FILE – Chickens walk in a fenced pasture at an organic farm in Iowa on Oct. 21, 2015. Iowa agriculture officials said Monday, Oct. 31, 2022, that another commercial egg farm in the state has been infected with bird flu, the first commercial farm case identified since April when a turkey farm was infected. The latest case is in Wright County in north central Iowa, housing about 1.1 million chickens. (AP Photo/Charlie Neibergall, File)
Tag: Flu
-
The Worst Pediatric-Care Crisis in Decades
At the height of the coronavirus pandemic, as lines of ambulances roared down the streets and freezer vans packed into parking lots, the pediatric emergency department at Our Lady of the Lake Children’s Hospital, in Baton Rouge, Louisiana, was quiet.
It was an eerie juxtaposition, says Chris Woodward, a pediatric-emergency-medicine specialist at the hospital, given what was happening just a few doors down. While adult emergency departments were being inundated, his team was so low on work that he worried positions might be cut. A small proportion of kids were getting very sick with COVID-19—some still are—but most weren’t. And due to school closures and scrupulous hygiene, they weren’t really catching other infections—flu, RSV, and the like—that might have sent them to the hospital in pre-pandemic years. Woodward and his colleagues couldn’t help but wonder if the brunt of the crisis had skipped them by. “It was, like, the least patients I saw in my career,” he told me.
That is no longer the case.
Across the country, children have for weeks been slammed with a massive, early wave of viral infections—driven largely by RSV, but also flu, rhinovirus, enterovirus, and SARS-CoV-2. Many emergency departments and intensive-care units are now at or past capacity, and resorting to extreme measures. At Johns Hopkins Children’s Center, in Maryland, staff has pitched a tent outside the emergency department to accommodate overflow; Connecticut Children’s Hospital mulled calling in the National Guard. It’s already the largest surge of infectious illnesses that some pediatricians have seen in their decades-long careers, and many worry that the worst is yet to come. “It is a crisis,” Sapna Kudchadkar, a pediatric-intensive-care specialist and anesthesiologist at Johns Hopkins, told me. “It’s bananas; it’s been full to the gills since September,” says Melissa J. Sacco, a pediatric-intensive-care specialist at UVA Health. “Every night I turn away a patient, or tell the emergency department they have to have a PICU-level kid there for the foreseeable future.”
I asked Chris Carroll, a pediatric-intensive-care specialist at Connecticut Children’s, how bad things were on a scale of 1 to 10. “Can I use a Spinal Tap reference?” he asked me back. “This is our 2020. This is as bad as it gets.”
The autumn crush, experts told me, is fueled by dual factors: the disappearance of COVID mitigations and low population immunity. For much of the pandemic, some combination of masking, distancing, remote learning, and other tactics tamped down on the transmission of nearly all the respiratory viruses that normally come knocking during the colder months. This fall, though, as kids have flocked back into day cares and classrooms with almost no precautions in place, those microbes have made a catastrophic comeback. Rhinovirus and enterovirus were two of the first to overrun hospitals late this summer; now they’re being joined by RSV, all while SARS-CoV-2 remains in play. Also on the horizon is flu, which has begun to pick up in the South and the mid-Atlantic, triggering school closures or switches to remote learning. During the summer of 2021, when Delta swept across the nation, “we thought that was busy,” Woodward said. “We were wrong.”
Children, on the whole, are more susceptible to these microbes than they have been in years. Infants already have a rough time with viruses like RSV: The virus infiltrates the airways, causing them to swell and flood with mucus that their tiny lungs may struggle to expel. “It’s almost like breathing through a straw,” says Marietta Vazquez, a pediatric-infectious-disease specialist at Yale. The more narrow and clogged the tubes get, “the less room you have to move air in and out.” Immunity accumulated from prior exposures can blunt that severity. But with the pandemic’s great viral vanishing, kids missed out on early encounters that would have trained up their bodies’ defensive cavalry. Hospitals are now caring for their usual RSV cohort—infants—as well as toddlers, many of whom are sicker than expected. Infections that might, in other years, have produced a trifling cold are progressing to pneumonia severe enough to require respiratory support. “The kids are just not handling it well,” says Stacy Williams, a PICU nurse at UVA Health.
Coinfections, too, have always posed a threat—but they’ve grown more common with SARS-CoV-2 in the mix. “There’s just one more virus they’re susceptible to,” Vazquez told me. Each additional bug can burden a child “with a bigger hill to climb, in terms of recovery,” says Shelby Lighton, a nurse at UVA Health. Some patients are leaving the hospital healthy, only to come right back. There are kids who “have had four respiratory viral illnesses since the start of September,” Woodward told me.
Pediatric care capacity in many parts of the country actually shrank after COVID hit, Sallie Permar, a pediatrician at NewYork-Presbyterian and Weill Cornell Medicine, whose hospital was among those that cut beds from its PICU, told me. A mass exodus of health-care workers—nurses in particular—has also left the system ill-equipped to meet the fresh wave of demand. At UVA Health, the pediatric ICU is operating with maybe two-thirds of the core staff it needs, Williams said. Many hospitals have been trying to call in reinforcements from inside and outside their institutions. But “you can’t just train a bunch of people quickly to take care of a two-month-old,” Kudchadkar said. To make do, some hospitals are doubling up patients in rooms; others have diverted parts of other care units to pediatrics, or are sending specialists across buildings to stabilize children who can’t get a bed in the ICU. In Baton Rouge, Woodward is regularly visiting the patients who have just been admitted to the hospital and are still being held in the emergency department, trying to figure out who’s healthy enough to go home so more space can be cleared. His emergency department used to take in, on average, about 130 patients a day; lately, that number has been closer to 250. “They can’t stay,” he told me. “We need this room for somebody else.”
