Category: Health

Aug. 18, 2022 – Researchers are chasing a range of potential culprits in the race to find the causes of long COVID. Some things they agree on: There will be a number of different causes, and the symptoms will vary wildly from case to case.

The two leading theories: The persistence of the coronavirus that causes COVID-19, and an overactive immune response.

There’s evidence the SARS-CoV-2 virus – or at least pieces of it – can hide out and linger in the body, and it’s possible this is feeding an ongoing, over-the-top immune reaction.

Other viruses are known to do this. Epstein-Barr virus is seen as the cause of most cases of multiple sclerosis. Chronic fatigue syndrome, long a medical mystery, has also been linked to viral infections.

With a fired-up immune system meeting up with a lingering virus, the causes of long COVID promise to be as numerous as the range of symptoms it produces – 62, according to a recent U.K. study.

Long COVID is a syndrome – a cluster of symptoms that can be driven by different things in different people – says Michael VanElzakker, PhD, of the Division of Neurotherapeutics at Massachusetts General Brigham Hospital in Boston.

“So, it doesn’t have to be one cause, one symptom, one diagnosis, one treatment,” he says. “It’s a convergence of mechanisms that can drive subjective symptoms in different ways in different people.”

VanElzakker teamed up with microbiologist Amy Proal, PhD, to create the PolyBio Research Foundation in Washington state. It focuses on complex chronic inflammatory diseases like myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). They have been looking at long COVID, also.

Writing in June in the journal Frontiers in Microbiology, they say long COVID is often described as unusual or mysterious, but it shouldn’t be. It can take months or years for a person to clear the Ebola virus, for example. Other syndromes that may be sparked by viruses, like ME/CFS, have been connected to long-term health effects and produce symptoms matching long COVID.

VanElzakker thinks persistent virus plays a key role, but he says skeptics argue that tests that find pieces of genetic material known as RNA are just finding harmless remnants. Researchers are going to have to use multiple methods to show that actual leftover virus can be a cause, he says.

“Which is fair,” he says. “Bold claims require lots of evidence.”

While a patient may test negative for COVID, those bits of virus may be lurking in other organs or systems. At the same time, they may also cause your immune system to signal a false alarm response. Data suggests the immune system may be overresponding to residual virus.

Akiko Iwasaki, PhD, of the Department of Immunobiology at the Yale School of Medicine, and colleagues found evidence the immune systems of long COVID patients are reacting to something.

In a preprint study that has not yet been peer-reviewed, they reported they found evidence that COVID-19 infection had reactivated herpes viruses – Epstein-Barr virus and varicella-zoster virus, which causes chickenpox and shingles. These herpes viruses never leave the body, and Iwasaki’s team found evidence the immune systems of long COVID patients might be responding to these reactivated viruses.

They also found evidence of exhausted immune cells known as T cells, and found that the single most obvious difference in the blood of long COVID patients versus people who didn’t have long COVID was the level of the stress hormone cortisol.

Cortisol levels “alone were the most significant predictor for long COVID classification,” they wrote.

Attacking Lung Cells

At the University of North Carolina School of Medicine in Chapel Hill, researchers have been looking at the lungs of mice after they clear the virus to find out what is driving the disease.

A team including Richard Boucher, MD, director of UNC’s Marsico Lung Institute, looked at mice between 15 and 120 days after the virus had cleared and found it had infected cells deep in the lung. These cells have two key roles: they lubricate lungs and exchange oxygen for carbon dioxide.

“So, you get a double hit early on,” he says. “You don’t have enough of these cells, so they don’t produce the lubricant that you need. Your lungs can get stiff, and it gets very difficult to breathe.”

The immune system is then triggered to help clean up the viral infection. In the mice, it stayed activated for up to 4 months, their research found. “That’s probably the majority of what goes on in the lung with people post-COVID, and that will show up as shadows on a CT scan,” Boucher says.

But he and others suspect the immune response to COVID-19 can trigger processes similar to those seen in the early stages of pulmonary fibrosis, a progressive scarring of the lung.

“You have a lot of extra immune cells in the lung that shouldn’t have been there, and the immune cells began to put down fibrous tissue, or scar, because they couldn’t repair things,” Boucher says.

