New Coronavirus News from 18 Nov 2022

Human case of swine-origin influenza A virus detected in Denmark, according to CDC study [News-Medical.Net, 18 Nov 2022]

By Neha Mathur

In a recent study published in the Emerging Infectious Disease Journal, researchers detected a swine influenza A virus (IAV)-infected patient in routine surveillance at the National Influenza Center in Denmark. The detected influenza variant appeared distinct from any variant found previously in Denmark.

Background
As per official records, during the 2021–22 influenza season, 16,160 cases in Denmark were due to the influenza A virus, predominantly the H3N2 subtype. During this time, no cases of swine-origin influenza virus occurred in humans. Since the 2009 influenza A(H1N1) pandemic, no reports of persistent human-to-human IAVs transmission have come to light. Also, there have been only sporadic reports of human infections with swine IAVs. Yet, the zoonotic potential of IAVs is highly concerning.

Case report
A young man in his 50s, working at a swine abattoir in Denmark, was hospitalized after acute onset of illness on November 24, 2021. He had dizziness in the night, followed by chest pain, pain radiating toward the left arm, diarrhea, and malaise, but no fever. The patient suffered repeated convulsions and had to be admitted to the intensive care unit (ICU) and put on ventilation to cease seizures and manage declining oxygen levels.

He had no cardiovascular, kidney, neurological, or other impairment, including pneumonia, that could rationalize his sudden bout of severe illness. However, a pharynx swab sample of the patient tested positive for IAV. Notably, no other coworker at the patient's workplace reported the incidence of influenza.

With antiviral medication (oseltamivir) and supportive treatments, the patient's clinical condition improved over the next two days, so he was discharged from the hospital. The researchers submitted the remaining sample material to the Danish National Influenza Center, which confirmed it was positive for the pandemic H1N1 strain.

Further analysis by whole-genome sequencing revealed its consensus sequence to be of the H1N1 subtype. Notably, the virus was more similar to swine IAVs than human influenza strains. The team uploaded this sequence to the global initiative on sharing all influenza data (GISAID) database.

The sequence had no match to IAV sequences in GISAID, as revealed by the Basic Local Alignment Search Tool (BLAST) searches; however, a comparison to in-house sequences of swine influenza viruses from Denmark showed a close resemblance to 2021 swine IAVs. This viral strain had several genetic and antigenic differences from other influenza A viruses detected in Denmark. Also, it had poor reactogenicity to the currently used human seasonal influenza vaccines. Furthermore, its phylogenetic analyses revealed that most gene segments were similar to the H1N1 subtype. On the contrary, its neuraminidase and non-structural segments belonged to the clade 1C avian-like swine influenza A(H1N1) found in Eurasia.

Conclusion
Earlier in Denmark, an elderly patient with comorbidities experienced classical influenza-like illness (ILI). However, the reported case in this study was unique because a previously healthy adult experienced severe and sudden illness. Another distinct observation was that this patient experienced convulsions, which are rare in adults and typically accompanied by fever or encephalitis. Therefore, the infecting viral strains in these two cases are likely genetically distinct.

Detection of a variant IAV via routine surveillance highlighted the importance of continuous monitoring of both human and swine IAVs with zoonotic potential. Additionally, it underscored the need to promptly take countermeasures for those who come in contact with swine owing to their occupation and experience ILI.

Journal reference:
• Andersen KM, Vestergaard LS, Nissen JN, George SJ, Ryt-Hansen P, Hjulsager CK, et al. (2022). Severe human case of zoonotic infection with swine-origin influenza A virus, Denmark, 2021. Emerging Infectious Diseases. doi: https://doi.org/10.3201/eid2812.220935 https://wwwnc.cdc.gov/eid/article/28/12/22-0935_article

What does the COVID-19 'variant soup' mean for the Asia-Pacific region as travel ramps up? [ABC News, 18 Nov 2022]

By Erin Handley

As Australia anticipates a fourth wave the Asia-Pacific region has been served up what is been dubbed a "COVID variant soup".

Key points:
• New COVID variants are competing for dominance in the region
• Singapore recently had a rise in hospitalisations due to XBB
• Countries like Japan and South Korea are bracing for a "twindemic" of COVID and flu in winter

This soup is a mix of sub-variants vying for dominance according to Sanjaya Senanayake from the Australian National University Medical School.

