Since the last BA.2.86 update, lab and epidemiological data have trickled in. Many of us took a big sigh of relief after seeing specific results over the weekend.
Any update on when the ‘23 monovalent boosters will be at pharmacies and doctor’s offices ready to go?
Also, the UK is restricting autumn booster eligibility to those at greatest risk : 65+ yo, residents of care homes for older adults, people in a “clinical risk group,” frontline health and social care workers, the immunosuppressed, etc (see link below). The UK moved their release date forward to September 11. In the US, our boosters won't even be through the FDA/CDC process yet. There seems to be a great sense of urgency, at least in the UK.
Will autumn boosters be similarly restricted here in the US?
I hope you can include another "unanswered question" in future posts on this general topic: "is it more or less likely to lead to Long COVID?" If YLE is not mentioning LC for a reason, please say why. Otherwise, these posts feed into the narratives that minimize LC and gaslight patients.
I presume she's not mentioning it because there is, AFAIK, zero data on that question at the moment. There's little enough data on long-term effects of COVID in general, much less any correlations with any specific variant. Let's recall that SARS-Cov-2 has only been with us for four years now. We still know every little about long-term effects.
Yep, the data is not in yet, we just getting around to two years PASC data. This one just appear as a blip on the radar a few weeks ago. There does appear to be reduction in PASC with vaccination and antivirals. Also associated with reduction in autoantibodies.
Thank you for the update. Are symptoms with the new variant similar to past variants? I've known of a couple of people who recently become ill and have lost their sense of smell. Obviously, we don't know which variant they had, but it seemed like this symptom was more common with past variants than the newer ones.
So I guess I'm left wondering - if it traded antibody escape for infectivity, isn't that kind of a wash? At the end of the day, I want to know "Will I get sick?" and I don't much care which mechanism is preventing sickness.
So, we don’t know its growth rate or severity because surveillance is massively down? In other words, che sera sera? For this variant, for any future Covid variant, and for any future pandemic?
Meanwhile, basic, non-pandemic, non public health healthcare staffing is going great:
“A recent survey of tens of thousands of healthcare workers across California found that 83% reported understaffing in their departments, and 65% said they have witnessed or heard of care being delayed or denied due to staff shortages.
Additionally, more than 40% of the workers surveyed said they feel pressured to neglect safety protocols and skip breaks or meals due to short staffing.
"It's heartbreaking to see our patients suffer from long wait times for the care they need, all because Kaiser won't put patient and worker safety first," Paula Coleman, a clinical laboratory assistant at Kaiser Permanente in Englewood, Colorado, said in a statement late last month. "We will have no choice but to vote to strike if Kaiser won't bargain in good faith and let us give patients the quality care they deserve."”
Thank you, once again, for the timely, clear update. Can you say more what variables you are looking at to determine that we are in a wave? (I continue to find the wastewater data hard to read--but it looks like, at least in my area, we are approaching March 2023 levels.) Related, do you have any additional recommendations with regard to personal mitigation in response to the wave?
This is very reassuring news, Dr. Jetalina. Thank you for sharing it with us. Now we sit tight until next week’s meeting here in the US on the details regarding the fall boosters :-)
May we assume the evolutionary pressure is to favor spread but not necessarily virulence (the likelihood of making people sick when infected)? If so, I'd think a virus would "want" to spread rapidly without causing symptoms (or at least not too quickly). I suppose that's not too likely at least for symptoms that are due to gearing-up of the immune system. Are the endogenous retroviruses that have (over millions of years) accreted to make up several percent of the human genome an example of this? (Or does that only apply to retroviruses?)
How do we get at home test? Should we start buying them now vs waiting because of expiration dates? What if we still have some free tests? Do you think they’re still useable?
I purchased more masks yesterday. I think I’ll get some cleaning supplies and hand sanitizer too; just in case.
This link should help you find out if your tests at home are still valid. Insurance companies have mostly stopped covering them, you'll have to buy them at a store or order online.
One of the maddening aspects of this pandemic is that there's no single category of "advice giver" that's really competent enough to give definitive answers to questions like this, because they lie in this weird zone between medical, legal, financial, ethical, and psychosocial. For example, if your question is "Do I buy X now or later?" inevitably you run into sticky questions like "How much will they cost later? Is there room in your home to store them in a cool, dry area? Will your homeowners insurance cover them if they're destroyed in a fire?" etc
My wife and I were pleasantly surprised that we were able to order more at-home tests which were covered by our medical insurance. It’s certainly worth a try. Ditto Janet Day’s comment and link to see if your test kits have an extended date from the original. Many of ours have, so it’s very worth looking them up.
