COVID-19 Data Dispatch

Author: Betsy Ladyzhets

  • Variant Q&A: Why scientists are concerned about BA.2.86, and which questions they’re still investigating

    Variant Q&A: Why scientists are concerned about BA.2.86, and which questions they’re still investigating

    The CDC’s Traveler Surveillance program, which offers free PCR tests to international travelers entering the U.S., was one of the first surveillance programs to pick up BA.2.86, pictured in dark red on the right-most bar of this chart.

    Last week, I introduced you to BA.2.86, a new Omicron variant that’s garnered attention among COVID-19 experts due to its significant mutations. We’ve learned a lot about BA.2.86 since last Sunday, though there are many unanswered questions to be answered as more research is conducted.

    Here’s my summary of what we know so far—and what scientists are still working to understand. Overall, this variant has some concerning properties, but more data are needed before we know what kind of impact it will have on disease transmission and severity.

    Where did BA.2.86 come from?

    BA.2.86 was first identified in Israel earlier this month. Scientists then picked it up in Denmark, the U.S., U.K., and several other countries across multiple continents (and in people without recent travel history), suggesting that it has been spreading under the radar for a while.

    However, as I’ve noted with past variants, the country where BA.2.86 was first identified is not necessarily the country where it developed. Many countries around the world are doing fairly limited COVID-19 testing and sequencing these days, so nations like Israel and the U.S. (which have more robust surveillance, relatively speaking) are likely to catch new variants.

    Why are scientists concerned about BA.2.86?

    BA.2.86 worries experts because it has a number of mutations: about 30 in its spike protein, compared to BA.2, its closest relative. The spike protein is the part of the coronavirus that binds to and enters human cells, so mutations tend to accumulate here, enabling the virus to cause new infections in people who have already been infected or vaccinated.

    BA.2, you might remember, was a dominant variant in early 2022, so it’s unexpected to see a descendant of this lineage pop up now. Scientists hypothesize that BA.2.86 might have evolved in a single person with a persistent infection; the virus could have multiplied and mutated over the course of several months or a year in someone originally infected with BA.2. This evolution also could have occurred in an animal population, then transferred back to humans.

    Scientists have similar hypotheses about the original Omicron variant, which was also very different from circulating strains when it emerged. In fact, BA.2.86 is about as different from XBB.1.5 (a recently dominant variant globally) as Omicron BA.1 was from Delta.

    Where has BA.2.86 been identified so far?

    Surveillance efforts in many countries have now found BA.2.86, ranging from Thailand to South Africa. This variant is evidently already spreading globally; unlike Omicron’s initial emergence, however, we don’t have a singular country to watch for signals of how BA.2.86 may impact transmission trends.

    In the U.S., researchers have found BA.2.86 in three different states:

    • One case in Michigan, from a person tested in early August
    • One traveler returning to a D.C.-area airport from Japan, their infection caught through the CDC’s travel surveillance program
    • Wastewater from a sewershed in Elyria, Ohio

    As surveillance is currently fairly uneven across the U.S., we can likely assume that BA.2.86 is present in other states already. Continued testing in the next few weeks will provide a clearer picture of the situation.

    How does BA.2.86 impact transmission and disease severity?

    This is one question that we can’t answer yet, though scientists are concerned about its potential. In a risk assessment report published this past Wednesday, the CDC said that mutations present in BA.2.86 suggest that this variant may have greater capacity to “escape from existing immunity from vaccines and previous infections” when compared to recent variants.

    However, this is just a hypothesis based on genomic sequences. The CDC report cautions that it’s too soon to know how transmissible BA.2.86 is or any impact it may have on symptom severity. To answer this question, scientists will need to identify more cases caused by this variant, then track their severity and spread.

    Will our new booster shots work against BA.2.86?