His team treated the mice with nintedanib, a relatively new drug for idiopathic pulmonary fibrosis, and it appears to help, Boucher says. The FDA approved the drug in 2020 to treat chronic fibrosing (scarring), one of the first treatments for the condition.

In earlier work, Iwasaki and colleagues, including epidemiologist Mady Hornig, MD, of Columbia University, also looked at unexplained post-infection syndromes.

“Certain acute infections have long been associated with an unexplained chronic disability in a minority of patients,” they write in Nature Medicine. “These post-acute infection syndromes represent a substantial health care burden, but there is a lack of understanding of the underlying mechanisms, representing a significant blind spot in the field of medicine.”

That may be changing with research into long COVID, Hornig says. “The pandemic is one of those turning points,” she says.

The sheer number of patients and the chance to monitor them will offer answers about these syndromes, she says. “We have at least some acknowledgment that there is the possibility of a range of disabling features that can affect a wide range of organ systems,” she says.

What remains unknown, Hornig says, is the degree to which specific pathogens create critical differences in the individual’s persistent symptoms.

For example, she believes that ME/CFS has multiple causes, and she has been investigating the things that may be at play. While about 75% of patients with ME/CFS report a triggering infection, the rest do not.

Another theory is that small blood clots – blood clots are a hallmark of severe COVID-19 infection – might be the root of some of the symptoms of long COVID.

VanElzakker from Mass General Brigham says research into that theory still needs to be repeated, but he would be surprised if the blood clots were not involved.

For now, at long COVID clinics nationwide, health care professionals are treating the symptoms without waiting for proof of a cause. Research into exactly what triggers the cascade of events offers the hope of new treatments. Studies are underway worldwide. The Biden administration pledged support for expanded research in April.

THURSDAY, Aug. 18, 2022 (HealthDay News) — Countries that are closer to achieving universal health coverage saw smaller declines in routine childhood vaccinations during the pandemic, a new study reveals.

The World Health Organization describes universal health coverage as “all individuals and communities receive the health services they need without suffering financial hardship.”

Researchers were able to use the pandemic as a “natural experiment” to compare differences in childhood immunization coverage based on countries’ progress toward universal health coverage.

“Our findings strongly suggest that policymakers should continue to advocate for policies aimed at achieving universal health coverage in coming years,” said the study authors, who included Yesim Tozan, an assistant professor at New York University’s School of Global Public Health.

“This study also sets the stage for future research in understanding the synergistic impact of investments in global health security and universal health coverage strategies on countries’ health system resilience,” they said.

The team used immunization data from WHO/UNICEF, which includes information on 195 countries and 14 childhood vaccines between 1997 and 2020.

The study also used the 2019 Universal Health Coverage (UHC) Service Coverage Index, a measure that represents level of coverage.

Countries who had a high UHC index were associated with a 2.7% smaller decline in childhood vaccination coverage during 2020 when compared to countries with a lower UHC index.

Before the pandemic, countries with a high UHC index had an average childhood immunization coverage rate of 92.7%. By comparison, those with a lower UHC index had a coverage rate of 86.2%.

In 2020, the coverage rate was 91.9% in high UHC countries, while it was 81.7% in countries with a lower UHC index.

The findings were published Aug. 16 in the journal PLOS Medicine .

“The COVID-19 pandemic has affected the delivery of essential health services across countries worldwide,” Tozan said in a journal news release. “This study provided the much-needed quantitative evidence of the protective effects of universal health coverage in times of public health crises.”

More information

The World Health Organization has more on universal health coverage.

Aug. 18, 2022 – Acknowledging the seriousness of the monkeypox outbreak in the United States, the White House announced today that 1.8 million more vaccine doses will be available to order by local and state jurisdictions that are running low on supply starting next week.

At the same time, U.S. officials will send 50,000 more courses of tecovirimat (TPOXX), the only treatment currently FDA-approved for monkeypox, nationwide.

“We’re focused on helping state and local partners turn these doses into vaccinations because more shots in arms is how we get the outbreak under control,” Robert Fenton, recently appointed White House monkeypox coordinator, said at a media briefing today.

More than 13,500 cases of monkeypox had been identified in 49 states as of Aug. 17, said CDC Director Rochelle Walensky, MD.

The Biden administration has also increased testing capacity from 6,000 tests per week to 80,000 tests per week, the White House said.