Experts are also grappling with how to strike the right balance between raising awareness among caregivers and managing fears that may morph into overconcern. On the one hand, with all the talk of SARS-CoV-2 being “mild” in kids, some parents might ignore the signs of RSV, which can initially resemble those of COVID, then get much more serious, says Ashley Joffrion, a respiratory therapist at Baton Rouge General Medical Center. On the other hand, if families swamp already overstretched hospitals with illnesses that are truly mild enough to resolve at home, the system could fracture even further. “We definitely don’t want parents bringing kids in for every cold,” Williams told me. The key signs of severe respiratory sickness in children include wheezing, grunting, rapid or labored breaths, trouble drinking or swallowing, and bluing of the lips or fingernails. When in doubt, experts told me, parents should call their pediatrician for an assist.
With winter still ahead, the situation could take an even darker turn, especially as flu rates climb, and new SARS-CoV-2 subvariants loom. In most years, the chilly viral churn doesn’t abate until late winter, which means hospitals may be only at the start of a grueling few months. And still-spotty uptake of COVID vaccines among little kids, coupled with a recent dip in flu-shot uptake and the widespread abandonment of infection-prevention measures, could make things even worse, says Abdallah Dalabih, a pediatric-intensive-care specialist at Arkansas Children’s.
The spike in respiratory illness marks a jarring departure from a comforting narrative that’s dominated the intersection of infectious disease and little children’s health for nearly three years. When it comes to respiratory viruses, little children have always been a vulnerable group. This fall may force Americans to reset their expectations around young people’s resilience and recall, Lighton told me, “just how bad a ‘common cold’ can get.”
Katherine J. Wu
Source link -
Is It Flu, RSV or COVID? Experts Fear the ‘Tripledemic’
Oct. 25, 2022 – Just when we thought this holiday season, finally, would be the back-to-normal one, some infectious disease experts are warning that a so-called tripledemic – influenza, COVID-19, and RSV – may be in the forecast.
The warning isn’t without basis.
- The flu season has gotten an early start. As of Oct. 21, early increases in seasonal flu activity have been reported in most of the country, the CDC says, with the southeast and south-central areas having the highest activity levels.
- Children’s hospitals and emergency departments are seeing a surge in children with RSV.
- COVID-19 cases are trending down, according to the CDC, but epidemiologists – scientists who study disease outbreaks – always have their eyes on emerging variants.
Predicting exactly when cases will peak is difficult, says Justin Lessler, PhD, a professor of epidemiology at the University of North Carolina at Chapel Hill. Lessler is on the coordinating team for the COVID-19 Scenario Modeling Hub, which aims to predict the course COVID-19, and the Flu Scenario Modeling Hub, which does the same for influenza.
For COVID-19, some models are predicting some spikes before Christmas, he says, and others see a new wave in 2023. For the flu, the model is predicting an earlier-than-usual start, as the CDC has reported.
While flu activity is relatively low, the CDC says, the season is off to an early start. For the week ending Oct. 21, 1,674 patients were hospitalized for flu, higher than in the summer months but fewer than the 2,675 hospitalizations for the week of May 15, 2022.
As of Oct. 20, COVID-19 cases have declined 12% over the last 2 weeks, nationwide. But hospitalizations are up 10% in much of the Northeast, The New York Times reports, and the improvement in cases and deaths has been slowing down.
As of Oct. 15, 15% of RSV tests reported nationwide were positive, compared with about 11% at that time in 2021, the CDC says. The surveillance collects information from 75 counties in 12 states.
Experts point out that the viruses — all three are respiratory viruses — are simply playing catchup.
“They spread the same way and along with lots of other viruses, and you tend to see an increase in them during the cold months,” says Timothy Brewer, MD, professor of medicine and epidemiology at UCLA.
The increase in all three viruses “is almost predictable at this point in the pandemic,” says Dean Blumberg, MD, a professor and chief of pediatric infectious diseases at the University of California Davis Health. “All the respiratory viruses are out of whack.”
Last year, RSV cases were up, too, and began to appear very early, he says, in the summer instead of in the cooler months. Flu also appeared early in 2021, as it has this year.
That contrasts with the flu season of 2020-2021, when COVID precautions were nearly universal, and cases were down. At UC Davis, “we didn’t have one pediatric admission due to influenza in the 2020-2021 [flu] season,” Blumberg says.
The number of pediatric flu deaths usually range from 37 to 199 per year, according to CDC records. But in the 2020-2021 season, the CDC recorded one pediatric flu death in the U.S.
Both children and adults have had less contact with others the past 2 seasons, Blumberg says, “and they don’t get the immunity they got with those infections [previously]. That’s why we are seeing out-of-season, early season [viruses].”
Eventually, he says, the cases of flu and RSV will return to previous levels. “It could be as soon as next year,” Blumberg says. And COVID-19, hopefully, will become like influenza, he says.
“RSV has always come around in the fall and winter,” says Elizabeth Murray, DO, a pediatric emergency medicine doctor at the University of Rochester Medical Center and a spokesperson for the American Academy of Pediatrics. This year, children are back in school and for the most part not masking, she says. “It’s a perfect storm for all the germs to spread now. They’ve just been waiting for their opportunity to come back.”
