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‘Living with COVID’: Where the Pandemic Could Go Next

Jennifer Rigby and Julie Steenhuysen wrote . . . . . . . . .

As the third winter of the coronavirus pandemic looms in the northern hemisphere, scientists are warning weary governments and populations alike to brace for more waves of COVID-19.

In the United States alone, there could be up to a million infections a day this winter, Chris Murray, head of the Institute of Health Metrics and Evaluation (IHME), an independent modeling group at the University of Washington that has been tracking the pandemic, told Reuters. That would be around double the current daily tally.

Across the United Kingdom and Europe, scientists predict a series of COVID waves, as people spend more time indoors during the colder months, this time with nearly no masking or social distancing restrictions in place.

However, while cases may surge again in the coming months, deaths and hospitalizations are unlikely to rise with the same intensity, the experts said, helped by vaccination and booster drives, previous infection, milder variants and the availability of highly effective COVID treatments.

“The people who are at greatest risk are those who have never seen the virus, and there’s almost nobody left,” said Murray.

These forecasts raise new questions about when countries will move out of the COVID emergency phase and into a state of endemic disease, where communities with high vaccination rates see smaller outbreaks, possibly on a seasonal basis.

Many experts had predicted that transition would begin in early 2022, but the arrival of the highly mutated Omicron variant of coronavirus disrupted those expectations.

“We need to set aside the idea of ‘is the pandemic over?'” said Adam Kucharski, an epidemiologist at the London School of Hygiene and Tropical Medicine. He and others see COVID morphing into an endemic threat that still causes a high burden of disease.

“Someone once told me the definition of endemicity is that life just gets a bit worse,” he added.

The potential wild card remains whether a new variant will emerge that out-competes currently dominant Omicron subvariants.

If that variant also causes more severe disease and is better able to evade prior immunity, that would be the “worst-case scenario,” according to a recent World Health Organization (WHO) Europe report.

“All scenarios (with new variants) indicate the potential for a large future wave at a level that is as bad or worse than the 2020/2021 epidemic waves,” said the report, based on a model from Imperial College of London.

CONFOUNDING FACTORS

Many of the disease experts interviewed by Reuters said that making forecasts for COVID has become much harder, as many people rely on rapid at-home tests that are not reported to government health officials, obscuring infection rates.

BA.5, the Omicron subvariant that is currently causing infections to peak in many regions, is extremely transmissible, meaning that many patients hospitalized for other illnesses may test positive for it and be counted among severe cases, even if COVID-19 is not the source of their distress.

Scientists said other unknowns complicating their forecasts include whether a combination of vaccination and COVID infection – so-called hybrid immunity – is providing greater protection for people, as well as how effective booster campaigns may be.

“Anyone who says they can predict the future of this pandemic is either overconfident or lying,” said David Dowdy, an infectious disease epidemiologist at Johns Hopkins Bloomberg School of Public Health.

Experts also are closely watching developments in Australia, where a resurgent flu season combined with COVID is overwhelming hospitals. They say it is possible that Western nations could see a similar pattern after several quiet flu seasons.

“If it happens there, it can happen here. Let’s prepare for a proper flu season,” said John McCauley, director of the Worldwide Influenza Centre at the Francis Crick Institute in London.

The WHO has said each country still needs to approach new waves with all the tools in the pandemic armory – from vaccinations to interventions, such as testing and social distancing or masking.

Israel’s government recently halted routine COVID testing of travelers at its international airport, but is ready to resume the practice “within days” if faced with a major surge, said Sharon Alroy-Preis, head of the country’s public health service.

“When there is a wave of infections, we need to put masks on, we need to test ourselves,” she said. “That’s living with COVID.”


Source : Reuters

Can You Totally Avoid Catching COVID? These “NOVIDs” Share Their Secrets.

Hannah Docter-Loeb and Emma Wallenbrock wrote . . . . . . . . .

Well over half the U.S. population had caught COVID by February 2022. That majority has only gotten bigger in the months since as contagious, immune-system-evading variants continue to circulate.

Yet, despite COVID’s pervasiveness, there are some people who have managed to avoid it—the “NOVIDs.” We know because their number includes some of our colleagues. We found other people via social media who claim to have avoided infection with the virus to the best of their knowledge. Many of the people whom we spoke to had one thing in common: the ability to work from home. They also tended to be cautious, though many also do plenty of socializing.

While there’s some—or a lot—of plain and simple chance involved in staying negative, those who have done so offer us a look at what it takes to remain uninfected (for now), as the pandemic wears on.

* * * * * * *

I have a fairly weak immune system since I live with a chronic illness (imagine the sickly kid who missed a lot of school, catches every cold), so I have been cautious from the start.

My mask is on any time I go into a store, ride public transportation, or am generally indoors with strangers. I eat at restaurants or go to bars if there is an outdoor space or decent ventilation, like big open windows or those garage-style doors some places have, but I skip places that don’t fit that criteria. I have visited a few friends’ homes, usually to spend time outside.

I think a lot about the variables of where I am going and who else is going to be there, and then make decisions. In 2021, I went to Disney World. Disney was limiting capacity to 30 percent and using its serious hospitality skills to enforce masking, but I drove down from Brooklyn because there wasn’t any vaccination requirement to fly. Months later, I felt comfortable flying to the U.K. because everyone had to have tested negative within 72 hours to be on the flight.

