Category: Corona Virus

MONDAY, Feb. 26, 2024 (HealthDay News) -- The Adaptive COVID-19 Treatment Trial (ACTT) risk profile identifies hospitalized COVID-19 patients who benefit most from baricitinib treatment, according to a study published online Feb. 27 in the Annals of Internal Medicine.

Noting that the ACTT risk profile previously demonstrated that hospitalized patients in the high-risk quartile benefit most from remdesivir, Catharine I. Paules, M.D., from the Penn State Health Milton S. Hershey Medical Center, and colleagues examined potential baricitinib-related treatment effects by risk quartile in a post hoc analysis of the ACTT-2 trial, conducted in 999 adults hospitalized with COVID-19 at 67 trial sites in eight countries. Participants received baricitinib plus remdesivir or placebo plus remdesivir.

The researchers found that baricitinib plus remdesivir was associated with a reduced risk for death, reduced progression to invasive mechanical ventilation or death, and improved recovery rate compared with placebo plus remdesivir in the high-risk quartile (hazard ratios, 0.38, 0.57, and 1.53, respectively). Compared with control participants, those receiving baricitinib plus remdesivir had significantly larger increases in absolute lymphocyte count and significantly larger decreases in absolute neutrophil count after five days, with the largest effects seen in the high-risk quartile.

"To our knowledge, no other clinical trials have assessed clinical benefit from an immunomodulator with relation to dynamics in hematologic parameters, and these data suggest the relevance of these measurements in predicting treatment response," the authors write.

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Risk Profile IDs COVID Patients Who Will Benefit From Baricitinib - HealthDay

CLEVELAND, Ohio The state did not release the number of new COVID-19 cases early Thursday afternoon as usual due to a technical issue, a spokesperson said.

New weekly case numbers are normally released at 2 p.m.

Last week, the number of new COVID-19 cases in Ohio stayed steady at 7,199, only two cases up from the previous week.

The slight increase ended a five-week run of falling weekly case numbers.

As recently as early January, weekly case numbers hit 15,046.

The total COVID-19 case count since early 2020 in Ohio has reached at least 3,712,548.

Previously: Nov. 16 Ohio COVID-19 update

Feb. 22 recap

* Total reported cases: 3,705,349, up 7,197.

* Total individuals with updated vaccine: 1,275,978, up 11,638.

* Total reported deaths: 43,608, up 91.

* Total reported hospitalizations: 149,643, up 236.

* Total reported ICU admissions: 15,722, up 12.

Julie Washington covers healthcare for cleveland.com. Read previous stories at this link.

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No update of weekly coronavirus numbers; Ohio Health Department blames technical glitch - cleveland.com

On a ride to high school one morning, Shelley Marshall asked her daughter how things were going with her field hockey team.

At least, that's what she intended to say. The words came out so garbled that her daughter said, "Mom, what is going on? Are you having a stroke or something? Look at me."

Marshall looked fine. Although slurred speech is a classic stroke symptom, she didn't have a droopy face or arm weakness. In a clear voice, she told her daughter not to worry.

Marshall, though, was concerned.

Two days earlier, she noticed that she'd slurred her own name. Her blood pressure had recently been slightly elevated. And she was still recovering from a serious bout of COVID-19, her third. All of this was unusual for Marshall, then 47 and in excellent health, thanks in part to running nearly every day.

Marshall called her boyfriend, Lyle Sarver, to tell him she was on her way to the emergency room at the hospital in Harrisburg, Pennsylvania, where they both worked in administration.

He met her there. By then, she felt totally fine.

A brain scan revealed otherwise.

The carotid arteries in the neck are major blood vessels for the brain. One of Marshall's was almost completely blocked in two places. She also had a carotid artery dissection, which is a tear of the inner layer of the wall of a carotid artery.

Despite those problems, Marshall's symptoms were still somewhat minimal. Doctors wanted to gather more information via an angiogram, a scan that shows blood flow through vessels.

While waiting for it, the symptoms began to build.

Marshall garbled her speech more often. She noticed she could no longer say certain words, especially "perfectly," which she tried over and over.

She had a headache that kept getting worse and some paralysis on her right side.

By now, her daughter, Kennley McCown, was there. Marshall was in so much pain she feared she would die. Just saying "I love you" to her daughter took all the strength she had.

Sarver feared that Marshall might have lasting deficiencies.

The angiogram was done the next morning. That afternoon, Marshall underwent a procedure to clear the blockages in her carotid artery. Doctors placed three stents to improve blood flow. The surgery was expected to last three hours; it took six because her problems turned out to be more complex.