Self-Care vs. Not
RSV can pose a risk for anyone, but most at risk are children under age 5, especially infants under age 1, and adults over age 65. There is no vaccine for it. Symptoms include a runny nose, decreased appetite, coughing, sneezing, fever, and wheezing. But in young infants, there may only be decreased activity, crankiness, and breathing issues, the CDC says.
Keep an eye on the breathing if RSV is suspected, Murray tells parents. If your child can’t breathe easily, is unable to lie down comfortably, can’t speak clearly, or is sucking in the chest muscles to breathe, get medical help. Most kids with RSV can stay home and recover, she says, but often will need to be checked by a medical professional.
She advises against getting an oximeter to measure oxygen levels for home use. “They are often not accurate,” she says. If in doubt about how serious your child’s symptoms are, “don’t wait it out,” she says, and don’t hesitate to call 911.
Symptoms of flu, COVID, and RSV can overlap. But each can involve breathing problems, which can be an emergency.
“It’s important to seek medical attention for any concerning symptoms, but especially severe shortness of breath or difficulty breathing, as these could signal the need for supplemental oxygen or other emergency interventions,” says Mandy De Vries, a respiratory therapist and director of education at the American Association for Respiratory Care. Inhalation treatment or mechanical ventilation may be needed for severe respiratory issues.
Precautions
To avoid the tripledemic – or any single infection – Timothy Brewer, MD, a professor of medicine and epidemiology at UCLA, suggests some familiar measures: “Stay home if you’re feeling sick. Make sure you are up to date on your vaccinations. Wear a mask indoors.”
-
Bird flu case prompts Omaha zoo to close several exhibits
OMAHA, Neb. (AP) — Omaha’s Henry Doorly Zoo & Aquarium has closed several exhibits and taken other precautions after one of its pelicans died from the bird flu.
The zoo said one of its pink-backed pelicans that died on Thursday tested positive for the highly pathogenic avian influenza. A second pelican became ill Friday and was euthanized.
As a precaution, the zoo has closed its Lied Jungle, Desert Dome and Simmons Aviary exhibits to the public for at least 10 days.
The Omaha zoo was one of many across the country that closed down its aviaries and moved birds inside whenever possible to help protect them from avian influenza that is primarily spread by the droppings of wild birds.
The zoo reopened its aviary in June after bird flu cases waned, but some cases continued to be reported across the country throughout the summer, and the outbreak has started to make a resurgence this fall.
More than 47 million chickens and turkeys have been slaughtered in 42 states to limit the spread of bird flu during this year’s outbreak. Officials order entire flocks to be killed when the virus is found on farms. More than 6 million chickens and turkeys were slaughtered last month to limit the spread of the disease.
The Omaha zoo also took precautions to protect its birds by limiting staff access to them and requiring workers to clean their shoes before entering areas where the birds are kept.
The zoo said its pelicans live outside, so they do come into contact with wild birds. But the pelicans don’t come into contact with other zoo birds and no other birds in the zoo’s collection have shown symptoms of bird flu.
“It is very important that Omaha’s Henry Doorly Zoo and Aquarium immediately tighten our protocols to protect our birds and guard against any potential spread of avian influenza,” Sarah Woodhouse, the zoo’s director of animal health, said in a statement. “This is important both to prevent infection of other zoo birds, and to prevent the virus from being dispersed off zoo grounds.”
Unlike on farms, zoos are generally allowed to isolate and treat an infected bird as long as they take precautions to protect the other birds in their collections.
Health officials emphasize that bird flu doesn’t jeopardize food safety because infected birds aren’t allowed into the food supply and properly cooking meat and eggs to 165 degrees Fahrenheit will kill any viruses.
-
Bird flu case prompts Omaha zoo to close several exhibits
OMAHA, Neb. — Omaha’s Henry Doorly Zoo & Aquarium has closed several exhibits and taken other precautions after one of its pelicans died from the bird flu.
The zoo said one of its pink-backed pelicans that died on Thursday tested positive for the highly pathogenic avian influenza. A second pelican became ill Friday and was euthanized.
As a precaution, the zoo has closed its Lied Jungle, Desert Dome and Simmons Aviary exhibits to the public for at least 10 days.
The Omaha zoo was one of many across the country that closed down its aviaries and moved birds inside whenever possible to help protect them from avian influenza that is primarily spread by the droppings of wild birds.
The zoo reopened its aviary in June after bird flu cases waned, but some cases continued to be reported across the country throughout the summer, and the outbreak has started to make a resurgence this fall.
More than 47 million chickens and turkeys have been slaughtered in 42 states to limit the spread of bird flu during this year’s outbreak. Officials order entire flocks to be killed when the virus is found on farms. More than 6 million chickens and turkeys were slaughtered last month to limit the spread of the disease.
The Omaha zoo also took precautions to protect its birds by limiting staff access to them and requiring workers to clean their shoes before entering areas where the birds are kept.
The zoo said its pelicans live outside, so they do come into contact with wild birds. But the pelicans don’t come into contact with other zoo birds and no other birds in the zoo’s collection have shown symptoms of bird flu.
“It is very important that Omaha’s Henry Doorly Zoo and Aquarium immediately tighten our protocols to protect our birds and guard against any potential spread of avian influenza,” Sarah Woodhouse, the zoo’s director of animal health, said in a statement. “This is important both to prevent infection of other zoo birds, and to prevent the virus from being dispersed off zoo grounds.”