"It's all still Omicron, but it's these new sub-variants. So they're going to challenge our immune system, and we will see an increase in cases," Dr Senanayake said.

"But hopefully, because of our hybrid immunity, it should be a short, sharp wave in terms of both cases and hospitalisations."

The COVID variant "swarm" or soup adds a complexity that makes waves harder to predict, according to the science journal Nature.

The current state of the virus is varied across our region; as Singapore comes down from the crest of a wave fuelled by the variant XXB, Japan is seeing an uptick in cases.

Case numbers appear to be fairly stable in South-East Asian countries, where many Australians might travel over the upcoming holiday period.

Meanwhile, many Pacific countries are reporting low or no COVID cases despite experts saying transmission is still occurring, highlighting that the quality of data collection varies drastically between nations.

Global health researcher at the University of Sydney School of Public Health Meru Sheel said it's no longer fruitful to draw comparisons at this stage.

"We're definitely way past that phase of the pandemic where we should be comparing countries … I think it's arbitrary," Dr Sheel said.

"The borders are open, people are moving, viruses are circulating … whether we like it or not, infection is inevitable."

Still, there are some lessons to be learned from outbreaks abroad.

And there are measures people can take to protect themselves and their communities, which can also have an impact at a population level.

Winter is coming in Japan
Australia is bracing for a fourth COVID wave, but Japan is looking at its eighth.

The Japanese health ministry's experts panel warned it could be the biggest surge in case numbers for the country since the pandemic began.

Last month Japan lifted travel restrictions for foreigners welcoming almost half a million overseas travellers in October — more than double the previous month.

It is also entering winter, like other northern-hemisphere countries South Korea and Taiwan — although for now Taiwan's cases are declining.

Dr Senanayake said COVID was perennial but can pose more of a problem in winter, in part due to behavioural reasons – such as people gathering together closely indoors to escape the cold.

"They also have to worry about the 'twindemic' with the flu resurgence, as we saw in Australia," he said.

The twindemic is something nearby South Korea is expecting too, according to Kim Woo-joo, a professor of infectious diseases at the Korea University Guro Hospital and one of the country's leading COVID experts.

"From late October, the daily number of newly confirmed COVID-19 cases are increasing," Dr Kim said.

The resurgence has several causes; the proliferation of sub-variants from abroad, mass gatherings for events and the easing of restrictions, although indoor mask-wearing is still required and a seven-day isolation period is still recommended.

"Government does not want to enforce social distancing measures anymore," Dr Kim said.

There is also some degree of complacency from individuals, as well as low vaccination rates for the fourth dose and Omicron bivalent vaccines, he said.

"Increasing vaccination rates among people is necessary, but the acceptance rate is very low, even compared to that of the United States."

Cases are climbing and Dr Kim said he expected an increasing wave, with BQ.1 and BQ.1.1 emerging as the dominant sub-variants.

Singapore's 'short, sharp' XBB wave
The BQ.1 offshoots are also expected to lead to rising infections in Europe, North America and Africa, but it was a different story in Singapore recently.

The city-state is seeing a decline after a spike in cases and hospitalisations fuelled by the highly-transmissible XBB variant.

"XBB is what we call a recombinant strain, so it's two different COVID strains or sub-variants coming together," Dr Senanayake said.

"But the good news is that Singapore had a short, sharp rise in cases – it wasn't anything as bad as their worst peak by any means.

"And it started to come down very quickly, both in terms of cases and hospitalisations."

Both BQ.1 and XBB are present in Australia and could become dominant here.

Singapore is one of the busiest aviation hubs in Asia, which could aid its spread.

Although Singapore saw an increase in hospitalisations and XBB is reported to be more transmissible than previous sub-variants, it is also less severe.

Some reports describe XBB as a kind of "escape artist", but the Institute for Health Metrics and Evaluation said it "does not appear to have immune escape with BA.5 [an Omicron sub-variant], meaning individuals who were previously infected with BA.5 will maintain their immunity against the new sub-variant".

Dr Senanayake said Singapore had a very high vaccination rate of more than 90 per cent.