Diagnosed a case of influenza B today with rapid testing, in a patient who also had Covid diagnosed less than 2 weeks ago.
80 yo feeling really fatigued, dizzy, congested, and with productive cough. Could have assumed it was still Covid, but repeat rapid Covid test negative, and spidey sense lead me to check for flu...
So yeah, Covid is here, and flu I think coming sooner than we would like.
And the fact that he picked up flu <2 weeks after Covid means not the best isolation going on out there.
Treating.
...and the kids are back to school so here we go...
Yeah, that's why we need the COVID/Flu at home test. At least you can figure out which treatment you need if not a coinfection. Seems only POC have this dual capability.
I wear an N95. Two patients came in to see me just yesterday for "check ups", only revealing symptoms midway through their visits after I asked: "you know, you seem to be showing signs of being sick."
Swabbed them and both Covid +
I think my mask will hold the line as it has these 3+ years. Good luck to you as well.
What is the difference in terms of getting sick from BA.2.86 with regard to the virus being better able to avoid antibodies but having less infectivity. Does that mean it is less infection than it would have been had the variables been reversed, i.e., less able to escape antibodies but having greater infectivity.
I just experienced TGA, Transient Global Amnesia, two days before I had Covid symptoms. What is the evidence of a link between these two incidents? My neighbor experienced the same sequence of events two weeks before me.
My mom had that years before covid, and saw a neurologist. It's terrifying. It's extremely random, and not very well understood. I hope you got a referral to some sort of specialist you can keep following up with, and that you've got emergency contacts lined up and contingency plans with family.
Respectfully following-up from a few YLE posts ago were Dr. K recommended that anyone infected wait “at least 6 months” before getting a booster and promised more detail in future posts. Would love to know more about the “why” behind this.
Any update on when the ‘23 monovalent boosters will be at pharmacies and doctor’s offices ready to go?
Also, the UK is restricting autumn booster eligibility to those at greatest risk : 65+ yo, residents of care homes for older adults, people in a “clinical risk group,” frontline health and social care workers, the immunosuppressed, etc (see link below). The UK moved their release date forward to September 11. In the US, our boosters won't even be through the FDA/CDC process yet. There seems to be a great sense of urgency, at least in the UK.
Will autumn boosters be similarly restricted here in the US?
https://healthmedia.blog.gov.uk/2023/08/08/covid-autumn-booster-vaccine-2023-everything-you-need-to-know/
Middle of September is last I heard. Believe cleared FDA but waiting for CDC's ACIP. Think the guidelines are going to be the same as last fall.
I hope you can include another "unanswered question" in future posts on this general topic: "is it more or less likely to lead to Long COVID?" If YLE is not mentioning LC for a reason, please say why. Otherwise, these posts feed into the narratives that minimize LC and gaslight patients.
I presume she's not mentioning it because there is, AFAIK, zero data on that question at the moment. There's little enough data on long-term effects of COVID in general, much less any correlations with any specific variant. Let's recall that SARS-Cov-2 has only been with us for four years now. We still know every little about long-term effects.
Yep, the data is not in yet, we just getting around to two years PASC data. This one just appear as a blip on the radar a few weeks ago. There does appear to be reduction in PASC with vaccination and antivirals. Also associated with reduction in autoantibodies.
I had to look up PASC to realize it meant "post-acute sequelae of COVID-19," which is the medical term for so-called "long COVID" (https://www.nature.com/articles/s41590-023-01601-2)
Sorry, I try to define terms that are abbreviated. I usually keep that in mind in my substack. You should see some of the papers I read. Sometimes in slow because I have to familiarize myself with new ones. They always follow the rule “Provided they are not obscure to the reader, abbreviations communicate more with fewer letters. Writers have only to ensure that the abbreviations they use are too well known to need any introduction, or that they are introduced and explained on their first appearance.” https://www.paperpal.com/blog/academic-writing-guides/language-grammar/abbreviations-in-research/#:~:text=When%20to%20abbreviate%3A%20Using%20too%20many%20abbreviations%20in,it%E2%80%99s%20best%20to%20abbreviate%20terms%20you%20use%20repeatedly.