I did have one morning where I woke up convinced that I had finally caught COVID. It was Jan. 2 and I was still feeling terrible after partying too hard (outdoors) in Edinburgh on New Year’s Eve. Turned out I was just hungover, dehydrated, and too old to party that hard anymore. — Daisy Rosario, senior supervising producer, Slate

* * * * * * *

The main reason I think I have avoided it is relative physical isolation. I live alone and I was 100 percent at home for the first 18 months [of the pandemic], then the 10 months or so since then have been at about 80 percent at home, so my physical proximity to people has been limited. Until a few months ago I would be masked whenever in a public building, but now I only do so in medical settings. I was vaccinated from around March 2021 and have since had a second jab and booster. I think I am probably due for another booster anytime now.

I have had a few close calls. Each time I have taken a test to check and it has come back negative. A couple of times I have taken PCR tests at the local testing center, but more often I took the lateral flow tests that were given out for free by the NHS and took these before going to places where I might be in contact with others. I feel fortunate to have avoided this so far, but the isolation and uncertainty over the past few years have certainly taken a negative toll on my mental health. — Charles Ward, from Hemel Hempstead, England (as told to Emma Wallenbrock)

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As a college student, it feels almost inevitable that you’ll catch COVID-19. Think 300-person lecture halls peppered with fits of coughing. Think poorly ventilated parties with suffocating peer pressure to unmask. And think about the countless casual interactions—in the dining hall, library, or gym—where you might reasonably forget to keep your guard up. I can’t think of a single close friend who hasn’t caught the virus. But I’ve somehow managed to slip through the cracks, probably because of my “responsible dumb luck.”

I try to be careful. I’m double-vaccinated and boosted. I almost always mask up indoors. I avoid large group settings as best I can. But I’ve also had so many close calls that I wonder when my luck will finally run out. My college roommate tested positive for COVID the day after I moved out. A close friend stayed at my house for two days, and we ate indoors at a restaurant, drove in the same car, and watched a movie together. He tested positive on day three. A girl I chatted with for four hours on a date texted me a few days later that she was positive. And these are just the close calls that I’m aware of! —Simar Bajaj, from Fremont, California (as told to Emma Wallenbrock)

* * * * * * *

We live in an affluent suburb of D.C., a very expensive neighborhood, but we live here comfortably by virtue of my father’s post as a bureaucrat at the Pentagon since the early ’80s, when housing prices were much more reasonable. There is ample outdoor space, public parks, and quiet tree-lined streets. I’ve always just accidentally had very good mental health and the ability to be content with a small social circle. We took the pandemic seriously from the beginning and all our friends did the same. We updated our behaviors when public health guidance changed.

With all these privileges, the pandemic has felt like a bit of a blessing. I work at a progressive company with excellent benefits and the ability to work remotely productively, even more productively than at the office. I now have more time to spend by myself and with my family and greater autonomy in how I do my work. —Jonathan Zuckerman, website developer, Slate

I do COVID research for a living. I still take COVID very seriously because I see the impact of it. My stance now is that if people want to take on personal risks, that’s their choice to make but they have an obligation not to pass their infections on to other people. I still wear a high-grade mask when I’m in grocery stores or the post office—community spaces where people have to be and are at high risks of COVID—to limit my risk to other people. I will go to restaurants or the occasional bar, depending on how I’m feeling or if I have events coming up that I want to make sure I’m negative for. I’ve definitely put myself in situations where I could have been exposed to COVID and as far as I’m aware I haven’t gotten it yet. I have volunteered for a lot of studies that look at antibody levels, and no one has seen any unexplained spikes in my antibody levels that could have been explained by an infection that wasn’t detected.

I definitely feel like I’m waiting for the other shoe to drop. When we have these huge waves of COVID, I always tell people, “You’re not guaranteed to get it in this wave, but in our lifetime I think everyone will very likely get COVID unless we make drastic changes about transmission.” I feel like it is inevitable but I try to be really conscientious of it. I won’t risk passing it on to other people should I get infected.

The joke that I and other people who work in health care make is that, being in the hospitals all the time before vaccines were available, we were “microdosing COVID.” If I have had a COVID infection, it’s never manifested as symptoms or a positive test.

I think, having worked on so many COVID-related studies, there is some aspect of COVID we’re yet to learn about that will explain situations like mine or those of other people who are befuddled as to why they haven’t gotten infected. I look forward to learning those things, but for now I’m going to keep operating the way I’ve been operating. — Laurel Bristow, from Atlanta (as told to Hannah Docter-Loeb)

* * * * * * *

I don’t do things anymore. I work from home, and I don’t go anywhere on a regular basis beyond the park and the grocery store. Since the start of the pandemic, I have been to a movie theater a total of two times. I occasionally go out to a restaurant but almost exclusively ask for outdoor seating. I wear a KN95 mask every time I step out of my apartment and diligently test myself before going anywhere where I’ll be around people outside of my household.

I’ve been lucky to evade catching COVID so far. I know for many people it isn’t that easy, whether they have a medical emergency, are raising children, or just don’t have the option to work remotely. Even so, I don’t feel lucky. Mostly, I feel tired. Seeing strangers at the grocery store without a mask, talking about their vacation plans, coughing and sneezing without covering their mouths (seriously, adults are doing this), it makes me feel like I’m spending all this energy for no reason.

