Category: Corona Virus

Four years ago in the spring of 2020, physicians and patients coined the term "long COVID" to describe a form of the viral infection from which recovery seemed impossible. (And the old nickname "long-haulers" seems so quaint now.)

What started as a pandemic that killed nearly 3 million people globally in 2020 alone would turn into a chronic disease causing a long list of symptoms from extreme fatigue, to brain fog, tremors, nausea, headaches, rapid heartbeat, and more.

Today, 6.4% of Americans report symptoms of long COVID, and many have never recovered.

Still, we've come a long way, although there's much we don't understand about the condition. At the very least, physicians have a greater understanding that long COVID exists and can cause serious long-term symptoms.

While physicians may not have a blanket diagnostic tool that works for all patients with long COVID, they have refined existing tests for more accurate results, said Nisha Viswanathan, MD, director of the University of California Los Angeles Long COVID Program at UCLA Health.

Also, a range of new treatments, now undergoing clinical trials, have emerged that have proved effective in managing long COVID symptoms.

Catecholamine testing, for example, is now commonly used to diagnose long COVID, particularly in those who have dysautonomia, a condition caused by dysfunction of the autonomic nervous system and marked by dizziness, low blood pressure, nausea, and brain fog.

Very high levels of the neurotransmitter, for example, were shown to indicate long COVID in a January 2021 study published in the journal Clinical Medicine.

Certain biomarkers have also been shown indicative of the condition, including low serotonin levels. A study published this year in Cell found lower serotonin levels in patients with long COVID driven by low levels of circulating SARS-CoV-2, the virus that causes the condition.

Still, said Viswanathan, long COVID is a disease diagnosed by figuring out what a patient does not have by ruling out other causes rather than what they do. "It's still a moving target," she said, meaning that the disease is always changing based on the variant of acute COVID.

Dysautonomia, and especially the associated brain fog, fatigue, and dizziness, are now common conditions. As a result, physicians have gotten better at treating them. The vagus nerve is the main nerve of the parasympathetic nervous system that controls everything from digestion to mental health. A February 2022 pilot study suggested a link between vagus nerve dysfunction and some long COVID symptoms.

Vagus nerve stimulation is one form of treatment which involves using a device to stimulate the vagus nerve with electrical impulses. Viswanathan has been using the treatment in patients with fatigue, brain fog, anxiety, and depression results, she contends, have been positive.

"This is something tangible that we can offer to patients," she said.

Curative treatments for long COVID remain elusive, but doctors have many more tools for symptom management than before, said Ziyad Al-Aly, MD, a global expert on long COVID and chief of research and development at the Veterans Affairs St. Louis Health Care System.

For example, physicians are using beta-blockers to treat postural tachycardia syndrome (POTS), a symptom of long COVID that happens when the heart rate increases rapidly after someone stands up or lies down. Beta-blockers, such as the off-label medication ivabradine, have been used clinically to control heart rate, according to a March 2022 study published in the journal HeartRhythm Case Reports.

"It's not a cure, but beta-blockers can help patients manage their symptoms," said Al-Aly.

Additionally, some patients respond well to low-dose naltrexone for the treatment of extreme fatigue associated with long COVID. A January 2024 article in the journal Clinical Therapeutics found that fatigue symptoms improved in patients taking the medication.

Al-Aly said doctors treating patients with long COVID are getting better at pinpointing the phenotype or manifestation of the condition and diagnosing a treatment accordingly. Treating long COVID fatigue is not the same as treating POTS or symptoms of headache and joint pain.

It's still all about the management of symptoms and doctors lack any US Food and Drug Administrationapproved medications specifically for the condition.

Still, a number of large clinical trials currently underway may change that, said David F. Putrino, PhD, who runs the long COVID clinic at Mount Sinai Health System in New York City.

Two clinical trials headed by Putrino's lab are looking into repurposing two HIV antivirals to see whether they affect the levels of circulating SARS-CoV-2 virus in the body that may cause long COVID. The hope is that the antivirals Truvada and maraviroc can reduce the "reactivation of latent virus" that, said Putrino, causes lingering long COVID symptoms.

Ongoing trials are looking into the promise of SARS-CoV-2 monoclonal antibodies, produced from cells made by cloning a unique white blood cell, as a treatment option. The trials are investigating whether these antibodies may similarly target viral reservoirs that are causing persistence of symptoms in some patients.

Other trials are underway through the National Institutes of Health (NIH) RECOVER initiative in which more than 17,000 patients are enrolled, the largest study of its kind, said Grace McComsey, MD.

McComsey, who leads the study at University Hospitals Health System in Cleveland, said that after following patients for up to 4 years researchers have gathered "a massive repository of information" they hope will help scientists crack the code of this very complex disease.

She and other RECOVER researchers have recently published studies on a variety of findings, reporting in February, for example, that COVID infections may trigger other autoimmune diseases such as rheumatoid arthritis and type 2 diabetes. Another recent finding showed that people with HIV are at a higher risk for complications due to acute COVID-19.