    The FDA and CDC are planning to distribute booster shots this fall, based on the XBB.1.5 variant that dominated COVID-19 spread in the U.S. this spring and earlier in the summer. As Eric Topol points out in a recent Substack post, this booster choice made sense a couple of months ago, but it’s unlikely to work well against BA.2.86 if that variant takes off.

    More research is needed on this topic, of course, but the existing genomic data is concerning. Having an XBB.1.5 booster this fall, if we see a BA.2.86-driven surge, would be like having a booster based on Delta, when Omicron is spreading: better than no booster, but unlikely to provide full protection.

    “The strategy of picking a spike variant for the mRNA booster at one point in time and making that at scale, going through regulatory approval, and then for it to be given 3 or more months later is far from optimal,” Topol writes. “We desperately need to pursue a variant-proof vaccine and there are over 50 candidate templates from broad neutralizing antibodies that academic labs have published over the last couple of years.”

    Will current COVID-19 tests and treatments work for BA.2.86?

    According to the CDC’s risk assessment, current tests should still detect BA.2.86 and treatments should work against it, based on early studies of the variant’s genomic sequences. More research (from health agencies and companies) will provide further data on any changes to test or treatment effectiveness.

    Mara Aspinall points out in her testing-focused Substack that rapid tests, in particular, tend to be unaffected by variants because they test for the N protein, a different part of the coronavirus from the spike protein (which is the main area of viral evolution). However, if you’re taking a rapid test, it’s always a good idea to follow best practices for higher accuracy—testing multiple times, swabbing your throat, etc.—and get a PCR if available.

    How are scientists tracking the coronavirus’ continued evolution?

    BA.2.86 has arrived in an era of far less COVID-19 surveillance, compared to what we had available a year or two ago. Most people rely on rapid tests (if they test at all), which are rarely reported to the public health system and can’t be used for genomic surveillance. As a result, it might take longer to identify BA.2.86 cases even as this variant spreads more widely.

    However, there are still some surveillance systems tracking the virus—and all are now attuned to BA.2.86. A couple worth highlighting in the U.S.:

    • Wastewater surveillance increasingly includes testing for variants. The CDC has a dashboard showing variant testing results from sewage; this is happening in about 400 sewersheds now and will likely increase in the future.
    • The CDC also supports a travel surveillance program at major international airports, in partnership with Concentric by Ginkgo and XpressCheck. This program caught one of the first BA.2.86 cases in the U.S. (the traveler from Japan mentioned above).
    • Several major testing companies and projects continue virus surveillance, via both limited PCR samples and wastewater. These include Helix, Biobot, and WastewaterSCAN.

    What will BA.2.86 mean for COVID-19 spread this fall and winter?

    While BA.2.86 is similar to Omicron BA.1 in its level of mutations, it’s not yet driving significant disease spread at the same level that we saw from Omicron when that variant first emerged in late 2021. All warnings at this point are tentative, based on very limited data.

    In a Twitter thread last week, virologist Marc Johnson pointed to three potential scenarios for BA.2.86:

    • It could “fizzle,” or fail to outcompete currently-circulating variants and spread widely despite its concerning array of mutations.
    • It could “displace” the current variants and contribute to increased transmission, but not cause a huge wave on the same level as Omicron BA.1 in late 2021.
    • It could cause a major wave, comparable to the initial Omicron spread.

    Based on analysis from Johnson and other experts I follow, the second scenario seems most likely. But if the U.S. and other countries had meaningful public health protections in place, we could actually contribute to those odds, rather than leaving things up to evolutionary chance. Remember: variants don’t just evolve in a vacuum. We create them, by letting the virus spread.

    Sources and further reading:

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    More variant reporting

  • National numbers, August 27

    National numbers, August 27

    Biobot’s wastewater surveillance data suggest a potential plateau in COVID-19 spread, though future weeks of data will be needed to say for sure.