But I’ve watched COVID ruin so many lives, including the lives of people I love. I know three people who are still dealing with long-term effects from COVID, one of whom has developed other chronic health conditions as a result. I also know plenty of people with unrelated health conditions that make getting COVID (and, for some of my friends, even getting vaccinated) especially risky. So I’d rather be this careful for the rest of my life than know I’m not doing my best to keep my community safe. — Shivani Ishwar, data and analytics designer, Slate

* * * * * * *

“The biggest change since COVID hit is how much smaller my life has gotten.” — Megan Chialastri

Even after my first round of COVID shots, I felt most comfortable in places that required proof of vaccination to enter, so my experience at many bars and restaurants was pretty limited. I switched to a more expensive gym that required vaccines. Over time, though, I’ve let my guard down further and further. Going to the movies is one of my favorite things in the world, and I’ve continued to do that with varying degrees of masking (because I love theater snacks). I just got back from a bus trip to NYC, where I saw three Broadway shows (and wore a mask in all theaters).

While I stay up on my vaccinations and mask up most of the time indoors, sometimes I forget, and my personal practices are only as good as the practices around me. Hardly anywhere requires vaccination anymore, so if I want to exist outside of my one-bedroom apartment, there’s inherently a risk.

The biggest change since COVID hit is how much smaller my life has gotten. Going out seems more exhausting. I get anxious in bigger crowds. I’ve had more of a tendency to keep to myself, which is possibly the reason I’ve stayed clear. — Megan Chialastri, from Philadelphia (as told to Emma Wallenbrock)

* * * * * * *

I’m retired, I’m in my late 60s, and my husband is 10 years older than me and is a cancer survivor. I’m living in a situation that’s of higher risk for somebody in my household. I’m also a retired nurse and have been pretty acutely aware of just how devastating this virus is from the very beginning. I myself had gallbladder surgery in my 50s and ended up with complications and in the ICU with severe lung impairment. I had a fear of any kind of severe respiratory illness. When COVID was exploding pre-vaccine, people were dying of severe lung injury. That set me up for being pretty paranoid about the possibility of contracting the virus.

We got vaccinated as soon as that option was available. I’ve masked from the beginning, and as we’ve learned more about the efficacies of different types of masks, I’ve gone from a variety of cloth masks to KN95s, and if I’m out at all in an indoor setting, I always wear a good N95 that is tight-fitting. I firmly believe that masking is your first line of protection.

But the strategies have primarily been social isolation. I’ve always had a tight circle of friends and we used to do carefree socializing, and we just don’t do that anymore. I have the ability at this point in my life to have my groceries delivered, to order in—I have enough financial security to make those things happen. I’m discouraged by our public health response and I think it’s unfortunate that people are forced into a self-protective mode. — Mary Herrick from Portland, Oregon (as told to Hannah Docter-Loeb)

* * * * * * *

I have no idea how my house (me, another adult, a 5-year-old) has avoided COVID. We’re up to date on our shots, but a lot of people who fit that description have had it! We live in a small college town located in a rural county and have not traveled much since the pandemic—none of us has gotten on an airplane. Neither of the adults in the family has a job that requires physical presence, and I think that might be the biggest factor here. However, the child has been back in preschool for about a year—sometimes masking, sometimes not, in accordance with the county’s reported transmission levels.

All in all, it seems like a crapshoot. I have thought so many times, “This is IT.” Somehow, it never has been. — Rebecca Onion, senior editor, Slate

* * * * * * *

The principles I lived by are all pretty much what we were told throughout: Wash your hands when you get home and all those other times. Don’t sweat outdoor transmission (I did wear my mask while biking around at first). I wear my mask indoors in every public space—grocery stores, bodegas, always on the subway. My one dicey exception was the gym, where enforcement was extremely lax once you were past the front desk, and then nonexistent from late summer ’20 onward except for one relapse in the bleak, bleak delta variant days. I’d skip the gym when infection rates went up and then would go back when they seemed to slow, weighing my deep moodiness that exercise could dispel against the possibility of getting sick. When I’d leave New York, I’d kind of watch for what people in L.A. or Colorado were doing (wearing masks less, as it was summer), so just living in a pretty well-masked place (masked up for good reasons—it’s crowded here) probably did most of it for me. I watched a lot of TV, saw people outside, let what I think constituted “my life” drain and then trickle back bit by bit. — Ben Richmond, senior director of operations for podcasts, Slate

* * * * * * *

I feel like we’re ducking and dodging it like Neo in The Matrix. My wife has become somewhat of a mask guru and knows how to find the highest-quality ones in bulk online. Our two kids (6 and 3) will wear them without argument. The general rule in our family at this point is to wear them indoors and in crowded spaces outdoors.