As soon as her medication wore off, Sarver asked Marshall if she knew who he was and where she was.

"Lyle," she answered. "The hospital."

Kennley also tested her for several days.

"Say 'perfectly,' Mom," she'd ask.

Each time Marshall's pronunciation was perfect.

They all felt better knowing she avoided any major cognitive deficiencies. Since Marshall's stroke in March 2023, her memory is slightly fuzzier, but nothing significant, she said.

While she was in the hospital, doctors made sure she had no other issues. They also sought a reason for her stroke. The lack of other reasons along with the emerging link between COVID-19 and an increased risk of heart attack and stroke led her doctors to believe her severe case of COVID-19 may have contributed to her stroke.

Marshall took two months off work to heal and regain her strength. She and Kennley went on a long-planned trip to the beach in Florida, but only after she got her doctor's clearance to fly and had researched specialists at her destination, just in case.

"I feel tremendously lucky, but I'm also still a little scared, especially about COVID," she said. "I do what I can to prevent it."

Stories From the Heart chronicles the inspiring journeys of heart disease and stroke survivors, caregivers and advocates.

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Healthy runner's stroke followed a bad bout of COVID-19 - Source ONE News

Nearly 1.2 million people have died from COVID-19 in the United States according to official federal counts, but multiple studies of excess mortality suggest that these totals are undercounted. While excess deaths provide an estimation of deaths that likely would not have occurred under normal, non-pandemic conditions, there is scant evidence into whether the SARS-CoV-2 virus contributed to these additional deaths, or whether these deaths were caused by other factors such as health care disruptions or socioeconomic challenges.

Now, a new study led by the University of Pennsylvania and Boston University provides the first concrete data showing that many of these excess deaths were likely uncounted COVID-19 deaths. Published in the Proceedings of the National Academy of Science, the study compared reported COVID-19 deaths to excess deaths due to non-COVID, natural causes, such as cardiovascular diseases and other chronic illnesses, and found that increases in non-COVID excess deaths occurred at the same time or in the month prior to increases in reported COVID-19 deaths in most US counties.

The study provides compelling evidence that the burden of the COVID-19 pandemic went well beyond what is estimated by COVID-19 deaths alone. It also raises important questions about the variation across the country in the coding of COVID-19 deaths on death certificates, says Irma Elo, coauthor of the paper and professor in the Department of Sociology in Penns School of Arts & Sciences. The study also points to the overlooked burden that the pandemic had in nonmetropolitan areas where health care resources are often inadequate or lacking.

The researchers explain that focusing on excess deaths by natural causes rather than all-cause excess death estimates provides a more accurate understanding of the true impact of COVID-19. This is because it eliminates external causes for mortality, such as intentional or unintentional injuries, for which COVID-19 would not be a direct contributing factor.

Our findings show that many COVID-19 deaths went uncounted during the pandemic, says study corresponding author Andrew Stokes, a Penn alum, member of Elos American Mortality Center, and associate professor of global health at Boston University School of Public Health.

The temporal correlation between reported COVID-19 deaths and excess deaths classified as non-COVID-19 natural causes offers insight into the causes of these deaths, Stokes says. We observed peaks in non-COVID-19 excess deaths in the same or prior month as COVID-19 deaths, a pattern consistent with these being unrecognized COVID-19 deaths that were missed due to low community awareness and a lack of COVID-19 testing.

Lead author Eugenio Paglino, a Ph.D. candidate in demography and sociology in Penn Arts & Sciences adds that, if the primary explanation for these deaths were health care interruptions and delays in care, the non-COVID excess deaths would likely occur after a peak in reported COVID-19 deaths and subsequent interruptions in care. However, this pattern was not observed nationally or in any of the geographic subregions we assessed.

The researchers used novel statistical methods to analyze monthly data on natural-cause deaths and reported COVID-19 deaths for 3,127 counties during the first 30 months of the pandemic, from March 2020 to August 2022. They estimated that 1.2 million excess natural-cause deaths occurred in United States counties during this period and found that roughly 163,000 of these deaths did not have COVID-19 listed on the death certificates.

Analyzing both temporal and geographical patterns of these deaths, the researchers found that the gap between these non-COVID excess deaths and reported COVID-19 deaths was largest in nonmetropolitan counties, the West, and the South, and that the second year of the pandemic saw almost as many non-COVID-19 excess deaths in the as in the first year, contrary to previous research. Meanwhile, metropolitan areas in New England and the mid-Atlantic states were the only areas to report more COVID-19 deaths than non-COVID-19 excess deaths.

These findings imply that, contrary to our expectations, the U.S. death investigation system failed to capture a sizeable portion of all COVID-19 deaths well after the initial emergency period and into the third year of the pandemic, Paglino says.