    During the most recent week of data available (August 6-12), the U.S. reported about 12,600 new COVID-19 patients admitted to hospitals, according to the CDC. This amounts to:

    • An average of 1,800 new admissions each day
    • 3.8 total admissions for every 100,000 Americans
    • 22% more new admissions than the prior week (July 30-August 5)

    Additionally, the U.S. reported:

    • 13.4% of tests in the CDC’s surveillance network came back positive
    • A 1% lower concentration of SARS-CoV-2 in wastewater than last week (as of August 23, per Biobot’s dashboard)
    • 25% of new cases are caused by Omicron XBB.1.6; 21% by EG.5; 11% by XBB.2.3; 13% by FL.1.5.1 (as of August 19)

    This week, our limited COVID-19 data picture suggests that transmission may be starting to level off. But if BA.2.86 or another newer variant enters this high-spread environment, the outlook could get less rosy.

    One sign of a possible plateau: Biobot’s national wastewater surveillance dashboard shows a very slight downward trend, with SARS-CoV-2 levels dropping by about 1% from August 16 to August 23. This is based on just one week of data, though, so we’ll have to see what further updates show.

    Biobot’s regional data similarly show potential good trends: the Midwest appears to have passed the peak during this surge, as of the last two weeks, while the South and Northeast also show slight plateaus. Coronavirus levels are still trending up in the West, but less intensely.

    Data from both Biobot and WastewaterSCAN suggest that COVID-19 spread has turned a corner in some Midwest sewersheds, such as Johnson County, Kansas; Lawrence, Kansas; Lonoke County, Arkansas; Lincoln, Nebraska; and Warren, Michigan. Still, more data are needed to see if these trends hold.

    Test positivity data from the CDC’s respiratory surveillance network also suggest that COVID-19 spread may be slowing. After a rapid rise through July, test positivity increased by just 8% in the most recent week of data (ending August 19), from 12.4% to 13.4%. This is still a high overall positivity rate, though, especially considering how difficult PCR tests are to access these days.

    Hospitalizations continue to rise as well: the CDC reported a 22% increase in new COVID-19 patients from the week ending August 5 to the week ending August 12. While hospitalizations are significantly delayed compared to other metrics, these data show one of the surge’s severe impacts. We have even less data about Long COVID, the other main severe impact.

    BA.2.86, a new variant that scientists are watching closely, isn’t yet impacting transmission in the U.S. based on our current data. But it could lead to another increase in cases, if it proves able to outcompete the now-dominant group of XBB variants. (More on BA.2.86 later in today’s issue.)

    Remember: new variants don’t appear magically out of nowhere. People encourage their evolution, by allowing the virus to continue spreading unchecked. In addition to protecting ourselves and our communities, COVID-19 safety measures help to prevent further mutation.

    more national numbers

  • COVID source callout: Nebraska stops reporting wastewater data

    The Nebraska state health department has discontinued its wastewater surveillance data page, depriving residents of important COVID-19 updates at a time when cases are rising.

    Multiple local news outlets in the state (including the Omaha World-Herald, the Lincoln Journal-Star, and the radio station KIOS) reported the removal. Nebraska’s health department previously shared wastewater updates through PDF reports, published every two weeks; these reports included recent COVID-19 trends along with data about variants sequenced in the state’s sewage.

    Now, the health department’s wastewater surveillance page redirects to an error message, reading: “This page is currently unavailable.” The change came as wastewater data in Nebraska and across the country were showing an increase in coronavirus spread, local reporters covering the story have pointed out.

    Nebraska’s health department discontinued this webpage due to the federal public health emergency’s end in May, a spokesperson for the agency told the World-Herald and Journal-Star. The agency is still tracking wastewater data, the spokesperson said. But it’s apparently redesigning its public website to include as little information as possible.

    “Data continues to be tracked for that program and is available upon request,” the agency spokesperson told local reporters. Nebraska’s wastewater data still appear to be available on the CDC’s dashboard, as well. But new data for Nebraska sites were most recently added to that dashboard in early August, so it’s unclear whether CDC updates will continue after the local page’s end.