Still, others like Al-Aly and Putrino felt that the initiative isn't moving fast enough. Al-Aly said that the NIH needs to "get its act together" and do more for long COVID. In the future, he said that we need to double down on our efforts to expand funding and increase urgency to better understand the mechanism of disease, risk factors, and treatments, as well as societal and economic implications.

"We did trials for COVID-19 vaccines at warp speed, but we're doing trials for long COVID at a snail's pace," he said.

Al-Aly is concerned about the chronic nature of the disease and how it affects patients down the line. His large-scale study published last month in the journal Science looked specifically at chronic fatigue syndrome triggered by the infection and its long-term impact on patients.

He's concerned about the practical implications for people who are weighted down with symptoms for multiple years.

"Being fatigued and ill for a few months is one thing, but being at home for 5 years is a totally different ballgame."

See more here:

4 Years In, a Sobering Look at Long COVID Progress - Medscape

ANN ARBOR, MI - JULY 30: Michigan Stadium, the largest stadium in the United States, and second largest stadium in the world, home of the Michigan Wolverines football team and women's lacrosse team in Ann Arbor, Michigan on July 30, 2019. (Photo B

FOX 2 (WJBK) - The NCAA has handed down penalties for the University of Michigan's football program Tuesday in connection to coronavirus recruiting violations.

Penalties include three years of probation, fine, and recruiting restrictions, the NCAA announced. According to a release, Michigan and five people who currently - or previously worked for the football program have reached an agreement with NCAA enforcement staff on recruiting violations and coaching activities by non-coaching staff members that happened in the football program.

"A Committee on Infractions panel has approved the agreement. One former coach did not participate in the agreement, and that portion of the case will be considered separately by the Committee on Infractions, after which the committee will release its full decision," the announcement said.

The agreed-upon violations involve in-person recruiting contacts during a COVID-19 dead period, impermissible tryouts, and the program exceeding the number of allowed countable coaches when non-coaching staff members engaged in on- and off-field coaching activities "including providing technical and tactical skills instruction to student-athletes."

The decision also involved the school's agreement that the violations "demonstrated a head coach responsibility violation and the former football head coach failed to meet his responsibility to cooperate with the investigation."

The school agreed it did not stop or recognize the "impermissible recruiting contacts" and did not make sure that the football program adhered to rules for non-coaching staff members.

"The committee will not discuss further details in the case to protect the integrity of the ongoing process, as the committee's final decision including potential violations and penalties for the former coach is pending.

"By separating the cases, the Division I Committee on Infractions publicly acknowledges the infractions case and permits the school and the participating individuals to immediately begin serving their penalties while awaiting the committee's final decision on the remaining contested portion of the case. That decision will include any findings and penalties for the former coach. This is the fourth case where the committee has used multiple resolution paths."

Former Michigan star, current staffer Denard Robinson arrested for OWI in Ann Arbor

The penalties in this case include three years of probation for the school, a fine and recruiting restrictions with the "Level I-Mitigated classification for the school. "

The participating individuals also agreed to one-year show-cause orders consistent with the Level II-Standard and Level II-Mitigated classifications of their violations.

Read more:

Michigan football penalized by NCAA for coronavirus recruiting violations - FOX 2 Detroit

AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

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Which states have found bird flu in dairy cows? Why is measles coming back? What states are having a measles outbreak? When is respiratory virus season over?

Our guest is AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. American Medical Association Chief Experience Officer Todd Unger hosts.

Unger: Hello, and welcome to the AMA Update video and podcast. Today we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine, and Public Health, Andrea Garcia. I'm Todd Unger, AMA's chief experience officer. Welcome back, Andrea.

Garcia: Thanks, Todd. It's great to be here as always.

Unger: Well, let's begin where we left off last week, and that's with bird flu. Andrea, what updates do we have on that topic?

Garcia: Well, that virus is continuing to spread among cattle, but I think the good news is there have been no new reports of human infection here in the U.S. There was some news according to the CDC that Vietnam has reported its first human infection with a low pathogenic avian influenza virus, that's H9N2.

It's a different subtype of avian flu than the highly pathogenic avian flu that's most reported globally and that's causing the outbreaks in poultry and cattle here in the U.S. At this time, there is no indication that this human infection in Vietnam is causing person-to-person spread or poses a threat to U.S. public health.

Unger: Well, that's good news. On the other hand, you did mention increased spread here among cattle, and that's obviously a problem. What is that looking like?

Garcia: There was a report in Reuters that indicated North Carolina and South Dakota became the seventh and eighth states to identify avian flu in a dairy herd. And just as a reminder, when we talked last week, the USDA had reported infections across six states, so Texas, Kansas, Ohio, Michigan, Idaho and New Mexico.

