are listed on the health departments website.
And, health officials say, if you dont feel well, stay at home to avoid infecting anyone else at your Thanksgiving table.
TOPEKA Health officials warn travelers to watch out for a highly contagious new COVID-19 variant when making plans this month.
During a Tuesday update on COVID-19 cases, the University of Kansas Health System reported treating 24 COVID-19 patients this week. Dana Hawkinson, director of infection prevention and control at the system, said the slight increase up from 16 cases the week prior, showed the virus is still spreading in Kansas communities.
We know the virus is circulating out there, so everybody be careful and have a plan when you are traveling and going to visit families and friends, Hawkinson said.
The Centers for Disease Control and Prevention reported a spike in a new subvariant, the HV.1 COVID-19 variant. For the week ending Nov. 11, the latest national data shows COVID-19 hospitalization rose about 8.6% and COVID-19-related deaths rose about 9.1%. During that same time frame, 16, 239 people were hospitalized due to the virus.
Andrea Garcia, vice president of science, health and medicine at the American Medical Association, said there has been a seasonal spread.
We have a new COVID variant called HV.1 that we do need to keep an eye on, Garcia said. Its just been a few short weeks and HV.1 has become the variant responsible for most COVID cases here in the U.S.
Kansas COVID-19 cases havent been widely documented by the state since the end of the federal COVID-19 emergency declaration. Since the CDC stopped tracking cases of infection, hospitalizations are now the primary indicator of COVID-19 spread.
While cases in general remain low, Montana, Wyoming, Nebraska and Kansas have documented rising clusters of cases. In Kansas, CDC data shows around 197 new weekly hospitalizations.
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In our study, a statistically significant improvement of clinical (SpO2 and PaO2/FiO2 ratio) and biological (Lymphocytes, CRP, IL-6, Ferritin, D-dimers, Fibrinogen) parameters was attributed to the use of therapeutic plasma exchange in the first group. Additionally, a statistically significant difference was observed comparing clinical (SpO2 and PaO2/FiO2 ratio) and biological (WBC, D-dimers, Fibrinogen) between both groups included in this study, as well as a higher extubation rate, a lower ICU length of stay and mortality in group 1.
Beyond its pulmonary tropism, COVID-19 is a systemic disease with multi-organ involvement attributed to an excessive immune response to the virus [20, 21]. In fact, this hyperinflammatory induced state has been well documented and corresponds to the "cytokine storm" syndrome previously described in various conditions [8, 9].
Serum cytokine levels that are elevated in patients with COVID-19-associated cytokine storm include interleukin-1, interleukin-6, IP-10 (Interferon gamma-induced protein 10), TNF (Tumor Necrosis Factor), interferon-, MIP-1 and 1 (Macrophage Inflammatory Protein-1 Alpha and 1 Beta) proteins, and VEGF (Vascular Endothelial Growth Factor) [10, 21]. Higher levels of interleukin-6 are strongly associated with shorter survival [11]. Circulating activated CD4+and CD8+(Cluster Of Differentiation 4 and 8) T cell and plasmablast levels are also increased in COVID-19 [12].
In addition to elevated systemic cytokine levels and activated immune cells, several clinical and laboratory abnormalities, such as elevated CRP and d-dimer levels, hypoalbuminemia, renal dysfunction, and effusions, are also observed in COVID-19. These organ failures and biological abnormalities reflect the degree of hyperinflammation and tissue damage and can predict the prognosis of COVID-19 [13].
Pre-existing comorbidities such as hypertension, diabetes, and obesity are associated with more severe forms of COVID-19 [14], perhaps due to the pre-existing chronic inflammatory state or a lower threshold for the development of organ dysfunction due to the immune response [5].
Naturally, therapies targeting hyperinflammation, such as immunosuppressants [15], and therapeutic plasma exchange therapy (given their proven role in blood purification by eliminating high molecular weight circulating substances and restoring homeostasis in many dysregulated biological pathways [16]), have a valuable place in the therapeutic arsenal against COVID-19.