    Even if the Nebraska health department does continue sending data to the CDC, the national dashboard is less accessible to residents hoping to keep track of COVID-19 trends than the state’s reports were. As I’ve written before, local dashboards and alert systems are always better when it comes to tailoring updates for a specific community.

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  • Sources and updates, August 20

    • New toolkit for estimating COVID-19 risk from wastewater: Researchers at Mathematica published a new, open-source toolkit for interpreting wastewater data. It includes an algorithm that scientists and health officials can use to identify when a new surge might be starting based on wastewater results, as well as a risk estimator tool that combines wastewater data with healthcare metrics. The researchers developed this toolkit using data from North Carolina during the Delta and Omicron surges; their paper in PNAS last month describes it further, as does a blog post by the Rockefeller Foundation (which funded the project). This tool doesn’t provide real-time updates, as it only includes wastewater data through December 2022, but it offers a helpful model for using this source to inform public health policies.
    • Vaccine delays for uninsured Americans: The CDC estimates that new COVID-19 boosters will become available in late September or early October, as I wrote last week. But Americans without health insurance may have to wait longer to get the shots or pay a hefty price tag, according to recent reporting from POLITICO. A federal government program with national pharmacy chains, which will provide the shots for free to uninsured people, is not slated to start until mid-October. Instead, uninsured people will need to pay out-of-pocket or find one of a small number of federal health centers to get vaccinated; this is likely to discourage vaccinations, POLITICO reports. And the number of uninsured people is only growing thanks to Medicaid redeterminations.
    • Budget cuts at the CDC could mean layoffs: A recent op-ed in STAT News, written by two researchers familiar with the CDC’s organizational structure, warns that budget cuts at the agency could lead to a significant reduction in public health workers. The CDC’s budget was cut as part of the federal government’s debt ceiling negotiations last month, the authors explain. It faces a cut of about 10%, or $1.5 million a year, which could lead to significant layoffs. The reduced jobs are particularly likely to impact staff at the state and local levels, the op-ed’s authors argue, rather than at the CDC’d headquarters in Atlanta. “Reductions there will cut public health services and will have their greatest impact on the most vulnerable populations,” they write.
    • Vaccine effectiveness for young children: Speaking of the CDC: the agency published a study this week in its Morbidity and Mortality Weekly Report describing COVID-19 vaccine effectiveness for the youngest children who are eligible (i.e. under five years old). Researchers at the CDC and partners at healthcare centers across the country tracked COVID-related emergency department and urgent care visits among young children, from July 2022 through July 2023. Effectiveness for the primary series was low: Moderna’s two-dose series scored just 29% effective at preventing ED and urgent care visits, while Pfizer’s three-dose series was 43% effective. Children who received a bivalent (Omicron-specific) follow-up dose were much more protected, however: this regimen was 80% effective. Bivalent boosers should be a priority for young kids along with adults, the study suggests.
    • Immune system changes following COVID-19: Another notable study from this week, from scientists at Weill Cornell Medicine and other institutions, describes how severe COVID-19 cases may damage patients’ immune systems. The researchers analyzed how specific genes were expressed in immune system cells taken from people who had severe cases of COVID-19. They found expression changes as long as a year after patients’ initial infections, and connected those changes to inflammation, organ damage, and other long-term issues. These genetic changes may point to one cause for Long COVID symptoms, though the study is somewhat limited by its focus on patients who had severe symptoms early on (as most people with Long COVID have initially milder cases).
    • Smell and taste loss following COVID-19: While smell loss has long been considered a classic COVID-19 symptom, a new study shows that taste loss is also common, even among people who don’t lose their sense of smell. Researchers at the Monell Chemical Senses Center (a nonprofit center in Philadelphia) studied these symptoms through an online survey, which included about 10,000 participants between June 2020 and March 2021. COVID-positive participants were more likely to report smell issues, taste issues, and both together, compared to people who didn’t get sick, the researchers found. Their survey methodology—which included asking people to self-assess their senses by smelling common household objects—could be used for further large-scale studies of these symptoms, the researchers write.

