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Sleep apnea raises risk of long Covid by up to 75% for some, study says | CNN

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CNN
—

Adults who have obstructive sleep apnea have up to an 75% increased risk, on average, of developing long Covid after a SARS-CoV-2 infection compared with people without sleep apnea, a new study found.

Women with obstructive sleep apnea had up to an 89% increased risk, while men had a 59% higher risk, according to the analysis of electronic health data on nearly 1.8 million people.

Obstructive sleep apnea is a potentially dangerous disorder in which breathing stops for about 10 seconds multiple times during the night due to a blockage of the airways by heavy or relaxed soft tissues in the mouth and throat.

A second analysis of medical records of a smaller group of 330,000 adults found the risk to be only 12%, according to the study, which is part of RECOVER, or Researching Covid to Enhance Recovery. RECOVER is a National Institutes of Health initiative dedicated to understanding why some people develop long Covid and how best to detect, treat, and prevent the condition.

Why the huge difference in numbers? People in the larger study had additional health concerns, or comorbidities, such as obesity, diabetes, high blood pressure and heart disease, said senior study author Lorna Thorpe, co-lead of the RECOVER Clinical Science Core at NYU Langone Health.

“The range of 12% to 75% is likely due to a combination of different study populations and different levels of comorbidities, but also different definitions of long Covid,” she said. “We didn’t even have a diagnostic code for long Covid until October 2021.

“I believe the risk is likely to be in the middle, but we will need additional studies to tease that out,” added Thorpe, a professor and director of the division of epidemiology at NYU Grossman School of Medicine.

A third analysis of medical records of 102,000 children with sleep apnea found no correlation between sleep apnea and long Covid after the various confounding health conditions were factored out, “which, of course, is great news,” Thorpe said.

“By using three very large networks of electronic health records, we were able to do this study three times, which is one of the strengths of the research,” she added. “This study is the first collaboration of this focus and scale to find that adults with sleep apnea are at greater risk for long Covid.”

This is an “important study” on long Covid, said Dr. Sairam Parthasarathy, a principal investigator of the University of Arizona Health Sciences RECOVER Adult Study and professor of medicine.

“Research needs to be done in a prospective study to verify this association, and if found to be true these findings have implications for treatment of long Covid,” said Parthasarathy, who was not involved in the study.

“It is important to note that some of the symptoms of long Covid such as fatigue may be related to obstructive sleep apnea, and that the treatment of obstructive sleep apnea may improve such long Covid-related symptoms,” he added.

The study, published Thursday in the journal Sleep, is one of a several studies released since Congress allocated $1.15 billion to NIH in January 2021, to study the long-term effects of Covid over a four-year period. To date, the agency says it has used about $811 million to fund research.

Researchers wanted to investigate the role of sleep apnea in long Covid due to the well-known association between the condition and poorer outcomes after a Covid infection.

“People with sleep apnea are at higher risk for a more severe case of Covid-19, admission to intensive care at the hospital and for mortality,” Thorpe said.

“Obstructive sleep apnea can result in increased inflammation, potentially disrupted sleep leading to an increased propensity to develop infections and reduced immunity,” said Dr. Bhanu Prakash Kolla, a sleep medicine specialist in the Center for Sleep Medicine at the Mayo Clinic in Rochester, Minnesota.

“This could potentially explain the pathway by which obstructive sleep apnea leads to an increased risk of having Covid and also … (long Covid),” said Kolla, who was not involved in the study.

Sleep apnea is an underdiagnosed condition regardless of gender, said the University of Arizona’s Parthasarathy.

“It is conservatively estimated that 80% of patients with obstructive sleep apnea (OSA) are not diagnosed,” he said. In addition, “an assumption with these analyses is that patients with OSA are likely to be treated. However, nearly half of them are not using the treatment.”

Why would women have up to an 89% higher risk compared with 59% in men? The study did not address that issue.

However, “one can postulate this difference may be based on what we know about sex differences in sleep and immune responses,” said Dr. Phyllis Zee, director of the Center for Circadian and Sleep Medicine at Northwestern University Feinberg School of Medicine in Chicago.

Zee, who was not involved with the new research, coauthored one of the first published studies on the link between sleep apnea and serious Covid infection.

“Women typically have stronger immune responses to viral infections, and thus also vulnerability for post-infection inflammation,” Zee said. “Women in general have more insomnia and with long Covid tend to present with fatigue and insomnia symptoms, which are also common symptoms of long Covid.”

Another reason could be that sleep apnea has historically been considered a male disease, Thorpe said, which could mean that by the time a woman is diagnosed her apnea is more advanced.

“It could be that the women who are documented in electronic health records have more severe sleep apnea because physicians more often look for sleep apnea among men,” she said.

As scientists continue to learn more about long Covid, further information will become available, Thorpe said. In the meantime, people who have sleep apnea — or who snore, snort and stop breathing at night, which are all signs of the condition — should be exceedingly careful when they contact Covid.

“People with sleep apnea who get infected with Covid should seek early treatment and consider getting Paxlovid, the oral medication prescribed to reduce risk of severe outcomes,” Thorpe said. “They should also keep up with their vaccinations to lower the risk of infection in the first place.”

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Covid-19 is no longer a public health emergency, but others remain | CNN

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CNN
—

The Covid-19 pandemic hit a major milestone this month as public health emergency declarations were ended by both the United States government and the World Health Organization. Emergency declarations for mpox also recently ended.

This doesn’t mean Covid-19 and mpox are no longer of concern, but it does mark the end of the availability of certain logistical capabilities to manage them.

Still, other critical health challenges were identified as health emergencies years before the start of the Covid-19 pandemic and continue to be so: the opioid crisis in the US and the global spread of poliovirus.

Some public health concerns can be serious health threats without a formal emergency declaration, said Dr. Tom Frieden, former director of the US Centers for Disease Control and Prevention.

It largely boils down to the logistics of government operations.

“When there’s an unusual situation that requires multiple parts of an agency or multiple parts of the government or multiple parts of society to come together and coordinate, collaborate and work efficiently, then an emergency declaration can be a useful tool,” said Frieden, president and CEO of Resolve to Save Lives, an organization focused on global epidemic prevention and cardiovascular health.

“Sometimes, an emergency is declared to make the point that it’s a big problem, to get people’s attention. Sometimes, an emergency is declared to get things done because that’s the only way you can bring certain governmental capacities to bear.”

According to WHO, a public health emergency of international concern is “an extraordinary event” that poses public health risk through the international spread of disease.

It creates an agreement between countries to abide by WHO’s recommendations for managing the emergency, often requiring a “coordinated international response.” Each country, in turn, declares its own public health emergency – declarations that carry legal weight. Countries use them to marshal resources and waive rules in order to ease a crisis.

In the US, the secretary of the Department of Health and Human Services can declare a public health emergency for diseases or disorders that pose a threat, including “significant outbreaks” of an infectious disease, bioterrorist attacks or otherwise.

This triggers the availability of a set of resources and actions for the federal government, such as additional funds and data and reporting requirements.

Emergency declarations typically last up to 90 days, with formal renewal required as necessary every three months after that.

The opioid crisis was determined to be a public health emergency in October 2017, during the Trump administration, driven by the rising rates of opioid-related deaths and opioid use disorder.

The declaration has been renewed for more than five years, most recently at the end of March.

According to the CDC, the opioid epidemic started in 1999 with a rise in prescription opioid overdose deaths. Deaths started to increase precipitously as synthetic opioids – particularly fentanyl – started to take over in 2013.

In 2021, overdose deaths reached record levels in the US, and about three-quarters – more than 80,000 deaths – involved opioids.

Within the first year of the opioid emergency declaration, HHS used expanded authorities to field a survey about treatment for opioid use disorder among providers and to expedite research on the topic.

Public health emergencies are also declared to help with recovery after natural disasters, most recently for severe storms that hit Mississippi in March.

However, the Government Accountability Office considers both federal management of the public health emergency system and efforts to combat drug misuse to be “high-risk” areas that are vulnerable or in need of broad reform.

In a recent report, the federal watchdog group said that it has found “persistent deficiencies in HHS’s leadership role preparing for and responding to public health emergencies” and no demonstrated progress in federal agencies’ actions to address drug misuse.

WHO has considered poliovirus a public health emergency of international concern since 2014.

A committee formed to address the emergency reviewed the most recent data on cases and spread this month and voted unanimously that ongoing risks merited an extension of the emergency declaration, which the director-general formalized Friday.

The committee was “encouraged by reported progress” but says that risks remain high for factors including weak vaccination rates that could have been affected by the Covid-19 pandemic.

WHO identified seven counties with potential risk for international spread. And the US is among a group of 37 countries with recently detected cases.

In July, a polio case identified in New York became the first in the US in nearly a decade. The identified case, along with several positive wastewater tests in nearby communities, met WHO criteria to consider the US a country with circulating poliovirus.

Experts warned that it could just be the “tip of the iceberg,” with hundreds of cases spreading silently.

Childhood vaccination rates in the US dropped during the Covid-19 pandemic. A CDC report found that about 93% of kindergarteners enrolled in the 2021-22 school year got the required vaccines, including measles, mumps and rubella (MMR); diphtheria, tetanus and acellular pertussis (DTaP); and polio. Coverage fell for the second year in a row amid the pandemic, from about 94% the previous year and below the federal target of 95%.

