Covid-19 Policy Update: State of Affairs
Wednesday, September 20, 2023
Didn’t expect to hear from me again, did you? (One reader’s reaction to seeing a Covid Update back in their inbox).
That was the plan, but then we had a few new variants surprise us, a summer wave, and some reformulated vaccines. So, it felt like it might be useful to provide a quick state of affairs.
I hope everyone had a great summer and that their fall is getting off to a good start.
—John
State of Affairs
Another Summer Wave: Cases and hospitalizations rose over the summer and continue to rise.
Pediatric Cases: Via AAP:
“Recent analysis of the data shows the number of children under age 18 with confirmed COVID-19 at hospital admission increased nearly five-fold from 237 new admissions the week ending June 17 to 1,175 in the week ending Sept. 9.”
“June had the lowest level of pediatric COVID-19 hospital admissions since data collection began in 2020.”
Variants Fueling The Wave:
The main variants driving cases are EG.5 and FL.1.5.1, both XBB variant descendants that share a mutation known as F456L, which appears to be helping them spread more than other virus siblings.
What's Going On With COVID? Via Emily Oster:
"What I will say is, at this point the risks of COVID for most people are comparable to the risks associated with other illnesses. So whatever your approach to COVID is, it should likely be your approach to illness in general. If you have someone in your household with a weakened immune system, it makes sense to be careful (isolate if sick, wash hands frequently, etc.) with any illness, not just COVID."
"This logic applies to a lot of the specific questions I hear about COVID. Should we be more worried about COVID with a newborn than with an older infant? Yes, similar to other viruses. In this early period, some added caution about illness is warranted. Should I isolate from my healthy breastfeeding five-month-old when I have COVID? Probably not. Unless you’d do that for all illnesses, it doesn’t make sense here."
As usual, it’s worth reading the entire post.
Free Covid Tests: “The Biden administration announced that it is providing $600 million in funding to produce new at-home COVID-19 tests and is restarting a website allowing Americans to again order up to four free tests per household — aiming to prevent possible shortages during a rise in coronavirus cases that has typically come during colder months.”
BA.2.86 Variant
This caused quite a bit of buzz a few weeks ago because scientists were concerned BA.2.86 had 30 mutations.
"The evolutionary jump of BA.2.86 is similar to that of the original Omicron, which burst onto the scene in the winter of 2021, resulting in a spike in infections."
But good news! Via Scott Gottlieb: "More reassuring data on BA.2.86, it’s not the “game changer” some initially feared; this analysis from @sigallab who tested live Omicron BA.2.86 subvariant isolated from a South African swab: “it evolved similar immune escape to what is circulating now, but no better.”
CIDRAP: "Two more lab groups—one from Sweden's Karolinska Institute and the other from Harvard University—have reported results of antibody neutralization lab experiments, which suggest vaccination or previous infection offer some protection against the highly mutated BA.2.86 SARS-CoV-2 variant."
Early indications are that the new boosters will work against this variant too:
"Moderna, Pfizer say updated COVID shots generate strong response versus BA.2.86"
Via Eric Topoll: "These data were published (preprint) with Moderna’s XBB.1.5 booster and show very good levels of neutralizing antibodies induced against BA.2.86, in keeping with the response to the target of XBB.1.5. Also note the similar response to 2 of the major current circulating variants of EG.5.1 and FL.1.5.1."
"It's been downgraded from a hurricane to not even a tropical storm. We're lucky," Topol said. "This one could have been really bad."
"Early research data has shown that antibodies produced by prior infection or existing vaccines against the coronavirus were sufficient to protect against the new BA.2.86 variant."
Updated Vaccines
Reformulated Vaccines: The updated COVID vaccine approved by the FDA is based on the XBB.1.5 variant.
CDC ACIP: Via CIDRAP:
"The advisory committee voted 13-1 to recommend updated COVID-19 vaccines for people ages 6 months and older." It came one day after the FDA authorized for emergency use mRNA vaccines from Moderna and Pfizer-BioNTech.