The researchers say that many of these geographical differences in death patterns are likely explained by differences in state policies, coding of COVID-19 deaths on death certificates, or political biases by local officials that influenced COVID-19 policies. In rural areas, for example, COVID-19 testing was more limited, and political biases or stigma around COVID-19 may have affected whether COVID-19 was listed on a death certificate. Conversely, reported COVID-19 deaths may have exceeded non-COVID-19 excess deaths due to successful mitigation policies that encouraged physical distancing and masking and likely lowered cases of other respiratory diseases. Certain protocols in some states, such as in Massachusetts, also enabled death investigators to list COVID-19 as an official cause of death within 60 days of a diagnosis (until March 2022), rather than the 30-day limit in other states.

Geographic variation in the quality of cause of death reporting not only adversely affected pandemic response in areas where COVID-19 deaths were underreported, but it also reduced the accuracy of our national surveillance data and modeling, says study coauthor Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation.

Accurate information on how many people in a community die from COVID-19or any other causeis essential for making decisions about public health, says study coauthor Maria Glymour, chair and professor of epidemiology at BUSPH. It is also important for families. Everyone deserves to know why a loved one died. Resources and commitment to ensure accurate death investigations are essential, and these findings of uncounted COVID-19 deaths indicate those resources are lacking in many communities.

Members of the team are working on understanding how the pandemic is affecting U.S. death rates, even as the acute pandemic has ended. The researchers hope this new data will encourage future analyses using hospitalizations and other local data to continue to parse uncounted COVID-19 deaths from excess natural-cause deaths as well as deaths due to external causes.

Jillian McKoy of Boston University greatly contributed to this story.

Irma Elo is a Tamsen and Michael Brown Presidential Professor in the Department of Sociology in the School of Arts & Sciences and a research associate at the Population Studies Center and Population Aging Research Center at the University of Pennsylvania.

Eugenio Paglino is a doctoral student in the Department of Sociology in the School of Arts & Sciences and at the Population Studies Center at Penn.

Andrew Stokes is an associate professor in the Department of Global Health at the School of Public Health at Boston University.

Katherine Hempstead is a senior policy advisor at the Robert Wood Johnson Foundation.

Other authors include Samuel H. Preston of Penn Arts & Sciences; Dielle J. Lundberg, Zhenwei Zhou, Rafeya Raquib, and M. Maria Glymour of BU; Joe A. Wasserman of the Research Triangle Institute; Elizabeth Wrigley-Field of the University of Minnesota; and Yea-Hung Chen of the University of California, San Francisco.

The work was supported by The Robert Wood Johnson Foundation (Grant 77521), the National Institute on Aging (R01-AG060115, R01-AG060115-04S1, K00-AG068431), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C-HD041023), the W.K. Kellogg Foundation (P-6007864-2022), the Agency for Healthcare Research and Quality (T32HS013853), and the National Science Foundation (CCF-2200052).

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Researchers find many 'natural' and COVID-19 deaths likely related | Penn Today - Penn Today

On February 13, the Washington Post reported that the Centers for Disease Control and Prevention (CDC) plans to issue new guidelines that would substantially pull back on recommendations for people infected with Covid-19.

The guidelines, which are expected to drop in April, will reportedly no longer recommend that most Americans infected with the virus stay away from work and school for five days. Instead, they will advise people that they can leave home if theyve been fever-free for at least 24 hours (without fever-reducing medicine like ibuprofen or acetaminophen) and have mild and improving symptoms. The Posts story didnt mention whether or how the new guidelines would recommend using tests to guide decision-making.

Its a reasonable move, says Aaron Glatt, an infectious disease doctor and hospital epidemiologist at Mount Sinai South Nassau Hospital on Long Island. When youre doing public health, you have to look at what is going to be listened to, and what is doable.

Guidelines that adhere to the highest standards of infection control might please purists in public health who dont have to make policies for the real world. However, guidelines that seem to acknowledge that workers often dont have paid sick leave and emergency child care, and that social interactions are important to folks, are more likely not only to be followed but to engender trust in public health authorities.

Its important to note that the new recommendations will be aimed toward the broader community and the people who live, work, and go to school in it not toward hospitals, nursing homes, and other facilities whose residents are both less socially mobile and more vulnerable to the viruss worst effects.

That means the people who are at higher risk of getting severely ill or dying if they get infected people who are older and sicker at baseline will likely be subject to different, more conservative guidelines. Which makes sense, says Glatt: Its not the same approach in a 4-year-old kid as it is in a nursing home. It shouldnt be.

