POST 262. July 21, 2022. CORONAVIRUS. Michael Osterholm, PhD: “I think the (COVID) challenge we have and continue to have are these viruses keep throwing 210-mile-an-hour curveballs. We just don’t know what the next situation is going to be.” (H)

New this week: Parechovirus & Marburg virus disease.

for links to POSTS 1-262 in chronological order highlight and click on

https://doctordidyouwashyourhands.com/2022/07/coronavirus-tracking-links-to-posts-1-262/

NEWS

“…parechovirus, (is) a common pathogen that usually causes mild, cold-like symptoms or no symptoms at all. But in rare instances — particularly among infants — it can cause severe illness and irreparable brain tissue damage…

Last week, the Centers for Disease Control and Prevention issued a health alert notifying doctors, nurses and public health departments to the fact that the virus has been circulating nationally since May. The C.D.C. is urging clinicians to consider it as a possible diagnosis for any babies with unexplained fever, seizures or sepsis-like symptoms….

“For the most part, parechovirus causes illness that tends to be very mild,” said Dr. Ami Patel, an attending physician in the division of pediatric infectious diseases with the Ann & Robert H. Lurie Children’s Hospital of Chicago. “Very rarely do we get more severe illness.”..

The C.D.C. alert said it has received reports of cases since May, but did not specify how many or in which states. It did note, however, that the cases have all been a subtype of parechovirus known as A3, which is most often linked to severe illness…

Parechovirus tends to circulate in the late summer and early fall, and typically peaks every other year, the C.D.C. says. But beyond that, there is not much specific information about national infection rates and whether they are increasing.

“It’s not one we commonly test for, or that we necessarily need to test for,” Dr. Patel said. “It’s not a virus we nationally track, like influenza.”

The C.D.C. alert said it has received reports of cases since May, but did not specify how many or in which states. It did note, however, that the cases have all been a subtype of parechovirus known as A3, which is most often linked to severe illness…

The purpose of the C.D.C. alert is not to alarm parents, experts say. It is to help ensure that pediatricians and other health care providers are aware parechovirus is circulating, so they can consider it as a possible diagnosis in certain sick children.” (A)

“Ghana has confirmed its first two cases of the highly infectious Marburg virus disease, the World Health Organization (WHO) said Sunday in a statement.

The announcement comes after two unrelated patients from the southern Ashanti region of Ghana, both of whom later died, tested positive for the virus.

The patients had shown symptoms including diarrhea, fever, nausea, and vomiting, WHO said, adding that more than 90 contacts are being monitored.

Marburg is a highly infectious viral hemorrhagic fever in the same family as the better known Ebola virus disease and has a fatality ratio of up to 88%, according to WHO. “Illness begins abruptly, with high fever, severe headache, and malaise,” it stated.

The virus is transmitted to humans from fruit bats and can then be spread human-to-human through direct contact with the bodily fluids of infected people or surfaces and materials contaminated with these fluids, WHO explained.

The global health body said containment measures were being put in place and that more resources would be deployed in response to the outbreak in Ghana. WHO also warned that “without immediate and decisive action, Marburg can easily get out of hand.”

There are no approved vaccines or antiviral treatments for the Marburg virus. However, a patient’s chances of survival can be improved with care including oral or intravenous rehydration and treatment of specific symptoms, WHO said.” (B)

UPDATES

As cases of monkeypox continue to rise in the US, a top health official is stressing that the outbreak needs to be handled in a more rigorous manner.

“This is something we definitely need to take seriously. We don’t know the scope and the potential of it yet, but we have to act like it will have the capability of spreading much more widely than it’s spreading right now,” Dr. Anthony Fauci told CNN on Saturday.

Former US Food and Drug Administration Commissioner Dr. Scott Gottlieb warned that it may be too late to control and contain the virus.

“I think the window for getting control of this and containing it probably has closed. If it hasn’t closed, it’s certainly starting to close,” Gottlieb told CBS’ Margaret Brennan on Sunday on “Face the Nation.”