Pride and Protection?

Also, in a move to target people at highest risk, the CDC plans to partner with large LGBTQ+ events in the coming weeks and months to offer testing and vaccinations on-site. To date, 93% of reported monkeypox cases involve men who have sex with men, Walensky said.

“These events are important opportunities for people to connect with their community and to enjoy themselves,” she said. “They’re also a chance to provide public health messages and resources to individuals who might otherwise be hard to reach.”

Going where the people are, Fenton said, will boost local efforts and help slow the virus’s spread.

The White House has started working with health departments in North Carolina, Georgia, and Louisiana to prepare for upcoming LGBTQ+ gatherings. For example, the administration worked with North Carolina to develop a plan to offer vaccines during the Charlotte Pride Festival & Parade this coming weekend..

Officials also plan to work with the promoters of Southern Decadence in New Orleans and Atlanta Black Pride Weekend events, both scheduled for Labor Day weekend. These efforts are part of a U.S. Department of Health and Human Services pilot program that sets aside 50,000 more doses of vaccine from the Strategic National Stockpile that local officials can request along with the vaccines they already have.

Some follow-up will be required. “We recognize that there are going to be some people who have traveled to large-scale events – and that they’re going to have to receive dose one of their vaccine and then they will necessarily receive dose two at their local jurisdiction,” Walensky said.

Monkeypox a Moving Target

The situation with monkeypox is “fluid,” Walensky and other government officials acknowledged during the briefing. For example, an early recommendation to provide one dose of the Jynneos monkeypox vaccine (from drugmaker Bavarian Nordic) and delay the second is no longer advised.

“The one-dose delayed strategy was … very concerning because of the absence of data and the emergence of some data to suggest it might be a strategy that is not as effective as we would like it to be,” said Peter Marks, MD, PhD, director of the FDA Center for Biologics Evaluation and Research.

Instead, two doses are recommended 4 weeks apart. Also, maximum protection from the vaccine is expected 2 weeks after that second dose, Walensky said.

Ramping Up Treatment

The 50,000 courses of TPOXX to be sent across the country will be made available where the outbreak is most severe, Fenton said. “That is five times as many treatments as confirmed cases in the U.S.”

The government will determine how many doses of TPOXX a particular location gets based on a formula that considers the number of local cases and the number of people at high risk in that location, including people with HIV or other immunocompromising conditions, said Dawn O’Connell, assistant secretary for preparedness and response at Health and Human Services.

While announcing big numbers for more vaccines and TPOXX treatment doses across the country, the officials also emphasized the importance of working with local community leaders, organizations, and health departments.

Think Nationally, Act Locally

“We know we have to do more to mitigate the spread of this virus and to protect those at risk,” Health and Human Services Secretary Xavier Becerra said. “Our work with state and local partners could not be more critical than at this particular moment.”

In addition to reaching those at highest risk, the government is placing an emphasis on fairly providing education, testing, prevention, and treatment. The median age of people with monkeypox is 35. About 35% of cases occur in white people, 33% among Hispanic people, and nearly 28% occur in Black people, CDC data reveals.

“Many of the events we are focusing on … are really events that focus on populations that are overrepresented in this outbreak, including the trends that we are seeing among Black and Latino individuals,” said Demetre Daskalakis, MD, deputy coordinator of the White House monkeypox response and director of the CDC Division of HIV Prevention.

Going Forward

“Most Americans still are learning about monkeypox, what it is, and what it is not. CDC’s website can answer most of those questions,” Becerra said.

The sole maker of the Jynneos vaccine in Copenhagen, Denmark, has announced it is unlikely its production can keep up with demand. But U.S. officials are working with Bavarian Nordic to ramp up manufacturing by partnering with a vaccine maker in the U.S. Details are still being worked out.

Another possibility is for Bavarian Nordic to partner with a large U.S. pharmaceutical company to increase capacity, O’Connell said.

“On July 15, when we announced an order with Bavarian Nordic for an additional 2.5 million vials of Jynneos vaccine, we shared that those doses will be filled at a U.S.-based contract manufacturer,” she said.