So now we're seeing dairy farmers across the country going on the defensive to try and prevent further spread. Many are banning visitors and disinfecting vehicles coming onto their land. Some are even cutting down trees to discourage wild birds from landing, since that first case in Texas and Kansas appear to have originated with birds.

Many are increasing their safety and cleaning procedures. In that Reuters article, one dairy farmer described her farm as a gated community for cows, where only the most essential people are allowed to go since people can unintentionally contribute to that spread by carrying in contaminated bird droppings on their boots or on their vehicles. The good news is that, as we discussed last week, cows do seem to recover, whereas the disease is lethal in poultry.

Unger: I never thought I'd heard that term gated community for cattle, but I understand folks wanting to protect their herds, and that's a big problem. So we'll continue to pay attention to this. Has the increased spread change the risk at all to people?

Garcia: No. The CDC says that the risk for most people remains low. However, some dairy farmers are concerned about a potential drop in demand for milk and cheese due to fear. The USDA did report finding bird flu in some unpasteurized milk samples, but agricultural officials say that pasteurized milk is safe. Farmers are also isolating those infected cattle and dumping their milk.

Unger: All right, Andrea, thank you so much for the update there. Let's turn now to another disease that is back in the headlines and continues to be for the past several weeks, and that's the measles. Andrea, what's going on there?

Garcia: Well, two new cases, one in Las Vegas, the other in Los Angeles, have really put this disease back in the news. More measles cases have also been reported in Georgia and here in Illinois. Unfortunately, the cases in both Las Vegas and Los Angeles were found in people who visited popular tourist destinations that are often, as you know, filled with people. The one in LA reportedly visited Universal Studios and the Santa Monica Pier over Easter weekend. The one in Vegas reportedly visited the MGM Grand resort on the strip and then additional nearby locations.

So public health officials are warning that unvaccinated individuals who were at these reported locations during the designated dates and times may be at risk for developing measles within 21 days from that exposure date. Last Thursday, the CDC said that the rapid rise in measles cases in the first few months of 2024 threatens the U.S. elimination status. And that's a situation we haven't faced since 2019 when prolonged outbreaks posed a similar problem.

Unger: Well, Andrea, where exactly do we stand in terms of cases?

Garcia: Well, Todd, on Thursday, we saw the CDC release an analysis of measles activity. And that was from January 1 of 2020 to March 28 of 2024. That said that cases in that first quarter of 2024 have risen 17-fold compared to that mean first quarter average that we've seen from 2020 to 2023. As of the March 28 data cutoff for that analysis, we had seen 97 cases of measles reported to the CDC, and then as of April 11, we have a total of 121 measles cases reported by 18 jurisdictions. So that number is definitely continuing to increase.

Of those 121 cases, 86 were linked to seven outbreaks, including a large one here in Chicago where most of those 61 cases that have been identified have been linked to that outbreak at a migrant shelter. If we look at the measles cases this year, though, 47% have occurred in children younger than five. Young children also had that highest level of hospitalization, at about 65%. And of people infected, 82% were unvaccinated or had an unknown vaccination status.

Of the 20 outbreaks, which we know involves three or more cases that we've seen since 2020, so far seven of those have occurred in 2024. And for further context, in all of 2023, we had 58 cases. And we are only in April. So maintaining that measles elimination status, which we know helps reduce cases, deaths and costs, means that no outbreaks have persisted for 12 months or more in a setting where we know the surveillance system is working well.

Unger: So tell us a little bit more about this status. What do we need to do to help maintain the status?

Garcia: Well, CDC has said that really comes down to increasing MMR vaccination coverage, especially in those close-knit and under-vaccinated communities. And as a reminder, that vaccine is incredibly safe and effective. We know that two shots are about 97% effective at preventing measles. I think the other steps include encouraging vaccination before international travel and then rapidly investigating those suspected measles cases.

Most measles cases are still imported. However, of those, 61% in U.S. residents who were eligible for vaccination but were unvaccinated or had an unknown vaccination status. So the CDC is also reportedly seeing a shift this year in overseas regions where people were likely exposed.

So during that study period that we talked about earlier, the two most common WHR regions where we saw cases were from the Eastern Mediterranean or the Middle East and Africa, but six of the 2024 cases were reported to have originated in European and Southeast Asian regions. So that's a 50% increase from earlier in the study period.

So according to the CDC, along with under-vaccination here in the U.S. population, there's a global gap in measles vaccination that is also fueling this rise in cases. And if we look at those numbers more closely, first dose coverage declined from 86% in 2019 to 83% in 2022, leaving nearly 22 million children younger than one vulnerable to the virus.

Unger: Andrea, besides this huge, as you point out, global vaccination gap, is there anything else that is kind of fueling this now? Why is it happening?

Garcia: Well, in the U.S., some of it is driven, of course, by misinformation, which is causing parents to seek vaccine exemptions. Every year, that number of kids in kindergarten with measles vaccination is going down.