While no longer under a formal emergency declaration, Covid-19 continues to be part of the “landscape of health threats,” Frieden said.

But the efficiency and coordination that the formal declaration helps facilitate should always be the goal.

“I think there are really important lessons from Covid, including the need to have a much more resilient public health system so that we can find problems quickly and implement effective solutions quickly,” Frieden said.

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Covid-19 Pandemic Timeline Fast Facts | CNN

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CNN
—

Here’s a look at the coronavirus outbreak, declared a worldwide pandemic by the World Health Organization. The coronavirus, called Covid-19 by WHO, originated in China and is the cousin of the SARS virus.

Coronaviruses are a large group of viruses that are common among animals. The viruses can make people sick, usually with a mild to moderate upper respiratory tract illness, similar to a common cold. Coronavirus symptoms include a runny nose, cough, sore throat, possibly a headache and maybe a fever, which can last for a couple of days.

WHO Situation Reports

Coronavirus Map

CNN’s early reporting on the coronavirus

December 31, 2019 – Cases of pneumonia detected in Wuhan, China, are first reported to WHO. During this reported period, the virus is unknown. The cases occur between December 12 and December 29, according to Wuhan Municipal Health.

January 1, 2020 – Chinese health authorities close the Huanan Seafood Wholesale Market after it is discovered that wild animals sold there may be the source of the virus.

January 5, 2020 – China announces that the unknown pneumonia cases in Wuhan are not SARS or MERS. In a statement, the Wuhan Municipal Health Commission says a retrospective probe into the outbreak has been initiated.

January 7, 2020 – Chinese authorities confirm that they have identified the virus as a novel coronavirus, initially named 2019-nCoV by WHO.

January 11, 2020 – The Wuhan Municipal Health Commission announces the first death caused by the coronavirus. A 61-year-old man, exposed to the virus at the seafood market, died on January 9 after respiratory failure caused by severe pneumonia.

January 17, 2020 – Chinese health officials confirm that a second person has died in China. The United States responds to the outbreak by implementing screenings for symptoms at airports in San Francisco, New York and Los Angeles.

January 20, 2020 – China reports 139 new cases of the sickness, including a third death. On the same day, WHO’s first situation report confirms cases in Japan, South Korea and Thailand.

January 20, 2020 – The National Institutes of Health announces that it is working on a vaccine against the coronavirus. “The NIH is in the process of taking the first steps towards the development of a vaccine,” says Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases.

January 21, 2020 – Officials in Washington state confirm the first case on US soil.

January 23, 2020 – At an emergency committee, WHO says that the coronavirus does not yet constitute a public health emergency of international concern.

January 23, 2020 – The Beijing Culture and Tourism Bureau cancels all large-scale Lunar New Year celebrations in an effort to contain the growing spread of coronavirus. On the same day, Chinese authorities enforce a partial lockdown of transport in and out of Wuhan. Authorities in the nearby cities of Huanggang and Ezhou Huanggang announce a series of similar measures.

January 28, 2020 – Chinese President Xi Jinping meets with WHO Director General Tedros Adhanom in Beijing. At the meeting, Xi and WHO agree to send a team of international experts, including US Centers for Disease Control and Prevention staff, to China to investigate the coronavirus outbreak.

January 29, 2020 – The White House announces the formation of a new task force that will help monitor and contain the spread of the virus, and ensure Americans have accurate and up-to-date health and travel information, it says.

January 30, 2020 – The United States reports its first confirmed case of person-to-person transmission of the coronavirus. On the same day, WHO determines that the outbreak constitutes a Public Health Emergency of International Concern (PHEIC).

January 31, 2020 – The Donald Trump administration announces it will deny entry to foreign nationals who have traveled in China in the last 14 days.

February 2, 2020 – A man in the Philippines dies from the coronavirus – the first time a death has been reported outside mainland China since the outbreak began.

February 3, 2020 – China’s Foreign Ministry accuses the US government of inappropriately reacting to the outbreak and spreading fear by enforcing travel restrictions.

February 4, 2020 – The Japanese Health Ministry announces that ten people aboard the Diamond Princess cruise ship moored in Yokohama Bay are confirmed to have the coronavirus. The ship, which is carrying more than 3,700 people, is placed under quarantine scheduled to end on February 19.

February 6, 2020 – First Covid-19 death in the United States: A person in California’s Santa Clara County dies of coronavirus, but the link is not confirmed until April 21.

February 7, 2020 – Li Wenliang, a Wuhan doctor who was targeted by police for trying to sound the alarm on a “SARS-like” virus in December, dies of the coronavirus. Following news of Li’s death, the topics “Wuhan government owes Dr. Li Wenliang an apology,” and “We want freedom of speech,” trend on China’s Twitter-like platform, Weibo, before disappearing from the heavily censored platform.

February 8, 2020 – The US Embassy in Beijing confirms that a 60-year-old US national died in Wuhan on February 6, marking the first confirmed death of a foreigner.

February 10, 2020 – Xi inspects efforts to contain the coronavirus in Beijing, the first time he has appeared on the front lines of the fight against the outbreak. On the same day, a team of international experts from WHO arrive in China to assist with containing the coronavirus outbreak.

February 10, 2020 – The Anthem of the Seas, a Royal Caribbean cruise ship, sets sail from Bayonne, New Jersey, after a coronavirus scare had kept it docked and its passengers waiting for days.

February 11, 2020 – WHO names the coronavirus Covid-19.

February 13, 2020 – China’s state-run Xinhua News Agency announces that Shanghai mayor Ying Yong will be replacing Jiang Chaoliang amid the outbreak. Wuhan Communist Party chief Ma Guoqiang has also been replaced by Wang Zhonglin, party chief of Jinan city in Shandong province, according to Xinhua.

February 14, 2020 – A Chinese tourist who tested positive for the virus dies in France, becoming the first person to die in the outbreak in Europe. On the same day, Egypt announces its first case of coronavirus, marking the first case in Africa.

February 15, 2020 – The official Communist Party journal Qiushi publishes the transcript of a speech made on February 3 by Xi in which he “issued requirements for the prevention and control of the new coronavirus” on January 7, revealing Xi knew about and was directing the response to the virus on almost two weeks before he commented on it publicly.

February 17, 2020 – A second person in California’s Santa Clara County dies of coronavirus, but the link is not confirmed until April 21.

February 18, 2020 – Xi says in a phone call with British Prime Minister Boris Johnson that China’s measures to prevent and control the epidemic “are achieving visible progress,” according to state news Xinhua.

February 21, 2020 – The CDC changes criteria for counting confirmed cases of novel coronavirus in the United States and begins tracking two separate and distinct groups: those repatriated by the US Department of State and those identified by the US public health network.

February 25, 2020 – The NIH announces that a clinical trial to evaluate the safety and effectiveness of the antiviral drug remdesivir in adults diagnosed with coronavirus has started at the University of Nebraska Medical Center in Omaha. The first participant is an American who was evacuated from the Diamond Princess cruise ship docked in Japan.

February 25, 2020 – In an effort to contain the largest outbreak in Europe, Italy’s Lombardy region press office issues a list of towns and villages that are in complete lockdown. Around 100,000 people are affected by the travel restrictions.

February 26, 2020 – CDC officials say that a California patient being treated for novel coronavirus is the first US case of unknown origin. The patient, who didn’t have any relevant travel history nor exposure to another known patient, is the first possible US case of “community spread.”

February 26, 2020 – Trump places Vice President Mike Pence in charge of the US government response to the novel coronavirus, amid growing criticism of the White House’s handling of the outbreak.

February 29, 2020 – A patient dies of coronavirus in Washington state. For almost two months, this is considered the first death due to the virus in the United States, until autopsy results announced April 21 reveal two earlier deaths in California.

March 3, 2020 – The Federal Reserve slashes interest rates by half a percentage point in an attempt to give the US economy a jolt in the face of concerns about the coronavirus outbreak. It is the first unscheduled, emergency rate cut since 2008, and it also marks the biggest one-time cut since then.

March 3, 2020 – Officials announce that Iran will temporarily release 54,000 people from prisons and deploy hundreds of thousands of health workers as officials announced a slew of measures to contain the world’s deadliest coronavirus outbreak outside China. It is also announced that 23 members of Iran’s parliament tested positive for the virus.

March 4, 2020 – The CDC formally removes earlier restrictions that limited coronavirus testing of the general public to people in the hospital, unless they had close contact with confirmed coronavirus cases. According to the CDC, clinicians should now “use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.”

March 8, 2020 – Italian Prime Minister Giuseppe Conte signs a decree placing travel restrictions on the entire Lombardy region and 14 other provinces, restricting the movements of more than 10 million people in the northern part of the country.

March 9, 2020 – Conte announces that the whole country of Italy is on lockdown.

March 11, 2020 – WHO declares the novel coronavirus outbreak to be a pandemic. WHO says the outbreak is the first pandemic caused by a coronavirus. In an Oval Office address, Trump announces that he is restricting travel from Europe to the United States for 30 days in an attempt to slow the spread of coronavirus. The ban, which applies to the 26 countries in the Schengen Area, applies only to foreign nationals and not American citizens and permanent residents who’d be screened before entering the country.