Monkeypox has been detected throughout most of the US, except for a handful of states, according to the US Centers for Disease Control and Prevention. The states with the most cases include New York, California, Illinois and Florida.

The latest data shows that the CDC has tracked at least 1,814 probable or confirmed cases in the US, as of Friday, and a total of 12,556 confirmed cases in 68 countries.

Fauci, who is director of the National Institute of Allergy and Infectious Diseases and President Joe Biden’s chief medical adviser, told CNN’s Laura Coates that the numbers are “very likely an undercount.”

“Whenever you have the emergence of something like this, you are always probably looking at what might be — might be, we don’t know — the tip of the iceberg, so that’s the reason why we’ve got to get the testing out there in a much, much more vigorous way,” Fauci said.

Gottlieb echoed the need for testing.

“We’re probably detecting just a fraction of the actual cases because we had, for a long time, a very narrow case definition on who got tested and by and large, we’re looking in the community of men who have sex with men and at STD clinics. So we’re looking there, we’re finding cases there, but it’s a fact that there’s cases outside that community right now. We’re not picking them up because we are not looking there.”

The US Centers for Disease Control and Prevention said Friday that there have been eight cases of monkeypox diagnosed among individuals who were female at birth and that no cases have been reported in children or adolescents…

The former FDA commissioner compared the response to the monkeypox virus with the start of the Covid-19 pandemic, saying the US is making “a lot of the same mistakes,” such as a lack of testing early on and not enough vaccines distributed to the community.

“We could have gotten control of this if we had been more aggressive up front,” Gottlieb said.

The CDC is working with five commercial laboratories to expand testing capacity, expanding capacity from an initial 6,000 up to 80,000 specimens per week.

Gottlieb also criticized the CDC for its response to the virus.

“The White House has intervened to take more control of the response away from CDC. This can’t be our response every time, that when CDC drops the ball, the White House and the political leadership need to step in,” Gottlieb said. “That’s what’s happened here. It happened in Covid. We need to fundamentally reform how we respond to these crises.” (C)

“As the monkeypox outbreak grows in the United States, demand for the vaccine is outstripping the nation’s supply, Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, said at a news briefing on Friday.

“We don’t yet have all the vaccine that we would like in this moment,” she said.

When the supply crunch will ease is unknown. The federal government made another 131,000 doses available to states and other jurisdictions on Friday. But the scope of the outbreak remains unclear, in part because diagnostic testing has been slow and limited.

Nearly 1,500 cases have been identified in the United States, primarily in men who have sex with men, and the figure is likely to rise in the coming weeks, Dr. Walensky said. Globally, more than 11,000 cases have been identified in 65 countries, she added.

“Our window of opportunity to control it is rapidly closing,” said Anne Rimoin, an epidemiologist and monkeypox expert at the University of California, Los Angeles. “There are probably a lot more cases out there than we’re aware of.”

The Department of Health and Human Services ordered an additional 2.5 million doses of the vaccine, known as Jynneos, on Friday, but those doses are not scheduled to arrive until next year.

A previously ordered 2.5 million doses should begin arriving late this year, officials said…

Public health experts have criticized the U.S. response to the outbreak as slow and inefficient, beset by some of the same problems that plagued the early months of the Covid-19 pandemic.

Initially, for instance, monkeypox testing was extremely limited, and each diagnosis had to be confirmed by the C.D.C., creating delays that might have allowed the virus to spread unseen and unchecked.

“Now we’re in a situation where it’s going to be exceedingly difficult, with limited supplies of the vaccine and still some problems with testing, to get this under control,” Dr. Gonsalves said…

But health officials should be doing more active surveillance for the disease, experts said…

New tests, including those that can detect the virus in asymptomatic people, are needed, Dr. Rimoin said, as is active surveillance in animal populations, which might become reservoirs for the virus.

The virus is unlikely to remain in the networks and communities in which it is currently spreading, she added, and expanding testing is particularly important given the limited vaccine supply.