Unlike on farms, zoos are generally allowed to isolate and treat an infected bird as long as they take precautions to protect the other birds in their collections.
Health officials emphasize that bird flu doesn’t jeopardize food safety because infected birds aren’t allowed into the food supply and properly cooking meat and eggs to 165 degrees Fahrenheit will kill any viruses.
-
Teach Your Kids to Stop the Spread of Viruses
Teach Your Kids to Avoid Colds
091e9c5e820faac4091e9c5e820faac4FED-Footermodule_FED-Footer_091e9c5e820faac4.xmlwbmd_pb_templatemodule0144002/02/2021 01:57:340HTML
-
Teach Your Kids to Stop the Spread of Viruses
Teach Your Kids to Avoid Colds
091e9c5e820faac4091e9c5e820faac4FED-Footermodule_FED-Footer_091e9c5e820faac4.xmlwbmd_pb_templatemodule0144002/02/2021 01:57:340HTML
-
Death of Son Reinforces Flu Vaccination Message
Oct. 4, 2022 – Brent called his dad, Jeb Teichman, MD, in November 2019 saying he had felt sick for the past 3 days. The otherwise healthy 29-year-old had a cough, sore throat, and was running a fever.
“It was what the CDC would call classic influenza-like illness,” Jeb Teichman said. “It was too late to start antivirals, so I gave him advice on symptomatic treatment. We texted the next day, and I was glad to hear that his fever was trending down and that he was feeling a little bit better.”
Two days later, his son called again.
“He said he was having trouble breathing, and over the phone I could hear him hyperventilating.” The retired pediatrician and health care executive told his son to seek medical care.
“Then I got the call that no parent wants to get.”
Brent’s cousin Jake called saying he couldn’t wake Brent up.
“I called Jake back a few minutes later and asked him to hold up the phone,” Teichman said. “I listened to EMS working on my son, calling for round after round of many medications. He was in arrest and they couldn’t revive him.”
“To this day when I close my eyes at night, I still hear the beeping of those monitors.”
Brent had no health conditions to put him at higher risk for complications of the flu. “Brent was a wonderful son, brother, uncle, and friend. He had a passion for everything he did, and that included his chosen calling of the culinary arts but also included University of Kentucky sports,” Teichman says.
Brent planned to get a flu vaccine but had not done it yet. “In his obituary, we requested that in lieu of flowers or donations, people go get their flu shot,” his father said.
“I’m here today to put a face on influenza,” Teichman said at a news briefing Tuesday on preventing the flu and pneumococcal disease, sponsored by the National Foundation for Infectious Diseases (NFID).
New Survey Numbers ‘Alarming’
The NFID commissioned a national survey of more than 1,000 U.S. adults to better understand their knowledge and attitudes about the flu, pneumococcal disease, vaccines, and the impact of COVID-19.
“We were alarmed to learn that only 49% of U.S. adults plan to get their flu vaccine this season,” said Patricia A. “Patsy” Stinchfield, a registered nurse, NFID president, and moderator of the news briefing. “That is not good enough.”
In addition, 22% of people at higher risk for flu-related complications do not plan to get vaccinated this season. “That’s a dangerous risk to take,” Stinchfield said.
An encouraging finding, she said, is that 69% of adults surveyed recognize that an annual flu vaccination is the best way to prevent flu-related hospitalizations and death.
“So, most people know what to do. We just need to do it,” she said.
The top reason for not getting a flu shot this year, mentioned by 41% of people surveyed, is they do not think vaccines work very well. Another 39% are concerned about vaccine side effects, and 28% skip the vaccine because they “never get the flu.”
The experts on the panel emphasized the recommendation that all Americans 6 months or older get the flu vaccine, preferably by the end of October. Vaccination is especially important for those at higher risk of complications from the flu, including children under 5, pregnant women, people with one or more health conditions, the immunocompromised, and Americans 65 years and older.
Stinchfield acknowledges that the effectiveness of the flu vaccine varies season to season, but even if the vaccine does not completely match the circulating viruses, it can help prevent serious outcomes like hospitalization and death. One of the serious potential complications is pneumonia or “pneumococcal disease.”
“Our survey shows that only 29% of those at risk have been advised to receive a pneumococcal vaccine,” Stinchfield says.
“The good news is that among those who were advised to get the vaccine, 74% did receive their pneumococcal vaccine,” she said. “This underscores a key point to you, my fellow clinicians: As health professionals, our recommendations matter.”
Higher Doses for 65+ Americans
The CDC updated recommendations this flu season for adults 65 and older to receive one of three preferentially recommended flu vaccines, said CDC Director Rochelle Walensky, MD. The CDC is recommending higher-dose, stronger vaccines for older Americans “based on a review of the available studies, which suggested that in this age group, these vaccines are potentially more effective than standard-dose … vaccines.”
During most seasons, people 65 and older bear the greatest burden of severe flu disease, accounting for most flu-related hospitalizations and deaths.
“They are the largest vulnerable segment of our society,” Walensky said.
What Will This Flu Season Be Like?
Health officials in the flu vaccine business also tend to be in the flu season prediction business. That includes Walensky.
“While we will never exactly know what each flu season will hold, we do know that every year, the best way you can protect yourself and those around you is to get your annual flu vaccine,” she said while taking part remotely in the briefing.