Dr Sheel said although XBB is spreading faster and indicates a level of immune evasion from the original Omicron variant, vaccines were key and there were lessons from looking at Singapore.

"What the experience of Singapore is showing is that, despite the vaccine coverage, despite the national immunity, we can still see an increase in cases and that new variants are coming and still causing these, I guess it could be a blip, or a wave of infection," she said.

"We need to be alert from a public health response perspective. We can't just stop, because we still have elderly and immunocompromised people at risk in the population.

"If your health workers start getting reinfected, then it becomes a challenge for your healthcare system."

Vaccinate before you travel
In South-East Asia, Indonesia has just wrapped up its hosting of the G20 in Bali.

One of the attendees – Cambodian Prime Minister Hun Sen – tested positive for COVID and left the country.

Cases in the world's fourth largest country are seeing a slight rise, but COVID measures recently re-introduced in Bali appeared to be more about the global summit than stopping the spread.

Epidemiologist Jane Soepardi said the XBB variant had arrived in Indonesia but was not dominant in the country yet.

Another consideration was the quality of surveillance, with cases under-reported globally.

"The tests in Indonesia are very low. It's very under diagnosed, under reported," Dr Soepardi said.

"High cases are always in Jakarta — this is very biased here, because in Jakarta there are so many tests and you can easily get tested for free, while in other provinces, it's not so."

Dr Soepardi said there should be more testing in tourist areas for peace of mind, adding that the isolation period in the country is 10 days.

She said government officials had to remind people of current restrictions.

"Now we have seen more cases, it's arising. So people are forgetting about this pandemic," she said.

Dr Senanayake said Indonesia had a lower vaccination coverage than some other countries.

But he said the development of their own vaccine – which has been declared halal for Muslims – might help.

"That's a good thing for Indonesia – their own homegrown vaccine, something they can be proud of, and less suspicious of, and that might help vaccine cases," he said.

Thailand too has recently developed its own vaccine – a homegrown mRNA shot.

Dr Senanayake said Thailand had good public health messaging during the pandemic and a robust health system.

"They've got pretty good public health infrastructure … the way they look after certain infections like dengue," he said.

For many countries in the region, travel and tourism are key to their economies.

"When you're not a rich country, it does come down to an important decision between tourism and health," he said.

"A lot of other countries, it's a matter of being able to feed your family by having the borders open versus not having COVID but dying from starvation. They're the realities."

Dr Sheel said we now have Omicron-specific vaccines available.

"I think the best thing people can do is make sure they're vaccinated before they travel," Dr Sheel said.

"The key is we know the vaccines work against more severe forms of disease, and the vaccine was always meant to protect people from dying, essentially."

Other steps include hand hygiene, isolating if you have a respiratory illness, wearing a mask in crowded places, and gathering outside over Christmas.

"It offers individual protection, community level protection to some extent Those are the key things that people can do at an individual level, that then contributes to population health."

New Coronavirus News from 17 Nov 2022

What Was the COVID-19 Recession? Is There an End in Sight? [TheStreet, 17 Nov 2022]

Was it the shortest recession in history? Or is it still ongoing?

What Was the COVID-19 Recession?
According to the National Bureau of Economic Research (NBER), the official arbiter ofrecession, a sharp economic downturn coincided with the onset of the COVID-19 pandemic.

It officially categorized the COVID-19 recession as a two-month contraction between February and April of 2020, after which stay-at-home orders and lockdown restrictions were lifted in many parts of the world.

A stock market crash had ushered in the Covid-19 recession—not just one, in fact, but several:
•　Over the span of three days in March 2020, the New York Stock Exchangeimplemented emergency stops during its trading sessions to avoid a complete meltdown. The Dow Jones Industrial Average lost 37% of its value, while the S&P 500declined 34%. These days would come to be known as Black Monday I (March 9, 2020), Black Thursday (March 12, 2020) and Black Monday II (March 16, 2020).
•　Like the virus itself, the capitulation knew no boundaries, and stock market indexesaround the globe also experienced staggering declines: The Nikkei in Tokyo, FTSE 100 in London, and IBOVESPA in Brazil all posted double-digit losses, marking their worst performance since the Financial Crisis of 2007–2008.Source: BEA.gov

What Caused the Covid-19 Recession?
Back in the 1970s, an economist named Julius Shiskin popularly defined a recession as two quarters of negative GDP growth. While stock market pundits commonly point to that classification, the NBER looks at a host of other indicators to paint a more complete picture on the economy—and when all is said and done, the economy’s continued poor performance just might as well cause the NBER to revise and extend its timeframe for the COVID-19 recession.