It hasn’t been perfect, though. We had some close calls, especially in 2021. We traveled as a family to places like Florida (to see my parents) and Hawaii (a nonrefundable trip purchased in 2019 that we had already rescheduled once) right before delta came raging in. My wife and I took a weekend trip to San Francisco just for a quick change of scenery and were back in the safe confines of our home before omicron exploded. And then there was the carnival of sinus and ear infections this spring that accosted our entire household and got so bad that we couldn’t believe it wasn’t COVID. (It wasn’t. The amount of rapid and PCR tests we took was insane.) My most recent trip was a solo weekend excursion to Las Vegas to provide moral support to my brother in the World Series of Poker. I figured if there was ever gonna be a place for it to finally happen, it would be there. Masks don’t exist in Vegas for the most part. I still wore mine. I PCR-tested a few days after returning home and was in the clear. — Derreck Johnson, designer, Slate

* * * * * * *

As far as I know, I’ve never had COVID, mostly because, at every turn, I’ve been both lucky and privileged. Lucky that I was a senior in high school in 2020 and never found myself a pawn in the politics of K–12 school reopening and masking policies. Privileged that the college I started at in September 2020 has kept up a mask mandate and a testing program of twice-weekly PCRs for all students. Lucky that I haven’t caught COVID from working my food service jobs. Privileged that I don’t have to rely on those jobs for my livelihood, that my parents work white-collar office jobs and have been able to work from home for two years.

I’ve been fairly conscientious too; I wear a mask in all public indoor spaces, including public transportation. When omicron hit I abandoned cloth masks for KN95s. And I just plain don’t get out much. But I know people who’ve been just as privileged and conscientious as me who’ve nevertheless gotten it. I’ve avoided it. It’s just plain, dumb luck. (Knock on wood.) — Anna Kraffmiller, from Waltham, Massachusetts, as told to Emma Wallenbrock

* * * * * * *

When I think about why I haven’t had COVID yet, I tend to bounce between three explanations. At the “self-congratulatory” side of the spectrum, I feel proud of myself: I have been cautious, and not getting sick is my reward. In the middle is “I’m just lucky.” Maybe some people are immune to COVID. And then at the other side of the scale is: I’m just really unpopular. Everyone else testing positive at the same time is a little bit like seeing a group of friends post photos to social media from a hangout you weren’t invited to.

All of this, of course, comes with a caveat: I haven’t had COVID so far as I know. I’ve been sick a couple of times in the pandemic — once I even lost my sense of smell. But I persistently tested negative, and other respiratory viruses can interfere with your ability to smell too.

But I suspect I’ll test positive the day this article is published.


Source : Slate

Hypertension Elevates Risk for More Severe COVID-19 Illness

Hypertension more than doubles the risk of hospitalization related to Omicron infection, even in people who are fully vaccinated and boosted, according to a new study led by investigators in the Smidt Heart Institute at Cedars-Sinai. The findings are published in the journal Hypertension.

The risk is especially widespread given that nearly 1 out of every 2 adults in the U.S. have hypertension, according to the U.S. Centers for Disease Control and Prevention.

“The take-home message is that avoiding infection is extremely important—even when the circulating viral variant is presumed to cause mild disease in most people,” said Joseph E. Ebinger, MD, a clinical cardiologist and director of clinical analytics at the Smidt Heart Institute and first author of the study.

By reviewing electronic medical records, Cedars-Sinai investigators identified 912 people who were fully vaccinated with an mRNA vaccine, received a booster shot and were subsequently diagnosed with COVID-19 during the Omicron surge that occurred in Southern California from Dec. 1, 2021 through April 20, 2022. Of these individuals, 145 required hospitalization.

“We were surprised to learn that many people who were hospitalized with COVID-19 had hypertension and no other risk factors,” said Susan Cheng, MD, MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute and a senior author of the study. “This is concerning when you consider that almost half of American adults have high blood pressure.”

The team also found that chronic kidney disease, having had a heart attack, or heart failure, greatly increases the risk of hospitalization after infection.

“These findings were expected considering that these are chronic medical conditions that are well established to be associated with worse outcomes,” said Ebinger, an assistant professor in the Department of Cardiology in the Smidt Heart Institute.

Because hypertension is common in people with chronic kidney disease, heart attack and heart failure, the investigators conducted an analysis that excluded patients diagnosed at some point with these conditions. The risk for hospitalization was still substantial for people diagnosed with hypertension alone.

The risk of being hospitalized with COVID-19 also increased with age and duration between a study participant’s last vaccination and infection. Hypertension, however, was associated with the greatest magnitude of risk: 2.6-fold.

These findings extend reports from early in the pandemic that also found associations between hypertension and severe COVID-19. Notably, the researchers found that conditions such as obesity and diabetes, risk factors identified early in the pandemic, were not as strongly associated with hospitalization during the Omicron surge. The hypertension risk, however, persisted. More research is needed to understand the biological processes that may cause more severe COVID-19 illness in people with hypertension, and how to reduce this risk.

“Uncovering why hypertension is linked to COVID-19 could help us better understand how SARS-CoV-2 affects the body and provide clearer targets for prevention and treatment,” said Cheng, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science at Cedars-Sinai.

Meanwhile, people with hypertension who develop COVID-19 should be aware of their heightened risk for hospitalization and talk to their physician about antiviral therapy, according to Ebinger.


Source: Cedars-Sinai

Infographic: How China’s COVID Quarantine Rules Have Evolved

Source : Sixth Tone

Infographic: 中國国务院 – 各地要严格落实疫情防控“九不准”要求

Source : 新华社

A Province-by-province Look at Excess Deaths in Canada During the Pandemic

Imagine the COVID-19 pandemic never happened — people still would have died across Canada, and the number of deaths would have been somewhat predictable based on data from previous years.

In a new study, Dr. Kimberlyn McGrail, a professor in UBC’s school of population of public health, examined all “excess deaths” across Canadian provinces during the first 19 months of the pandemic, and how many of those were attributed specifically to COVID-19. Excess deaths are deaths above and beyond what would have been expected under normal circumstances.