"Though some on the advisory group said a recommendation focusing on those ages 65 and older and others at higher risk might be better for targeting those at most risk for severe complications, many were swayed by data, including those on long COVID, showing that no group is at low risk from the virus."
"Shortly after ACIP's vote, the CDC accepted the group's recommendation, which allows immunization campaigns to begin."
More via Katelyn Jetelina summarizing the meetings:
"More than half of children hospitalized for Covid-19 do not have a co-morbidity."
"Behind adults 75+ years, infants (<6 months) had the highest rate of Covid-19 hospitalization. The burden of severe illness is lowest among children ages 5–17 years compared to other age groups."
"For kids, hospitalization rates were lower or comparable to flu. Once hospitalized, though, more kids went to the ICU for Covid-19 than for flu."
Vaccine effectiveness: Emergency department and urgent care visits: 60% effectiveness among kids and adults. (As a comparison, this effectiveness is higher than for the flu vaccine.) Hospitalizations: 65% effectiveness, but this waned over time (→ 22% six months later). There is sustained protection against ICU admission."
How Long Should You Wait?: Katelyn Jetelina with a good summary of minimum waiting (2-3 months), maximum wait (8-12 months), and the latest on mixing-and-matching.
CDC Director Cohenin in the NYT: "As a Doctor, a Mother and the Head of the C.D.C., I Recommend That You Get the Latest Covid Booster"
"Some viruses, however, change over time. This coronavirus is one of them. It finds ways to evade our immune systems by constantly evolving. That’s why our vaccines need to be updated to match the changed virus."
"Even though many Americans have been exposed to previous versions of the virus because they’ve been infected, that protection decreases over time. This is partly why you can get Covid more than once and why you can still get very sick even if you had it before. That’s why the C.D.C. is recommending an updated Covid-19 vaccine, which is better matched to the currently circulating virus, for everyone age 6 months and older."
Covid-19 Research
Original mRNA Vaccines Protect Children From COVID-19-Associated ED Visits: Study:
"Complete primary vaccination with the original mRNA COVID-19 vaccines helped protect against COVID-19-associated emergency department (ED) or urgent care (UC) encounters for children aged 6 months to 5 years."
"Complete primary vaccination helped protect against ED or UC encounters in young children after analysis of data in the VISION electronic health record. Though few children received a bivalent vaccine dose, it provided 80% protection for those who received a complete primary series compared to unvaccinated children."
Original Pfizer COVID Vaccine 33% Effective Against Emergency In Young Kids: CIDRAP on a new study.
"The risk of SARS-CoV-2 encounters appeared lower for those with 2 vs 3 doses of BNT162b2 [Pfizer vaccine], albeit with wide CIs, which is likely due to more immune-evasive Omicron sublineages (e.g., BQ.1-related and XBB-related strains) becoming dominant by the time young children received their third dose and longer median time since dose 3 compared with dose 2," the study authors wrote.”
“The OR of 0.67, which is equivalent to vaccine effectiveness of 33%, is much lower than the roughly 70% efficacy against symptomatic illness seen in a clinical trial when BA.2 sublineages were predominant, they noted. "Updated vaccines will likely be needed to maintain protection against contemporary Omicron strains in young children," they concluded.”
How Covid Affects the Heart: Via the NYT: Three years into the pandemic, the short- and long-term risks are becoming more clear.
“A large 2022 study tracking medical records of 691,455 patients in the United States found that people had a significantly higher risk of developing virtually all heart-related diseases in the year after a Covid infection. According to the research, people were 1.5 times more likely to have a stroke, nearly twice as likely to have a heart attack, and had between 1.6 and 2.4 times the risk of developing different types of arrhythmias.”