Years ago, a fraudulent study claimed there was a link between the vaccine and autism. Of course, that study was later debunked. And other studies have searched for a connection but failed to find one. So to be very clear, there's no connection between the MMR vaccine and autism. So here's where physicians and particularly pediatricians can play an important role in curbing that spread of misinformation by talking to parents, being very clear about the evidence and the very real dangers and potential long-term effects of measles.

According to the CDC, in the decades before the measles vaccine was available, 48,000 people were hospitalized per year. One thousand people developed dangerous brain inflammation, and 400 to 500 people died.

Unger: So big risks there, and we need to close that gap. The evidence is really clear and getting those vaccinations, if you haven't already, so critical. Andrea, we haven't talked about RSV, COVID, and the flu and the array of other viruses for a while. The weather does seem, of course, to be getting nicer, thank goodness, it is here in Chicago, and we're now well into spring. Are we kind of out of the woods with viruses for the moment?

Garcia: Well, it appears so. And according to a recent report in the Associated Press, which was sharing CDC data, the 2023, '24 respiratory virus season is slowing for all three viruses. Overall, respiratory illness activity is currently the highest in the central U.S. North Dakota is the only state that is experiencing high activity levels at the moment.

The CDC gauges this activity by tracking doctor visits that involve a patient showing flu-like symptoms. And for that week of April 5, those made up only about 2.76% of all visits. The other metric, as you know, we look at is the test positivity rate for each virus, which can help inform which viruses are the most prevalent. While results are delayed for the CDC data set, flu has had the highest test positivity rate since mid-December.

Hospitalizations, of course, give us that idea of severity associated with each virus. COVID is hospitalizing people at a rate of 2.21 per 100,000. That's the highest rate among the three viruses. However, hospitalization rates for all three viruses are declining. I think the key takeaway from all of this as well, activity levels are still elevated. We're seeing decreasing trends across each of these metrics, which do suggest that the season is waning.

Unger: All right. Well, why don't we finish up then with that piece of good news. Andrea, thanks so much for being here and keeping us informed. To all the folks out there listening, if you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join.

We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today and please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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What illnesses are going around? RSV, COVID-19, influenza, measles outbreak, plus avian flu news - American Medical Association

School students without wearing masks walk past a COVID-19 mural at Korukkupet in Chennai.

When the COVID-19 pandemic set out on a worldwide rampage in late 2019, it did not care for who it affected. However, even through its apparent indiscriminate spread, the virus displayed clear favourites for torture candidates: the elderly.

Data from the World Health Organization (WHO) has revealed that over 80% of the total COVID-19-related between 2020 and 2021 occurred in senile populations aged 60 years or older. Since then, a flurry of studies have consistently shown that people above 65 are at higher risk of developing serious symptoms of the viral infection and now we might finally know why.

To understand how the coronavirus plans its assault on our bodies, a study delved into the part of our bodies that encounters the virus first: our noses. More specifically, researchers wanted to examine how our nasal cells respond to the SARS-CoV-2 virus, which they hoped could offer crucial insights into potential treatment strategies tailored to different age groups.

The research focused on the early effects of SARS-CoV-2 infection on human nasal epithelial cells (NECs). We have an abundance of epithelial cells covering the inside and outside of our bodies, which are instrumental in carrying out key bodily functions and protecting us. The team cultured NECs to mimic the cellular environment of the nasal cavity and infected them with SARS-CoV-2.

By analysing cells donated by participants spanning various age groups, including children (0-11 years), adults (30-50 years), and the elderly (over 70 years), the study discovered that there were distinct age-related responses to the coronavirus. The team found that children's NECs responded swiftly to SARS-CoV-2 by ramping up the production of interferons, key components of the body's antiviral defence system, which effectively restricted viral replication.

In contrast, NECs from elderly individuals exhibited increased viral replication, accompanied by heightened cell shedding and damage. This could be why the elderly are at greater risk of severe COVID-19 than other groups, even with the advent of vaccinations.

Our research reveals how the type of cells we have in our nose changes with age, and how this affects our ability to combat SARS-CoV-2 infection, explains lead author Claire Smith. This could be crucial in developing effective anti-viral treatments tailored to different age groups, especially for the elderly who are at higher risk of severe COVID-19.

By properly understanding the age-specific differences in nasal cell response to SARS-CoV-2, researchers can develop targeted antiviral therapies that enhance interferon production in older adults. This could potentially mitigate the severity of COVID-19 and reduce mortality rates in this demographic.

Moreover, the study underscores the importance of considering age as a critical factor in research and treatment strategies for infectious diseases. Beyond COVID-19, future research should explore how aging impacts the body's response to other viral infections, informing preventive measures and therapeutic interventions across diverse age groups.

The findings of this research have been published in Nature Microbiology and can be accessed here.

**

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Why Do Children Handle COVID-19 Better Than Old People? The Answer May Lie in Their Noses | Weather.com - The Weather Channel

This year is not yet one-third over, yet measles cases in the United States areon track to be the worstsince a massive outbreak in 2019. At the same time, anti-vaccine activists are recklessly sowing doubts and encouraging vaccine hesitancy. Parents who leave their children unvaccinated are risking not only their health but also the well-being of those around them.