Dr. McGrail spoke about the findings, published today in the Canadian Medical Association Journal.

Why look at “excess deaths” rather than just COVID-19 deaths when trying to understand the pandemic?

The pandemic had a direct effect on deaths, in that people got the virus and unfortunately some died from it, but the pandemic also had other effects. People delayed care, or had surgeries, diagnostics and appointments cancelled, which can lead to poorer outcomes. We also had other public health events going on — particularly in B.C. with the ongoing tainted drug supply and the heat dome in the summer of 2021. Those things were potentially affected by the pandemic. So overall mortality is a better indication of what’s actually happening at the population level.

How do we know how many deaths were expected?

I used data provided by Statistics Canada. They look at trends in the population’s size and age in the five years preceding the pandemic to model what would have been expected in 2020-21, absent the pandemic.

What did you learn about excess deaths across Canada during the pandemic?

Excess mortality is just an estimate, but the experience across the provinces, according to what Statistics Canada is telling us, is very different. We saw very little to no excess death in the Atlantic provinces, and quite high excess deaths in western provinces.

What are some possible explanations for this wide variation?

One of the challenges is that a number of different things could contribute to this variation, and it’s probably not one or another, but a combination.

For COVID-19 deaths, differences in COVID-19 reporting practices could be contributing. Each province defines and counts COVID-19 deaths in different ways, and reports them at different speeds.

For overall excess deaths, it could be because provinces differed in their responses to COVID-19. It could be because of the additional public health events going on. Or it could be the broader implications of COVID-19, like cancelled surgeries and delayed diagnostics. There may also be some inaccuracy in the modelling of expected deaths by Statistics Canada.

Your study shows that excess deaths far exceeded COVID-19 deaths in some provinces. How is that possible?

I’ll use the heat dome in the summer of 2021 as a particular example. The B.C. Coroners Service has now attributed almost 600 deaths to that event. You might say that’s not related to COVID-19. However, so much policy attention was being placed on COVID-19 at the time. Some of the precautions, with people being locked down, limited activity and so on, might have contributed to how we responded to the heat dome, which in turn could have contributed to deaths. For example, lots of older people living alone didn’t have the usual level of social support and people checking on them.


Source : The University of British Columbia


Read also at Statistics Canada

Provisional death counts and excess mortality, January 2020 to February 2022 . . . . .

Researchers Develop Rapid Test to Keep Track of Immunity to Sars-COV-2 Variants

Jovana Drinjakovic wrote . . . . . . . . .

The experts agree — the pandemic is not over. Infections are ticking up again, fueled by the new variants our immune systems are ill prepared for.

That’s according to a U of T study which found that the antibodies generated in people who were vaccinated and/or recovered from COVID-19 prior to 2022 failed to neutralize the variants circulating today.

The study was led by Igor Stagljar, a professor of biochemistry and molecular genetics, at the Donnelly Centre for Cellular and Biomolecular Research, at Temerty Faculty of Medicine, and Shawn Owen, an associate professor of pharmaceutics and pharmaceutical chemistry, at the University of Utah.

The journal Nature Communications published their findings.

The researchers expect that the antibody test they developed to measure immunity in the study’s participants will become a valuable tool for deciding who needs a booster and when, which will help save lives and avoid future lockdowns.

“The truth is we don’t yet know how frequent our shots should be to prevent infection,” said Stagljar. “To answer these questions, we need rapid, inexpensive and quantitative tests that specifically measure Sars-CoV-2 neutralizing antibodies, which are the ones that prevent infection.”

Many antibody tests have been developed over the past two years. But only a few of the authorized ones are designed to monitor neutralizing antibodies, which coat the viral spike protein so that it can no longer bind its receptor and enter cells.

It’s an important distinction, as only a fraction of all Sars-CoV-2 antibodies generated during infection are neutralizing. And while most vaccines were specifically designed to produce neutralizing antibodies, it’s not clear how much protection they give against variants.

“Our method, which we named Neu-SATiN, is as accurate as, but faster and cheaper than, the gold standard, and it can be quickly adapted for new variants as they emerge,” he said.

Neu-SATiN stands for Neutralization Serological Assay based on split Tri-part Nanoluciferase, and it is a newer version of SATiN, which monitors the complete IgG pool, which they developed last year.

The development of Neu-SATiN was spearheaded by Zhong Yao, a senior research associate in Stagljar’s lab, and Sun Jin Kim, a postdoctoral fellow in Owen’s lab, who are the co-first authors on the paper.

The pin prick test is powered by the fluorescent luciferase protein from a deep-water shrimp. It measures the ability of the viral spike protein to bind the human ACE2 receptor, each of which is attached to a luciferase fragment. The binding brings the luciferase pieces into proximity so that they reconstitute a full-length protein, which gives off a glow of light that is captured by the luminometer instrument. When patient blood sample is added into the mixture, the neutralizing antibodies will bind the spike protein, preventing it from contacting ACE2. Consequently, luciferase remains in pieces, with an accompanying drop in light signal. The plug and play method can be adapted to different variants within a couple of weeks by engineering variant mutations into the spike protein.

The researchers applied Neu-SATiN to blood samples collected from 63 patients with different histories of COVID-19 infection and vaccination up to November 2021. Patient neutralizing capacity was assessed against the original Wuhan strain and the variants, Alpha, Beta, Gamma, Delta and Omicron.