  • BA.2.86 is the latest variant to watch; send me your questions

    Last week, several variant experts that I follow on Twitter (which I refuse to call by its new name, thanks) started posting about a new SARS-CoV-2 variant, first detected in Israel. They initially called it Omicron BA.X while waiting for more details to emerge about the sequence; it’s now been named BA.2.86.

    Scientists and health officials are concerned about BA.2.86 because it has many mutations on its spike protein, showing significant deviation from other versions of Omicron. This variant evolved from an earlier Omicron strain (BA.2) rather than XBB, which is the primary lineage spreading across the world right now—and is the primary focus of booster development for this fall.

    Here are two relevant threads with more info (the first for a more general audience, the second going into more details about mutations):

    Virologists hypothesize that BA.2.86 may have evolved in someone with a chronic infection—essentially gaining more and more mutations as the same person stayed sick for many months. Similar hypotheses apply to Delta and Omicron, though it’s hard to get definitive answers without actually finding those patients.

    Another reason for concern: as of today, BA.2.86 has been detected on three different continents. In addition to Israel, scientists have found it in Denmark and the U.S. Since most countries are not doing rigorous genomic surveillance these days, the cases found so far suggest that this variant is actually far more widespread; it just went undetected until now.

    The World Health Organization recently designated BA.2.86 as a Variant Under Monitoring, meaning that its genetic information suggests concern but little else is known at this time. The CDC has also said it’s tracking the new variant.

    I’m keeping today’s post about BA.2.86 short due to the limited information we have so far. But I’d like to dive into it more next week. So, send me your questions about this variant or about genomic surveillance more broadly, and I will answer them in next Sunday’s newsletter.

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  • National numbers, August 20

    National numbers, August 20

    While the rise in hospitalizations has been modest, test positivity is on a similar level to the last couple of surges, per the CDC. Data as of August 18.

    During the most recent week of data available (July 30 through August 5), the U.S. reported about 10,300 new COVID-19 patients admitted to hospitals, according to the CDC. This amounts to:

    • An average of 1,500 new admissions each day
    • 3.1 total admissions for every 100,000 Americans
    • 14% more new admissions than the prior week (July 23-29)

    Additionally, the U.S. reported:

    • 12.2% of tests in the CDC’s surveillance network came back positive
    • A 10% higher concentration of SARS-CoV-2 in wastewater than last week (as of August 16, per Biobot’s dashboard)
    • 25% of new cases are caused by Omicron XBB.1.6; 21% by EG.5; 11% by XBB.2.3; 13% by FL.1.5.1 (as of August 19)

    The summer COVID-19 surge continues. While wastewater surveillance data suggest that transmission trends may be turning around in some places, the virus is largely still increasing across the U.S. New variants are on the horizon, too.

    Nationally, coronavirus levels in wastewater are the highest they’ve been since last winter’s holiday surge, according to data from Biobot Analytics. Viral concentrations have tripled since mid-June, and continue to follow a similar pattern to the Delta surge that we experienced at about the same time in summer 2021.

    Biobot’s regional data suggest that the Midwest—which reported a serious spike last week—may have turned a corner in this surge, with viral levels going into a plateau. This pattern is based on just one week of data, though, so we’ll have to see what next week’s numbers show.

    Wastewater data from the CDC and WastewaterSCAN similarly show continued increases in COVID-19 spread. Some counties in Southern states, such as Florida, Georgia, and Alabama, are reporting particularly large upticks. Hawaii may be a state to watch, too, as residents face health access challenges following the recent wildfires.