Measles isone of the most contagioushuman viruses more so than thecoronavirus and is spread through direct or airborne contact when an infected person breathes, coughs or sneezes. The virus can hang in the air for up to two hours after an infected person has left an area. It can cause serious complications, including pneumonia, encephalitis and death, especially in unvaccinated people. According to the Centers for Disease Control and Prevention,one person infected with measles can infect 9 out of 10 unvaccinated individualswith whom they come in close contact.

But measles can be prevented with the measles, mumps and rubella vaccine. Two doses are 97% effective. When 95% or more of a community is vaccinated, herd immunity protects the whole. Unfortunately, vaccination rates are falling. Theglobal vaccine coverage rateof the first dose, at 83%, and second dose, at 74%, are well under the 95% level.Vaccination coverage among U.S. kindergartnershas slipped from 95.2% during the 2019-2020 school year to 93.1% in the 2022-2023 school year, according to the CDC, leaving about 250,000 kindergartners at risk each year over the past three years.

The virus is slipping through the gaps. According to the World Health Organization, in 2022,37 countries experienced large or disruptive measles outbreakscompared with 22 countries in 2021. In the United States, there have beenseven outbreaks so far this year, with 121 cases in 18 jurisdictions. Most are children. Many of the outbreaks in the United States appear to have been triggered byinternational travelor contact with a traveler. Disturbingly, 82% of those infectedwere unvaccinatedor their status unknown. ...

The largest toll has been in Illinois, followed by Florida. But when an outbreak hit the Manatee Bay Elementary School in Broward County in early March, Floridas top public health official, state Surgeon General Joseph A. Ladapo,did not follow the standard recommendationthat parents of unvaccinated children keep them home for 21 days to avoid getting the disease. Instead,Dr. Ladapo said, Florida would be deferring to parents or guardians to make decisions about school attendance. This means allowing children without protection to go to school. Dr. Ladapos letter was an unnecessarily reckless act of pandering to an anti-vaccine movement with increasing political influence.

Vaccine hesitancy is being encouraged by activists who warn of government coercion, using social media to amplify irresponsible claims. An article published March 20 on the website of Robert F. Kennedy Jr.s Childrens Health Defense organization is headlined,Be Very Afraid? CDC, Big Media Drum Up Fear of Deadly Measles Outbreaks.The author, Alan Cassels, claims that the news media is advancing a a fear-mongering narrative, and adds, Those of us born before 1970 with personal experience pretty much all agree that measles is a big meh. We all had it ourselves and so did our brothers, sisters and school friends. We also had chicken pox and mumps and typically got a few days off school. The only side effect of those diseases was that my mom sighed heavily and called work to say she had to stay home to look after a kid with spots.

Today, he adds, Big media and government overhyping the nature of an illness, which history has shown us can be a precursor to some very bad public health policies such as mandatory vaccination programs and other coercive measures.

This is just wrong. TheCDC reportsthat, in the decade before the measles vaccine became available in 1963, the disease killed 400 to 500 people, hospitalized 48,000 and gave 1,000 people encephalitis in the United States every year and that was just among reported cases. The elimination of measles in the United States in 2000, driven by a safe and effective vaccine, was a major public health success. Though the elimination status still holds,the U.S. situation has deteriorated.The nation has been below 95% dose coverage for three consecutive years, and 12 states are below 90%. At the same time, the rest of the world must also strive to boostchildhood vaccination rates, which slid backward during the COVID-19 pandemic. According to the WHO, low-income countries with the highest risk of death from measles continue to have the lowest vaccination rates, only 66%.

The battle against measles requires a big not a meh effort.

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Measles more contagious than the coronavirus. And it's back - Globe Gazette

Overview

SARS-CoV-2 PCR percent positivity, as detected in integrated sentinel surveillance as part of the Global Influenza Surveillance and Response System (GISRS) and reported to FluNet was around 8.0% from 69 countries during the week ending 31 March 2024.

Globally, JN.1 was the most reported variant of interest (VOI, now reported by 121 countries), accounting for 95.1.8% of sequences in week 13 compared to 93.0% in week 10. Its parent lineage, BA.2.86, has been declining and accounted for 1.6% of sequences in week 13 compared to 3.0% in week 10. Three variants under monitoring (VUMs): XBB, XBB.1.9.1, and XBB.2.3 have been de-escalated after having a prevalence of less than 1% for more than eight epidemiological weeks globally and across the WHO regions.

Globally, the number of new cases decreased by 11% during the past 28-day period of 4-31 March 2024 compared to the previous 28-day period (5 February to 3 March 2024), with over two hundred and seven-five thousand new cases reported. The number of new deaths decreased by 41% as compared to the previous 28-day period, with over 4200 new fatalities reported. As of 31 March 2024, over 774 million confirmed cases and more than seven million deaths have been reported globally.