Aug. 18, 2022 – Making eye contact and picking up on subtle nonverbal cues that show that someone is listening is nearly impossible on a crowded video conference call. It’s hard to know if others on the call are listening or engaged, especially if they have their video turned off. That lack of social connection contributes to what some call “Zoom fatigue.”

Now, a new study suggests that using hand signals to show feelings such as empathy or solidarity during video conference meetings could lessen that fatigue.

Researchers in London found that people in groups that used a series of hand gestures called Video Meeting Signals (VMS) during Zoom calls reported feeling closer to others in the group and more engaged in the calls, compared to those who didn’t use hand signals.

The study, published Aug. 3 in the journal PLOS One, could help address a common problem with video conferencing by helping people feel more connected to one another in a virtual meeting space, according to Paul Hills, a researcher at University College London and CEO of the management consulting company Konektis, which trains companies to use VMS.

“What most people just experience during these calls is boredom or frustration or thinking, ‘It’s just not worth it because no one is listening, and if they’re not going to listen to me, I’m not going to listen to them,'” says Hills, who co-authored the study.

As a longtime business management consultant, Hills had worked with dozens of companies to make meetings more efficient and productive.

“I’d always been amazed at how much time can be wasted in meetings, even before Zoom,” he says. “When Zoom came along, I just saw it get worse, and I was tearing my hair out. I realized when I was talking to other people, they were also tearing their hair out.”

Hills used hand signals for communication when he once worked as a lifeguard in Cornwall, England, and as a mentor for a group that provides support to at-risk young people.

“I just thought, there’s power in gestures here,” he says.

The VMS system created by Hills includes the gestures he already used, others commonly used in sports, and signs used in American Sign Language and British Sign Language.

Waving a hand over your head means you’d like to speak next. A double thumbs up means you agree. A hand over your heart is an expression of empathy and compassion. A hand massaging the top of your head tells others you have a question. A raised hand means you share the experience shared by another participant.

Information from companies Hills trained to use the VMS system suggested it was effective, but there was no clinical data to back that up. So he partnered with a team at University College London to do two trials to measure how well the system works.

More than 100 psychology undergraduate students in an online seminar at the university took part in the first trial. Students in the VMS group had a 45-minute training session on how to use the hand signals before the seminar began. The other group took part as usual.

Surveys done after two sessions showed much higher satisfaction with online interactions among those in the VMS group, compared to the other group. They reported feeling closer to their classmates, were more engaged, and thought they had learned more. They were also more likely than those in the other group to use positive language to describe the seminar.

These findings were confirmed in a second trial with 137 adults who were not students. In that study, one group received a much briefer training in VMS and a second group did a short training on how to use Zoom reaction emojis. A third group didn’t use either of the signals.

As in the first study, the VMS group felt more socially connected than the group with no training. They also had more positive scores than those in the emoji group, which a researcher says suggests the benefits come not just from reactions that convey emotion, but specifically from physical actions.

The responses mirrored what Hills had heard from some of the companies he’d worked with.

“From a manager’s perspective, I know that people are listening now and responding positively or negatively to what I am saying,” says Heather Coupland, a program manager at a business support company called Oxford Innovation Services Ltd. The company, in Oxford, England, began using the hand signals in video conferences in March 2021.

“Beforehand, I had no idea who was listening, as I just had a circle with a name, and it is so frustrating,” she says. “The benefits to remote-working mental health are significant.”

The study findings offer an interesting option for promoting connectivity in a video conference space, says Jack Tsai, PhD, a professor of public health at the University of Texas Health Science Center in Houston.

“Video conference is limited in reflecting body language and even facial expressions, and so physical gestures may help amplify those expressions,” says Tsai, who was not part of the study.

“While I think the visual gestures are interesting and can be a way to engage students, there is some evidence that younger generations of adults are losing some abilities to read body language and interpret facial expressions and emotions due to the age of social media,” he says.

“The visual gestures in the study are designed to have specific messages tied to them and does not rely on students interpreting them in any way with nuance, so I don’t know if that may improve or worsen this issue.”

Find a VMS training video here.

Aug. 18, 2022 – Should parents of young schoolchildren be worried about monkeypox?

So far, at least nine children in the U.S. have tested positive for monkeypox. As of now, the American Academy of Pediatrics says the risk of children becoming infected with the virus is low.