March 13, 2020 – Trump declares a national emergency to free up $50 billion in federal resources to combat coronavirus.

March 18, 2020 – Trump signs into law a coronavirus relief package that includes provisions for free testing for Covid-19 and paid emergency leave.

March 19, 2020 – At a news conference, officials from China’s National Health Commission report no new locally transmitted coronavirus cases for the first time since the pandemic began.

March 23, 2020 – United Nations Secretary-General António Guterres calls for an immediate global ceasefire amid the pandemic to fight “the common enemy.”

March 24, 2020 – Japan’s Prime Minister Shinzo Abe and International Olympic Committee (IOC) president Thomas Bach agree to postpone the Olympics until 2021 amid the outbreak.

March 25, 2020 – The White House and Senate leaders reach an agreement on a $2 trillion stimulus deal to offset the economic damage of coronavirus, producing one of the most expensive and far-reaching measures in the history of Congress.

March 27, 2020 – Trump signs the stimulus package into law.

April 2, 2020 – According to the Department of Labor, 6.6 million US workers file for their first week of unemployment benefits in the week ending March 28, the highest number of initial claims in history. Globally, the total number of coronavirus cases surpasses 1 million, according to Johns Hopkins University’s tally.

April 3, 2020 – Trump says his administration is now recommending Americans wear “non-medical cloth” face coverings, a reversal of previous guidance that suggested masks were unnecessary for people who weren’t sick.

April 8, 2020 – China reopens Wuhan after a 76-day lockdown.

April 14, 2020 – Trump announces he is halting funding to WHO while a review is conducted, saying the review will cover WHO’s “role in severely mismanaging and covering up the spread of coronavirus.”

April 20, 2020 – Chilean health officials announce that Chile will begin issuing the world’s first digital immunity cards to people who have recovered from coronavirus, saying the cards will help identify individuals who no longer pose a health risk to others.

April 21, 2020 – California’s Santa Clara County announces autopsy results that show two Californians died of novel coronavirus in early and mid-February – up to three weeks before the previously known first US death from the virus.

April 28, 2020 – The United States passes one million confirmed cases of the virus, according to Johns Hopkins.

May 1, 2020 – The US Food and Drug Administration issues an emergency-use authorization for remdesivir in hospitalized patients with severe Covid-19. FDA Commissioner Stephen Hahn says remdesivir is the first authorized therapy drug for Covid-19.

May 4, 2020 – During a virtual pledging conference co-hosted by the European Union, world leaders pledge a total of $8 billion for the development and deployment of diagnostics, treatments and vaccines against the novel coronavirus.

May 11, 2020 – Trump and his administration announce that the federal government is sending $11 billion to states to expand coronavirus testing capabilities. The relief package signed on April 24 includes $25 billion for testing, with $11 billion for states, localities, territories and tribes.

May 13, 2020 – Dr. Mike Ryan, executive director of WHO’s health emergencies program, warns that the coronavirus may never go away and may just join the mix of viruses that kill people around the world every year.

May 19, 2020 – WHO agrees to hold an inquiry into the global response to the coronavirus pandemic. WHO member states adopt the proposal with no objections during the World Health Assembly meeting, after the European Union and Australia led calls for an investigation.

May 23, 2020 – China reports no new symptomatic coronavirus cases, the first time since the beginning of the outbreak in December.

May 27, 2020 – Data collected by Johns Hopkins University reports that the coronavirus has killed more than 100,000 people across the US, meaning that an average of almost 900 Americans died each day since the first known coronavirus-related death was reported nearly four months earlier.

June 2, 2020 – Wuhan’s Health Commission announces that it has completed coronavirus tests on 9.9 million of its residents with no new confirmed cases found.

June 8, 2020 – New Zealand Prime Minister Jacinda Ardern announces that almost all coronavirus restrictions in New Zealand will be lifted after the country reported no active cases.

June 11, 2020 – The United States passes 2 million confirmed cases of the virus, according to Johns Hopkins.

June 16, 2020 – University of Oxford scientists leading the Recovery Trial, a large UK-based trial investigating potential Covid-19 treatments, announce that a low-dose regimen of dexamethasone for 10 days was found to reduce the risk of death by a third among hospitalized patients requiring ventilation in the trial.

June 20, 2020 – The NIH announces that it has halted a clinical trial evaluating the safety and effectiveness of drug hydroxychloroquine as a treatment for the coronavirus. “A data and safety monitoring board met late Friday and determined that while there was no harm, the study drug was very unlikely to be beneficial to hospitalized patients with Covid-19,” the NIH says in a statement.

June 26, 2020 – During a virtual media briefing, WHO announces that it plans to deliver about 2 billion doses of a coronavirus vaccine to people across the globe. One billion of those doses will be purchased for low- and middle-income countries, according to WHO.

July 1, 2020 – The European Union announces it will allow travelers from 14 countries outside the bloc to visit EU countries, months after it shut its external borders in response to the pandemic. The list does not include the US, which doesn’t meet the criteria set by the EU for it to be considered a “safe country.”

July 6, 2020 – In an open letter published in the journal Clinical Infectious Diseases, 239 scientists from around the world urge WHO and other health agencies to be more forthright in explaining the potential airborne transmission of coronavirus. In the letter, scientists write that studies “have demonstrated beyond any reasonable doubt that viruses are released during exhalation, talking, and coughing in microdroplets small enough to remain aloft in air and pose a risk of exposure at distances beyond 1 to 2 meters (yards) from an infected individual.”

July 7, 2020 – The Trump administration notifies Congress and the United Nations that the United States is formally withdrawing from WHO. The withdrawal goes into effect on July 6, 2021.

July 21, 2020 – European leaders agree to create a €750 billion ($858 billion) recovery fund to rebuild EU economies ravaged by the coronavirus.

July 27, 2020 – A vaccine being developed by the Vaccine Research Center at the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, in partnership with the biotechnology company Moderna, enters Phase 3 testing. The trial is expected to enroll about 30,000 adult volunteers and evaluates the safety of the vaccine and whether it can prevent symptomatic Covid-19 after two doses, among other outcomes.

August 11, 2020 – In a live teleconference, Russian President Vladimir Putin announces that Russia has approved a coronavirus vaccine for public use before completion of Phase 3 trials, which usually precedes approval. The vaccine, which is named Sputnik-V, is developed by the Moscow-based Gamaleya Institute with funding from the Russian Direct Investment Fund (RDIF).

August 15, 2020 – Russia begins production on Sputnik-V, according to Russian state news agency TASS.

August 23, 2020 – The FDA issues an emergency use authorization for the use of convalescent plasma to treat Covid-19. It is made using the blood of people who have recovered from coronavirus infections.

August 27, 2020 – The CDC notifies public health officials around the United States to prepare to distribute a potential coronavirus vaccine as soon as late October. In the documents, posted by The New York Times, the CDC provides planning scenarios to help states prepare and advises on who should get vaccinated first – healthcare professionals, essential workers, national security “populations” and long-term care facility residents and staff.

September 4, 2020 – The first peer-reviewed results of Phase 1 and Phase 2 clinical trials of Russia’s Covid-19 vaccine are published in the medical journal The Lancet. The results “have a good safety profile” and the vaccine induced antibody responses in all participants, The Lancet says.

October 2, 2020 – Trump announces that he and first lady Melania Trump have tested positive for Covid-19. He spends three nights at Walter Reed National Military Medical Center receiving treatment before returning to the White House.

October 12, 2020 – Drugmaker Johnson & Johnson announces it has paused the advanced clinical trial of its experimental coronavirus vaccine because of an unexplained illness in one of the volunteers.”Following our guidelines, the participant’s illness is being reviewed and evaluated by the ENSEMBLE independent Data Safety Monitoring Board (DSMB) as well as our internal clinical and safety physicians,” the company said in a statement. ENSEMBLE is the name of the study. The trial resumes later in the month.

December 10, 2020 – Vaccine advisers to the FDA vote to recommend the agency grant emergency use authorization to Pfizer and BioNTech’s coronavirus vaccine.

December 14, 2020 – US officials announce the first doses of the FDA authorized Pfizer vaccine have been delivered to all 50 states, the District of Columbia and Puerto Rico.

December 18, 2020 – The FDA authorizes a second coronavirus vaccine made by Moderna for emergency use. “The emergency use authorization allows the vaccine to be distributed in the U.S. for use in individuals 18 years and older,” the FDA said in a tweet.

January 14, 2021 – The WHO team tasked with investigating the origins of the outbreak in Wuhan arrive in China.

January 20, 2021 – Newly elected US President Joe Biden halts the United States’ withdrawal from WHO.

February 22, 2021 – The death toll from Covid-19 exceeds 500,000 in the United States.

February 27, 2021 – The FDA grants emergency use authorization to Johnson & Johnson’s Covid-19 vaccine, the first single dose Covid-19 vaccine available in the US.

March 30, 2021 – According to a 120-page report from WHO, the novel coronavirus that causes Covid-19 probably spread to people through an animal, and probably started spreading among humans no more than a month or two before it was noticed in December of 2019. The report says a scenario where it spread via an intermediate animal host, possibly a wild animal captured and then raised on a farm, is “very likely.”

April 17, 2021 – The global tally of deaths from Covid-19 surpasses 3 million, according to data compiled by Johns Hopkins.