“We thought it would be important to monitor people that have been vaccinated to see if they still have protection and how long it lasts,” said Owen, who did his postdoctoral training in the Donnelly Centre with distinguished bioengineer and University Professor Molly Shoichet. “But we also wanted to see if you were vaccinated against one variant, does it protect you against another variant?”

The neutralizing antibodies were found to last about three to four months when their levels would drop by about 70 per cent irrespective of infection or vaccination status. Hybrid immunity, acquired through both infection and vaccination, produced higher antibody levels at first, but these too dropped significantly four months later.

Most worryingly, infection and/or vaccination provided good protection against the previous variants, but not Omicron, or its sub-variants, BA.4 and BA.5.

The data match those from a recent UK study, which showed that both neutralizing antibodies and cellular immunity, a type of immunity provided by memory T cells, from either infection, vaccination, or both, offered no protection from catching Omicron. In a surprising twist, the UK group also found that infections with Omicron boosted immunity against earlier strains, but not against Omicron itself, for reasons that remain unclear.

It’s important to stress that vaccines still confer significant protection from severe disease and death, said Stagljar. Still, he added that the findings from his team and others call for vigilance in the coming period given that the more transmissible BA4 and BA5 sub-variants can escape immunity acquired from earlier infections with Omicron, as attested by rising reinfections.

“There will be new variants in the near future for sure,” Stagljar said. “Monitoring and boosting immunity with respect to circulating variants will become increasingly important and our method could play a key role in this since it is fast, accurate, quantitative and cheap.”


Source: University of Toronto

A Viral Reprise: When COVID-19 Strikes Again and Again

Laura Ungar wrote . . . . . . . . .

For New York musician Erica Mancini, COVID-19 made repeat performances.

March 2020. Last December. And again this May.

“I’m bummed to know that I might forever just get infected,” said the 31-year-old singer, who is vaccinated and boosted. “I don’t want to be getting sick every month or every two months.”

But medical experts warn that repeat infections are getting more likely as the pandemic drags on and the virus evolves – and some people are bound to get hit more than twice. Emerging research suggests that could put them at higher risk for health problems.

There’s no comprehensive data on people getting COVID-19 more than twice, although some states collect information on reinfections in general. New York, for example, reports around 277,000 reinfections out of 5.8 million total infections during the pandemic. Experts say actual numbers are much higher because so many home COVID-19 tests go unreported.

Several public figures have recently been reinfected. U.S. Health and Human Services Secretary Xavier Becerra and Canadian Prime Minister Justin Trudeau said they got COVID-19 for the second time, and U.S. Sen. Roger Wicker of Mississippi said he tested positive a third time. All reported being fully vaccinated, and Trudeau and Becerra said they’d gotten booster shots.

“Until recently, it was almost unheard of, but now it’s becoming more commonplace” to have COVID-19 two, three or even four times, said Dr. Eric Topol, head of Scripps Research Translational Institute. “If we don’t come up with better defenses, we’ll see much more of this.”

Why? Immunity from past infections and vaccination wanes over time, experts say, leaving people vulnerable.

Also, the virus has evolved to be more contagious. The risk of reinfection has been about seven times higher with omicron variants compared with when delta was most common, research out of the United Kingdom shows. Scientists believe the omicron mutants now causing the vast majority of U.S. cases are particularly adept at getting around immunity from vaccination or past infection, especially infection during the original omicron wave. U.S. health officials are mulling whether to modify boosters to better match recent changes in the coronavirus.

The first time Mancini got COVID-19, she and her fiancé spiked fevers and were sick for two weeks. She couldn’t get tested at the time but had an antibody test a couple months later that showed she had been infected.

“It was really scary because it was so new and we just knew that people were dying from it,” said Mancini. “We were really sick. I hadn’t been sick like that in a long time.”

She got vaccinated with Pfizer in the spring of 2021 and thought she was protected from another infection, especially since she was sick before. But though such “hybrid immunity” can provide strong protection, it doesn’t guarantee someone won’t get COVID-19 again.

Mancini’s second bout, which happened during the huge omicron wave, started with a sore throat. She tested negative at first, but still felt sick driving to a gig four hours away. So she ducked into a Walgreens and did a rapid test in her car. It was positive, she said, “so I just turned the car around and drove back to Manhattan.”

This bout proved milder, with “the worst sore throat of my life,” a stuffy nose, sneezing and coughing.

The most recent illness was milder still, causing sinus pressure, brain fog, a woozy feeling and fatigue. That one, positive on a home test and confirmed with a PCR test, hit despite her Moderna booster shot.

Mancini doesn’t have any known health conditions that could put her at risk for COVID-19. She takes precautions like masking in the grocery store and on the subway. But she usually doesn’t wear a mask on stage.

“I’m a singer, and I’m in these crowded bars and I’m in these little clubs, some of which don’t have a lot of ventilation, and I’m just around a lot of people,” said Mancini, who also plays accordion and percussion. “That’s the price that I’ve paid for doing a lot throughout these past few years. It’s how I make my living.”

Scientists don’t know exactly why some people get reinfected and others don’t, but believe several things may be at play: health and biology, exposure to particular variants, how much virus is spreading in a community, vaccination status and behavior. British researchers found people were more likely to be reinfected if they were unvaccinated, younger or had a mild infection the first time.