Still,“children and adolescents are more likely to be exposed to monkeypox if they live in or have recently traveled to a community with higher rates of infection,” the academy says.

As back-to-school season officially kicks off, read on to learn more about how to prevent the spread of monkeypox.

What Are the Signs of Monkeypox in Children?

Monkeypox infection in children appears in the same way it shows up in adults. The most common sign of monkeypox in children and adults is a skin rash that looks like raised bumps, according to the CDC.

Paulette Grey Riveria, MD, a family medicine doctor and a regional medical director for the Louisiana Department of Health, says that you can tell if a rash is monkeypox by the way it changes over time. “A monkeypox rash will change from being initially flat, to raised, to filled with fluid, and finally to a scab that eventually falls off and is replaced by a fresh layer of skin,” she says.

Monkeypox sores usually appear all at once and go through the different stages together, and it’s less common to have sores in different stages, Riveria says Fever, headache, fatigue, and swollen lymph nodes are also common in children with monkeypox, but they may not appear in every single case, the CDC says.

Are Kids at Risk for Severe Sickness From Monkeypox?

Carlos Oliveira, MD, a pediatric infectious disease doctor at Yale New Haven Children’s Hospital in Connecticut, says most monkeypox cases are “self-limiting,” meaning they go away on their own without treatment. That said, the American Academy of Pediatrics warns that infants, young children, children with weakened immune systems, and children with skin conditions like eczema are more likely to become severely sick if they catch monkeypox.

The CDC also says that children under 8 years old infected with the Congo Basin variant of monkeypox are more likely to have a severe infection. (That said, the monkeypox variant spreading around the world right now is the West African variant, which is known to cause a milder illness.)

How Can Schools Prevent the Spread of Monkeypox?

The monkeypox virus mainly spreads when people have direct contact with the fluid inside monkeypox rashes. This can happen through skin-to-skin contact or by touching items that have encountered the rash of an infected person. Things like towels, bedding, clothing, toiletries, and shared utensils all can spread monkeypox.

The CDC also says poxviruses like monkeypox are hardy; researchers have found live virus in the home of a person infected with monkeypox 15 days after they had left.

The good news is that the strategies schools have already used to prevent the spread of COVID-19 can be used to prevent monkeypox as well, like “encouraging personal space, promoting frequent hand-washing, and telling parents to keep kids home when sick,” Riveria says.

For older students, like those in high school, Riveria says “the best precaution is awareness.” She says it’s important for young adults to know what monkeypox rashes look like, how monkeypox spreads, and where they can get health care and treatment.

Young adults should “avoid contact with a person who has monkeypox or has been exposed to the virus,” she says. “While awareness is critical, aligning responsible behavior with that awareness is just as important.”

AreThere Monkeypox Treatments and Vaccines for Kids?

Oliveira says the medication tecovirimat and the Jynneos vaccine can be used to prevent severe monkeypox infections in children.

Tecovirimat is a medication that can treat viruses in the same family as monkeypox. It is FDA-approved for treating smallpox, but the CDC allows it to be used for severe monkeypox infection. According to the CDC, a 28-month-old child received tecovirimat and had no harmful side effects, but there haven’t been any studies on how the medication affects kids.

The Jynneos vaccine was approved in 2019 to prevent smallpox and monkeypox in adults. This month, the FDA gave emergency use authorization for the vaccine to be given to children younger than 18 years old who are at risk of severe sickness from monkeypox. That said, pediatricians need permission from the FDA to give the Jynneos vaccine to children, according to Oliveira.

For mild cases of monkeypox, the World Health Organization says care should focus on easing symptoms and managing complications. Parents or caretakers of children with monkeypox should avoid touching any items the child may have had skin contact with and use personal protective equipment like gloves when handling contaminated items. Any person with monkeypox is contagious until all their lesions have scabbed over and healed, says Oliveira.

“The CDC recommends that individuals with monkeypox stay in isolation for the course of their disease, which normally lasts between 2 to 4 weeks,” he says. “Hand hygiene is a simple and effective tool to prevent infection. Isolation and vaccination of close contacts is also recommended.”

Riveria reassured parents that while monkeypox can cause more severe illness in children, compared to adults, “we are not seeing this theoretical risk play out in reality thus far.”

“Parents should be vigilant, but not hypervigilant,” she says.