“The faster you can identify cases, the better you are at isolating them and preventing onward transmission,” Dr. Rimoin said.

Jynneos, the only vaccine approved by the F.D.A. specifically for monkeypox, is given in two doses, 28 days apart. It is made by Bavarian Nordic, a small company in Denmark, and its global supply has been exceedingly limited.

The United States has purchased nearly seven million doses in total, but has received just 372,000 of them, Dawn O’Connell, the assistant secretary for preparedness and response at the Department of Health and Human Services, said on Friday. So far, 156,000 doses have been distributed nationally, she said.”  (D)

“The spread of monkeypox has ignited a debate within the New York City Health Department over whether the agency should encourage gay men to reduce their number of sexual partners during this summer’s outbreak.

Inside the department, officials are battling over public messaging as the number of monkeypox cases has nearly tripled in the last week, nearly all of them among men who have sex with men. A few epidemiologists say the city should be encouraging gay men to temporarily change their sexual behavior while the disease spreads, while other officials argue that approach would stigmatize gay men and would backfire.

The internal divisions peaked when the health department issued an advisory last week suggesting that having sex while infected with monkeypox could be made safer if people avoided kissing and covered their sores. Several officials at the agency were outraged, saying the agency was giving misleading and even dangerous health advice, according to several epidemiologists within the department and a review of internal emails.

The advice on safer sex was not medically sound, said Dr. Don Weiss, the director of surveillance for the department’s Bureau of Communicable Disease, in an interview. He believes the department should advise those at risk of monkeypox to temporarily reduce their number of partners, saying, “We’re not telling people what they have to do to be safe.”

His concerns are shared by some of his colleagues, emails and interviews show, indicating growing frustration and pessimism within the ranks of the health department as the window for controlling New York City’s monkeypox epidemic — the largest such outbreak in the United States — quickly closes.

Monkeypox has been spreading globally since early May. In New York City, where nearly all monkeypox patients are gay or bisexual men, there were 618 documented cases of monkeypox in the city as of Monday, though Dr. Weiss said that the true number of infections was far higher, because testing has been limited.

The strategy favored by Dr. Weiss, who has long played a frontline role in the department’s response to disease outbreaks, has received little traction within the department.”  (E)

“Several highly effective vaccines were developed at an unprecedented speed to combat the COVID-19 pandemic. During the phase 3 clinical trials, mRNA vaccines had vaccine efficacy of 94–95% in preventing symptomatic infections. After the rollout, real-world evidence showed that the mRNA vaccines provided ~90% effectiveness against infection. Then came the variants. The wave after wave of new variants, with ever-increasing transmissibility and capacity to escape existing immunity, challenge the ability of vaccines to prevent infection and transmission. The effectiveness of a primary series of mRNA vaccines (two doses) to prevent hospitalization and death is also being chipped away by these highly immune-evasive variants. Vaccine-mediated protection became shorter-lived, especially with the emergence of Omicron variants. People look at these data and wonder, what is the point of getting the vaccines if they will not prevent symptomatic infections, and the protection does not last? Well, to expect robust protection from just the primary series of any vaccines is unreasonable—and was always likely to be—but somehow society has placed too high a bar on what is considered an acceptable number of doses for COVID-19 vaccines. Instead, we need to understand that we’re going to be getting boosters in the foreseeable future, and to appreciate their benefits.

Vaccines against other infectious diseases are given in multiple doses. Many of our childhood vaccines require multiple doses—5 doses for (diphtheria/tetanus/pertussis), 4 doses (Haemophilus influenza type b, pneumococcal conjugate, inactivated poliovirus), or 3 doses (hepatitis B) are all commonly given before the age of 18 years. These doses are required and not considered optional to achieve immunity. In adulthood, many of these vaccines need periodic booster doses to maintain immunity. The influenza virus requires annual vaccination doses for all ages. Yet, people don’t complain about having to get their 60th dose of the influenza vaccine. We should think of COVID-19 vaccines the same way.