August 3, 2021 – According to figures published by the CDC, the more contagious Delta variant accounts for an estimated 93.4% of coronavirus circulating in the United States during the last two weeks of July. The figures show a rapid increase over the past two months, up from around 3% in the two weeks ending May 22.

August 12, 2021 – The FDA authorizes an additional Covid-19 vaccine dose for certain immunocompromised people.

August 23, 2021 – The FDA grants full approval to the Pfizer/BioNTech Covid-19 vaccine for people age 16 and older, making it the first coronavirus vaccine approved by the FDA.

September 24, 2021 – CDC Director Dr. Rochelle Walensky diverges from the agency’s independent vaccine advisers to recommend boosters for a broader group of people – those ages 18 to 64 who are at increased risk of Covid-19 because of their workplaces or institutional settings – in addition to older adults, long-term care facility residents and some people with underlying health conditions.

November 2, 2021 – Walensky says she is endorsing a recommendation to vaccinate children ages 5-11 against Covid-19, clearing the way for immediate vaccination of the youngest age group yet in the US.

November 19, 2021 – The FDA authorizes boosters of the Pfizer/BioNTech and Moderna Covid-19 vaccines for all adults. The same day, the CDC also endorses boosters for all adults.

December 16, 2021 – The CDC changes its recommendations for Covid-19 vaccines to make clear that shots made by Moderna and Pfizer/BioNTech are preferred over Johnson & Johnson’s vaccine.

December 22, 2021 – The FDA authorizes Pfizer’s antiviral pill, Paxlovid, to treat Covid-19, the first antiviral Covid-19 pill authorized in the United States for ill people to take at home, before they get sick enough to be hospitalized. The following day, the FDA authorizes Merck’s antiviral pill, molnupiravir.

December 27, 2021 – The CDC shortens the recommended times that people should isolate when they’ve tested positive for Covid-19 from 10 days to five days if they don’t have symptoms – and if they wear a mask around others for at least five more days. The CDC also shortens the recommended time for people to quarantine if they are exposed to the virus to a similar five days if they are vaccinated.

January 31, 2022 – The FDA grants full approval to Moderna’s Covid-19 vaccine for those ages 18 and older. This is the second coronavirus vaccine given full approval by the FDA.

March 29, 2022 – The FDA authorizes a second booster of the Pfizer/BioNTech and Moderna Covid-19 vaccines for adults 50 and older. That same day, the CDC also endorses a second booster for the same age group.

April 25, 2022 – The FDA expands approval of the drug remdesivir to treat patients as young as 28 days and weighing about seven pounds.

May 17, 2022 – The FDA authorizes a booster dose of Pfizer/BioNTech’s Covid-19 vaccine for children ages 5 to 11 at least five months after completion of the primary vaccine series. On May 19, the CDC also endorses a booster dose for the same age group.

June 18, 2022 – The CDC recommends Covid-19 vaccines for children as young as 6 months.

August 31, 2022 – The FDA authorizes updated Covid-19 vaccine booster shots from Moderna and Pfizer. Both are bivalent vaccines that combine the companies’ original vaccine with one that targets the BA.4 and BA.5 Omicron sublineages. The CDC signs off on the updated booster shots the following day.

May 5, 2023 – The WHO says Covid-19 is no longer a global health emergency.

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The way the US government tracks Covid-19 is about to change | CNN

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CNN
—

When the US public health emergency ends May 11, the US Centers for Disease Control and Prevention will have to change some of the ways it tracks Covid-19 in the United States, but the agency says it won’t lose its sightlines on the infection as it continues to be part of American life.

On Thursday, for the first time in three years, the CDC will stop posting a national count of Covid-19 cases. The agency’s color-coded maps of county-level transmission and disease burden will be retired, the CDC will no longer track variants down to the state level, and it will update its genomic surveillance estimates every two weeks instead of weekly.

“Though our data going forward will be different, they will continue to provide timely insights for CDC, for local health officials, as well as for the public to understand Covid-19 dynamics,” CDC Principal Deputy Director Dr. Nirav Shah said.

“In short, we will still be able to tell that it’s snowing, even though we’re no longer counting every snowflake.”

Instead of following Covid-19 cases, the agency will track the burden and spread of disease primarily through hospitalizations and deaths.

The move to stop posting a national case count is largely symbolic. The number of Covid-19 cases known to public health officials has long been undercounted. The percent of detected cases has only fallen further as people have turned to rapid home testing for a diagnosis. At some points in the pandemic, experts estimated that the true number of cases was more than 14 times higher than official counts.

Other metrics that people are used to seeing on the CDC’s Covid Data Tracker are also going to go away. As CNN previously reported, the CDC will stop publishing detailed, color-coded Covid-19 Transmission Levels and Covid-19 Community Level maps that have been tied to recommendations about when to wear masks, when it’s a good idea for people to test to prevent the spread of disease and when to avoid large indoor public gatherings.

When the public health emergency ends, more states are expected to stop reporting Covid-19 cases to CDC. Iowa, for example, has already stopped. So the CDC says it won’t be feasible to maintain a national count or update its maps.

Future recommendations for precautions like masking will instead be tied to hospitalization levels.

Covid-19 will retain its designation as a nationally notifiable disease, but that’s just a recommendation, says Dr. Brendan Jackson, who leads the CDC’s Covid-19 response. It doesn’t carry any authority for required reporting. When the public health emergency ends, it will be a state-by-state decision whether to share those numbers, Jackson said Thursday.

The CDC says it will still publish the case counts it gets from states, but that will be in a different section of its website, and the numbers won’t be totaled.

Some experts say they’re disappointed to see that the CDC will have to go back to an older, fragmented system of having to ask states to share data.

“We’re kind of reverting back to a system where the CDC kind of independently negotiates all these data sharing agreements with the states and they make it more voluntary,” said Beth Blauer, associate vice provost for public sector innovation at Johns Hopkins University.

“I think having the states do this all independently doesn’t make a ton of sense because it doesn’t help us understand, in the aggregate, the impact that disease is having on our communities,” Blauer said.

She also said it will be very difficult to scale this system back up should another large, immediate public health threat emerge.

Starting next week, vaccination counts will become discretionary. Jackson said that most, but not all, of the 64 jurisdictions that report to the CDC have signed data use agreements to share their vaccine administration numbers. They may not share as much as they have in the past about who is getting vaccinated or do it as frequently, which may limit the nation’s ability to spot widespread racial, ethnic or socioeconomic disparities for future vaccination campaigns. Starting in June, the CDC says, it will update its vaccination data on a monthly basis.

Laboratories will no longer be required to send testing data to the CDC, which will hamper the ability to understand test positivity rates, a metric that, early in the pandemic, helped public health officials know whether they were doing enough testing or if transmission in a community was going up or down. Positivity rates were used in the transmission maps but also for the CDC’s tracking of variants.

The CDC will still get some lab testing data from another system called the National Respiratory and Enteric Virus Surveillance System, a network of about 450 labs that help it track illnesses like influenza and respiratory syncytial virus, or RSV.

Variant tracking will continue, but the CDC will have to adjust some of the metrics it uses to model variant proportions. State-level estimates of variant proportions with go away, but regional levels will remain. Those will be updated twice a month going forward instead of weekly, as they are now.

The way the CDC will collect data on deaths will change, too. Instead of scraping numbers from state website and getting direct reports from states, which counted deaths based on the date they were reported, the CDC will switch to a national system that counts deaths based on death certificate data. The agency says this system has become much more timely and will be a more stable way to count Covid-19 deaths going forward. It will also add a new metric to its death reporting: the percentage of all deaths reported that week that are caused by Covid-19.

Hospitals will still have to report Covid-19 data through April 2024, but they won’t track as many metrics or submit that information as frequently. Hospitals have shared information daily through most of the pandemic, but now that reporting will be weekly.

Hospitalizations and deaths are known as lagging indicators because they increase only after people have gotten sick. Studies released Friday from CDC epidemiologists show that hospitalizations may not lag behind cases as much as we once thought they did.

The new studies, published in the CDC’s Morbidity and Mortality Weekly Report, show that Covid-19 hospitalizations lagged one day behind increases in reported cases and four days behind increases in emergency room visits.

The research also shows that the new system the CDC will be using to track deaths will show trends 13 days earlier than data collected from states, the system that’s being discontinued.

With case levels low across most of the country, the need for these kinds of insights has gone away, or scientists have found other ways to get the information, such as testing of wastewater, which begins to increase about a week before testing data reflects an uptick in spread. Wastewater testing is available in some places, but not all areas have this capability.

The CDC will also maintain traveler surveillance, testing wastewater on airplanes in an effort to spot new incoming threats.

The CDC will also maintain what it calls sentinel systems: smaller, but nationally representative networks of hospitals and laboratories that will feed in more detailed data. This is much the same way the agency tracks patterns in other respiratory diseases, such as the flu and RSV. The CDC says recent investments in these sentinel systems will help it maintain eyes on Covid-19.

Instead, it will be using hospitalizations and emergency room visits as the primary ways it tracks Covid-19 and as the basis for its recommendations. When hospitalization rates in an area are high, for example, it will be recommending that people wear masks, said Jackson.