How severe will the flu season be this year? William Schaffner, MD, said he gets that question a lot. “Don’t think about that. Just focus on the fact that flu will be with us each year.”
“We were a little bit spoiled. We’ve had two mild influenza seasons,” said Schaffner, medical director of NFID and a professor of infectious diseases and preventive medicine at Vanderbilt University. “I think with all the interest in COVID, people have rather forgotten about influenza. I’ve had to remind them that this is yet another serious winter respiratory virus.”
“As I like to say, flu is fickle. It’s difficult to predict how serious this next outbreak of influenza this season is going to be. We could look at what happened in the Southern Hemisphere,” he said.
For example, Australia had the worst influenza season in the past 5 years, Schaffner said. “If you want a hint of what might happen here and you want yet another reason to be vaccinated, there it is.”
What we do know, Walensky said, is that the timing and severity of the past two flu seasons in the U.S. have been different than typical flu seasons. “And this is likely due to the COVID mitigation measures and other changes in circulating respiratory viruses.” Also, although last flu season was “relatively mild,” there was more flu activity than in the prior, 2020-21 season.
Also, Walensky said, last season’s flu cases began to increase in November and remained elevated until mid-June, “making it the latest season on record.”
The official cause of Brent Teichman’s death was multilobar pneumonia, cause undetermined. “But after 30-plus years as a pediatrician … I know influenza when I see it,” his dad said.
“There’s a hole in our hearts that will never heal. Loss of a child is devastating,” he said. The flu “can take the life of a healthy young person, as it did to my son.”
“And for all those listening to my story who are vaccine hesitant, do it for those who love you. So that they won’t walk the path that we and many other families in this country have walked.”
To prove their point, Teichman and Stinchfield raised their sleeves Tuesday and received flu shots during the news briefing.
“This one is for Brent,” Teichman said.
-
It’s flu vaccine time and seniors need revved-up shots
Doctors have a message for vaccine-weary Americans: Don’t skip your flu shot this fall — and seniors, ask for a special extra-strength kind.
After flu hit historically low levels during the COVID-19 pandemic, it may be poised for a comeback. The main clue: A nasty flu season just ended in Australia.
While there’s no way to predict if the U.S. will be as hard-hit, “last year we were going into flu season not knowing if flu was around or not. This year we know flu is back,” said influenza specialist Richard Webby of St. Jude Children’s Research Hospital in Memphis.
Annual flu shots are recommended starting with 6-month-old babies. Flu is most dangerous for people 65 and older, young children, pregnant women and people with certain health problems including heart and lung diseases.
Here’s what to know:
REVVED-UP SHOTS FOR SENIORS
As people get older, their immune system doesn’t respond as strongly to standard flu vaccination. This year, people 65 or older are urged to get a special kind for extra protection.
There are three choices. Fluzone High-Dose and Flublok each contain higher doses of the main anti-flu ingredient. The other option is Fluad Adjuvanted, which has a regular dosage but contains a special ingredient that helps boost people’s immune response.
Seniors can ask what kind their doctor carries. But most flu vaccinations are given in pharmacies and some drugstore websites, such as CVS, automatically direct people to locations offering senior doses if their birth date shows they qualify.
Webby advised making sure older relatives and friends know about the senior shots, in case they’re not told when they seek vaccination.
“They should at least ask, ‘Do you have the shots that are better for me?’” Webby said. “The bottom line is they do work better” for this age group.
If a location is out of senior-targeted doses, it’s better to get a standard flu shot than to skip vaccination, according to the Centers for Disease Control and Prevention.
All flu vaccines in the U.S. — including types for people younger than 65 — are “quadrivalent,” meaning they guard against four different flu strains. Younger people have choices, too, including shots for those with egg allergies and a nasal spray version called FluMist.
WHY FLU EXPERTS ARE ON ALERT
Australia just experienced its worst flu season in five years and what happens in Southern Hemisphere winters often foreshadows what Northern countries can expect, said Dr. Andrew Pekosz of the Johns Hopkins Bloomberg School of Public Health.
And people have largely abandoned masking and distancing precautions that earlier in the pandemic also helped prevent the spread of other respiratory bugs like the flu.
“This poses a risk especially to young children who may not have had much if any previous exposure to influenza viruses prior to this season,” Pekosz added.
“This year we will have a true influenza season like we saw before the pandemic,” said Dr. Jason Newland, a pediatric infectious disease specialist at Washington University in St. Louis.
He said children’s hospitals already are seeing an unusual early spike in other respiratory infections including RSV, or respiratory syncytial virus, and worries flu likewise will strike earlier than usual — like it did in Australia.
The CDC advises a flu vaccine by the end of October but says they can be given any time during flu season. It takes about two weeks for protection to set in.
The U.S. expects 173 million to 183 million doses this year. And yes, you can get a flu shot and an updated COVID-19 booster at the same time — one in each arm to lessen soreness.
FLU SHOTS OF THE FUTURE
The companies that make the two most widely used COVID-19 vaccines now are testing flu shots made with the same technology. One reason: When influenza mutates, the recipes of so-called mRNA vaccines could be updated more quickly than today’s flu shots, most of which are made by growing influenza virus in chicken eggs.
Pfizer and its partner BioNTech are recruiting 25,000 healthy U.S. adults to receive either its experimental influenza shot or a regular kind, to see how effective the new approach proves this flu season.
Rival Moderna tested its version in about 6,000 people in Australia, Argentina and other countries during the Southern Hemisphere’s flu season and is awaiting results.