Covid-19 hospitalization rates among adults 65 and over are at least four times what they are in other age groups, and rates are particularly high among adults 75 and over, according to the CDC. In a study published in October, the agency reported that those 65 and older constituted nearly 90 percent of Covid-19 deaths in hospitals.

The older adults getting hospitalized and dying with Covid-19 now are not the otherwise well people with active work and social lives who were getting severely ill earlier in the pandemic, says Shira Doron, an infectious disease doctor and hospital epidemiologist at Tufts Medicine in Boston. Theyre people with severe underlying illness and compromised immune systems and for many, its not even clear Covid-19 is whats causing their decline. Im really struck by how totally different the Covid inpatient population even the Covid death population that Im seeing is from 2020, or even 2021, she says.

Its hard to tell exactly how many of the worst-affected adults are infected in facilities like hospitals and nursing homes in other words, how many of them would be relatively unaffected by a revised set of guidelines. Its also hard to tell how many older adults, aware of their higher risk, take more measures to protect themselves in public, like wearing masks and gathering outdoors.

However, its worth noting the experiences of states that have already loosened recommendations. Since Oregon loosened its guidelines in May 2023, the state has not seen unusual increases in transmission or severity; California made similar changes in January 2024. In revising their recommendations, state officials hoped to reduce the burdens on workers without sick leave and reduce disruptions on schools and workplaces, according to the Posts reporting.

Doron says the reason loosened isolation guidelines havent led to mayhem in Oregon nor in Europe, where the recommendations changed two years ago is because isolation never did much to reduce transmission to begin with. This has nothing to do with the science of contagiousness and the duration of contagiousness. It has to do with [the fact that] it wasnt working anyway, she says.

Leaning away from what doesnt work to reduce the viruss impact and toward what does work is a smarter way forward, she says.

Isolation guidelines havent been effective for mitigating Covid-19 harms because so many people simply do what they want, regardless of whether theyre sick and they may avoid reporting symptoms to avoid being forced to comply with an isolation policy.

Imagine a workplace or school policy adheres to the current CDC guidelines, which recommend that people who test positive for Covid-19 infection stay home for at least five days. That policy creates a perverse incentive for some people who have symptoms to avoid getting tested, Doron says, because they dont want to miss school, work, or a social event. Because so many people dont have paid sick time, acknowledging even mild symptoms can lead to real financial losses when it means missing a week of work.

At the same time, because these guidelines build testing into their protocols, they lead lots of other people and the federal government to spend money on at-home tests, which are often inaccurate early in infection. Thats a waste of resources that could save more lives if they were instead spent on providing tests to people likeliest to benefit from Paxlovid and getting them treated, says Doron.

For that reason, she thinks that in addition to changing isolation guidelines, the CDC should change the guidelines around testing. You should only be testing when it will change something, and that should be because you need Paxlovid or an antiviral, Doron says. (Clarity and greater focus on who qualifies for Paxlovid would also be helpful, she says current CDC recommendations are too broad.)

The CDCs revised guidelines likely wont be formally released until April at the earliest, and their details are as yet unclear. While theyre recommendations, not requirements, employers and state and local health departments often use them to guide their own policies.

One area where a new set of guidelines could make a big difference is in elevating and normalizing masking, says Jay Varma, an epidemiologist and biotechnology executive with extensive experience in state and federal public health practice. He hopes the new recommendations lean heavily into putting forth masking in public as a matter of routine for people who leave home as soon as they feel well.

CDC should be thinking of this as a decades-long effort to promote cultural acceptance that being in public with a mask is similar to washing your hands, wearing a condom, or smoking outdoors: Its a form of politeness and consideration for others, Varma wrote in an email to Vox.

After all, in the long term, its a lot easier to change social norms around masking than it is to get people used to giving up their social lives for days or weeks at a time.

It would also be helpful for public health officials to encourage people to factor in who gets exposed if they leave isolation soon after a Covid diagnosis, says Glatt. Its hard to build nuance into a one-size-fits-all recommendation, but the guidelines could suggest that, for example, people who have regular social contact with someone they know takes high-dose immunosuppressive medications act differently than people who dont have that kind of contact.

Thats something thats very difficult for a guideline to take into account, he acknowledges.

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What the CDCs new COVID guidelines could mean for you - Vox.com

Italy

Victims relatives hail creation of commission but ex-ministers say it will be used as political attack

Thu 15 Feb 2024 08.11 EST

Italy will carry out an inquiry into its handling of the coronavirus pandemic in a move hailed as a great victory by the relatives of people killed by the virus but criticised by those who were in power at the time.