CDC Director Dr. Rochelle Walensky acknowledged some of these data changes in a Senate committee hearing this week, although she emphasized that the CDC was not “changing the steam” of its work on Covid-19.

“As the public health emergency is set to end next week, I do want to just reiterate that we at CDC are not changing the steam at which we are working through resolving this public health emergency,” Walensky said at a hearing of the Senate Committee on Health Education, Labor and Pensions.

“It is the case at the end of the public health emergency, we will have less window as to the data,” she said. “We won’t get laboratory reporting. We won’t get case reporting. So we’ll lose some of that.”

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Free Covid-19 tests aren’t guaranteed after May 11, but there’s still time to stock up | CNN

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CNN
—

When the US Covid-19 public health emergency ends this month, coronavirus tests will still be available, but there will be changes to who pays for them.

Questions remain about exactly what those coverage changes will look like, but the guarantee of free testing will be lost for many – and some costs may shift to become out-of-pocket.

There are still ways to take advantage of the benefits provided by the public health emergency before it expires May 11.

For the past two years, the federal government has required private insurance companies to cover up to eight Covid-19 tests each month. Packs of home tests can be found at pharmacies and other local retailers, and costs may be covered upfront or reimbursed by insurance plans.

The Biden administration launched COVIDtests.gov in January 2022 to allow US households to order free Covid-19 test kits to be delivered to home. The site is still up and running, with four free tests available to any household that hasn’t ordered since December.

Also, the US Food and Drug Administration has extended the expiration date for many home tests beyond what is printed on the box. Check the agency’s website before throwing them out.

“People should go out and ensure that they have tests available, because what we know about Covid is it’s quite pernicious, and clearly, people can get it more than once,” said Mara Aspinall, a professor at Arizona State University’s College of Health Solutions and a testing and diagnostics expert.

“It’s critical that people have the ability to test and then isolate or stay at home if they test positive.”

Once the public health emergency ends, Covid-19 tests – both home tests and laboratory tests – will be subject to cost sharing, in which costs of services are divided between the patient and their insurance plan.

Private insurers will no longer be required to cover the costs of testing. The federal government has encouraged continued coverage, but each company will ultimately be able to make their own decision. So far, details on those plans are scarce.

The Blue Cross Blue Shield Association told CNN that it’s evaluating the best way to keep members informed of changes. Moving into the next phase, coverage may include “reasonable limits” on tests.

“As COVID-19 becomes endemic, each Blue Cross and Blue Shield company is looking at how best to support access to diagnostic testing for COVID-19, just as is done for all other diagnostic testing,” said David Merritt, senior vice president of policy and advocacy for the Blue Cross Blue Shield Association. “We are committed to protecting patients from unnecessary costs, while ensuring they receive the care they need, when they need it.”

Aetna told CNN that it did not have any details to share. Cigna, Humana and UnitedHealthcare did not respond to multiple requests for comment.

Medicare Part B beneficiaries will continue to have coverage for lab tests when ordered by a provider, but the same will not apply for home tests.

For those on Medicaid plans, all tests will continue to be covered for free until the end of September 2024.

The US Centers for Disease Control and Prevention will also continue to support uninsured individuals and socially vulnerable communities “pending resource availability,” according to a roadmap outlined by the US Department of Health and Human Services.

There may be other avenues to free or cheap testing, too – perhaps through state and local governments or other programs.

Recently, for example, the North Carolina Department of Health and Human Services announced the expansion of a program that now allows all state residents to order free tests through June.

The Rockefeller Foundation, a private philanthropic organization, has also extended a public-private partnership program that works with states to get free tests to at-risk communities.

“The testing phenomenon during Covid changed many times,” Aspinall said.

It was a core focus at the beginning, but the priority then shifted to vaccines, she said. The initial Omicron wave brought a renewed interest in testing, and long waits for lab-based tests drove people to home tests.

“It put power and privacy in an individual consumer’s hand,” Aspinall said.

Millions of households took advantage of free Covid-19 tests provided by the federal government in the months after it launched, and a recent CDC report shows that the program helped to get kits to many who otherwise wouldn’t have tested and improved equity in testing overall.

About 60% of US households ordered a test kit from COVIDTests.gov, and nearly a third of all US households reported using at least one of those tests by April or May last year.

Nearly a quarter of people who reported using the government-provided tests said that they probably would not have tested for Covid-19 if not for the free kits, according to the report – suggesting that more than 13 million people took a Covid-19 test who otherwise wouldn’t have. More than 1 in 5 people who used their free tests reported at least one positive result.

Overall, use of the free test kits was similar across racial and ethnic groups. This is a “considerable difference” from other home test kits, where use was “highly inequitable,” according to the report. Black people were more likely than White people to use tests provided through COVIDTests.gov but 72% less likely than White people to use other at-home test kits.

Now, however, Covid-19 cases are a third of what they were a year ago, and hospitalizations and deaths are about as low as they’ve ever been. Testing rates have dropped significantly, too.

Along with the decreased transmission, the volume of testing may have dropped as people better understand what the course of an infection looks like, Aspinall said.

She estimates that people may use an average of one or two tests per incident, down from an average of five or six.

While Covid-19 “remains a public health priority,” the federal government says “we are in a better place in our response than we were three years ago, and we can transition away from the emergency phase.”

Still, experts agree that continued monitoring is key. Advancements in technologies like wastewater surveillance have helped supplement dwindling testing data, but testing will continue to be an important tool for individuals to keep themselves and their loved ones safe and healthy.

“The public health emergency may be over but Covid is not over,” Aspinall said.

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Doctors watching for more cases after mysterious cluster of brain infections strikes kids in southern Nevada | CNN

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CNN
—

Disease detectives with the US Centers for Disease Control and Prevention are investigating a cluster of rare and serious brain abscesses in kids in and around Las Vegas, Nevada, and doctors from other parts of the country say they may be seeing a rise in cases, too.

In 2022, the number of brain abscesses in kids tripled in Nevada, rising from an average of four to five a year to 18.

“In my 20 years’ experience, I’ve never seen anything like it,” said Dr. Taryn Bragg, an associate professor at the University of Utah who treated the cases.

Pediatric neurosurgeons like Bragg are rare. She is the only one for the entire state of Nevada, and because she treated all the cases, she was the first to notice the pattern and to alert local public health officials.

“After March of 2022, there was just a huge increase,” in brain abscesses, Bragg said. “I was seeing large numbers of cases and that’s unusual.”

“And the similarities in terms of the presentation of cases was striking,” Bragg said.

In almost every case, kids would get a common childhood complaint, such as an earache or a sinus infection, with a headache and fever, but within about a week, Bragg says, it would become clear that something more serious was going on.

After a presentation on the Nevada cases the Epidemic Intelligence Service Conference on Thursday, doctors from other parts of the country said they are seeing similar increases in brain abscesses in kids.

“We’re just impressed by the number of these that we’re seeing right now,” said Dr. Sunil Sood, a pediatric infectious disease specialist at Northwell Health, a health system in New York. He estimates they are seeing at least twice as many as usual, though they haven’t done a formal count. He urged the CDC to continue investigating and work to get the word out.

Brain abscesses are not, by themselves, reportable conditions, meaning doctors aren’t required to alert public health departments when they have these cases.

They typically only come to the attention of public health officials when doctors notice increases and reach out.

Brain abscesses are pus-filled pockets of infection that spread to the brain. They can cause seizures, visual disturbances, or changes in vision, speech, coordination or balance. The earliest symptoms are headaches and a fever that comes and goes. Abscesses often require several surgeries to treat, and kids may spend weeks or even months in the hospital recovering after they have one.

In the Clark County cluster, roughly three-quarters of the cases were in boys, and most were around age 12.

Dr. Jessica Penney is the CDC Epidemic Intelligence Service officer, or “disease detective,” assigned to Southern Nevada Health District, the health department that investigated the cases. She presented her investigation of the Clark County cluster at the CDC’s annual Epidemic Intelligence Service conference on Thursday.

Penney says as they tried to figure out what was driving the increase, they looked at a slew of factors – travel, a history of Covid-19 infection, underlying health, any common activities or exposures – and they didn’t find anything that linked the cases.

Then, she says they decided to look back in time, looking for brain abscess cases in children under 18 all the way back to 2015.

“I felt like that helped us get a better sense of what might be contributing to it,” Penney said in an interview with CNN.

From 2015 to 2020, Penney says the number of cases of brain abscesses in Clark County was pretty stable at around four a year. In 2020, the number of brain abscesses in kids dipped, probably because of measures like social distancing, school closures, and masking – things that shut down the spread of all kinds of respiratory infections, not just Covid-19. In 2021, as restrictions began to lift, the number of these events returned back to normal levels, and then in 2022, a big spike.

“So the thoughts are, you know, maybe in that period where kids didn’t have these exposures, you’re not building the immunity that you would typically get previously, you know with these viral infections,” Penney said. “And so maybe on the other end when we you had these exposures without that immunity from the years prior, we saw a higher number of infections.”

This is a theory called the immunity debt. Doctors have recently seen unusual increases in a number of serious childhood infections, such as invasive group A strep. Some think that during the years of the pandemic, because children weren’t exposed to the number of viruses and bacteria they might normally encounter, it left their immune systems less able to fight off infections.