___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
-
COVID Attacks DNA in Heart, Unlike Flu, Study Says
Sept. 30, 2022 — COVID-19 causes DNA damage to the heart, affecting the body in a completely different way than the flu does, according to a recent study published in Immunology
The study looked at the hearts of patients who died from COVID-19, the flu, and other causes. The findings could provide clues about why coronavirus has led to complications such as ongoing heart issues.
“We found a lot of DNA damage that was unique to the COVID-19 patients, which wasn’t present in the flu patients,” Arutha Kulasinghe, one of the lead study authors and a research fellow at the University of Queensland in Australia, told the Brisbane Times.
“So in this study, COVID-19 and flu look very different in the way they affect the heart,” he said.
Kulasinghe and colleagues analyzed the hearts of seven COVID-19 patients, two flu patients, and six patients who died from other causes. They used transcriptomic profiling, which looks at the DNA landscape of an organ, to investigate heart tissue from the patients.
Due to previous studies about heart problems associated with COVID-19, he and colleagues expected to find extreme inflammation in the heart. Instead, they found that inflammation signals had been suppressed in the heart, and markers for DNA damage and repair were much higher. They’re still unsure of the underlying cause.
“The indications here are that there’s DNA damage here, it’s not inflammation,” Kulasinghe said. “There’s something else going on that we need to figure out.”
The damage was similar to the way chronic diseases such as diabetes and cancer appear in the heart, he said, with heart tissue showing DNA damage signals.
Kulasinghe said he hopes other studies can build on the findings to develop risk models to understand which patients may face a higher risk of serious COVID-19 complications. In turn, this could help doctors provide early treatment. For instance, all seven COVID-19 patients had other chronic diseases, such as diabetes, hypertension, and heart disease.
“Ideally in the future, if you have cardiovascular disease, if you’re obese or have other complications, and you’ve got a signature in your blood that indicates you are at risk of severe disease, then we can risk-stratify patients when they are diagnosed,” he said.
The research is a preliminary step, Kulasinghe said, due to the small sample size. This type of study is often difficult to conduct because researchers have to wait for the availability of organs, as well as request permission from families for post-mortem autopsies and biopsies, to be able to look at the effects on dead tissues.
“Our challenge now is to draw a clinical finding from this, which we can’t at this stage,” he added. “But it’s a really fundamental biological difference we’re observing [between COVID-19 and flu], which we need to validate with larger studies.”
-
The ‘End’ of COVID Is Still Far Worse Than We Imagined
When is the pandemic “over”? In the early days of 2020, we envisioned it ending with the novel coronavirus going away entirely. When this became impossible, we hoped instead for elimination: If enough people got vaccinated, herd immunity might largely stop the virus from spreading. When this too became impossible, we accepted that the virus would still circulate but imagined that it could become, optimistically, like one of the four coronaviruses that cause common colds or, pessimistically, like something more severe, akin to the flu.
Instead, COVID has settled into something far worse than the flu. When President Joe Biden declared this week, “The pandemic is over. If you notice, no one’s wearing masks,” the country was still recording more than 400 COVID deaths a day—more than triple the average number from flu.
This shifting of goal posts is, in part, a reckoning with the biological reality of COVID. The virus that came out of Wuhan, China, in 2019 was already so good at spreading—including from people without symptoms—that eradication probably never stood a chance once COVID took off internationally. “I don’t think that was ever really practically possible,” says Stephen Morse, an epidemiologist at Columbia. In time, it also became clear that immunity to COVID is simply not durable enough for elimination through herd immunity. The virus evolves too rapidly, and our own immunity to COVID infection fades too quickly—as it does with other respiratory viruses—even as immunity against severe disease tends to persist. (The elderly who mount weaker immune responses remain the most vulnerable: 88 percent of COVID deaths so far in September have been in people over 65.) With a public weary of pandemic measures and a government reluctant to push them, the situation seems unlikely to improve anytime soon. Trevor Bedford, a virologist at the Fred Hutchinson Cancer Center, estimates that COVID will continue to exact a death toll of 100,000 Americans a year in the near future. This too is approximately three times that of a typical flu year.
I keep returning to the flu because, back in early 2021, with vaccine excitement still fresh in the air, several experts told my colleague Alexis Madrigal that a reasonable threshold for lifting COVID restrictions was 100 deaths a day, roughly on par with flu. We largely tolerate, the thinking went, the risk of flu without major disruptions to our lives. Since then, widespread immunity, better treatments, and the less virulent Omicron variant have together pushed the risk of COVID to individuals down to a flu-like level. But across the whole population, COVID is still killing many times more people than influenza is, because it is still sickening so many more people.
Bedford told me he estimates that Omicron has infected 80 percent of Americans. Going forward, COVID might continue to infect 50 percent of the population every year, even without another Omicron-like leap in evolution. In contrast, flu sickens an estimated 10 to 20 percent of Americans a year. These are estimates, because lack of testing hampers accurate case counts for both diseases, but COVID’s higher death toll is a function of higher transmission. The tens of thousands of recorded cases—likely hundreds of thousands of actual cases every day—also add to the burden of long COVID.
The challenge of driving down COVID transmission has also become clearer with time. In early 2021, the initially spectacular vaccine-efficacy data bolstered optimism that vaccination could significantly dampen transmission. Breakthrough cases were downplayed as very rare. And they were—at first. But immunity to infection is not durable against common respiratory viruses. Flu, the four common-cold coronaviruses, respiratory syncytial virus (RSV), and others all reinfect us over and over again. The same proved true with COVID. “Right at the beginning, we should have made that very clear. When you saw 95 percent against mild disease, with the trials done in December 2020, we should have said right then this is not going to last,” says Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia. Even vaccinating the whole world would not eliminate COVID transmission.