    Test positivity also continues to increase, with the CDC reporting that about 12% of COVID-19 tests reported to its respiratory network returned positive results in the week ending August 16. Hospital admissions and emergency department visits are still going up as well, though these metrics are reported with two-week delays.

    The CDC updated its variant data this week, reporting that Omicron EG.5 continues to outcompete other XBB lineages. EG.5 doesn’t have a huge advantage in transmission, though, so it’s increasing relatively slowly amid a sea of other similar variants.

    But a new variant, called BA.2.86, may be one to watch more closely. Health officials are on the alert after seeing just a few cases in the U.S., Israel, and Denmark due to a number of mutations in this variant’s spike protein, which diverge significantly from other strains. (More on this variant later in today’s issue.)

    While the CDC says it’s monitoring this new variant, the agency’s genomic surveillance is far sparser than it was a year or two ago. The agency and its research partners are now sequencing under 5,000 coronavirus samples a week, compared to almost 100,000 a week at the height of Omicron. With this small sample pool, the CDC is less equipped to catch BA.2.86, or any other variants that may arise.

    more national numbers

  • COVID source call-out: When will we get fall boosters?

    The CDC expects that our next round of COVID-19 booster shots will be available in early fall, likely late September or early October. But this limited information has been distributed not through formal reports or press releases—rather, through the new CDC director’s media appearances.

    These booster shots will be targeted to Omicron XBB.1.5, one of the most recently-circulating subvariants. It’ll be an important immunity upgrade, especially for seniors and other higher-risk people, as the last round of updated vaccines came almost a year ago. Plus, these new boosters are basically the federal government’s one initiative to combat COVID-19 as we head into another inevitable fall and winter of respiratory illness.

    Considering the shots’ importance, we have surprisingly little information about when they’ll be available or how they will be distributed. During one media appearance (on NPR’s All Things Considered in early August), CDC Director Dr. Mandy Cohen said that the boosters would be available “probably in the early October time frame.” Then, a week later (on former federal official Andy Slavitt’s podcast), she said boosters would come “by the third or fourth week of September.”

    In both interviews, Cohen shared few details beyond this vague timeline. I would love to see more details from the federal government about their plans—for producing the shots, and also for distributing them in our post-federal emergency landscape. It also seems unclear how the CDC and other agencies will promote the boosters, considering how most officials are now pretending COVID-19 is no longer a concern. (Case in point: Cohen’s many mask-less appearances since she started as CDC director.)

    more source spotlights

  • Sources and updates, August 13

    • CDC identifies continued Long COVID risk: A new study from the CDC this week, published in the agency’s Morbidity and Mortality Weekly Report, summarizes data from the CDC and Census Household Pulse Survey examining Long COVID prevalence in the U.S. According to the survey, Long COVID prevalence declined slightly from summer 2022 to early 2023, but has remained consistent this year at about 6% of all U.S. adults. The survey also found that about one in four adults with Long COVID consistently report “significant activity limitations” from the condition, meaning they are less able to work and participate in other aspects of daily life. Treating Long COVID and supporting long-haulers should be priorities for the healthcare system, the study’s authors write.
    • Mitochondrial dysfunction in Long COVID: Another new paper, published this week in Science Translational Medicine, demonstrates the role that mitochondria may play in Long COVID. Researchers at the Children’s Hospital of Philadelphia studied tissue samples from autopsies and animals infected with COVID-19, finding that the coronavirus led to malfunctioning mitochondria in several key organ systems. These malfunctions may contribute to Long COVID symptoms such as fatigue and brain fog, and could be a target for future treatments. Elizabeth Cooney at STAT News covered the study in more detail.
    • Benefits of vaccination during pregnancy: One more notable new study: researchers at the National Institute of Allergy and Infectious Diseases (or NIAID, part of the NIH) tracked the impacts of COVID-19 vaccination for pregnant people. The study included 240 vaccinated participants who contributed blood samples, between July 2021 through January 2022. Both the parents and their newborns developed antibodies against the coronvirus following infection, the researchers found. While previous papers have demonstrated the value of vaccination for new parents, this study is one of the largest so far to show that protection is conferred to newborns.
    • Wastewater surveillance webinar from the People’s CDC: If you’ve been following wastewater data to keep up with COVID-19 trends but have had questions about how this form of surveillance works, you may find it helpful to watch this recorded webinar from health advocacy organization the People’s CDC. In the video, Marc Johnson, a professor at the University of Missouri and director of the state’s wastewater surveillance program, talks through how wastewater is tested for the coronavirus (and variants), how to interpret wastewater data, cryptic lineages, and more. Understanding this novel data source is increasingly important now, as traditional healthcare data on COVID-19 are less reliable.
    • New federal heat surveillance dashboard: Finally, in other public health news, the federal government has launched a new dashboard to track heat-related health issues. The dashboard compiles data from Emergency Medical Services reports across the country, representing responses to 911 calls for any health reason related to heat stress. (You can see the list of potential health events in the dashboard’s documentation.) Currently, many southern states are experiencing high levels of heat-related health problems, according to the dashboard. Many of the same states are also experiencing COVID-19 upticks right now—trends that may be related, as more people gather inside during hot weather.