In a multicenter case-control study was conducted by Gucyetmez et al. [17] to determine the effectiveness of TPE in patients with COVID-19 admitted to five ICUs in Turkey. The patients were divided into two groups: group 1 consisted of 18 patients who received three consecutive TPE sessions, and group 2 consisted of 35 patients who only received standard therapeutic protocol. The mean SpO2 in group 1 was 917% vs. 895% in group 2. The same study also reported a mean pre-TPE WBC count of 9.084.1103/L compared to a mean post-TPE WBC count of 9.143.5103/L. To date, the study by Gucyetmez et al. and ours are the only ones to have included SpO2 and WBC count as variables to study the effectiveness TPE in COVID-19.
Similarly, to our findings, a randomized control trial including 87 patients divided into two groups [18], depending on who benefited from TPE on top of the standard therapeutic protocol or just the latter, and in which significant improvement in PaO2/FiO2 ratio, CRP, IL-6, Ferritine, and D-dimers were noted before and after TPE sessions. The same study reported better clinical and biological parameters in the intervention group comparted to the control group.
While the efficiency of TPE has extensively documented, the diversity of methods used by each center has been well documented, particularly in the literature review conducted by Krzych et al. [6] and later by Beraud et al. [19], the latter of which included 34 articles (1 randomized controlled trial, 4 casecontrol studies, 15 case series, and 14 case reports, totaling 267 patients treated with plasma TPE).
We highlighted three major differences. First, the number of sessions varied from 1 to 9 sessions depending on the case series in question. Second, there was a variability in the choice of replacement fluid, with Fresh Frozen Plasma (FFP) being the most commonly used, followed by 5% albumin. Finally, there was a predominance of regional citrate anticoagulation (RCA) [6, 19].
In the absence of guidelines regarding the practical aspects of TPE and following the departments procedural habits, we opted for a number of 5 consecutives TPE sessions using FFP as a substitution fluid and heparin for anticoagulation given that RCA is not available. The therapy was provided to patients based on the informed consent of either the patient or a proxy, and also based on the therapys availability given the limited number of machines, consumables, and FFP.
Taking into account the therapys procedural diversity, a multinational team of the International Society of Blood Transfusion (ISBT) conducted a literature review relying on the recommendations of the American Society for Apheresis (ASFA) to formulate preliminary clinical practice recommendations related to the performance of plasma exchanges in COVID-19 [22], which concluded up to the date of its publication that the use of TPE in COVID-19-induced cytokine storm is categorized as Class III, Grade 2B, meaning that its optimal role is not established, and that the quality of evidence evaluated at that time supported only a weak overall recommendation for this approach, indicated in critically-ill COVID-19 patients with virtually no absolute contraindications, initiated early in the disease progression, using FFP or ideally convalescent plasma for substitution, and RCA for anticoagulation. The recommended exchange volume is 1 to 1.5 times the patients TPV (Total Plasma Volume), for virtually as many sessions as necessary.
The results of our cohort are in line with those widely reported by several studies already in the literature, advocating for the effectiveness of plasma exchange in COVID-19, especially in severely ill patients requiring ICU care.
The COVID-19 pandemic proved to be a unique experience, opening the door to an unlimited potential of research and experimentation. While our study could have been better led, with more clinical and biological parameters monitored, it offers ad significant sample size, with valuable results.
That said, further studies are needed to first describe more specifically and closely delineate the clinical-biological spectrum of the cytokine storm induced by COVID-19, particularly its often-neglected extrapulmonary manifestations, but also to support the safety and efficacy of plasma exchange in COVID-19.
In this sense, it would be preferable to evaluate the use of plasma exchange alone, or in combination with other therapies, for COVID-19 patients in the context of prospective, randomized, and controlled clinical trials. This approach could yield fruitful results in saving lives and paving the way for future consideration of plasma exchange in similar diseases.