Scientists also aren’t sure how soon someone can get infected after a previous bout. And there’s no guarantee each infection will be milder than the last.

“I’ve seen it go both ways,” said Dr. Wesley Long, a pathologist at Houston Methodist. In general, though, breakthrough infections that happen after vaccination tend to be milder, he said.

Doctors said getting vaccinated and boosted is the best protection against severe COVID-19 and death, and there’s some evidence it also lessens the odds of reinfection.

At this point, there haven’t been enough documented cases of multiple reinfections “to really know what the long-term consequences are,” said Dr. Peter Hotez, dean of Baylor University’s tropical medicine school.

But a large, new study using data from the U.S. Department of Veterans Affairs, which hasn’t yet been reviewed by scientific peers, provides some insight, finding that reinfection increases the risk for serious outcomes and health problems such as lung issues, heart disorders and diabetes compared with a first infection. The risks were most pronounced when someone was ill with COVID-19, but persisted past the acute illness as well.

After Mancini’s last bout, she dealt with dizziness, headaches, insomnia and sinus issues, though she wondered if that was more due to her busy schedule. In a recent week, she had 16 shows and rehearsals — and has no room for another COVID-19 reprise.

“It was not fun,” she said. “I don’t want to have it again.”


Source : AP

Alarm in Beijing After Announcement Zero-COVID Policy May Last Five Years

Helen Davidson wrote . . . . . . . . .

Authorities in Beijing have sparked confusion and alarm after announcing the strict zero-Covid policy could be in place for the next five years, including mass mandatory testing and travel restrictions.

The notice, published on Monday afternoon, was attributed to Cai Qi, the Beijing secretary of the Chinese Communist party. The original text said: “In the next five years, Beijing will unremittingly grasp the normalisation of epidemic prevention and control.”

The notice was first posted by Beijing Daily and republished by other state media outlets. It spread widely across social media, but soon the reference to “five years” was removed from most online publications, and a related hashtag on Weibo was deleted.

It committed to maintain and improve the city’s “strict management of the joint prevention and control coordination mechanism”, and the emergency response system, including those designed to shut down circulation and transfer of the virus through “isolation, management and control… as soon as [transmissions] appear”. It also noted the continuation of strict residential inspections, the “normalisation” of regular testing, and the management of entry and exit to the city.

China’s authorities, under direction from President Xi Jinping, have repeatedly committed the country to the zero-Covid policy, despite the rest of the world choosing a path of coexistence or mitigation. Xi has ordered authorities to balance zero-Covid with economic growth, as the unpredictable measures grate with locals.

Monday’s announcement and the subsequent amendment sparked anger and confusion among Beijing residents online. Most commenters appeared unsurprised at the prospect of the system continuing for another half-decade, but few were supportive of the idea.

“Countdown to escape China,” said one Weibo user.

“The ultimate goal of fighting the epidemic is to return to normal life, and it seems that everyone has forgotten about this,” another noted.

A hashtag related to “in the next five years Beijing will unremittingly grasp the normalisation of epidemic and control” was viewed nearly 1m times before it was removed within a few hours.

Authorities have not clarified the statement or the removal of the reference to five years. Some observers suggested the “five years” phrase was a term used often in government announcements, but which appeared to be a timeline in this context, or that it was erroneously added in by the original publisher of the notice – the Beijing Daily.

The Beijing Daily did not provide clarification when contacted by the Guardian.

China’s “dynamic zero” strategy was effective during outbreaks of earlier variants, but was challenged by the high transmissibility of Omicron. The policy resulted in a lengthy, at times chaotic, and economically damaging lockdown in Shanghai, and tough travel and social curbs in Beijing. Other cities have also undergone arduous lockdowns, either city-wide or neighbourhood specific. Many cities and provinces have enacted compulsory mass testing every few days for residents who wish to move about the city.

On Sunday, Beijing announced in-person schooling would restart. Shanghai authorities also reported no new cases at the weekend for the first time since March. However, the threat of sudden lockdowns or travel curbs persists. Last week, Shenzhen contained a neighbourhood and locked down several residential buildings, after a single case was reported. On Sunday, it was extended to close entertainment venues and parks, as case numbers climbed to a dozen.


Source : The Guardian

Welcome to the Great Reinfection

Grace Browne wrote . . . . . . . . .

If you are unfortunate enough to have had an intimate encounter with the dreaded Sars-CoV-2 virus, I’m afraid your dalliance with it might not have been your last. Get ready for round two (and three, and maybe four—maybe ad infinitum). Welcome to the Great Reinfection.

In the early months of the pandemic, reinfections were a remarkable rarity, even making global news when discovered. “When the pandemic first started, everybody assumed that once you got it, you were done,” says Juliet Pulliam, director of the South African DSI-NRF Centre for Epidemiological Modelling and Analysis at Stellenbosch University.

Two years and some change in, that novelty has largely evaporated. A perfect storm of waning immunity, loosened restrictions, and an extremely transmissible variant making the rounds has meant reinfections are the new normal for many. But even setting aside these factors, it makes sense that there are now more reinfections than ever. At this stage of the pandemic, repeat infections would always have been more common than before, owing to the sheer number of people who’ve had Covid-19. You can’t get reinfected unless you’ve already been infected in the first place.