This coronavirus has also proved a wilier opponent than expected. Despite a relatively slow rate of mutation at the beginning of the pandemic, it soon evolved into variants that are more inherently contagious and better at evading immunity. With each major wave, “the virus has only gotten more transmissible,” says Ruth Karron, a vaccine researcher at Johns Hopkins. The coronavirus cannot keep becoming more transmissible forever, but it can keep changing to evade our immunity essentially forever. Its rate of evolution is much higher than that of other common-cold coronaviruses. It’s higher than that of even H3N2 flu—the most troublesome and fastest-evolving of the influenza viruses. Omicron, according to Bedford, is the equivalent of five years of H3N2 evolution, and its subvariants are still outpacing H3N2’s usual rate. We don’t know how often Omicron-like events will happen. COVID’s rate of change may eventually slow down when the virus is no longer novel in humans, or it may surprise us again.
In the past, flu pandemics “ended” after the virus swept through so much of the population that it could no longer cause huge waves. But the pandemic virus did not disappear; it became the new seasonal-flu virus. The 1968 H3N2 pandemic, for example, seeded the H3N2 flu that still sickens people today. “I suspect it’s probably caused even more morbidity and mortality in all those years since 1968,” Morse says. The pandemic ended, but the virus continued killing people.
Ironically, H3N2 did go away during the coronavirus pandemic. Measures such as social distancing and masking managed to almost entirely eliminate the flu. (It has not disappeared entirely, though, and may be back in full force this winter.) Cases of other respiratory viruses, such as RSV, also plummeted. Experts hoped that this would show Americans a new normal, where we don’t simply tolerate the flu and other respiratory illnesses every winter. Instead, the country is moving toward a new normal where COVID is also something we tolerate every year.
In the same breath that President Biden said, “The pandemic is over,” he went on to say, “We still have a problem with COVID. We’re still doing a lot of work on it.” You might see this as a contradiction, or you might see it as how we deal with every other disease—an attempt at normalizing COVID, if you will. The government doesn’t treat flu, cancer, heart disease, tuberculosis, hepatitis C, etc., as national emergencies that disrupt everyday life, even as the work continues on preventing and treating them. The U.S.’s COVID strategy certainly seems to be going in that direction. Broad restrictions such as mask mandates are out of the question. Interventions targeted at those most vulnerable to severe disease exist, but they aren’t getting much fanfare. This fall’s COVID-booster campaign has been muted. Treatments such as bebtelovimab and Evusheld remain on shelves, underpublicized and underused.
At the same time, hundreds of Americans are still dying of COVID every day and will likely continue to die of COVID every day. A cumulative annual toll of 100,000 deaths a year would still make COVID a top-10 cause of death, ahead of any other infectious disease. When the first 100,000 Americans died of COVID, in spring 2020, newspapers memorialized the grim milestone. The New York Times devoted its entire front page to chronicling the lives lost to COVID. It might have been hard to imagine, back in 2020, that the U.S. would come to accept 100,000 people dying of COVID every year. Whether or not that means the pandemic is over, the second part of the president’s statement is harder to argue with: COVID is and will remain a problem.
Sarah Zhang
Source link -
The Strongest Signal That Americans Should Worry About Flu This Winter
Sometime in the spring of 2020, after centuries, perhaps millennia, of tumultuous coexistence with humans, influenza abruptly went dark. Around the globe, documented cases of the viral infection completely cratered as the world tried to counteract SARS-CoV-2. This time last year, American experts began to fret that the flu’s unprecedented sabbatical was too bizarre to last: Perhaps the group of viruses that cause the disease would be poised for an epic comeback, slamming us with “a little more punch” than usual, Richard Webby, an influenza expert at St. Jude Children’s Research Hospital, in Tennessee, told me at the time.
But those fears did not not come to pass. Flu’s winter 2021 season in the Southern Hemisphere was once again eerily silent; in the north, cases sneaked up in December—only to peter out before a lackluster reprise in the spring.
Now, as the weather once again chills in this hemisphere and the winter holidays loom, experts are nervously looking ahead. After skipping two seasons in the Southern Hemisphere, flu spent 2022 hopping across the planet’s lower half with more fervor than it’s had since the COVID crisis began. And of the three years of the pandemic that have played out so far, this one is previewing the strongest signs yet of a rough flu season ahead.
It’s still very possible that the flu will fizzle into mildness for the third year in a row, making experts’ gloomier suspicions welcomingly wrong. Then again, this year is, virologically, nothing like the last. Australia recently wrapped an unusually early and “very significant” season with flu viruses, says Kanta Subbarao, the director of the WHO Collaborating Centre for Reference and Research on Influenza at the Doherty Institute. By sheer confirmed case counts, this season was one of the country’s worst in several years. In South Africa, “it’s been a very typical flu season” by pre-pandemic standards, which is still enough to be of note, according to Cheryl Cohen, a co-head of the country’s Centre for Respiratory Disease and Meningitis at the National Institute for Communicable Diseases. After a long, long hiatus, Subbarao told me, flu in the Southern Hemisphere “is certainly back.”