Our study has a number of strengths including a specific focus on the use of TPE in critically-ill patients, joining only a limited number of studies published to this day, as well as comparative approach comparing outcomes before and after TPE sessions within Group 1 and conducting an event-based comparison between both groups, enhancing the depth of the analysis. This Event-Based Comparison provides a meaningful endpoint, aligning with practical clinical outcomes. This study also carries certain weaknesses such as its retrospective and single-center design. Also, a longitudinal data analysis comparing parameters and outcomes at various time points, accounting for individual variations would have been more informative, specifically on the efficiency of TPE with less than 5 sessions.
In the analysis, we distinguished four potential types of places of death: deaths at home, in medical facilities (hospitals or other medical facilities), in facilities of social care (social care houses), or at other places. Most CVDs deaths occurred in medical facilities (more than 50% in all the studied years). Before the pandemic, around 26% of CVDs deaths occurred at home annually. During the pandemic, this proportion increased to more than 30% in 2021. COVID-19 deaths occurred mostly (around 90%) in medical facilities (Table 1).
For the studied years, Table 2 (pre-pandemic development) and Table 3 (development during the pandemic) show the annual changes in life expectancy at birth and contributions of deaths from CVDs and COVID-19 according to places of death.
Life expectancy at birth is a summary measure of the current health status of the population under study. If the level of mortality increases, life expectancy decreases, and vice versa. According to contributions of particular causes of death, if mortality from the selected cause increases, the contribution of this cause to a change in life expectancy is negative, i.e., worsening of mortality from any cause of death negatively contributes to a life expectancy change.
Between the years 2019 and 2020, the life expectancy at birth decreased by almost a year. The second pandemic year brought a further decrease in life expectancy, by more than a year (1.03years). The year 2022 was the first year since the pandemic during which life expectancy increased again (+1.76years).
Before the pandemic, a decrease in CVDs mortality contributed significantly to the growth in life expectancy (Tables 2 and 3). Between the years 2017 and 2018, the contribution of CVDs was even higher than the overall increase in life expectancy (+0.14 and+0.17years; the positive contribution of CVDs was moderated by a mortality increase from other causes of death).
A significant change was observed in the first pandemic yearthe contribution of CVDs was negative (0.18years; mortality from CVDs increased) and supported the negative development of life expectancy in 2020. Thus, the higher level of CVDs mortality in 2020 contributed to the overall reduction in life expectancy at birth (Table 3).
In the second year of the pandemic, there was a reversal. Despite the COVID-19 pandemic peaking in 2021, the positive development in CVDs mortality was observable. Improvement in CVDs mortality helped to moderate the life expectancy decrease caused mostly by COVID-19. In 2022, also CVDs contributed significantly (+0.15years) to the overall rapid increase in life expectancy (Table 3).
The next part of Tables 2 and 3 describes the contribution of COVID-19 to life expectancy changes. In the first year of the pandemic, COVID-19 mortality led to a reduction in life expectancy at birth by 0.74years. The second pandemic year was even worse, and COVID-19 itself led to a decrease in life expectancy by 1.19years. In the final year of the pandemic, mortality from COVID-19 decreased again.
Tables 2 and 3 show also the contribution of CVDs and COVID-19 mortality according to places at death. Most of the negative contribution of COVID-19 was due to deaths in medical facilities because most of the COVID-19 deaths occurred in hospitals (9092%). Vaccination against COVID-19 was initiated during the first months of 2021, preferably from the oldest age groups, or in facilities of social care. This is reflected in the positive contributions of COVID-19 mortality at facilities of social care to life expectancy change between 2020 and 2021.
The situation was different according to CVDs. Before the pandemic, contributions of CVDs mortality were around zero at all places except for medical facilities where decreasing CVDs mortality helped to increase the overall life expectancy. Whereas the CVDs mortality rates in hospitals improved until 2019, CVDs mortality rates out-of-medical facilities were almost stable (Table 2).