That's fine. I actually learned something.
Thank you for the update. Are symptoms with the new variant similar to past variants? I've known of a couple of people who recently become ill and have lost their sense of smell. Obviously, we don't know which variant they had, but it seemed like this symptom was more common with past variants than the newer ones.
So this is like saying that the latest variant is better at evading the patrol and worse at scaling the wall?
I love this analogy
Our neighbors across the river in Canada are masking up. I plan to be ready with masks, sanitizers and heightened awareness.
So I guess I'm left wondering - if it traded antibody escape for infectivity, isn't that kind of a wash? At the end of the day, I want to know "Will I get sick?" and I don't much care which mechanism is preventing sickness.
So, we don’t know its growth rate or severity because surveillance is massively down? In other words, che sera sera? For this variant, for any future Covid variant, and for any future pandemic?
Seems awfully close to the truth.
Meanwhile, basic, non-pandemic, non public health healthcare staffing is going great:
“A recent survey of tens of thousands of healthcare workers across California found that 83% reported understaffing in their departments, and 65% said they have witnessed or heard of care being delayed or denied due to staff shortages.
Additionally, more than 40% of the workers surveyed said they feel pressured to neglect safety protocols and skip breaks or meals due to short staffing.
"It's heartbreaking to see our patients suffer from long wait times for the care they need, all because Kaiser won't put patient and worker safety first," Paula Coleman, a clinical laboratory assistant at Kaiser Permanente in Englewood, Colorado, said in a statement late last month. "We will have no choice but to vote to strike if Kaiser won't bargain in good faith and let us give patients the quality care they deserve."”
https://www.commondreams.org/news/kaiser-nurses
Because Freedumb. Or something.
Love the word. Adopting it.
Thank you, once again, for the timely, clear update. Can you say more what variables you are looking at to determine that we are in a wave? (I continue to find the wastewater data hard to read--but it looks like, at least in my area, we are approaching March 2023 levels.) Related, do you have any additional recommendations with regard to personal mitigation in response to the wave?
This is very reassuring news, Dr. Jetalina. Thank you for sharing it with us. Now we sit tight until next week’s meeting here in the US on the details regarding the fall boosters :-)
All those immune escape mutations seem to be adding up to much less than the sum of the parts.
JPWeiland (a modeller) on Twitter says,
"Based on the data alone (suggested reduced infectivity AND only modest immune escape) one would think it wouldn't spread at all, and die out.
But we're finding it popping up everywhere and growing.
Something isn't adding up, but I'm not sure what it is."
Some are also saying it wouldn't be surprising if it mutates to gain some infectivity.
Guess we'll have to stay tuned!
May we assume the evolutionary pressure is to favor spread but not necessarily virulence (the likelihood of making people sick when infected)? If so, I'd think a virus would "want" to spread rapidly without causing symptoms (or at least not too quickly). I suppose that's not too likely at least for symptoms that are due to gearing-up of the immune system. Are the endogenous retroviruses that have (over millions of years) accreted to make up several percent of the human genome an example of this? (Or does that only apply to retroviruses?)
How do we get at home test? Should we start buying them now vs waiting because of expiration dates? What if we still have some free tests? Do you think they’re still useable?
I purchased more masks yesterday. I think I’ll get some cleaning supplies and hand sanitizer too; just in case.
https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/home-otc-covid-19-diagnostic-tests
This link should help you find out if your tests at home are still valid. Insurance companies have mostly stopped covering them, you'll have to buy them at a store or order online.
Public library in my area still provides free tests
Yeah I usually smurf rapid tests from public libraries. A few here, a few there. I save them up for the next time I want to see my mom, who has CLL
Don’t forget to surreptitiously acquire a TP stock😊 Paper towels, too
Or just buy a portable bidet: https://www.amazon.com/dp/B0881LFY6G?tag=travelandleisure-onsite-prod-20&linkCode=ogi&th=1&psc=1&ascsubtag=5432062%7Cn2ce0664afb984938b67207ba5b300c5c20%7CB0881LFY6G%7C1693945203754%7C
In March 2020 I pretty much bribed an Instacart driver to get TP for my household by giving them an exorbitant tip. It worked. Judge me.
Love it! Wish I would have thought about that! My friend in WA sent me toilet paper in VA.
Well you could have thought of it but you might not have been able to afford it. The things I've done to avoid Covid haven't exactly been noble.