Sood said he’s not sold on the theory that there’s some kind of immunity debt at work. Instead, he thinks Covid-19 temporarily displaced other infections for a while, essentially crowding others out. Now, as Covid-19 cases have fallen, he thinks other childhood infections are roaring back – he points to unprecedented surge in RSV cases last fall and winter as an example.

Sood says brain abscesses normally follow a very small percentage of sinus infections and inner ear infections in kids. Because they are seeing more of those infections now, the number of brain abscesses has increased proportionally, too.

If immunity debt or a higher burden of infections were to blame, it stands to reason that brain abscesses might have increased in other places, too.

Last year, the CDC worked with the Children’s Hospital Association to find and count brain abscesses in kids, to see if there was any sort of national spike. Data collected through May 2022 did not detect any kind of widespread increase, according to a study published in the Morbidity and Mortality Weekly Report last fall.

But Bragg thinks the data cutoff for the study may have been too early. She says spring 2022 was when she saw cases in her area really take off. She says the CDC is continuing to collect information on brain abscesses and evaluate local and national trends.

About a third of the brain abscesses in the Clark County cluster were caused by a type of bacteria called Streptococcus intermedius that normally hangs out harmlessly in the nose and mouth, where our immune system keeps it in check. But when it gets into places it shouldn’t be, like the blood or brain, it can cause problems.

That can happen after dental work, for example, or when someone has an underlying health condition that weakens their immunity, like diabetes.

That wasn’t the case with the kids in the Clark County cluster, however.

“These are healthy children. With no prior significant medical history that would make them more prone…there wasn’t any known immunosuppression or anything like that,” Bragg says.

Like the cases in Clark County, Sood says most of the kids they are seeing are older, in grade school and middle school. He says until kids reach this age, their sinus cavities are underdeveloped, and haven’t yet grown to their full size. This may make them particularly vulnerable to infection. He thinks these small spaces may become filled with pus and burst. When that happens over the eyebrow, or behind the ear, where the barrier between the brain and sinuses is thinner, the infection can travel to the brain.

Sood says the signs of a sinus infection in kids can be subtle and parents don’t always know what to watch for. If a child gets a cold or stuffy nose and then the next day wakes up with a red and swollen eye, or an eye that’s swollen shut, it’s a good idea to seek medical attention. They may also complain of a headache and point to the spot above their eyebrow as the location of the pain.

Bragg says so far, in 2023, she’s treated two more kids with brain abscesses, but the pace of new cases seems to be slowing down – at least she hopes that’s the case.

Some of the children she treated needed multiple brain and head and neck surgeries to clear their infections.

Sood says in his hospital, doctors have a patient who has been there for two to three months and had five surgeries, although he says she was an extreme case.

Penney says the CDC continues to watch the situation closely.

“We’re going to continue to monitor throughout the year working very closely with our community partners to see you know what, what happens down in Southern Nevada,” she said.

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End of data sharing could make Covid-19 harder to control, experts and high-risk patients warn | CNN

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KFF Health News
—

Joel Wakefield isn’t just an armchair epidemiologist. His interest in tracking the spread of covid is personal.

The 58-year-old lawyer who lives in Phoenix has an immunodeficiency disease that increases his risk of severe outcomes from covid-19 and other infections. He has spent lots of time since 2020 checking state, federal, and private sector covid trackers for data to inform his daily decisions.

“I’m assessing ‘When am I going to see my grandkids? When am I going to let my own kids come into my house?’ ” he said.

Many Americans have moved on from the pandemic, but for the millions who are immunocompromised or otherwise more vulnerable to covid, reliable data remains important in assessing safety.

“I don’t have that luxury to completely shrug it off,” Wakefield said.

The federal government’s public health emergency that’s been in effect since January 2020 expires May 11. The emergency declaration allowed for sweeping changes in the U.S. health care system, like requiring state and local health departments, hospitals, and commercial labs to regularly share data with federal officials.

But some shared data requirements will come to an end and the federal government will lose access to key metrics as a skeptical Congress seems unlikely to grant agencies additional powers. And private projects, like those from The New York Times and Johns Hopkins University, which made covid data understandable and useful for everyday people, stopped collecting data in March.

Public health legal scholars, data experts, former and current federal officials, and patients at high risk of severe covid outcomes worry the scaling back of data access could make it harder to control covid.

There have been improvements in recent years, such as major investments in public health infrastructure and updated data reporting requirements in some states. But concerns remain that the overall shambolic state of U.S. public health data infrastructure could hobble the response to any future threats.

“We’re all less safe when there’s not the national amassing of this information in a timely and coherent way,” said Anne Schuchat, former principal deputy director of the Centers for Disease Control and Prevention.

A lack of data in the early days of the pandemic left federal officials, like Schuchat, with an unclear picture of the rapidly spreading coronavirus. And even as the public health emergency opened the door for data-sharing, the CDC labored for months to expand its authority.

Eventually, more than a year into the pandemic, the CDC gained access to data from private health care settings, such as hospitals and nursing homes, commercial labs, and state and local health departments.

CDC officials have been working to retain its authority over some information, such as vaccination records, said Director Rochelle Walensky.

Walensky told the U.S. House in February that expanding the CDC’s ability to collect public health data is critical to its ability to respond to threats.

“The public expects that we will jump on things before they become public health emergencies,” she later told KFF Health News. “We can’t do that if we don’t have access to data.”

The agency is negotiating information-sharing agreements with dozens of state and local governments, Walensky said, as well as partnering with the Centers for Medicare & Medicaid Services. It is also lobbying for the legal power to access data from both public and private parts of the health care system. The hospital data reporting requirement was decoupled from the health emergency and is set to expire next year.

But it’s an uphill battle.

“Some of those data points we may not have anymore,” Walensky said, noting how access to covid test results from labs will disappear. That data became a less precise indicator as people turned to at-home testing.

Moving forward, Walensky said, the CDC’s covid tracking will resemble its seasonal flu surveillance, which uses information from sample sites to establish broad trends. It’ll offer a less granular view of how covid is spreading, which experts worry could make it harder to notice troubling new viral variants early.

Overall, federal courts — including the U.S. Supreme Court — have not been supportive of expanded public health powers in recent years. Some issued rulings to block mask mandates, pause mandatory covid vaccination requirements, and end the nationwide eviction moratorium.

Such power limits leave the CDC with its “utterly dysfunctional, antiquated” data collection system, said Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University. It’s like a “mosaic,” he said, in which states and territories collect data their own way and decide how much to share with federal officials.

Although covid numbers are trending down, the CDC still counts thousands of new infections and hundreds of new deaths each week. More than 1,000 Americans are also hospitalized with covid complications daily.

“When we stop looking, it makes it all more invisible,” Gostin said. “Covid knowledge and awareness is going to melt into the background.”

State and local public health officials are generally willing to share data with federal agencies, but they often run into legal hurdles that prevent them from doing so, said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials.

It will take a lot of work to loosen state restrictions on public health data. And the political will may be lacking, considering many jurisdictions have rolled back public health powers in recent years. Until rules change, the CDC’s power to help states is limited, Plescia said.

“Their hands are tied a little bit in how much they can do,” he said.

Public health officials rely on data to target interventions and track how well they’re working. A lack of information can create blind spots that exacerbate poor outcomes for high-risk populations, said Denise Chrysler, a senior adviser for the Network for Public Health Law.

“If you don’t have the data, you can’t locate who you’re failing to serve. They’re going to fall between the cracks,” she said.

The lack of covid data broken down by race and ethnicity in the early days of the pandemic obscured the outsize impact covid had on marginalized groups, such as Black and Hispanic people, Chrysler said. Some states, like New Jersey and Arizona, issued rules to mandate the collection of race and ethnicity data for covid, but they were temporary and tied to state emergency declarations, she said.

Inconsistent local data precipitated the end of privately run projects that supplemented government resources.

The available data researchers could pull from “was just terrible,” said Beth Blauer, associate vice provost for public sector innovation at Johns Hopkins, who helped launch its dashboard. The decision to end the program was practical.

“We were relying on publicly available data sources, and the quality had rapidly eroded in the last year,” she said.

The fast collapse of the data network also raises questions about state and local agencies’ long-term investments in tracking covid and other threats.

“I wish that we had a set of data that would help us guide personal decision-making,” Blauer said. “Because I’m still fearful of a pandemic that we don’t really know a ton about.”

To Schuchat, formerly of the CDC, there’s a lot of ground to regain after years of underinvestment in public health, long before the covid pandemic — and high stakes in ensuring good data systems.

The CDC’s detection of a vaping-related lung illness in 2019 was recognized after case reports from a hospital in Wisconsin, she said. And she attributed the nation’s slow reaction to the opioid crisis on poor access to emergency room data showing a troubling trend in overdoses.

“We’re much better when we detect things before there’s an emergency,” Schuchat said. “We can prevent major emergencies from happening.”

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Covid-sniffing dogs can help detect infections in K-12 schools, new study suggests | CNN

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CNN
—

Elementary students lined up behind a white curtain in the middle of a grand gymnasium at their school in northern California. They stood still as a dog handler walked a yellow Labrador along the other side of the curtain.

Hidden from the children’s view, the 2-year-old female pup sniffed each child’s shoes from beneath that curtain barrier. After each sniff, the dog looked back up at the handler. Then the handler brought the dog to the next tiny pair of feet beneath the curtain, and the dog curiously brought her snout close to those toes, then a young girl’s lavender tennis shoes and then another child’s white high-tops.