Why do we need booster doses? The primary series of vaccines kick-starts the immune response by engaging lymphocytes, white blood cells that detect specific features of the pathogen to expand in numbers and become instructed to eliminate the pathogen. Most of these cells disappear over time, except for a small subset of cells that are kept by the body for future use. These “memory cells” are responsible for long-lasting immunity against a given pathogen. What boosters do is stimulate these memory lymphocytes to quickly expand in numbers and to produce even more effective defenders. The booster also selects for B cells that can secrete antibodies that are even better at binding and blocking virus infection and spread.” (F)

“The rapid evolution of the coronavirus into an alphabet soup of subvariants presents a vexing challenge to health officials: They must make far-reaching policy decisions based on little biological certainty of which viral variants will be dominant this fall or winter.

The Food and Drug Administration said at the end of June that it would update coronavirus vaccines for a booster campaign in the fall targeting highly contagious Omicron subvariants. But the ground is shifting beneath its feet.

In just eight weeks, the subvariant known as BA.5 has gone from a blip in U.S. case counts to the dominant version of the virus in the country, now making up more than three-quarters of new cases. Perhaps the most transmissible subvariant yet, it is pushing up positive tests, hospitalizations and intensive care admissions across the country,

There is no evidence that BA.5 causes more severe disease, but the latest metrics certainly bust the myth that the virus will become milder as it evolves.

“None of us has a crystal ball, and we are trying to use every last ounce of what we can from predictive modeling and from the data that we have to try to get ahead of a virus that has been very crafty,” said Dr. Peter Marks, a top vaccine regulator at the F.D.A., after an advisory committee recommended that the agency prioritize vaccines specific to the Omicron subvariants. “For something that’s only nanometers in size, it’s pretty darn crafty. We’re trying to make our best judgment here.”

Omicron and its offshoots have dominated for about six months now, and whatever incarnation of the virus comes next is more likely to be tied to the Omicron family than to earlier versions, said Jerry Weir, a senior F.D.A. regulator.

That assumption is the best calculation that can be made at this time, according to outside experts not on the F.D.A. expert panel.

“Viruses like SARS-CoV-2 are always evolving, and it’s a near certainty that new mutants will emerge in any given six-month time frame,” said Jesse Bloom of the Fred Hutchinson Cancer Center in Seattle. “But as long as these mutants are descendants or close relatives of BA.2 or BA.4/BA.5, then a vaccine booster based on BA.4/BA.5, as the F.D.A. has recommended, should be a much better match to them than the current vaccine, even if it’s not a perfect match.”..

Emma Hodcroft, a molecular epidemiologist and researcher at the University of Bern in Switzerland, said Omicron’s evolution pattern had diverged from that of earlier variants. “The children of Delta were not dominant, but the children of Omicron are pushing out their siblings, if you will,” she said. “That’s hinting that Omicron is at the peak and that there will be smaller changes.”

Though more Omicron children could be on the way, she and other scientists emphasized that this would not preclude another variant appearing.

“Too many times we have made predictions on how we think SARS-CoV-2 will evolve and then been emphatically wrong,” said Nathan Grubaugh, an epidemiologist at the Yale School of Public Health. Last fall, he correctly predicted that an immune-evasive subvariant would emerge, but his expectation that it would come from the Delta variant was wrong.

“Obviously, we are seeing new variants emerge from within Omicron right now — BA.2, BA.4 and BA.5 — and that may continue to happen,” he said. “But we shouldn’t become unimaginative and think that will continue.”

Last year, ​​Sarah Cobey, an evolutionary biologist at the University of Chicago, was almost certain that the next variant would descend from Delta. “I nonetheless think it’s extremely likely the next variant will descend from Omicron,” she said last week, adding that it could have a wider degree of immune escape or increased transmissibility. “It’s likely the next variant has emerged already but will evade surveillance for some time,” she said…

“We’ve been trying to better guess the next flu variant for decades,” Dr. Hodcroft said. “And it turns out that it’s very complicated.”