Italy was the first western country to report an outbreak and has the second highest Covid-related death toll to date in Europe, at more than 196,000. Only the UKs death toll is higher.

The creation of a commission to examine the governments actions and the measures adopted by it to prevent and address the Covid-19 epidemiological emergency was approved by the lower house of parliament after passing in the senate.

A Covid-19 inquiry was among the election campaign pledges of the prime minister, Giorgia Meloni, whose far-right government came to power in October 2022.

Victims families had protested against an inquiry proposal by the previous administration, a vast coalition led by Mario Draghi, after attempts were made by the centre-left Democratic party (PD) and the League, which governs the worst-hit Lombardy region, to narrow its scope by focusing only on the outbreak in China and introducing a cutoff date of 31 January 2020, therefore not examining the scramble by the Italian government to contain rapidly rising infections and deaths in the weeks that followed.

Consuelo Locati, a lawyer representing hundreds of families who brought legal proceedings against former leaders, said: The families were the first to ask for a commission and so for us this is a great victory. The commission is important because it has the task, at least on paper, to analyse what went wrong and the errors committed so as not to repeat the massacre we all suffered.

The commission will investigate the actions of individuals including Giuseppe Conte, the former prime minister, Roberto Speranza, the former health minister, and Attilio Fontana, the president of Lombardy.

Conte, who now leads the Five Star Movement, which at the time was in government with the PD, accused Melonis government of cowardice and of creating an abnormal tool to politically attack its predecessors. But you will not govern for life and this could prove to be a dangerous precedent, he said, adding that he had nothing to hide.

Speranza claimed the objective of the commission was not to make the healthcare system more resilient but to vilify the former government.

In June last year, prosecutors in Bergamo, the Lombardy province heavily hit by Covid-19 at the start of the pandemic, shelved an investigation into Conte and Speranzas management of the emergency after they found no evidence connecting the deaths to their failure to swiftly adopt measures to contain the escalating virus.

Italys first coronavirus case was confirmed in Codogno in southern Lombardy on 21 February 2020. Two days later, an outbreak occurred at the hospital in Alzano Lombardo, a town in Bergamo. However, unlike Codogno, where quarantine measures were implemented immediately along with nine other towns in Lombardy and one in Veneto, Bergamo went into lockdown with the entire Lombardy region two weeks later.

A case brought by relatives of the deceased at Romes civil court is ongoing. The court is examining the same evidence that Bergamo prosecutors did, including the alleged absence of an updated national pandemic plan. The difference with the Rome case is that there will definitely be a sentence, which will either go in our favour or not, said Locati, whose father was among those to die early in the pandemic.

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Italy announces inquiry into its handling of Covid-19 pandemic - The Guardian

Since 2021, people with COVID-19 have been told to isolate themselves for at least five days to avoid spreading the disease. But that practice may soon join most mask mandates as relics of the peak pandemic era.

The U.S. Centers for Disease Control and Prevention (CDC) is said to be weighing a new, symptom-based approach to isolation for the general public, the Washington Post reported on Feb. 13. Under that potential approach, which may be rolled out for public feedback this spring, people could leave home when their symptoms are mild and improving and theyve been fever-free for at least 24 hours without medication, according to the Post.

That possible shift, which echoes similar moves in California and Oregon, would bring the CDCs recommendations for COVID-19 in closer step with its guidance on the flu. When people are sick with the flu, the CDC recommends they stay home until at least 24 hours after their fever has broken naturally, or until other symptoms clearwhich the agency says can take up to five days.

A CDC representative did not confirm or deny the Posts report when asked by TIME. The agency has no updates to COVID guidelines to announce at this time, the representative wrote in an email. We will continue to make decisions based on the best evidence and science to keep communities healthy and safe.

While the shift is not yet official, experts have previously predicted that 2024 will bring a further relaxation of COVID-19 policy. The guidance becomes lighter and lighter over time, and that actually makes sense as people build up more immunity, Dr. Ashish Jha, dean of the Brown University School of Public Health and the Biden Administrations former COVID-19 response coordinator, said in a January interview with TIME. I do expect that some of those guidances will dissipate.

Read More: Were In a Major COVID-19 Surge. Its Our New Normal

The virus itself has not evolved to become less contagious. But peoples tolerance for public-health precautions has plummeted. Many people in the U.S. havent paid attention to COVID-19 guidance in a long time, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. You have to face reality, he says.

Meeting people where they are may encourage them to take at least some precautions, he says. Some people who are unwilling or unable to isolate for five full days might be open to staying home for a shorter period of time when theyre acutely ill, for example.

