THE CORONAVIRUS FILES
By Amber Dance
COVID continues to endanger Black communities
Black Americans would be particularly vulnerable to a new, aggressive coronavirus variant, the NIH’s Dr. Anthony Fauci told The Root.
“The rate of hospitalization and the death rate … is clearly higher, greater in brown and Black populations in the United States compared to the general population and compared to whites,” Fauci told reporter Keith Reid.
He pointed to risk factors such as diabetes and high blood pressure, which affect communities of color at higher rates, as part of the reason.
Social inequities are also at play: Black people are more likely to live in crowded conditions or to work in essential jobs, increasing the risk of exposure.
Long COVID could also have an outsized impact among Black people, writes Alexa Spencer at the nonprofit Black news collaborative Word In Black.
Studies now indicate that some 7% of people who contract COVID experience long-term symptoms such as fatigue and shortness of breath. The high rates of COVID infections in Black communities suggest that long COVID will follow similar patterns, said Carol Oladele, director of research at Yale’s Equity Research and Innovation Center.
A Nature Communications study that examined long COVID by demographics found slightly higher rates of some long COVID symptoms in Black people. These included new-onset diabetes, chest pain, and headaches.
To help offset disparities in long COVID, Oladele told Spencer that it’s important for Black people to be able to easily participate in research studies on the condition.
“They’re the ones that stand to benefit, since they were hardest hit,” Oladele said.
For example, she suggested, studies might compensate workers for the wages they lose when participating.
CDC recommends precautions as cases rise in Northeast
COVID cases are, again, on the rise in the U.S.
Since hitting a low of fewer than 30,000 new cases per day in early April, the daily average is now back over 100,000.
That’s only the cases being officially counted, of course. The actual numbers may be five to 10 times that amount, experts told The Washington Post. Many are repeat infections, owing to omicron variants’ greater ability to evade the immune system.
Hospitalizations are also on the rise, albeit at a slower rate for now. Virus levels in wastewater are also high at several sites across the nation.
These changes were enough last week for the Biden administration to act. The CDC advised people in communities at high risk — covering 18% Americans, mostly in the Northeast — to go back to wearing masks in indoor public spaces and on public transportation. A further 28% of the population in medium-risk areas might want to consider masking if they’re at high risk for severe disease.
The CDC also recommended that older Americans who’ve had one booster get another.
The agency suggested more testing should happen in high-risk areas, and advised people to take a COVID-19 test before traveling.
The administration is making eight more free home tests available to U.S. households.
The White House also took no action before the May 16 deadline it had set to notify states about lifting the public health emergency. Thus, the emergency status will now continue until at least mid-October, and that means millions of people won’t be kicked off Medicaid rolls as early as health advocates feared.
“While officials stressed that the current situation is far less dire than the winter omicron-variant surge, they cautioned that the country will be ill prepared to respond effectively in coming months if Congress does not soon appropriate billions of dollars in coronavirus aid to buy a new tranche of antiviral treatments, vaccines and tests,” writes Yasmeen Abutaleb at The Washington Post.
But even the White House doesn’t seem to be prioritizing COVID just now. “The warnings from [CDC Director] Dr. Walensky and other federal officials seemed somewhat at odds with President Biden’s own stance,” notes The New York Times.
The White House skipped COVID briefings for six weeks, and Biden — more focused on inflation and the Ukraine war — is typically seen unmasked, even as his inner circle keeps tallying cases. (“Few close contacts” for Biden appears to be part of the White House prevention strategy.)
“The president’s stance could backfire if the virus’s latest surge continues to build,” says The Times. “It could look like a repeat of last summer, when the president declared ‘independence’ from the virus … only to see massive waves of illness and death once the delta and omicron variants hit.”
Regulators OK boosters for kids as young as 5
Boosters are now recommended for everyone as young as 5 years old, as the FDA and CDC agreed to third shots for kids between 5 and 11 last week.
Children can get the boosters once they’re five months out from the second shot of Pfizer’s vaccine, which was authorized for this age group in fall.
Fewer than 30% of these kids have completed that primary series.
Kids who are immunocompromised could already get a booster, so they are now eligible for a fourth shot.