In the first pandemic year (2020), the negative contribution of CVDs mortality to the overall change in life expectancy was mainly due to higher CVDs mortality at home and in social care houses. At these two places, the level of CVDs mortality worsened, i.e., the number of CVDs deaths at home or social care houses increased the most. In 2021, CVDs mortality in social care houses and in medical facilities improved and helped to decrease CVDs mortality. The contribution of CVDs mortality at home was already close to zero, but still negative (supporting the decrease in life expectancy). In the final pandemic year, 2022, contributions of CVDs mortality regardless of the place of death were positive again (Table 3).
Figure1 shows the overall development of CVDs health care provision and mortality in Czechia in time, i.e., development of the studied time seriesCVDs hospitalizations (panel A), CVDs ambulant care (B), CVDs deaths in medical facilities (C), at home, and in facilities of social care (D). The monthly data are adjusted for the length of particular months in the period January 2018December 2022. Clearly, in the time series, a strong seasonal pattern can be seen (see Fig.2Seasonal component of time series decomposition). There is also a long-term decreasing trend in some seriesabove all CVDs hospitalizations (Fig.1A) or CVDs deaths in medical facilities (Fig.1C). This trend started already before the pandemic. On the other hand, there was an increase in CVDs ambulant care before the pandemic, which was interrupted in 2020 (Fig.1B). The number of CVDs deaths at home or in facilities of social care had almost a stable trend during the studied period, however, with high variability (Fig.1D). The visible peak at the end of 2020 could be considered as an indirect effect of the pandemic and will be discussed later in more detail. The significant exceptional increases or decreases in the development are depicted in Fig.3.
Source:14,15,16, authors calculation, output of the SAS software, version 6.4.
Time series of monthly data adjusted for the length of particular months, January 2018December 2022, CVDs hospitalizations (A), CVDs ambulant care (B), deaths in medical facilities (C), deaths at home and facilities of social care (D), Czechia.
Source:14,15,16, authors calculation, output of the SAS software, version 6.4.
Seasonal component of time series decomposition (1=average month corresponding to the overall trend of the time series), January 2018December 2022, CVDs hospitalizations (A), CVDs ambulant care (B), deaths in medical facilities (C), deaths at home and facilities of social care (D), Czechia.
Source:14,15,16, authors calculation, output of the SAS software, version 6.4.
Irregular component of time series decomposition (1=average month corresponding to the overall trend and seasonal factor of the particular month of the time series), January 2018December 2022, CVDs hospitalizations (A), CVDs ambulant care (B), deaths in medical facilities (C), deaths at home and facilities of social care (D), Czechia. Note: the dotted horizontal line at value one represents the reference level corresponding to an expected values of the time series for a particular month reflecting the trend and seasonal pattern.
The seasonal patterns (Fig.2) of the analysed series are stable in time (in contrast to more traditional approaches to time series seasonal decomposition, the used X-13 methodology potentially allows for moving seasonal components, slightly developing in time). Values around one represent an average month within a year. There is a traditional decrease in the number of CVDs hospitalizations as well as CVDs ambulant care during the summer and in December each year (by some 20%, represented by values around 0.8 in Fig.2). On the other hand, the peak of CVDs mortality repeats annually in the first quartile of the year (regardless of the place of death).
Figure3 shows the irregular component of the time series decomposition. It reveals the unexpected or exceptional changes in the studied time series. Values around one correspond to expected values of the time series for a particular month reflecting the trend and seasonal pattern. For CVDs health care, there is an abrupt drop in March and April 2020, in both time series the values of provided health care decreased in those months to almost 70% of expected values (values around 0.7 in Fig.3). This decrease is partially replaced by an exceptional increase in CVDs ambulant care during the summer of 2020, however, this increase was only about 20%. Another decrease in the number of CVDs hospitalizations as well as ambulant care was observable at the end of 2020. The observable decrease in CVDs hospitalizations at the very end of 2022 may correspond to the strong flu epidemics at that time.