The dog was smelling for what are called volatile organic compounds that are known to be associated with Covid-19 infections.

While watching the Covid-sniffing dog in action, Dr. Carol Glaser saw her vision come to life.

Months prior, Glaser and her team were implementing the school’s Covid-19 testing program, using antigen nasal swab tests. Around that same time, Glaser heard about reports of dogs being used to screen for Covid-19 infections in sports venues, airports and other public settings.

That’s when Glaser had her “aha” moment – incorporating canines into Covid-19 testing programs at schools, nursing homes or other public facilities could help save time, personnel, possibly even costs, and “would be a lot more fun,” she said.

“I thought if we had dogs in schools to screen the students it would be so much faster and less burdensome for schools,” said Glaser, assistant deputy director in Central Laboratory Services and medical officer for infectious disease laboratories at the California Department of Public Health.

“Remember when an antigen test is done at school, as opposed to home, there’s a whole bunch of rules and regulations that run under that. It’s not as simple as just handing those things out at school and having the kids do them,” said Glaser, who oversaw antigen testing programs at some California public schools.

For now, Glaser and her colleagues described in a new study the lessons they learned from the Covid-19 dog screening pilot program that they launched in some California K-12 public schools.

In their research, published Monday in the journal JAMA Pediatrics, they wrote that the goal was to use dogs for screening and only use antigen tests on people whom the dogs screened as positive – ultimately reducing the volume of antigen tests performed by about 85%.

They wrote that their study supports the “use of dogs for efficient and noninvasive” Covid-19 screening and “could be used for other pathogens.”

The dogs used in the pilot program – two yellow Labradors named Rizzo and Scarlett – trained for a couple of months in a laboratory, sniffing donated socks that were worn by people who either had Covid-19 or didn’t. The dogs alerted their handlers when they detected socks that had traces of the disease – and received a reward of either Cheerios or liver treats.

“The one thing we do know for sure is when you’re collecting a sample off of a human being, you want to go where the most scent is produced. That is the head, the pits, the groin and the feet. Given those options, I went with feet,” said Carol Edwards, an author of the study and executive director of the nonprofit Early Alert Canines, which trains medical alert service dogs, including Rizzo and Scarlett.

“We collected some socks from people willing to donate socks, and we taught the dogs, by smelling the socks, which ones were the Covid socks and they picked it up very quickly,” Edwards said. “Then we moved into the schools and started sniffing the kids at the ankles.”

Last year, from April to May, the dogs visited 27 schools across California to screen for Covid-19 in the real world. They completed more than 3,500 screenings.

Rizzo acted as an energized worker, performing tasks with eagerness, Edwards said, while Scarlett tended to have more of a mellow and easygoing personality.

The screening process involves people – who voluntarily opted in to participate – standing 6 feet apart while the dogs, led by handlers, sniff each person’s ankles and feet. The dogs are trained to sit as a way of alerting their handlers that they detect a potential Covid-19 infection.

To protect each person’s privacy, sometimes the people face away from the dogs and toward a wall or behind a curtain, so that they can’t see the dogs or when a dog sits. If the dog sits in between two people, the handler will verbally ask the dog, “Show me?” And the dog will move its snout to point toward the correct person.

“Our dogs can come in, they can screen 100 kids in a half hour, and then only the ones the dog alerts on have to actually do a test,” Edwards said. “There’s no invasive nasal swab unless the dog happens to indicate on you.”

The researchers found that the dogs accurately alerted their handlers to 85 infections and ruled out 3,411 infections, resulting in an overall accuracy of 90%.

However, the dogs inaccurately alerted their handlers to infections in 383 instances and missed 18 infections, which means the dogs demonstrated 83% sensitivity and 90% specificity when it came to detecting Covid-19 infections in the study.

“Once we stepped into the schools, we saw a drop in their specificity and sensitivity due to the change,” Edwards said, referring to the distractions that children in a school setting can bring. However, Edward said, accuracy improved as the dogs spent more times in schools.

In comparison, Covid-19 BinaxNOW antigen tests have been shown in one real-world study to demonstrate 93.3% sensitivity and 99.9% specificity. That study was conducted in San Francisco and published in 2021 in The Journal of Infectious Diseases.

“We never said the dogs will replace the antigen. This was a time for us to learn how they compared,” Glaser said. “We will always plan on doing some amount of backup testing, but the idea would be that the actual antigen testing would be a fraction of what it would currently be because of the dogs.”

“To run these antigen testing programs at school, it’s taking a lot of school personnel resources, test cards as well as biohazard waste. So, I have no doubt in the long-run once it can be perfected, dogs will be cheaper, but I don’t have a great cost comparison,” she said.

This isn’t the first time that dogs’ abilities to detect traces of Covid-19 infections in real-time have been studied in the scientific literature.

“What we have learned in this work is that the dogs in general are capable of discriminating samples from individuals testing,” said Dr. Cindy Otto, professor and director of the Penn Vet Working Dog Center at the University of Pennsylvania, who was not involved in the new study.

Regarding the new research, Otto said, “On the surface their results are encouraging and with the appropriate selection of dogs, rigorous training and impeccable quality control, there is the potential for dogs to be incorporated in threat monitoring.”

Now that Glaser and her colleagues have published research about their Covid-19 dog screening pilot program, she is eager to implement the approach in nursing home settings.

“Honestly, schools aren’t that interested in testing anymore. The outbreaks just aren’t what they used to be, but what we have done is we’ve transitioned to nursing homes, because there is a tremendous need in nursing homes,” Glaser said, adding that many residents may prefer to undergo screening with a dog than with uncomfortable nasal swabs. “What would you rather have: A swab in your nose or something that just maybe tickles your ankle at most for testing?”

Covid-sniffing dogs Scarlett and Rizzo at a skilled nursing home in California.

In skilled nursing homes, the dogs visit each resident’s room to sniff their feet, calmly smelling for Covid-19 volatile organic compounds as the resident lies in bed or sits in a chair.

“Thinking about where dogs would be deployed, I do really think nursing homes and residential care facilities and even schools – if they were ever to have a big outbreak – would be the natural next fit for this,” Glaser said.

“We think we’ll probably end up primarily using them in nursing homes,” she said. “But we’re still doing a little bit of both – there was a school that asked us to come back last week.”

The pilot program within California public schools also has left Edwards with hope for future opportunities in which canines can help detect disease in humans.

“I really do think it’s the tip of the iceberg. This is the door swinging wide open, and now we need to collaborate with those in the science world and figure out where we can take this,” Edwards said.

“There’s been a lot of chatter, even in the very beginning of this project, talking about what other diseases they could do. We’ve talked about TB, we’ve talked about flu A and B, possibly for this next flu season, seeing if we can get the dogs to alert on that,” she said, as volatile organic compounds are also produced by people with influenza. “It’s just a matter of being able to figure out how to collect samples, how to train the dogs, and then to be safe and effective around those diseases too.”

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Suicides and suicide attempts by poisoning rose sharply among children and teens during the pandemic | CNN

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CNN
—

The rate of suspected suicides and suicide attempts by poisoning among young people rose sharply during the Covid-19 pandemic, a new study says. Among children 10 to 12 years old, the rate increased more than 70% from 2019 to 2021.

The analysis, published Thursday in the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, looked at what the National Poison Data System categorized as “suspected suicides” by self-poisoning for 2021 among people ages 10 to 19; the records included both suicide attempts and deaths by suicide.

The data showed that attempted suicides and suicides by poisoning increased 30% in 2021 compared with 2019, before the pandemic began.

Younger children, ages 10 to 12, had the biggest increase at 73%. For 13- to 15-year-olds, there was a 48.8% increase in suspected suicides and attempts by poisoning from 2019 to 2021. Girls seemed to be the most affected, with a 36.8% increase in suspected suicides and attempts by poisoning.

“I think the group that really surprised us was the 10- to 12-year-old age group, where we saw a 73% increase, and I can tell you that from my clinical practice, this is what we’re seeing also,” said study co-author Dr. Chris Holstege, professor of emergency medicine and pediatrics chief at the University of Virginia School of Medicine. “We’re seeing very young ages ages that I didn’t used to see attempting suicide by poisoning.

“It was pretty stunning from our perspective,” he said.

Twenty or so years ago, when he started working at the University of Virginia, he said, they rarely treated anyone ages 9 to 12 for suicide by poisoning. Now, it’s every week.

“This is an aberration that’s fairly new in our practice,” Holstege said.

The records showed that many of the children used medicines that would be commonly found around the house, including acetaminophen, ibuprofen and diphenhydramine, which is sold under brand names including Benadryl.

There was a 71% jump from 2019 to 2021 in attempts at suicide using acetaminophen alone, Holstege said.

The choice of over-the-counter medications is concerning because children typically have easy access to these products, and they often come in large quantities.

Holstege encourages caregivers to keep all medications in lock boxes, even the seemingly innocuous over-the-counter ones.

If a child overdoses on something like acetaminophen or diphenhydramine, Holstege encourages parents to bring their children into the hospital without delay, because the toxicity of the drug worsens over time. It’s also a good idea to call a poison center, a confidential resource that is available around the clock.