During the period from 4-31 March 2024, COVID-19 new hospitalizations and admissions to an intensive care unit (ICU) both recorded an overall decrease of 45% and 50% with over 49 000 and more than 1200 admissions, respectively.

In this edition, we include:

See the rest here:

COVID-19 epidemiological update 12 April 2024 - World Health Organization (WHO)

Severe outcomes from COVID-19 infections are much less common in children than in older adults, and new research suggests that important differences in how the nasal cells of young and elderly people respond to the SARS-CoV-2 virus could explain why children typically experience milder COVID-19 symptoms.

"Despite effective vaccines, age remains the single greatest risk factor for COVID-19 mortality," the authors write. "Children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rarely develop severe disease, while the mortality in infected people over 85 years is currently as high as 1 in 10."

The cell-culture study is published in Nature Microbiology and is based on nasal epithelial cells (NECs) collected from healthy participants, including children (0 to 11 years), younger adults (30 to 50 years), and the elderly (over 70 years).

All study participant samples were collected from the Great Ormond Street Hospital, University College London Hospital, and the Royal Free Hospital, all in the United Kingdom.

The study was conducted by culturing the nasal cells of each age-group, which resulted in a dataset of 139,598 cells. The researchers identified 24 distinct epithelial cell types.

Healthy NECs had several age-related differences, including differences in cell-type proportions in healthy control cultures, with a higher abundance of basal or progenitor subtypes in adult versus pediatric cultures. In addition, NEC cultures from older adult donors were thicker than pediatric cultures.

To see how the cultured cells reacted to COVID-19 infections, researchers infected cultures with an early-lineage SARS-CoV-2 isolate.

Cells collected from children had high expression of interferon-stimulated genes and incomplete viral replication. Interferon is one of the first defenses fronted by the body when faced with an infection.

Our research reveals how the type of cells we have in our nose changes with age, and how this affects our ability to combat SARS-CoV-2 infection.

Dr Claire Smith of the Great Ormond Street Institute of Child Health said in a press release from University College London, "Our research reveals how the type of cells we have in our nose changes with age, and how this affects our ability to combat SARS-CoV-2 infection. This could be crucial in developing effective anti-viral treatments tailored to different age groups, especially for the elderly who are at higher risk of severe COVID-19."

Read more:

Nasal cells offer clues about why COVID-19 is typically milder in children - University of Minnesota Twin Cities

A recent study led by researchers at the University College London (UCL) and the Wellcome Sanger Institute has unveiled significant differences in the way nasal cells from young and elderly individuals respond to the SARS-CoV-2 virus. This discovery provides new insights into why children generally exhibit milder COVID-19 symptoms compared to older adults.

The findings shed light on the initial interactions between the virus and human nasal epithelial cells (NECs), which are among the first cells targeted by the virus.

Children infected with SARS-CoV-2 rarely progress to respiratory failure. However, the risk of mortality in infected people over 85 years of age remains high, wrote the study authors.

Here we investigate differences in the cellular landscape and function of pediatric (<12years), adult (3050years) and older adult (>70years) ex vivo cultured nasal epithelial cells in response to infection with SARS-CoV-2.

The researchers analyzed nasal cells donated by healthy individuals across all three age groups to the Great Ormond Street Hospital (GOSH), University College London Hospital (UCLH), and the Royal Free Hospital.

The cells were cultured to regrow into the diverse cell types originally found in the nasal passages. Employing advanced single-cell RNA sequencing techniques, the researchers identified 24 distinct types of epithelial cells. Each age groups cultures were then exposed to SARS-CoV-2 in controlled experiments.

Three days post-infection, the results showed that childrens nasal cells mounted a rapid response by increasing the production of interferon, a critical component of the bodys initial antiviral defense, which effectively restricted viral replication. However, this robust antiviral response was found to diminish with age.

In elderly individuals, the NECs not only produced more infectious virus particles but also exhibited increased cellular shedding and damage. This could explain the higher severity of COVID-19 symptoms and complications seen in older adults.

Our research reveals how the type of cells we have in our nose changes with age, and how this affects our ability to combat SARS-CoV-2 infection. This could be crucial in developing effective antiviral treatments tailored to different age groups, especially for the elderly who are at higher risk of severe COVID-19, explained project leader Claire Smith, an associate professor in infection, immunity, and inflammation at UCL Great Ormond Street Institute of Child Health.

By carrying out SARS-CoV-2 infections of epithelial cells in vitro and studying the responses with single-cell sequencing, we get a much more detailed understanding of the viral infection kinetics and see big differences in the innate immune response between cell types, added co-senior author Kerstin Meyer, an expert in cellular genetics at the Wellcome Sanger Institute.

Despite the advancements in vaccination and treatment options, the mortality risk remains high for those over 85 who contract the virus. This research emphasizes the importance of age as a critical factor in both the study and treatment of infectious diseases.