  • NIH RECOVER’s Long COVID trials unlikely to lead to successful treatments, experts say

    NIH RECOVER’s Long COVID trials unlikely to lead to successful treatments, experts say

    The NIH has primarily spent its funds for Long COVID research on observational studies rather than clinical trials, according to new data shared with my article this week.

    Last week, the National Institutes of Health and Duke University announced five Long COVID clinical trials as part of the NIH’s RECOVER initiative. This might sound like an exciting milestone for the millions of people dealing with long-term symptoms—but in fact, experts and long-haulers are disappointed by the trials, I learned when covering this news for MuckRock and STAT News.

    RECOVER is the largest Long COVID research effort in the world; the NIH received $1.15 billion for it, provided by Congress in late 2020. It’s also been plagued by delays and criticisms, as I’ve reported before. As we approach the three-year mark of the initial funding, long-haulers are becoming increasingly frustrated with RECOVER’s lack of results.

    My latest story for MuckRock and STAT focuses on the clinical trials, but connects to larger issues with RECOVER and with the federal government’s response to Long COVID in general. Read it on STAT’s site here or on MuckRock’s here.

    A few key points from the story:

    • RECOVER is only testing a handful of drugs for Long COVID, instead focusing on behavioral interventions that outside experts say are unlikely to address underlying causes of symptoms. There are several lists of potential drugs that should be (and aren’t) prioritized, including one compiled by members of an advisory committee to RECOVER.
    • Looking more closely at the drug trials, experts shared concerns about the study designs, suggesting that RECOVER’s choices of controls, outcomes measures, and other aspects of the studies may lead to inaccurate results. For example, dysautonomia expert Lauren Stiles told me that the trial testing drugs for autonomic symptoms may fail to accurately capture whether those drugs help with Long COVID.
    • At this point, the NIH has no plans for further Long COVID trials or other research going beyond RECOVER. The initiative has almost fully allocated all of its $1.15 billion in funding, and NIH officials haven’t shared details about how they will continue Long COVID research after this study concludes (though they acknowledge more research will be necessary).

    RECOVER failed to put much funding in clinical trials to begin with, focusing instead on observational studies aiming to track Long COVID symptoms over time. While such studies could be valuable for better understanding the condition, RECOVER has largely replicated other research and hasn’t contributed useful, new information to the field, experts have told me. In fact, over 40,000 people have petitioned the NIH to retract RECOVER’s first paper based on its observational research.

    Many of RECOVER’s errors, such as choosing the wrong treatments to prioritize and focusing on observational studies over clinical trials, could’ve been avoided if the initiative had listened more to long-haulers and learned from experts in other post-infectious diseases. Long-haulers have done plenty of research themselves in the last three years, ranging from informal tests of different treatments to formal studies conducted by the Patient-Led Research Collaborative; yet these studies have not informed RECOVER.