Not all experts are as optimistic. Lucky Tran, a science communicator at Columbia University, called the potential end of five-day isolation periods a reckless anti-public-health policy that goes against science, encourages disease spread, and puts everyone at risk. The bare minimum we should have learned from this devastating pandemic that has killed and disabled millions is that we should stay home when sick. The rumored adjustment would completely ignore the continued suffering of people who are immunocompromised, chronically ill, disabled, or otherwise at heightened risk of severe COVID-19, Tran adds.

Eleanor Murray, an assistant professor of epidemiology at the Boston University School of Public Health, says it would be really strange for the CDC to relax its current guidance, given that even a five-day isolation period isnt always long enough to stop the spread. Studies have shown that a significant portion of people who catch COVID-19 test positive, and thus potentially remain contagious, for longer than five days. (The CDC currently recommends that people with COVID-19 wear a high-quality mask, such as an N95 or KN95, around others for at least 10 days after getting sick; its not clear whether that suggestion would remain in place if the guidelines change this spring.)

The absence of symptoms also isnt a guarantee that someone is no longer infectious, Murray says. Research has long suggested that pre-symptomatic or asymptomatic people can spread the virus, although they may not be as contagious as people who are sicker. At-home tests arent a perfect measure either, although they can provide some information about potential contagiousness.

Even still, Dr. Tara Bouton, an assistant professor at the Boston University Chobanian and Avedisian School of Medicine who has researched COVID-19 isolation periods, feels it's reasonable to loosen isolation guidance at this stage of the pandemic, when fewer people who get infected die or become hospitalized. That's in large part because lengthy isolation periods disproportionately penalize people whose income depends on working in person, Bouton says. The ability to isolate is a privilege, Bouton says, and public-health policy needs to balance the costs and benefits of asking people to do it.

Murray, however, fears that relaxing isolation guidance will make it easier for businesses to deny their employees time off to recover. If the CDC removes its current guidancewhich, Murray notes, is a recommendation rather than a mandateit would be providing information that is not evidence-based and is not going to help people make informed decisions, but will probably be used to limit paid leave.

So what would the experts do if they got sick with COVID-19?

Even though Bouton feels that a blanket five-day isolation recommendation is no longer necessary, she says she would stay home around that long because shes able toand because working as an infectious-disease doctor puts her in contact with lots of immunocompromised patients, who remain at increased risk of severe disease if they get infected.

Murray says she would stay home until her symptoms cleared up and wait until shed gotten two consecutive negative test results, spaced out by at least a day, before exiting isolation. (Often, that approach requires more than five days of isolation, since people can test positive on at-home rapid tests for more than a week.)

Tran says hed go even further: hed stay home for 10 days, self-test multiple times before ending isolation, and wear a maskas he usually does anywayupon returning to public spaces.

Osterholm, too, says hed stay home for five days and continue to wear an N95 in the immediate aftermath of his illness. Efforts like those are important, he saysbut theyre also not everything. Hed like the public-health community to devote more attention to encouraging vaccination among vulnerable older adults, many of whom have not gotten the latest shot, and streamlining Paxlovid access for high-risk patients.

Those efforts, Osterholm says, could save lives at a time when most COVID-19 deaths occur among people who are elderly or otherwise at high riskand at a time when Americans are moving on from COVID-19, whether official guidance tells them to or not.

Read more:

How Long Should You Isolate With COVID-19? Experts Are Split | TIME - TIME

People who have had COVID-19 have a significantly higher risk of suffering chronic fatigue than those who havent had the disease, a new study published Wednesday shows.

Our data indicate that COVID-19 is associated with a significant increase in new fatigue diagnoses, according to the study, published by the Centers for Disease Control and Prevention in the journal Emerging Infectious Diseases.

Physicians should be aware that fatigue might occur or be newly recognized [more than a year] after acute COVID-19, the report said.

Specifically, the study looked at electronic health records of more than 4,500 patients in Washington state who had COVID-19 in 2020 and 2021 and compared them to patients who hadnt had COVID. The study found the risk for chronic fatigue in those who had COVID was about four times the risk compared to people who hadnt contracted COVID.

Scientists also looked at a more broad definition of fatigue, which includes chronic fatigue as well as diagnoses of weakness and malaise. The study found that the risk of fatigue among COVID-19 patients was 68% higher among people whod had COVID than those who hadnt.

Among the 4,589 COVID-19 patients in the study, scientists identified 434 as incident fatigue cases, in which the person was diagnosed with fatigue after recovering from COVID-19. Of those, 81 were also identified as having chronic fatigue, which is a subset of general fatigue.

The risk of chronic fatigue after COVID-19 was more common among women, older people and those who had other medical conditions, the study said.