The FDA’s authorization was based in part on more infections of children during the omicron surge, plus concerns about long COVID in kids, writes Cecelia Smith-Schoenwalder at U.S. News & World Report.
Children younger than 5 have yet to be granted access to initial shots, though the FDA’s vaccine advisory committee is expected to meet in June to discuss authorization of vaccines from Moderna and perhaps Pfizer for that age group.
Latest on long COVID points to potential for vaccines to help
More than 75% of people who have long COVID had mild cases of the virus that didn’t initially require hospitalization, according to a new analysis of U.S. insurance claims.
“It’s generating a pandemic of people who were not hospitalized, but who ended up with this increased disability,” Penn State epidemiologist Dr. Paddy Ssetongo told health and science writer Pam Belluck at The New York Times.
Nearly one-third of the patients in the study were perfectly healthy, with no recorded preexisting conditions, before they developed long COVID.
Sixty percent were female, suggesting long COVID might be more likely to arise in females.
One possible treatment: A COVID shot. A new U.K.-based study backs up anecdotal evidence that vaccination improves long COVID symptoms, based on a large sample size of more than 28,000 people, reports Elizabeth Cooney at STAT.
The researchers found that getting vaccinated after a COVID-19 infection cut the odds of long COVID by 8.8% or more. (Getting vaccinated before infection also limits long COVID risk, by about half compared to unvaccinated people.)
The new study simply observed people, rather than enrolling vaccine and placebo-control groups, and cannot prove the vaccines reduced long COVID. Many people recover from long COVID on their own, and symptoms can also wax and wane, which might make it look like the vaccine helped when it really didn’t.
The data also pre-date both boosters and the omicron variant, so the situation may be different today.
It’s not clear why the vaccine would eliminate long COVID — but then, neither is it understood what causes the lingering symptoms in the first place.
One possibility is that a small amount of virus remains in the body post-infection. For example, scientists recently reported that bits of the coronavirus can be found in the gut months after the initial infection. One researcher called them viral “ghosts,” reports Heidi Ledford at Nature.
Further vaccination, then, might help by amplifying antibodies to wipe out those last vestiges of infection.
Long COVID is likely a collection of syndromes with different causes, so vaccination might only be effective for a subset of sufferers, adds Dr. Peter English in commentary provided by the Science Media Centre.
Given long COVID’s serious consequences for people and society, English said, “Anything that can reduce the burden of disease from long COVID at reasonable cost is, therefore, important and valuable.”
FDA nixes cheap antidepressant for COVID
The decades-old and inexpensive antidepressant fluvoxamine seemed to cut the number of high-risk COVID patients needing hospitalization by nearly one-third, according to a study of nearly 1,500 people in Brazil.
The FDA was unimpressed with the data, the agency said last week, saying it was “insufficient to conclude that fluvoxamine may be effective in the treatment of non-hospitalized patients with COVID-19 to prevent progression to severe disease and/or hospitalization.”
Nothing prevents physicians from prescribing fluvoxamine off-label to COVID patients, but Dr. David Boulware at the University of Minnesota requested FDA authorization back in December, reasoning such authorization would improve accessibility for the drug.
Though the antiviral drug Paxlovid has since been authorized, fluvoxamine could have provided an alternative for people who can’t take that medication, for example because it interacts with other drugs they’re taking.
The FDA criticized the Brazil trial for calling the drug successful if people who took it spent less than six hours in a hospital setting for COVID. It said that outcome was less important than other measures, such as a lower death rate.
Other trials with fluvoxamine were ended early because they were deemed pointless, reports Sophie Putka at MedPage Today.
Boulware said that one trial’s end had more to do with lack of funding and participants than the drug’s efficacy. He argued that using deaths as a key outcome in a now-highly vaccinated nation doesn’t make sense, and said fluvoxamine’s effects were comparable to those of the antiviral molnupiravir, which has been authorized.
“It’s not my first choice, as a physician,” Boulware told STAT’s Jason Mast, “but I should have the option.”
He said if data from ongoing trials support fluovoxamine for COVID, he and his collaborators may resubmit their FDA application.
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