    Plus, scientists with expertise in ME/CFS, dysautonomia, HIV/AIDS, and many other similar diseases could share lessons with RECOVER—but they aren’t leading the initiative. I thought Todd Davenport, a rehabilitation expert at University of the Pacific who’s studied ME/CFS, put it well when he said that RECOVER scientists “have parachuted into post-infectious illness and are now trying these things for the first time, to them. But it’s clear they haven’t done the reading.”

    I hope to continue covering RECOVER and other issues with Long COVID research in the U.S. If you have any tips or stories to share with me on this topic, please reach out.

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  • National numbers, August 13

    National numbers, August 13

    Wastewater data from Biobot Analytics suggest that coronavirus levels in the Northeast and South may be leveling off, while the Midwest is seeing a major spike.

    During the most recent week of data available (July 23 through 29), the U.S. reported about 9,000 new COVID-19 patients admitted to hospitals, according to the CDC. This amounts to:

    • An average of 1,300 new admissions each day
    • 2.8 total admissions for every 100,000 Americans
    • 13% more new admissions than the prior week (July 16-22)

    Additionally, the U.S. reported:

    • 10.6% of tests in the CDC’s surveillance network came back positive
    • A 9% higher concentration of SARS-CoV-2 in wastewater than last week (as of August 9, per Biobot’s dashboard)
    • 31% of new cases are caused by Omicron XBB.1.6; 17% by EG.5; 11% by XBB.2.3; 10% by XBB.1.9 (as of August 5)

    All major COVID-19 metrics continue to increase in the U.S., as we deal with a late-summer surge. Wastewater surveillance suggests that current virus spread is on pace with the Delta surge in 2021, though other data sources are less reliable these days.

    Wastewater data from Biobot continue to show an uptick nationally, following the same upward trend that started in late June. The CDC’s wastewater surveillance system and WastewaterSCAN network report similar trends.

    Biobot’s regional data suggest that the Northeast and South, the first two regions to see COVID-19 increases this summer, might be approaching their peaks, but it’s too early to say for sure. Regional test positivity numbers, from the CDC, show no sign of slowing their rise.

    Meanwhile, COVID-19 spread is going way up in the Midwest, per Biobot and WastewaterSCAN. Some sewersheds in Iowa, Michigan, Ohio, and nearby states have reported their viral levels in wastewater more than doubling over the last couple of weeks.

    Test positivity nationwide is now over 10%, per the latest data from the CDC’s respiratory virus testing network. Walgreens’ COVID-19 dashboard, which displays testing data from its pharmacies (i.e. a smaller sample size than the CDC network), reports a record high: of about 2,400 COVID-19 tests conducted in the week ending August 6, 45% were positive.

    Hospital admissions for COVID-19 are also on the rise, with about 1,300 new hospitalizations for COVID-19 each day in the week ending July 29, per the CDC. While it’s true that these numbers are far lower than peaks during prior surges, the data are also less reliable now— with fewer hospitals reporting to the CDC and fewer measures in those hospitals (like masking) to control infections.

    A lot of articles in the last couple of weeks have connected the recent surge to EG.5, the latest Omicron subvariant gaining ground in the U.S. However, this variant is not necessarily causing the surge; it doesn’t seem to be meaningfully more contagious or more severe than other recent strains, scientists are finding.

    Rather than a variant, I would personally attribute this surge to summer travel and gatherings, combined with waning immunity—it’s been many months since most Americans had contact with the virus through vaccination or infection.

    All of the virus-spreading activities going on right now will give SARS-CoV-2 more avenues to mutate. And there are other variants circulating globally that could cause more problems in the U.S. as well, as Eric Topol outlines in a recent Substack post. The next booster can’t come soon enough.

    more national numbers