“Research has shown that people who are vaccinated are roughly 40 to 60 percent less likely to have a heart attack or stroke following a Covid infection than those who are unvaccinated. This may be because vaccinated people are less likely to develop severe Covid, which in turn lowers the risk of many of these heart-related issues. Or the vaccine may help protect the cardiovascular system itself — by reducing the inflammatory effects of Covid, for example.”
“There is a small risk of developing myocarditis (inflammation of the heart muscle) in the weeks after getting an mRNA Covid vaccine made by Pfizer-BioNTech or Moderna. However, the risk of myocarditis after having Covid is much higher.”
As COVID-19 Cases Rose, So Did Diabetes — No One Knows Why: Via Nature.
ICYMI
Schools Grapple With COVID Safety Amid Late Summer Surge: Via Axios:
"A late summer COVID surge is prompting some school districts to reinstate safety measures, as they try to protect student and teacher health without risking further disruptions to learning."
"Why it matters: Widespread school closings are a non-starter, and officials in red and blue states also insist broad mask mandates won't return. But, in a flashback to the dark days of the pandemic, some districts in consultation with local health officials have reinstated limited masking and other precautions as COVID cases and hospitalizations rise."
"Driving the news: Districts in Kentucky and Texas have canceled classes after a surge of respiratory illnesses, including COVID, led to widespread absences."
Anti-Vaccine Movement on the Rise: Via Politico:
“There’s a real challenge here,” said one senior official who’s worked on the Covid response and was granted anonymity to speak candidly. “But they keep just hoping it’ll go away.”
“The White House’s reticence is compounded by legal and practical concerns that have cut off key avenues for repelling the anti-vaccine movement, according to interviews with eight current and former administration officials and others close to the process.”
The State of the American Student: CRPE warns that middle- and high-school students, who have the least time to catch up before they leave the K-12 system, may be suffering the most as schools emerge from the COVID-19 pandemic.
The average eighth grader, for instance, needs 7.4 months of schooling to catch up to pre-pandemic levels in reading, and 9.1 months of schooling in math.
The average score on the ACT college admission test last year was 19.8, the lowest since 1991.
“Invest in a national youth intervention strategy that develops, tests, and promotes new interventions (such as strengthening adult-student relationships) and innovative methods (such as AI technology) for struggling adolescents and young adults. Invest, too, in scaling already proven interventions, like high-quality tutoring and mentoring”
Chronic Absenteeism: Via the AP and Stanford University:
“Over a quarter of students missed at least 10% of the 2021-22 school year, leading to an estimated 6.5 million more chronically absent students”.
“Absences worsened in every state, and the rate doubled in seven compared to 2018-19.”
“Notably, the rise in absenteeism did not strongly correlate with state COVID rates, suggesting other issues may be driving these trends.”
A Generation at Risk: Published by the Building Bridges Initiative, the report is the product of a partnership of Democrats for Education Reform and the Thomas B. Fordham Institute.
“Though “written by committee,” it proposes some very bold ideas! We desperately want America’s leaders to show a greater sense of urgency in meeting the needs of today’s students, struggling as they are with learning loss and mental health challenges in the wake of the pandemic. But we also want policymakers to start building a more responsive system for the future, meaning one that should do the following:”
“Be firmly centered around students and their needs.”
“Give parents and families true information, power, and agency to understand, support, choose, and advocate for their children’s education in a real and actionable way.”
“Aim for a broader definition of student success and enable a broader set of providers—inside and outside of schools—to play a role in meeting our students’ needs.”
Mzansi Youth Choir: Performs "Everywhere" by Fleetwood Mac.
The Best of America: When Jaylan Gray's mom died, he quit school to care for his brother. Shortly after, their house was in need of repair, that’s when a nonprofit stepped in to fix their home. And now, more kind strangers are helping Jaylan follow his dreams.
Bear Cubs Getting In A Hammock: Is one of the greatest videos of all time.
Living The Good Life: A dog making some precision maneuvers in a helicopter.
Alexa, Siri, and ChatGPT: Meeting up in a break room.