The report illustrates the continuing burden of long COVID long after the emergency phase of the pandemic has ended. CDC survey data from last year said that up to 15% of U.S. adults had ever experienced long COVID and up to 6% of were currently experiencing long COVID.

Among those who have suffered long COVID regardless of whether the person was hospitalized fatigue is often a symptom.

Researchers for this study decided to focus on fatigue among COVID-19 patients because the symptom plays such a central role among those suffering from long COVID.

People who developed fatigue after COVID-19 had far worse clinical outcomes, the report said. Among more than 400 patients who dealt with post-COVID fatigue, 25.6% were hospitalized at some point following an acute bout of COVID-19 during the studys time frame. By contrast, only 13.6% of more than 4,000 patients who didnt develop post-COVID fatigue were later hospitalized.

Patients who had post-COVID fatigue were also at a higher risk of dying than those who did not develop fatigue, the report said.

The report also cautioned that doctors be alert for COVID patients who have a history of mood disorders; such patients are also at increased risk for post-COVID-19 fatigue, it said.

Doctors say the risk of long COVID is further reason to take prudent steps to avoid a coronavirus infection, including avoiding sick people, taking a test to verify a COVID-19 diagnosis and staying home if you are ill but asymptomatic. Masking up in crowded indoor settings, staying up to date on vaccinations and taking antiviral drugs like Paxlovid when experiencing COVID-19 symptoms may also help reduce the risk of long COVID.

People can get infected with coronavirus multiple times, the CDC said, and each time a person is infected or reinfected ... they have a risk of developing long COVID.

Originally posted here:

Risk for chronic fatigue soars among those who had COVID-19, study says - Los Angeles Times

image:

Cross-section of the brainstem: Neurons (blue-gray) are in close contact with immune cells (purple). The threadlike blue structures are extensions of the neurons, which can reach all the way into distant organs in the form of nerve fibers. According to the study, the immune cells and neurons in the brainstem can be activated directly via the nerve fibers as a result of inflammation in the lungs. Charit | Jenny Meinhardt

Credit: Charit | Jenny Meinhardt

Scientists still are not sure how neurological symptoms arise inCOVID-19. Is it becauseSARS-CoV-2infects the brain? Or are these symptoms the result of inflammation in the rest of the body? A study by Charit Universittsmedizin Berlinhas now produced evidence to support the latter theory. It was published today in the journalNature Neuroscience.*

Headaches, memory problems, and fatigue are just some of the neurological impacts that arise during coronavirus infection and can last well beyond the acute period. Even early on in the pandemic, researchers surmised that direct infection of the brain could be the cause. We took that as our hypothesis at the start, too. But so far, there has been no clear evidence that the coronavirus can persist in the brain, let alone proliferate, explains Dr. Helena Radbruch, head of the Chronic Neuroinflammation working group at the Department of Neuropathology at Charit. For that, we would have needed to find evidence of intact virus particles in the brain, for example. Instead, the indications that the coronavirus could infect the brain come from indirect testing methods, so they arent entirely conclusive.

According to a second hypothesis, the neurological symptoms would instead be a kind of side effect of the strong immune response the body deploys to defend against the virus. Past studies had produced indications that this might be the case. The current Charit study now bolsters this theory with detailed molecular biology and anatomical results from autopsies.

No signs of direct infection of the brain

For the study, the team of researchers analyzed various areas of the brain in 21 people who died in hospital settings, typically in an ICU, due to severe coronavirus infection. For comparison, the researchers studied nine patients who died of other causes after treatment in intensive care. First, they looked to see whether the tissue showed any visible changes and hunted for any indication of coronavirus. Then they conducted a detailed analysis of genes and proteins to identify the specific processes that had taken place inside individual cells.

Like other teams of researchers before them, the Charit scientists found coronavirus genetic material in the brain in some cases. But we didnt find neurons infected withSARS-CoV-2, Radbruch notes. We assume that immune cells absorbed the virus in the body and then traveled to the brain. Theyre still carrying the virus, but it doesnt infect cells of the brain. So coronavirus has invaded other cells in the body, but not the brain itself.

Brain reacts to inflammation in the body

Still, the researchers did note striking changes in molecular processes in some cells of the brain in those infected withCOVID-19: For example, the cells ramped up the interferon signaling pathway, which is typically activated in the course of a viral infection. Some neurons evidently react to the inflammation in the rest of the body, says Prof. Christian Conrad, head of the Intelligent Imaging working group at the Berlin Institute of Health at Charit (BIH) and one of the principal investigators in the study, along with Radbruch. This molecular reaction could be a good explanation for the neurological symptoms we see inCOVID-19patients. For example, neurotransmitters emitted by these cells in the brainstem could cause fatigue. Thats because the brainstem is home to groups of cells that control drive, motivation, and mood.