Lol. I thought about that after I posted. Last time, I was searching everywhere for TP.
I got one for travel. Nifty little device.
One of the maddening aspects of this pandemic is that there's no single category of "advice giver" that's really competent enough to give definitive answers to questions like this, because they lie in this weird zone between medical, legal, financial, ethical, and psychosocial. For example, if your question is "Do I buy X now or later?" inevitably you run into sticky questions like "How much will they cost later? Is there room in your home to store them in a cool, dry area? Will your homeowners insurance cover them if they're destroyed in a fire?" etc
My wife and I were pleasantly surprised that we were able to order more at-home tests which were covered by our medical insurance. It’s certainly worth a try. Ditto Janet Day’s comment and link to see if your test kits have an extended date from the original. Many of ours have, so it’s very worth looking them up.
Glad no bombshells here!
Seeing a lot of Covid in office right now.
Diagnosed a case of influenza B today with rapid testing, in a patient who also had Covid diagnosed less than 2 weeks ago.
80 yo feeling really fatigued, dizzy, congested, and with productive cough. Could have assumed it was still Covid, but repeat rapid Covid test negative, and spidey sense lead me to check for flu...
So yeah, Covid is here, and flu I think coming sooner than we would like.
And the fact that he picked up flu <2 weeks after Covid means not the best isolation going on out there.
Treating.
...and the kids are back to school so here we go...
Guess what, RSV season is here!
https://emergency.cdc.gov/han/2023/han00498.asp?ACSTrackingID=USCDC_511-DM112268&ACSTrackingLabel=HAN%20498%20-%20General%20Public&deliveryName=USCDC_511-DM112268
Remember: Hickam’s dictum, named after Dr. John Hickam: “a patient can have as many diseases as they damn well please.”
Yeah, although it’s tricky to catch. My husband and son both had strep and COVID coinfections recently. We didn’t catch the strep until weeks later.
Love this dictum, it really gets to the core of our hardwired binary thinking. Will try to stay meta, and not happy about the RSV tidings.
Yeah, that's why we need the COVID/Flu at home test. At least you can figure out which treatment you need if not a coinfection. Seems only POC have this dual capability.
Putting my mask back on while at work.
I wear an N95. Two patients came in to see me just yesterday for "check ups", only revealing symptoms midway through their visits after I asked: "you know, you seem to be showing signs of being sick."
Swabbed them and both Covid +
I think my mask will hold the line as it has these 3+ years. Good luck to you as well.
Weird. We have also seen a Flu B in our area as a coinfection with COVID. Seems like a really weird time for Flu B.
In a more "normal" time, this comes around in the spring. Things gotten weird past few years. Welcome to the new normal. This was back in 2020.
https://www.health.com/condition/flu/what-is-influenza-b
Flu B? Crap. No travel? Man that’s early. Buckle up, it’s going to be an other bumpy fall...
What is the difference in terms of getting sick from BA.2.86 with regard to the virus being better able to avoid antibodies but having less infectivity. Does that mean it is less infection than it would have been had the variables been reversed, i.e., less able to escape antibodies but having greater infectivity.
Thanks,
I just experienced TGA, Transient Global Amnesia, two days before I had Covid symptoms. What is the evidence of a link between these two incidents? My neighbor experienced the same sequence of events two weeks before me.
My mom had that years before covid, and saw a neurologist. It's terrifying. It's extremely random, and not very well understood. I hope you got a referral to some sort of specialist you can keep following up with, and that you've got emergency contacts lined up and contingency plans with family.
Respectfully following-up from a few YLE posts ago were Dr. K recommended that anyone infected wait “at least 6 months” before getting a booster and promised more detail in future posts. Would love to know more about the “why” behind this.
Will Novamax also cover the new variant? I'm still hoping to find a place that gives it this fall.
Novavax has developed a monovalent booster for this fall, to cover XBB, as have Pfizer and Moderna: https://www.usnews.com/news/health-news/articles/2023-08-30/explainer-what-to-know-about-the-new-covid-19-booster-shots-planned-for-fall
I think YLE posted that this is what she plans to get. I need to investigate it more. I’ve had moderna and Pfizer. Thinking I’ll get this one too.
Likewise on both counts—thinking about getting Novavax, and have had Moderna (4 shots) and Pfizer (1-last year’s bivalent).