Despite effective vaccines, age remains the single greatest risk factor for COVID-19 mortality. Children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rarely develop severe disease, while the mortality in infected people over 85years is currently as high as 1 in 10, noted the researchers.

It is fascinating that when we take away immune cells from nasal samples, and are only left with nasal epithelial cells grown in a dish, we are still able to identify age-specific differences in our bodys response to the SARS-CoV-2 between the young and elderly to explain why children are generally protected from severe COVID-19, said co-senior author Marko Nikolic, a clinical scientist the UCL Division of Medicine.

Understanding the cellular differences at the initiation of infection is just the beginning. We now hope to investigate the long-term implications of these cellular changes and test therapeutic interventions using our unique cell culture model. This gold-standard system is only possible with the support of our funders and the willingness of participants to provide their samples, Smith concluded.

The researchers suggest that future studies should explore how aging affects the bodys response to other viral infections, potentially leading to more age-specific medical strategies.

The study is published in the journal Nature Microbiology.

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Nasal cells protect children against severe COVID-19 - Earth.com

Long ago Oscar Wilde cautioned, The truth is rarely pure and never simple.The COVID-19 pandemic is winding down, but the truth about the original source of the virus remains as contentious and elusive as ever.

Experts positions have hardened, but at least the facts about the two competing theories are clear enough today for the public to understand, even if the correct theory for the origin of COVID-19 remains uncertain.

The initial and for a time most popular explanation is known as the zoonotic source or more commonly, the animal spillover theory. This postulates that the virus originated in bats, then spread to an intermediary mammal and then leaped to infect humans. The main support for this theory is that the first cases of COVID-19 were believed to be from a wet food market in Wuhan, China, where many exotic mammals are caged in cramped, unsanitary conditions, conducive to pathogen spread. This aligns with the fact that the majority of pandemics occur due to transmission from animals. Specifically, the other two 21st century pandemics involving related coronaviruses SARS CoV-1 in 2003 and MERS in 2012 involved animal to human transmission.

Many virologists and epidemiologists are on record supporting this theory, including Dr. Paul Offit, the noted pediatrician and vaccine expert, who is this countrys leading authority on the history of vaccines. Offits opinion carries significant weight, but he has still not backed his opinion with dispositive evidence. The major weakness of the animal spillover theory is that for nearly five years researchers have been testing extensively for the virus in exotic animals such as civets, pangolins and raccoon dogs but to date they have found no evidence of COVID-19 in any of them. Until the virus is isolated in an intermediate host, the animal spillover theory is merely speculative.

The countertheory is that the virus emerged from a laboratory where work on viral transmission was being performed: the lab leak theory. The main support for this theory is that Wuhan, where the virus emerged, is the most important site in Asia for gain-of-function research (viral manipulation that can enhance transmission). The Wuhan virus laboratory is only several miles from the wet market, where the first cases appeared. Also concerning is that genetic analysis shows that the COVID-19 virus contains a binding region, known as a furin cleavage site, with a pattern that rarely occurs in nature.

Historically, lab leaks are occasionally responsible for dangerous pathogen outbreaks: in 1979, anthrax escaped from a Soviet laboratory and in a separate incident, smallpox leaked from a laboratory in Great Britain. Among those favoring the lab leak theory are members of the U.S. intelligence community, including officials in the FBI and Department of Energy, which is especially well-versed in laboratory procedure and biological research. Experienced science journalists such as Matt Ridley and Nicholas Wade, who have studied the question, also favor the lab leak theory. Unfortunately no specific leak site has been identified and nothing has been proven; the lab leak theory remains inferential, and it has gained considerable traction since it was dismissed early on as a conspiracy theory by public health officials.

It has become fashionable to use the term conspiracy theory to discredit anyone or any idea that is contrary to a mainstream belief or political view. Where once the term was reserved for such confections as faked moon landings or multiple shooters firing at former President John F. Kennedy from a grassy knoll, now it is a fashionable ad hominem way to discredit people without confronting and refuting their arguments through discourse.

Ironically, in the search for the source of COVID-19, there have been at least two documented actual not theoretical conspiracies: one by leading U.S. public health officials to debunk the lab leak theory and another by the Chinese government, which destroyed evidence in a probable attempt to hinder investigation of the source. When real conspiracies are in the air, scientists should consider retiring their use of the term conspiracy theory and stick to explaining facts. The best way to debunk the lab leak theory is to discover the animal that serves as the intermediary. Name calling is not a becoming feature of science, and does nothing to discredit the lab leak theory.

This lingering uncertainty prompts some researchers to mutter, What difference, at this point, does it make? Regardless of whether the virus turns out to have come from animal spillover, we still have to pay more attention to laboratory security. Similarly, confirmation of a lab leak would also still demand heightened scrutiny of wet markets. But there is another important principle at stake in the search for the origin of COVID-19: our faith in science. The theory that turns out to be correct will tell us what was true and what was not, whom we should have trusted and who was speaking out of ignorance no matter how well-intentioned and whether anyone was attempting to deceive the public. In an open society, these are not trivial issues, especially when trust in science has taken the beating it took during COIVD-19.