Several peaks of CVDs mortality were seen during the studied years. The first peak occurred at the beginning of 2018. This likely corresponds to weather conditions and flu epidemics typical for this time of the year, however stronger in the studied year. Except for these smaller or bigger peaks repeating similarly (however, not strictly regularly so as to be included in the seasonality pattern) every year during the first months (reinforcing the long-term seasonal effect), there are no strong deviations from random fluctuations around one (corresponding to average months). The change occurred with the start of the pandemicin April 2020, there was an increase in the number of CVDs deaths at home by 10% in comparison to an average April in the studied years and an increase of almost 9% in deaths in facilities of social care. This corresponds to the observed decrease in CVDs health care or hospitalization in March or April of that year. For the sake of completeness, this time, from March 12th to May 17th, 2020, a State of Emergency was declared in Czechia24.
An even more significant increase in CVDs deaths occurred, however, at the end of 2020above all in October 2020 (increase by 12% in medical fac., 15% at home, and 29% in facilities of social care) and November 2020 (increase by 45% in facilities of social care, the increase in deaths at home or in medical facilities was around 23%). At this time, the next State of Emergency was declared in Czechia in the period from October 5th, 2020, to February 14th, 202124.
The last exceptional increase in deaths at home occurred in November 2021 by 14% and at medical facilities (hospitals) in December 2022 by 12% which likely corresponds to an already mentioned flu epidemic.
Post-COVID-19 symptoms like daytime sleepiness, fatigue, and memory/concentration problems may be because of reduced sleep efficiency and undiagnosed obstructive sleep apnea, a new study found.1
People who have COVID-19 have reported experiencing symptoms, such as chronic pain, brain fog, shortness of breath, chest pain, and intense fatigue, for either weeks, months, or years after a SARS-Cov-2 infection. One 2021 study found 76% of 1655 patients with COVID-19 had persistent symptoms for 6 months after leaving the hospital. Symptoms included respiratory and cardiac symptoms, as well as neurological symptoms63% had fatigue, 26% had sleep difficulties, 11% had smell disorders, 7% had taste disorders, 6% had dizziness, and 2% had myalgia and headache.
A U.S. Household Pulse Survey, conducted by the Census Bureau and National Center for Health Statistics, found the percentage of participants with lingering or new symptoms post-COVID dropped to 11% in January 2023 from 19% in June 2022. The decline reason remains unknown. A Yale Medicine cardiologist, Erica Spatz, MD, MHS, believed the decline could be due to more people getting vaccinated, as well as milder variants.2
A new single-center retrospective study, led by Katja Menzler, from the department of Neurology at Philipps-University Marburg in Marburg, Germany, aimed to evaluate the polysomnographic results of post-COVID-19 patientsand thus diagnosing potential sleep disorders. The study referred to the condition of experiencing lingering COVID-19 symptoms for > 12 weeks as post-COVID syndrome. Though, the Centers for Disease Control (CDC) refers to experiencing symptoms for > 4 weeks as Post-COVID Conditions.3 Risk factors linked to post-COVID syndrome include female, sex, middle age, other chronic diseases or psychiatric diseases, and the severity of the infection.
The study included 34 patients with post-COVID syndrome between March 2021 and December 2022. The sample had a mean age of 45.5 12.1 years, as well as 27 females and 7 males. All patients reported new-onset fatigue and sleepiness after SARS-CoV2 infection. Patients underwent polysomnography between January 2021 and October 2022.
After getting infected by COVID-19, one patient had excessive snoring and witnessed apnea;, another patient had preexisting snoring without apnes (after the infection snoring had increased), 4 patients had occasional snoring, 3 patients had previous asthma, and one patient had a history of pulmonary.