Beyond that basic math, it’s not really surprising that reinfections are happening, says Aubree Gordon, an infectious disease epidemiologist at the University of Michigan. “The virus has changed a lot,” she says. If you were infected with an earlier variant, Omicron is like that variety wearing a wig and makeup—making it largely unrecognizable to our bodies’ immune defenses and harder to stave off.

But if reinfections are now part and parcel of the future of the pandemic, just how common are they? An exact number is hard to pin down, thanks to a nosedive in testing and reporting that has made tracking all kinds of Sars-CoV-2 infections much trickier. Plus, not everyone defines a reinfection the same way; health authorities in the UK, for example, require at least 90 days to elapse between a first and second infection for this to count as a reinfection. Others, like the European Centre for Disease Prevention and Control, use a shorter 60-day minimum between infections.

In England, close to 900,000 possible reinfections have been identified since the beginning of the pandemic. Of those, over 10,000 were a third infection, and almost 100 were a fourth.

Pulliam’s own work has tried to put a number on how many infections are actually reinfections. She and her team found that as of last week, around 15 percent of current infections in South Africa are reinfections. “And that is almost certainly an underestimate,” she cautions, “because our surveillance isn’t great, and we probably missed a lot of people’s first infections.” But to answer just how prevalent reinfections are—in the grand scheme of things—Pulliam uses two words to sum it up: fairly rare.

She and her team have also investigated just how much Omicron has shaken things up. They started monitoring reinfections towards the end of the Beta wave in South Africa (which peaked in January 2021), looking at over 100,000 suspected reinfections. They found that the protection an initial infection offered against reinfection stayed the same all through the Beta wave and all through the Delta wave that peaked the following July. And then Omicron hit. The risk of reinfection steadily rose and stabilized at a higher number.

South Africa, Pulliam says, is uniquely placed to study reinfection, serving as a barometer for the rest of the world’s reinfection future, given that Omicron has already made its way through most of the population. “If what’s going on in South Africa is any indication, it’s that probably people are going to be reinfected over the course of years,” she says. Reinfection, Pulliam believes, is going to be a normal part of the way we live in the future.

Other studies have shown just how much Omicron has changed the reinfection calculation. According to data from the UK, the risk of being reinfected with Covid-19 was about eight times higher after Omicron became the reigning variant in the country compared with when Delta held the crown. Another paper from Imperial College London published in December 2021 found that Omicron was five times more likely to reinfect people than the previously dominant Delta variant.

Laith J. Abu-Raddad, an infectious disease epidemiologist at Weill Cornell Medical College in Qatar, has investigated how much a previous infection protects against a future one—and how much this has shifted because of Omicron. In a study published in March, he found that pre-Omicron, the effectiveness of a Covid infection against a reinfection hovered at about 90 percent—in both the vaccinated and unvaccinated. Post-Omicron that number dropped to about 50 percent. Reinfections, he says, “are becoming an accepted reality.”

It’s the sheer difference between Omicron and earlier variants that explains why the risk of reinfection has shot up. But the virus is still changing, so even if you’ve had Omicron, that doesn’t mean you won’t catch Covid again—and you can even get reinfected with the different manifestations of Omicron. A February preprint from researchers in Denmark suggests that the BA.2 sublineage of Omicron can reinfect people shortly after they’ve had the original BA.1 form, but the paper did conclude that such reinfections are rare. Some of those in the study were reinfected as quickly as 20 days after their initial infection, which, the authors write, calls into question just how suitable it is to use a minimum 60-day gap for classifying a case as a reinfection.

Similarly, Alex Sigal, a virologist at the Africa Health Research Institute in South Africa, has found a comparable pattern in his own research, which is also still in preprint. He and his team found that an infection with the original BA.1 version of Omicron offered little immune protection against the newer versions of Omicron, BA.4. and BA.5.

This could be a sign that the virus is beginning to mimic the natural rhythms of other coronaviruses, which infect and reinfect us many times in our lifetimes. We all come down with a coronavirus infection about every three years; sometimes even multiple times within the same year. Sars-CoV-2 could be no different. However, we don’t quite know whether these repeat infections are due to the fact that the initial infection gives us immunity that wanes posthaste, or if the viruses themselves evolve to outsmart our previously built immunological weaponry. Previous work that has attempted to answer this question leans towards the latter theory.

Knowing this, one solution to fighting all these reinfections, Sigal says, is to design a better vaccine. Moderna is already publishing data on a broader-type booster vaccine that mixes equal amounts of the spike proteins from the OG and Beta variants, which seems to work better at providing more universal coverage against the virus.

At the end of the day, the good news is, you’re not likely to get a severe case on your next tussle with the virus—in another study from Abu-Raddad, a reinfection was found to result in a 90 percent lower chance of ending up in the hospital or dying than your first infection. But you should still try not to repeat the experience. While your risk of severe disease or dying seems to be much less when reinfected, it doesn’t mean that there aren’t people who die on their second infection. “It’s not a gamble you really want to take,” warns Pulliam.

Plus, Sigal points out, “we don’t know what these repeated cycles of infection will do.” The more people harbor the virus, the more likely a variant we don’t like will emerge from the woodwork. And on an individual level, it’s possible that a second reinfection could be the one to cause long-term damage, like long Covid. Whether reinfection is, in fact, leading to long Covid is the really big question, says Pulliam. “It’s going to make a big difference in terms of whether we view it just as a cold virus going forward,” she says. “Or whether we view it as something that is really serious.”


Source : WIRED