The COVID-19 Recession Was So Much More Than GDP Contraction
What’s interesting about the COVID-19 crisis is that it not only fits within Shiskin’s definition, since GDP contracted by an astounding 34.5% in the first two quarters of 2020, and again at the onset of theDelta and Omicron variants but other economic indicators had also pointed to a looming contraction—one not just due to a health crisis. This may explain why the stock market went on to experience turbulence and anxiety well after the lockdowns ended.

The Covid-19 Recession Was Also an Inflation-Triggered Recession
One of the reasons why the Federal Reserve scrutinizes monthly data releases is that it knows that inflation is notoriously hard to control. Inflation alone can trigger a recession because the policy procedures used to rein it in—namely, by raising interest rates—are considered to be a “blunt instrument.” That means that it takes a while for their effects to be felt, and that they leave widespread, instead of targeted, fallout.

When interest rates rise, for example, it’s more difficult for consumers to obtain a car loan or a mortgage from a bank, and thus, the housing and retail sectors suffer. Credit card and student loan repayments also increase, and so consumer confidenceweakens. Businesses can’t afford to expand—and often, many are forced to reduce their workforces, which causes unemployment to rise.

One of the Federal Reserve’s preferred inflation gauges is the Personal Consumption Expenditures index (PCE), which measures the change in prices for the everyday items that make our lives possible. During March and April of 2020, the Core PCE actually declined before it began a steep, two-year ascent that has yet to level off—prices skyrocketed more than 10% in little more than two years! This trend would not be sustainable for any economy.

Remembering how Fed Chair Paul Volcker had to raise the Fed funds rate to an all-time high of 20.0% in order to tame inflation back in the 1980s may explain why its current Chair, Jerome Powell, quickly reacted to inflation’s surge by implementing a series of 0.75% rate hikes throughout much of 2022.

Unfortunately, the effects of these actions will be felt for some time to come.

The COVID-19 Recession Ignited a Series of Economic Shocks
What happens when people are scared for their lives, huddled at home, or even worse—trapped in the grips of a deadly disease with no treatment in sight? Production stops, manufacturing output plummets, businesses fail, and unemployment soars.

The COVID-19 pandemic introduced a series of supply shocks that strangled the economy and left supply chains hopelessly snarled. Borders closed, leaving shipments of raw materials and other items stalled for months. When lockdowns eased, demand for products surged, but manufacturing would take months to come back online, and inventories simply could not keep up fast enough.

COVID-related famines swept the globe, while oil-producing nations declared war on each other. To make matters worse, China reinstituted mandatory lockdowns between February and June of 2022, causing the entire cycle to repeat itself. It’s no wonder global economies continue to feel the malaise.

The COVID-19 Pandemic Popped Wall Street’s Bubble
Stretching from 2009 through February, 2020 the longest bull market in history had to end at some point. It could be argued that an asset bubble had engulfed the entire stock market, and a correction was needed to return stock prices closer to their intrinsic values.

And as anyone who blows a bubble knows, when it finally bursts, the results aren’t pretty. The warnings grew more ominous: The yield curve on US Treasuries inverted between May and October of 2019, which is often thought to be a reliable indicator of recession.

Is There an End to the COVID-19 Recession in Sight?
Controlling the virus itself will finally extinguish the COVID-19 recession, but so long as it has hosts to infect and variants that mutate, a cure remains elusive. Along with each surge, the economy falters, preventing a true recovery from taking form. Until then, investors would be wise to buckle up and follow sound approaches to keep their money as safe as possible—such as this bear market superpower from TheStreet’s Todd Campbell.