The polysomnography revealed 26% (n = 9) had a sleep latency of < 30 minutes, 35% (n = 12) had a total sleep time of < 6 hours, and 50% (n = 17) had a reduced sleep efficiency of < 80%. None of the patients demonstrated sleep-onset rapid eye movement (REM). The findings revealed a 35% prevalence of newly diagnosed obstructive sleep apnea in patients with fatigue stemmed from their COVID-19 infection.
Reports of the prevalence of [obstructed sleep apnea] in the general population vary, but range between 9% and 38% for mild to severe cases, and between 6% and 17% for only moderate to severe cases, the investigators wrote. The percentage of all [obstructed sleep apnea] cases observed in the present study was therefore in the upper range, and the percentage of moderate to severe cases was slightly higher than reports in the general population.
The investigators concluded by stating the treatment of obstructive sleep apnea with CPAP improved daytime sleepiness.
An improvement in fatigue was reported in these two patients after initiation of automatic positive airway pressure therapy, the investigators wrote. In line with these results, CPAP treatment led to discontinuation of daytime symptoms in the 50% of patients with [obstructive sleep apnea] who agreed to and tolerated CPAP treatment in our study, supporting our suggestion of [obstructed sleep apnea] being a treatable cause of fatigue and daytime sleepiness in patients with post-COVID syndrome.
References
There are several circulating subvariants of Omicron globally. But what are they and why are we not as concerned as WHO officials about it?
While the height of the pandemic may be over, the virus that causes COVID-19 continues to mutate with multiple variants circulating in every country.
Yet despite this, testing and surveillance have decreased, with experts urging people to keep taking the threat of this disease seriously.
"The world has moved on from COVID, and in many respects, that's good because people are able to stay protected and keep themselves safe, but this virus has not gone anywhere. It's circulating. It's changing, it's killing, and we have to keep up," Maria Van Kerkhove, the COVID-19 technical lead at the World Health Organization (WHO), told Euronews Next.
All the variants circulating today are sublineages of Omicron, a highly transmissible variant of COVID-19 that first emerged two years ago.
One sublineage, EG.5, also nicknamed Eris, currently represents more than half of the COVID-19 variants circulating globally. It was declared as a variant of interest by WHO back in August.
Cases of EG.5 increased over the summer, but it was recently outpaced in the United States by a closely related subvariant called HV.1. This subvariant now accounts for 29 per cent of the COVID-19 cases in the US, according to the latest figures from the Centres for Disease Control and Prevention (CDC).
"HV.1 is essentially a variant that's derived from EG.5.1 (and previously XBB.1.5) that's just accumulating a few mutations that allow it to better infect people who have immunity to SARS-CoV-2," Andrew Pekosz, a professor of molecular microbiology and immunology at Johns Hopkins University in the US, told Euronews Next.
Pekosz, who studies the replication of respiratory viruses, said that these variants likely emerged as random mutations as part of the natural evolution of viruses.
According to the European Centres for Disease Control and Prevention (ECDC), XBB 1.5-like variants such as EG.5 - or Eris - are currently dominant, making up about 67 per cent of cases in EU/EEA countries.
The prevalence of another Omicron sublineage called BA.2.86 has been "slowly increasing globally," according to WHO, which recently classified it as a "variant of interest". Its sequences were first reported in Israel and Denmark in July and August.
"BA.2.86, when it emerged, was something that was really concerning to scientists because it was a variant that had a large number of mutations, particularly in the spike protein, which is the target for the protective immunity that vaccines and infections give you," said Pekosz.
Scientists think that this variant likely originated in a person with a compromised immune system which allowed the virus to replicate and accumulate mutations at a faster rate, yet it hasnt come close to becoming dominant.
French authorities, however, recently said that most cases of BA.2.86 in the country were a new sublineage JN.1, which has been "detected in other countries but is mainly circulating in Europe and particularly in France".
It appears to have more mutations that make it more transmissible, Pekosz said.