“We want to make sure that the children are taken care of in regards to their mental health but also in regards to the poisoning if there’s suspicion that they took an overdose,” he said.

There were limitations to the data used in the new study. It captured only the number of families or institutions that reached out to the poison control line; it cannot account for those who attempted suicide by means other than poison. It also can’t capture exactly how many children or families sought help from somewhere other than poison control, so the increase in suspected suicides could be higher.

The American Academy of Pediatrics has noted that the Covid-19 pandemic exacerbated existing mental health struggles that existed even. In 2021, the group called child and adolescent mental health a “national emergency.” Emergency room clinicians across the country have also said they’ve seen record numbers of children with mental health crises, including attempts at suicide.

In 2020, suicide was the second leading cause of death among children ages 10 to 14 and the third leading cause among those 15 to 24, according to the CDC.

Although the height of the pandemic is over, kids are still emotionally vulnerable, experts warn. Previous attempts at suicide have been found to be the “strongest predictor of subsequent death by suicide,” the study said.

“An urgent need exists to strengthen programs focused on identifying and supporting persons at risk for suicide, especially young persons,” the study said.

Research has shown that there is a significant shortage of trained professionals and treatment facilities that can address the number of children who need better mental health care. In August, the Biden administration announced a plan to make it easier for millions of kids to get access to mental and physical health services at school.

At home, experts said, families should constantly check in with children to see how they are doing emotionally. Caregivers also need to make sure they restrict access to “lethal means,” like keeping medicines – even over-the-counter items – away from children and keeping guns locked up.

Dr. Aron Janssen, vice chair of clinical affairs at the Pritzker Department of Psychiatry and Behavioral Health at Lurie Children’s in Chicago, said he is not surprised to see the increase in suspected suicides, “but it doesn’t make it any less sad.”

Janssen, who did not work on the new report, called the increase “alarming.”

The rates of suicide attempts among kids had been increasing even prior to the pandemic, he said, “but this shows Covid really supercharged this as a phenomenon.

“We see a lot of kids who lost access to social supports increasingly isolated and really struggling to manage through day to day.”

Janssen said that he and his colleagues believe these suspected suicides coincide with increased rates of depression and anxiety and a sense of real dread about the future.

One of the biggest concerns is that “previous suicide attempts is the biggest predictor of later suicide completion,” he said. “We really want to follow these kids over time to better understand how to support them, to make sure that we’re doing everything within our power to help steer them away from future attempts.”

Janssen said it’s important to keep in mind that the vast majority of children survived even the worst of the pandemic and did quite well. There are treatments that work, and kids who can get connected to the appropriate care – including talk therapy and, in some cases, medication – can and do get better.

“We do see that. We do see improvement. We do see efficacy of our care,” Janssen said. “We just have to figure out how we can connect kids to care.”

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A new approach to a Covid-19 nasal vaccine shows early promise | CNN

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CNN
—

Scientists in Germany say they’ve been able to make a nasal vaccine that can shut down a Covid-19 infection in the nose and throat, where the virus gets its first foothold in the body.

In experiments in hamsters, two doses of the vaccine – which is made with a live but weakened form of the coronavirus that causes Covid-19 – blocked the virus from copying itself in the animals’ upper airways, achieving “sterilizing immunity” and preventing illness, a long-sought goal of the pandemic.

Although this vaccine has several more hurdles to clear before it gets to a doctor’s office or drug store, other nasal vaccines are in use or are nearing the finish line in clinical trials.

China and India both rolled out vaccines given through the nasal tissues last fall, though it’s not clear how well they may be working. Studies on the effectiveness of these vaccines have yet to be published, leaving much of the world to wonder whether this approach to protection really works in people.

The US has reached something of a stalemate with Covid-19. Even with the darkest days of the pandemic behind us, hundreds of Americans are still dying daily as the infection continues to simmer in the background of our return to normal life.

As long as the virus continues to spread among people and animals, there’s always the potential for it mutate into a more contagious or more damaging version of itself. And while Covid infections have become manageable for most healthy people, they may still pose a danger to vulnerable groups such as the elderly and immunocompromised.

Researchers hope next-generation Covid-19 vaccines, which aim to shut down the virus before it ever gets a chance to make us sick and ultimately prevent the spread of infection, could make our newest resident respiratory infection less of a threat.

One way scientists are trying to do that is by boosting mucosal immunity, beefing up immune defenses in the tissues that line the upper airways, right where the virus would land and begin to infect our cells.

It’s a bit like stationing firefighters underneath the smoke alarm in your house, says study author Emanuel Wyler, a scientist at the Max Delbruck Center for Molecular Medicine in the Helmholtz Association in Berlin.

The immunity that’s created by shots works throughout the body, but it resides primarily in the blood. That means it may take longer to mount a response.

“If they are already on site, they can immediately eliminate the fire, but if they’re like 2 miles away, they first need to drive there, and by that time, one-third of the house is already in full flames,” Wyler said.

Mucosal vaccines are also better at priming a different kind of first responder than injections do. They do a better job of summoning IgA antibodies, which have four arms to grab onto invaders instead of the two arms that the y-shaped IgG antibodies have. Some scientists think IgA antibodies may be less picky about their targets than IgG antibodies, which makes them better equipped to deal with new variants.

The new nasal vaccine takes a new approach to a very old idea: weakening a virus so it’s no longer a threat and then giving it to people so their immune systems can learn to recognize and fight it off. The first vaccines using this approach date to the 1870s, against anthrax and rabies. Back then, scientists weakened the agents they were using with heat and chemicals.

The researchers manipulated the genetic material in the virus to make it harder for cells to translate. This technique, called codon pair deoptimization, hobbles the virus so it can be shown to the immune system without making the body sick.

“You could imagine reading a text … and every letter is a different font, or every letter is a different size, then the text is much harder to read. And this is basically what we do in codon pair deoptimization,” Wyler said.

In the hamster studies, which were published Monday in the journal Nature Microbiology, two doses of the live but weakened nasal vaccine created a much stronger immune response than either two doses of an mRNA-based vaccine or one that uses an adenovirus to ferry the vaccine instructions into cells.

The researchers think the live weakened vaccine probably worked better because it closely mimics the process of a natural infection.

The nasal vaccine also previews the entire coronavirus for the body, not just its spike proteins like current Covid-19 vaccines do, so the hamsters were able to make immune weapons against a wider range of targets.

As promising as all this sounds, vaccine experts say caution is warranted. This vaccine still has to pass more tests before it’s ready for use, but they say the results look encouraging.

“They did a very nice job. This is obviously a competent and thoughtful team that did this work, and impressive in the scope of what they did. Now it just needs to be repeated,” perhaps in primates and certainly in humans before it can be widely used, said Dr. Greg Poland, who designs vaccines at the Mayo Clinic. He was not involved in the new research.

The study began in 2021, before the Omicron variant was around, so the vaccine tested in these experiments was made with the original strain of the coronavirus. In the experiments, when they infected animals with Omicron, the live but weakened nasal vaccine still performed better than the others, but its ability to neutralize the virus was diminished. Researchers think it will need an update.

It also needs to be tested in humans, and Wyler says they’re working on that. The scientists have partnered with a Swiss company called RocketVax to start phase I clinical trials.

Other vaccines are further along, but the progress has been “slow and halting,” Poland said. Groups working on these vaccines are struggling to raise the steep costs of getting a new vaccine to market, and they’re doing it in a setting where people tend to think the vaccine race has been won and done.

In reality, Poland said, we’re far from that. All it would take is another Omicron-level shift in the evolution of the virus, and we could be back at square one, with no effective tools against the coronavirus.

“That’s foolish. We should be developing a pan-coronavirus vaccine that does induce mucosal immunity and that is long-lived,” he said.

At least four nasal vaccines for Covid-19 have reached late-stage testing in people, according to the World Health Organization’s vaccine tracker.

The nasal vaccines in use in China and India rely on harmless adenoviruses to ferry their instructions into cells, although effectiveness data for these has not been published.

Two other nasal vaccines are finishing human studies.

One, a recombinant vaccine that can be produced cheaply in chicken eggs, the same way many flu vaccines are, is being put through its paces by researchers at Mount Sinai in New York City.

Another, like the German vaccine, uses a live but weakened version of the virus. It’s being developed by a company called Codagenix. Results of those studies, which were carried out in South America and Africa, may come later this year.

The German team says it’s eagerly watching for the Codagenix data.

“They will be very important in order to know where whether this kind of attempt is basically promising or not,” Wyler said.

They have reason to worry. Respiratory infections have proved to be tough targets for inhaled vaccines.

FluMist, a live but weakened form of the flu virus, works reasonably well in children but doesn’t help adults as much. The reason is thought to be that adults already have immune memory for the flu, and when the virus is injected into the nose, the vaccine mostly boosts what’s already there.

Still, some of the most potent vaccines such as the vaccine against measles, mumps and rubella use live attenuated viruses, so it’s a promising approach.

Another consideration is that live vaccines can’t be taken by everyone. People with very compromised immunity are often cautioned against using live vaccines because even these very weakened viruses may be risky for them.

“Although it’s strongly attenuated, it’s still a real virus,” Wyler said, so it would have to be used carefully.

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Tag: international-coronavirus

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