'Swarm' of variants is driving up California COVID cases. Is this the start of the next surge? [San Francisco Chronicle, 17 Nov 2022]

By MATT KAWAHARA, AIDIN VAZIRI

As winter looms, so does the question of whether another COVID-19 surge is in store for the Bay Area.

New coronavirus subvariants are rapidly spreading across the country and California, overtaking the strain that led to a U.S. summer wave. Cases have begun to tick upward statewide after a monthslong decline, just ahead of the holidays and a cold weather front that will drive people indoors.

Last winter, the omicron surge took off during the holiday season and peaked in the second week of January, when an astonishing 18,000-plus cases per day were being reported in the Bay Area — nearly four times higher than the peak of the previous winter wave.

While a rise in cases may be expected this winter, public health experts voiced optimism that any wave won’t be as severe as surges the past two winters. The uncertainty stems in part from dealing with an unpredictable virus that continues to evolve, giving rise to new emerging offshoots.

“The BQ.1, BQ.1.1, those are the variants that look like they’re going to predominate,” said Dr. Warner Greene, a senior investigator with the Gladstone Institutes. “They’re more immune-evasive, which means there will probably be more infections. But they don’t appear to have any greater pathogenicity than the original omicron, so that’s good news.”

He added, “There’s going to be a swarm of variants. Which ones take over may be different in different areas. But it’s unclear to what extent there will be a surge.”

On one hand, experts said, levels of immunity in the population are much higher now than during past winters from vaccinations, prior infections or both. The U.S. is reporting lower case and hospitalization rates than at this time in 2020 or 2021, and treatments exist to combat severe cases of the virus.

On the other, people are relaxing prevention measures like distancing and masking and returning to more normal interactions. Uptake of the most recent bivalent booster is low. And some of the newer variants, as Greene noted, appear better at dodging prior immunity.

Bay Area health officials Wednesday said a substantial increase in flu activity and other respiratory viruses, including RSV, since the start of November is already putting a strain on health systems across the region.

As of last week, the Centers for Disease Control and Prevention estimated the BQ.1 and BQ.1.1 omicron subvariants combined make up nearly half of COVID cases, 44%, in the U.S., overtaking the previously dominant BA.5 subvariant.

BQ.1 and BQ.1.1 had accounted for 22% of cases just two weeks earlier, while BA.5 made up over half of cases at that time, per the CDC.

A few other omicron offshoots were also pushing for circulation. BF.7 accounted for an estimated 7.8% of U.S. cases and BA.4.6 for an estimated 5.5% last week. BN.1, a descendent of BA.2.75, made up 4.3% and showed signs of taking off in the West region, where it accounted for 6.2% of cases.

BN.1 includes mutations that could give it “high immune escape,” which means that the virus has evolved to evade antibodies from vaccination or previous infection, according to predictions by infectious disease experts. The subvariant caused a surge of hospitalizations in Austria earlier this year.

In places where BQ.1 has gained prevalence, it has not seemed to cause huge surges or major increases in hospitalizations, said Dr. Robert Wachter, UCSF chair of medicine, citing France as an example. That is one reason Wachter believes a U.S. winter wave would be “mild to moderate, not severe,” he said.

“My suspicion is that it is close enough to the prior virus in terms of its structure and the way the immune system deals with it that the immunity people have from some combination of vaccines, boosters and prior infection is still tamping it down,” Wachter said. “But we’ll have to see.”

While the variants may be highly transmissible, several experts said there is no indication yet that they cause more severe illness than previous strains of the virus.

“So far, it would appear that the variants to date are not on average making us sicker or being very successful at reducing vaccine effectiveness against the severe outcomes we really care about most,” said Dr. Art Reingold, a UC Berkeley epidemiologist.

That said, reinfection could carry its own risks. A study published last week in Nature Medicine found that risk of organ failure, hospitalization and death from COVID-19 increases with repeat infections compared with an initial bout of the virus, regardless of vaccination status.

“Without ambiguity, our research showed that getting an infection a second, third or fourth time contributes to additional health risks in the acute phase, meaning the first 30 days after infection, and in the months beyond, meaning the long COVID phase,” said senior author Ziyad Al-Aly a clinical epidemiologist at theWashington University School of Medicine.

There is also the potential for long COVID and other lingering impacts of infection. The best defense, Reingold and other health experts said, is being vaccinated and boosted.