RNA viruses like SARS-CoV-2, which causes COVID-19, are known to pick up mutations at a faster rate than other viruses "because they make more mistakes and don't have the ability to fix those mistakes," according to Pekosz.
SARS-CoV-2 and its spike protein also appear to tolerate a lot of mutations, similar to what scientists see with influenza.
But so far, while scientists pay attention to these mutations, they are not seeing changes in disease severity, and the tests we use still detect the virus.
These new variants will continue to emerge and "for the most frail in society, especially those with certain underlying health conditions, they will continue to contribute to hospitalisations and even deaths," said Andrew Pollard, a professor of infection and immunity at the University of Oxford.
However, Pollard does not expect them to "reboot a pandemic" as globally, there is strong population immunity from vaccination and prior infection.
While new families of COVID-19 are likely being generated by mutation," there hasnt been one "as successful as the Omicron variants which are dominating," he said. At least for now".
The worst-case scenario would be a new variant that spreads more quickly and causes more severe illness that the vaccines do not work against.
We don't take anything for granted. We have different scenarios that we're planning for in terms of the variants and their detection, said Van Kerkhove,who is also WHO's interim director for epidemic and pandemic preparedness and prevention.
At the moment these variants are not causing a new large surge in cases or hospitalisations, and while experts say that there is still enough sequencing for them to detect emerging variants, these efforts have decreased.
What we've lost recently is the ability to really get a sense of the whole diversity that's present in these virus populations, said Pekosz.
Van Kerkhove encouraged people to continue to get tested if they think they have COVID-19 because that allows scientists to track the virus and later sequence it to study possible mutations.
"If youre not tested, you cant be sequenced," she said.
Reductions in testing and sequencing as well as increased delays in getting the data "is very challenging for us and slows down our ability to do risk evaluations of each of these subvariants," she added.
Most importantly, even as the world moves on, experts recommend that people get vaccinated, wear masks in crowds or around people at higher risk of severe COVID-19, and get tested to prevent its further spread.
SINGAPORE: The association of COVID-19 vaccination with severe side effects like stroke, cancer and heart attack is a "misperception" that has to be corrected, said Health Minister Ong Ye Kung on Saturday (Nov 25).
Speaking at the official opening of Sembawang Polyclinic at 21 Canberra Link, Mr Ong said the Ministry of Health has been "very transparent" about the side effects and risks of all vaccinations.
He acknowledged thatwhen talking to residents about taking the COVID-19 vaccination at least once a year, the common reaction was to worry about side effects but the side effects were generally "a bit of ache in the arm or slight fever".
"But today, if residents are worried about severe side effects like stroke, cancer and heart attack and they associate this with vaccination, we have to correct this misperception," he added.
"In the case of COVID-19 vaccination, the risk of myocarditis, especially amongst younger males, is well established and we have been publishing the results.
"But even before COVID-19 and vaccination, every day, there are 60 Singaporeans who either suffer a heart attack or stroke, and six more Singaporeans require kidney dialysis."
Mr Ong said these cases "are driven by lifestyles over many years" via the accumulation of too much salt and sugar, lack of exercise and smoking.
"But when you have so many people suffering from stroke, heart attack and dialysis every day, after a while, they start associating and blaming it on vaccination."
"We cannot link the two," Mr Ong said, adding that if one is really worried about heart attack, cancer and stroke, they should adopt healthier lifestyles.
In May, Mr Ong responded to questions from Member of Parliament Tan Wu Meng (PAP-Jurong) aboutmyocarditis or heart inflammationafter COVID-19 vaccination, then saying there were 160 reports of myocarditis and pericarditis linked to the vaccines as of Apr 27.
This was out of over 17 million COVID-19 vaccine doses administered in Singapore.
Of the 160 cases, he said 32 per cent had initial symptoms reported within one day of vaccination, another 20 per cent reported within two days and another 24 per cent reported within one week.
"The majority of cases of myocarditis from vaccination are generally mild and respond to treatment," said Mr Ong to the House in May.