Two millennia ago, the Roman Stoic philosopher Seneca said that time discovers truth and that many discoveries are reserved for ages still to come. Perhaps Seneca was too optimistic for this inquiry, but this should not deter the pursuit of one of the most important scientific questions of the 21st century, Where did COVID-19 come from?

Dr. Cory Franklin is a retired intensive care physician and the author of the book, The COVID Diaries 2020-2024:Anatomy of a Contagion As It Happened.

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Op-ed: The correct theory for the origin of COVID-19 remains uncertain - Chicago Tribune

The airways leading to our lungs culminate in myriad alveoli, minuscule one-cell-thick air sacs, whichare abutted by abundant capillaries. This interface, called the interstitium, is where oxygen in the air we breathe enters the bloodstream and is then distributed to the rest of the body by thecirculatory system.

The two kinds of SARS-CoV-2-susceptible lung-associated macrophages are positioned in two different places. So-called alveolar macrophages hang out in the air spaces within the alveoli.Once infected, these cells smolder, producing and dribbling out some viral progeny at a casual pace but more or less keeping a stiff upper lip and maintaining their normal function. This behavior may allow them to feed SARS-CoV-2s progression by incubating and generating a steady supply of new viral particles that escape by stealth and penetrate the layer of cells enclosing the alveoli.

Interstitial macrophages, the other cell type revealed to be easily and profoundly infected by SARS-CoV-2, patrol the far side of the alveoli, where the rubber of oxygen meets the road of red blood cells. If an invading viral particle or other microbe manages to evade alveolar macrophages vigilance, infect and punch through the layer of cells enclosing the alveoli, jeopardizing not only the lungs but the rest of the body,interstitial macrophages are ready to jump in and protect the neighborhood.

At least, usually.But when an interstitial macrophage meets SARS-CoV-2, its a different story. Rather than get eaten by the omnivorous immune cell, the virus infects it.

And an infected interstitial macrophage doesnt just smolder; it catches on fire. All hell breaks looseas the virusliterally seizes the controls and takes over, hijacking a cells protein- and nucleic-acid-making machinery.In the course of producingmassive numbers of copies of itself,SARS-CoV-2 destroys the boundaries separating the cell nucleus from the rest of the cell like a spatula shattering and scattering the yolk of a raw egg.The viral progeny exitthe spent macrophage and move on to infect other cells.

But thats not all. In contrast to alveolar macrophages, infected interstitial macrophages pump out substances that signal other immune cells elsewhere in the body to head for the lungs. In a patient, Krasnow suggested, this would trigger an inflammatory influx of such cells. As the lungs fill with cells and fluid that comes with them, oxygen exchange becomes impossible. The barrier maintaining alveolar integrity growsprogressively damaged.Leakage of infected fluids from damaged alveoli propels viral progeny into the bloodstream, blasting the infection and inflammation todistant organs.

Yet other substances released by SARS-CoV-2-infected interstitial macrophages stimulate the production of fibrous material in connective tissue, resulting in scarring of the lungs. In a living patient, the replacement of oxygen-permeable cells with scar tissue would further render the lungs incapable of executing oxygen exchange.

We cant say that a lung cell sitting in a dish is going to get COVID, Blish said. But we suspect this may be the point where, in an actual patient,the infection transitions from manageable to severe.

Compounding this unexpected findingis the discovery that SARS-CoV-2 uses a different route to infect interstitial macrophagesthan the one it uses to infect the other types.

Unlike alveolar type 2 cells and alveolar macrophages, to which the virus gains access by clinging to ACE2 on their surfaces, SARS-CoV-2 breaks into interstitial macrophages using a different receptor these cells display. In the study, blocking SARS-CoV-2s binding to ACE2 protected the former cells but failed to dent the latter cells susceptibility to SARS-CoV-2 infection.

SARS-CoV-2 was not using ACE2 to get into interstitial macrophages, Krasnow said.It enters via another receptor called CD209.

That would seem to explain why monoclonal antibodies developed specifically to block SARS-CoV-2/ACE2 interaction failed to mitigate or prevent severe COVID-19 cases.

Its time to find a whole new set of drugs that can impede SARS-CoV-2/CD209 binding.Now, Krasnow said.

The study was funded by the National Institutes of Health (grants K08AI163369, T32AI007502 and T32DK007217), the Bill & Melinda Gates Foundation, Chan Zuckerberg Biohub, the Burroughs WellcomeFund, Stanford Chem-H, the Stanford Innovative Medicine Accelerator, and the Howard Hughes Medical Institute.

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Stanford Medicine study flags unexpected cells in lung as suspected source of severe COVID - Stanford Medical Center Report