The bivalent booster is designed to protect against both the original coronavirus and the BA.4 and BA.5 variants, from which many new subvariants are descended.

Yet uptake of the booster, said UCSF’s Wachter, has been “pretty dismal.” Just 10.1% of eligible people in the U.S. age 5 and older have received it, according to the CDC.

“It’s flabbergasting to me that people are choosing not to get the new booster, especially if they haven’t had a jolt to their immunity in the form of a booster or infection any time in the last six-to-eight months or more,” Wachter said. “They could make themselves substantially safer by doing that than not.”

As the virus continues to evolve, staying up to date on available vaccines will be important, said Stanford infectious disease expert Dr. Robert Siegel.

More immune-evasive variants can cause more infections, which in turn increase the chance of new variants arising, Siegel said. This virus has shown the ability to “combine two different strains together and produce a third, unique strain.”

“When that happens, it’ll create lots and lots of variants,” Siegel said. “Most of them will go nowhere. What we see are the ones that have some selective advantage, they’re superior to the previous variant.”

A new variant can win out by being more infectious or better able to skirt protection of vaccines or prior infection. Siegel said rises in variant cases in Europe and on the East Coast are “a concern” as California tends to follow suit, but he also noted those waves have not yet led to high hospitalization rates.

There are early signals of an uptick in California. The state’s positive test rate is up for the second week in a row, growing to 5.3% compared to 4.5% last week. It’s the first time since mid-September that the positivity rate has tipped over 5%, the figure most public health officials consider the baseline for controlling spread of the virus.

Dr. Kim Rhoads, left, places a Covid-19 booster vaccine into a needle during a community health fair at Hayes Valley Playground on Wednesday, October 12, 2022, in San Francisco, Calif. Dr. Rhoads started Umoja Health during the pandemic as a response to fill in some of the voids in healthcare the Black community was facing. ?’So Umoja Health is that first of all, Umoja is a Swahili word, which means unity, but it means much more than unity. It actually refers to the oneness. So a singular focus or a singular mission. And so the idea is to convene the community partners who are concerned about COVID in their neighborhoods. That's how we started with COVID. We've expanded to other things. But to convene all of those community partners who have concerns so that we can, number one, hold our public health institutions accountable and our health care institutions accountable to the health of the public, but also so that we can then bring those resources into their communities and make it easy to access them,?“ Dr. Rhoads said. ?’So we're bringing the resources to provide that along with a little bit of food, a gift card, some goodies in a bag, and just a warm kind of hug in this time of of an unprecedented pandemic.?“

Yalonda M. James, Staff / The Chronicle

In Alameda County, officials are seeing “some increases” in COVID metrics like reported cases, test positivity and wastewater data, said health officer Dr. Nicholas Moss.

“Whether that becomes this fall and winter wave that we have been anticipating or ends up being more of just a bump is hard to know,” Moss said.

The county’s most recent data, from a few weeks ago, showed BA.5 as still the main culprit, though the state is projecting an increase in BQ.1 and BQ.1.1, Moss said. He added that regardless of which variant is taking hold, public health recommendations — getting the vaccines, staying home when sick, handwashing and considering masking in crowded indoor settings — still apply.

“Other viruses do this as well, it’s not a unique feature of COVID that it evolves these new strains,” Moss said. “But really the tools we rely on are going to look very similar no matter what.”

Hospitalizations in California are still relatively low but rising. As of Thursday, there were 1,842 patients hospitalized in the state with confirmed COVID-19, an 8% increase from the prior week, while the number of patients in intensive care unit beds grew by 15% to 225. It reversed a steady decline since late July.

The uptick is following early surges seen nationwide in influenza and respiratory syncytial virus, or RSV, common winter illnesses that saw lower-than-normal transmission the past two years.

“We’re going to be challenged this winter by flu, by RSV,” said Greene, of the Gladstone Institutes. “And the extent that coronavirus will kind of pile on top of these, we’ll just have to wait and see.”