The many variables mean that she and other experts cannot make a declaration with full confidence. She said, “It’s very hard to put these all into a machine and crunch it.”” (G)

“The new COVID-19 variant, called BA.5, has been rapidly spreading across the country and is now estimated to make up more than 60% of new cases, according to the CDC. It is highly transmissible, compared to previous variants, and seemingly more resistant to prior vaccinations and immunities.

These factors are making people think differently about wearing masks, which experts say are still an effective way to curb the spread of the virus. Los Angeles County, for example, will likely reinstate an indoor mask mandate at the end of the month due to rising COVID-19 cases.” (I)

“Right now, COVID-19 surges happen at all times of the year, unlike flu season, which can typically be linked to winter, Teng said.

“If we get to a point where it SARS-CoV-2 is also a seasonal virus … we can treat it more like the flu,” he said. “Then we have a prediction. We know when we have to start vaccinating to provide protection over the course of the season.”” (J)

“Dr. Anthony S. Fauci, who has repeatedly brushed off speculation that he would retire, says he has a time frame in mind for the end of his long government career. But those who are eager for him to go may have to wait a while: His plan is to leave by January 2025, the end of President Biden’s current term.” (K)

• A.‘We Were So Blindsided’: What New Parents Should Know About Parechovirus, By Catherine Pearson, https://www.nytimes.com/2022/07/19/well/family/parechovirus-symptoms.html?referringSource=articleShare
• B.Two dead as Ghana confirms its first outbreak of the deadly Marburg virus, By Irene Nasser and Nimi Princewill, https://www.cnn.com/2022/07/18/africa/ghana-first-marburg-outbreak-intl/index.html
• C.As Fauci warns monkeypox needs to be taken more seriously, former FDA commissioner says the window to control it ‘probably has closed’, By Carma Hassan, Aya Elamroussi and Hannah Sarisohn, https://www.cnn.com/2022/07/17/health/monkeypox-cases-undercounted-fauci/index.html
• D.Demand for Monkeypox Vaccine Exceeds Supply, C.D.C. Says, By Emily Anthes, https://www.nytimes.com/2022/07/15/health/monkeypox-vaccine-supply.html?referringSource=articleShare
• E.Debate Over Monkeypox Messaging Divides N.Y.C. Health Department, By Joseph Goldstein, https://www.nytimes.com/2022/07/18/nyregion/nyc-monkeypox-health-department-information-inaccurate.html?referringSource=articleShare
• F.Why You’ll Need to Get COVID-19 Boosters Again and Again, BY AKIKO IWASAKI AND ALBERT KO, https://time.com/6198402/covid-19-boosters/
• G.‘None of us has a crystal ball’: Scientists try to keep up with faster coronavirus evolution., By Adeel Hassan, https://www.nytimes.com/2022/07/20/health/covid-ba5-omicron-variant.html?referringSource=articleShare
• H.’This is a stay-tuned moment’: Dr. Michael Osterholm on omicron uptick, by Cailey Gleeson, https://www.beckershospitalreview.com/public-health/this-is-a-stay-tuned-moment-dr-michael-osterholm-on-omicron-uptick.html
• I.Will the BA.5 COVID strain force new mask mandates?, https://abcnews.go.com/Health/ba5-covid-strain-force-mask-mandates/story?id=87009430
• J.When can we stop worrying about COVID-19? Not yet, experts say, By Caroline Catherman, https://www.orlandosentinel.com/coronavirus/os-ne-coronavirus-is-covid-over-florida-ba5-20220717-bfuhx5lnhbfvvjlhehurbevv5a-story.html#:~:text=When%20can%20we,By%20Caroline%20Catherman
• K.Anthony Fauci says he will ‘almost certainly’ retire by January 2025., By Sheryl Gay Stolberg, https://www.nytimes.com/live/2022/07/18/world/covid-19-mandates-vaccine-cases?referringSource=articleShare
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