That does not bode terribly well for those of us up north. The same viruses that seed outbreaks in the south tend to be the ones that sprout epidemics here as the seasons do their annual flip. “I take the south as an indicator,” says Seema Lakdawala, a flu-transmission expert at Emory University. And should flu return here, too, with a vengeance, it will collide with a population that hasn’t seen its likes in years, and is already trying to marshal responses to several dangerous pathogens at once.
The worst-case scenario won’t necessarily pan out. What goes on below the equator is never a perfect predictor for what will occur above it: Even during peacetime, “we’re pretty bad in terms of predicting what a flu season is going to look like,” Webby, of St. Jude, told me. COVID, and the world’s responses to it, have put experts’ few forecasting tools further on the fritz. But the south’s experiences can still be telling. In South Africa and Australia, for instance, many COVID-mitigation measures, such as universal masking recommendations and post-travel quarantines, lifted as winter arrived, allowing a glut of respiratory viruses to percolate through the population. The flu flood also began after two essentially flu-less years—which is a good thing at face value, but also represents many months of missed opportunities to refresh people’s anti-flu defenses, leaving them more vulnerable at the season’s start.
Some of the same factors are working against those of us north of the equator, perhaps to an even greater degree. Here, too, the population is starting at a lower defensive baseline against flu—especially young children, many of whom have never tussled with the viruses. It’s “very, very likely” that kids may end up disproportionately hit, Webby said, as they appear to have been in Australia—though Subbarao notes that this trend may have been driven by more cautious behaviors among older populations, skewing illness younger.
Interest in inoculations has also dropped during the pandemic: After more than a year of calls for booster after booster, “people have a lot of fatigue,” says Helen Chu, a physician and flu expert at the University of Washington, and that exhaustion may be driving already low interest in flu shots even further down. (During good years, flu-shot uptake in the U.S. peaks around 50 percent.) And the few protections against viruses that were still in place last winter have now almost entirely vanished. In particular, schools—a fixture of flu transmission—have loosened up enormously since last year. There’s also just “much more flu around,” all over the global map, Webby said. With international travel back in full swing, the viruses will get that many more chances to hopscotch across borders and ignite an outbreak. And should such an epidemic emerge, with its health infrastructure already under strain from simultaneous outbreaks of COVID, monkeypox, and polio, America may not handle another addition well. “Overall,” Chu told me, “we are not well prepared.”
At the same time, though, countries around the world have taken such different approaches to COVID mitigation that the pandemic may have further uncoupled their flu-season fate. Australia’s experience with the flu, for instance, started, peaked, and ended early this year; the new arrival of more relaxed travel policies likely played a role in the outbreak’s beginning, before a mid-year BA.5 surge potentially hastened the sudden drop. It’s also very unclear whether the U.S. may be better or worse off because its last flu season was wimpy, weirdly shaped, and unusually late. South Africa saw an atypical summer bump in flu activity as well; those infections may have left behind a fresh dusting of immunity and blunted the severity of the following season, Cohen told me. But it’s always hard to tell. “I was quite strong in saying that I really believed that South Africa was going to have a severe season,” she said. “And it seems that I was wrong.” The long summer tail of the Northern Hemisphere’s most recent flu season could also exacerbate the intensity of the coming winter season, says John McCauley, the director of the Worldwide Influenza Centre at the Francis Crick Institute, in London. Kept going in their off-season, the viruses may have an easier vantage point from which to reemerge this winter.
COVID’s crush has shifted flu dynamics on the whole as well. The pandemic “squeezed out” a lot of diversity from the influenza-virus population, Webby told me; some lineages may have even entirely blipped out. But others could also still be stewing and mutating, potentially in animals or unmonitored pockets of the world. That these strains—which harbor especially large pandemic potential—could emerge into the general population is “my bigger concern,” Lakdawala, of Emory, told me. And although the particular strains of flu that are circulating most avidly seem reasonably well matched to this year’s vaccines, the dominant strains that attack the north could yet shift, says Florian Krammer, a flu virologist at Mount Sinai’s Icahn School of Medicine. Viruses also tend to wobble and hop when they return from long vacations; it may take a season or two before the flu finds its usual rhythm.
Another epic SARS-CoV-2 variant could also quash a would-be influenza peak. Flu cases rose at the end of 2021, and the dreaded “twindemic” loomed. But then, Omicron hit—and flu “basically disappeared for one and a half months,” Krammer told me, only tiptoeing back onto the scene after COVID cases dropped. Some experts suspect that the immune system may have played a role in this tag-team act: Although co-infections or sequential infections of SARS-CoV-2 and flu viruses are possible, the aggressive spread of a new coronavirus variant may have set people’s defenses on high alert, making it that much harder for another pathogen to gain a foothold.
No matter the odds we enter flu season with, human behavior can still alter winter’s course. One of the main reasons that flu viruses have been so absent the past few years is because mitigation measures have kept them at bay. “People understand transmission more than they ever did before,” Lakdawala told me. Subbarao thinks COVID wisdom is what helped keep Australian flu deaths down, despite the gargantuan swell in cases: Older people took note of the actions that thwarted the coronavirus and applied those same lessons to flu. Perhaps populations across the Northern Hemisphere will act in similar ways. “I would hope that we’ve actually learned how to deal with infectious disease more seriously,” McCauley told me.
But Webby isn’t sure that he’s optimistic. “People have had enough hearing about viruses in general,” he told me. Flu, unfortunately, does not feel similarly about us.
Katherine J. Wu
Source link