COVID in California: Indoor masking 'strongly recommended' again in L.A. County [San Francisco Chronicle, 18 Nov 2022]

BY AIDIN VAZIRI, MATT KAWAHARA

COVID in California: L.A. ‘strongly’ recommends indoor masking as cases rise

Los Angeles County health officials are now “strongly recommending” indoor masking due to a rise in COVID-19 infection rates, county health officials said.

New coronavirus subvariants are rapidly spreading across California, overtaking the strain that led to a U.S. summer wave and fueling concern that the next surge is already here. California COVID cases jumped 36%, according to data from the state health department, a pace of growth alarmingly similar to what the state saw ahead of prior COVID waves.

Latest updates: U.S. virus levels remain stagnant
COVID-19 trends have stopped improving in the U.S. as virus community levels remained stagnant for another week. The proportion of counties nationwide that fell into the “low” tier on Friday, based on hospitalization and case metrics used by the U.S. Centers for Disease Control and Prevention, was about 80.52%. Another 16.68% were in the “medium” category and the remaining 2.8% were categorized as having “high” community levels — numbers that showed little movement from the previous week.

The agency’s community transmission map, based on a separate metric that tracks the rates of new cases and positive tests, also changed little, with 38.61% of U.S. counties in the U.S. in the “high” virus transmission category, 32.84% in the “substantial” tier, 23.12% in “moderate,” and 5.43% of all counties with “low” virus transmission.

Bivalent booster improves immune response to newer omicron subvariants, Pfizer says
Pfizer said Friday that new data shows its bivalent booster shot improves immune response against COVID-19 subvariants that are emerging and circulating in the U.S. The omicron BA.4/BA.5-adapted booster elicited a higher antibody response against subvariants including BA.4.6, BA.2.75.2, BQ.1.1 and XBB.1 in adults aged 55 and older, one month after booster uptake, according to Pfizer and BioNTech.

The company said antibodies increased by about 11 times against BA.4.6, about 9 times against BQ.1.1, by 6.7 times against BA.2.72.2 and about 5 times against XBB.1.The omicron BQ.1 and BQ.1.1 subvariants accounted for about 49.7% of total coronavirus cases in the U.S. last week, according to the U.S. Centers for Disease Control and Prevention.

The BA.4.6 subvariant made up an estimated 4.4% of cases and BA.2.75.2 made up about 0.7% of cases, while XBB.1 was not yet prevalent enough to appear in data, per the CDC. As of Friday, 11.3% of eligible Americans aged 5 and older had received the bivalent booster, according to CDC data.

NFL games with fans last season were associated with COVID-19 spikes, study says
Fan attendance at NFL games during the 2020-21 season, the league’s first of the COVID-19 pandemic, was associated with ensuing increases in COVID-19 cases in areas where the games were held, according to a new study published in the journal Jama Network Open. For that season, some NFL teams played home games with no fans and others with their stadiums at limited capacity. The study looked at 269 games, 117 with no fans and 152 with fan attendance ranging from 748 to 31,700 people, and COVID-19 data for the host county and surrounding ones at 7, 14 and 21 days after games. It found that games with no crowds or fewer than 5,000 fans were not associated with COVID-19 spikes, but games with 20,000 or more fans were associated with 2.23 times the rate of spikes in the ensuing 14- and 21-day windows.

Researchers noted it was “impossible” to state a causal effect between fan attendance and ensuing COVID-19 increases as trends might have been influenced by public health regulations in those areas. “The spikes in COVID-19 for crowds of over 20,000 people suggest that large events should be handled with extreme caution during public health events where vaccines, on-site testing and various countermeasures are not readily available to the public,” researchers wrote.

BQ.1 and BQ.1.1 make up nearly half of U.S. cases
The omicron subvariants BQ.1 and BQ.1.1 made up 49.7% of the total coronavirus cases circulating in the United States last week, two months after they were initially detected, according to data published Friday by the U.S. Centers for Disease Control and Prevention.

BQ.1.1 accounted for 24.2% of circulating variants and BQ.1 made up an estimated 25.5% for the week ending Nov. 19. The proportion of the omicron BA.5 subvariant that drove this year’s summer surge declined to 24% of cases, compared with nearly 33.8% in the week ended Nov. 12. BF.7 also grew to make up 7.6% of the cases, followed by a “variant soup” that includes BN.1, BA.5.2.6, BA.4.6, BA.2.75, BA.2.75.2, BA.4, BA.1.1.529 and several other strains that are circulating.