The reactive nerve cells were found primarily in what are known as the nuclei of the vagus nerve. These are nerve cells located in the brainstem that extend all the way to organs such as the lungs, intestine, and heart. In simplified terms, our interpretation of our data is that the vagus nerve senses the inflammatory response in different organs of the body and reacts to it in the brainstem without there being any actual infection of brain tissue, Radbruch explains. Through this mechanism, the inflammation does spread from the body to the brain in a way, which can disrupt brain function.

Limited-time reaction

The neurons reaction to the inflammation is temporary, as shown by a comparison of people who died during an acute coronavirus infection with those who died at least two weeks afterward. The molecular changes are most evident during the acute infection phase, but they do normalize again afterward at least in the vast majority of cases.

We think its possible that if the inflammation becomes chronic, that could be what causes the neurological symptoms often observed in long COVID in some people, Conrad says. To follow up on this suspicion, the team of researchers is now planning to study the molecular signatures in the cerebral fluid of long COVID patients in greater detail.

*Radke J et al. Proteomic and transcriptomic profiling of brainstem, cerebellum, and olfactory tissues in early- and late-phaseCOVID-19. Nat Neurosci 2024 Feb 16. doi: 10.1038/s41593-024-01573-y

About the study The study was made possible by the explicit consent of patients and/or their family members, for which the research group is grateful. The work was performed within the framework of the National Autopsy Network (NATON), a research infrastructure that is part of Netzwerk Universittsmedizin (NUM), the university medicine research network, which is funded by the German Federal Ministry of Education and Research (BMBF). NUM was initiated and is coordinated by Charit. It pools the strengths of the 36 university medical centers in Germany.

Related links:

Original publication

Chronic Neuroinflammation working group (Radbruch)

Intelligent Imaging working group (Conrad)

Nature Neuroscience

People

Proteomic and transcriptomic profiling of brainstem, cerebellum and olfactory tissues in early- and late-phase COVID-19

16-Feb-2024

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How COVID-19 affects the brain - EurekAlert

The Health and Human Services Departments lack of cooperation with a congressional committee investigating the Covid-19 pandemic is unacceptable and could prompt the committee to force people to testify, the panels chairman said in a letter to the agency Friday.

The letter, shared exclusively with STAT, comes roughly two weeks after a top HHS official testified before the House Select Subcommittee on the Coronavirus Pandemic. Republicans including Chairman Rep. Brad Wenstrup (R-Ohio) were vocally frustrated with HHS Assistant Secretary for Legislation Melanie Egorins responses to questions about Covid-19s origins, shutdown policies, and federal messaging about vaccines.

While HHS has shared thousands of pages of documents pertaining to the coronavirus response with the panel, Republicans argue they are heavily redacted and offer no clear answers on these policies or the virus origin. They also accused HHS officials of dragging their feet on responding to at least a dozen inquiries.

We know, for a fact, that the Department is currently withholding critical documents. The Departments failure to provide the requested documents is unacceptable, Wenstrup wrote Friday.

Egorin said repeatedly during the hearing that the agency has produced documents that have been ongoing and responsive to your request.

If this next round of questions does not satisfy GOP committee leaders, Wenstrup warned that they will evaluate the use of the compulsory process to obtain the testimony of Department employees who know the answers to these questions.

The chairman then listed 12 separate times the committee asked for more information from HHS, spanning from February to November last year. For each, he requested more details about how HHS handled relevant staff interviews and email and document searches before handing over the redacted content to the committee.

HHS did not immediately respond to a request for comment.

Besides Egorins testimony, the committee has heard from nearly a dozen current and former health officials including retired infectious disease official Anthony Fauci and former National Institutes of Health Director Francis Collins, both of whom voluntarily testified in lengthy closed-door sessions.

Democrats have lamented that these briefings have not produced new information about the virus or shutdown policies, and instead are further politicizing the pandemic amid national divides over public health information.

The committees most recent hearing focused on the safety of Covid-19 vaccines and the governments messaging about their benefits.

Conspiratorial accusations manufacture distrust; fear mongering manufactures distrust. And with increased distrust, you increase vaccine hesitancy, said ranking member Rep. Raul Ruiz (D-Calif.) on Thursday. How does this help us prevent or better prepare for the next pandemic? It doesnt, it makes it worse, puts peoples lives at risk, and actually harms the American people.

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Congress may force more Covid-19 testimony from HHS - STAT