State HHS Secretary Ghaly shares suggestions for safer holiday gatherings
California is seeing rising rates of COVID-19, flu and other respiratory illnesses just ahead of the holidays. Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, suggested several things people can do try to gather more safely this winter: Those include everyone testing for the coronavirus before the gathering, staying home if sick, doing activities outside if possible and, if traveling, wearing a well-fitting and high-filtration mask en route, Ghaly said on a media call Thursday. “I know not all of these actions are possible, so consider what you might be able to do and do as many as you can,” he said. Ventilation is also important when indoors, so: “If you can’t open your window, at least open the doors in the area so you’re able to have some circulation, that would be beneficial,” Ghaly said.

Among the viruses surging in the U.S. is respiratory syncytial virus, or RSV, which typically resembles a mild cold but can cause more serious illness, especially in infants and elderly adults. There is no available vaccine for RSV. Ghaly cited getting vaccinated for COVID-19 and influenza, handwashing and covering your cough as other practices people can follow to try to help prevent spread of respiratory viruses.

State officials “concerned” with “very low” uptake of bivalent booster With COVID-19 rates rising in California, state officials are “concerned” about low numbers of people receiving the the bivalent booster shot, Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, said on a media call Thursday. As of Thursday, 13.3% of eligible Californians had received the booster, which is designed to protect against both the original coronavirus strain and the BA.4 and BA.5 variants that have given rise to newer subvariants now in circulation, according to the state’s health department.California’s booster uptake was higher than the 10.1% rate across the U.S., according to the Centers for Disease Control and Prevention.

But Ghaly termed it “very low,” adding that: “If you’re inclined to get it, there’s probably no better time than now to give yourself this period of protection over the next many weeks” with the holidays and colder months approaching.

Along with COVID-19 trends, the state is seeing increases in flu and respiratory syncytial virus, or RSV, in “every category we track,” Ghaly said. “Unlike the past two years, when we discussed a COVID and flu collision, this year we’re actually starting to see it,” he said. The state’s COVID-19 test positivity rate was 6.3% as of Thursday, up from 4.5% two weeks earlier. Ghaly noted the state has already seen RSV levels among children “that rival peaks from other years,” straining pediatric hospitals and emergency rooms.

Virus carries higher risk of epilepsy and seizures than influenza A COVID-19 infection carries a substantially greater risk for both seizures and epilepsy compared to an influenza infection, according to a retrospective analysis of over 300,000 people published in the medical journal Neurology.

The incidence of new seizures or epilepsy diagnoses in the six months following COVID-19 was low overall but higher than in matched patients with influenza, the researchers from Oxford University found. “This difference was more marked in people who were not hospitalized, highlighting the risk of epilepsy and seizures even in those with less severe infection,” the authors wrote, noting that children are at particular risk of seizures and epilepsy after COVID-19 “providing another motivation to prevent COVID-19 infection in pediatric populations.”

Oakland airport anticipates 90% of pre-pandemic traffic for Thanksgiving The Port of Oakland projects that 170,000 passengers will use Oakland International Airport during the five-day Thanksgiving holiday travel period from Nov. 23 through Nov. 27.

The figure marks at 10% increase over last Thanksgiving and more than 90% of the 2019 pre-pandemic traffic benchmark officials said. ”The Thanksgiving travel period is always busy, and the airport is ready to welcome holiday travelers,” said Bryant L. Francis, director of aviation at the Port of Oakland. “Travelers can help to make their journey smoother by arriving at the airport early, adhering to airline check-in and carry-on bag requirements and using airline apps for check-in whenever possible.”

Indoor masking ‘strongly recommended’ again in L.A. County Los Angeles County health officials are now “strongly recommending” indoor masking due to a rise in COVID-19 infection rates, county health officer Dr. Muntu Davis said in a media briefing Thursday. The county is seeing a daily rate of 100 new coronavirus cases per 100,000 residents, up from 86 the prior week, triggering the recommendation as per the county’s COVID-19 response plan, Davis said.

Settings where the recommendation applies are public indoor spaces, public transit – including buses, rideshares, taxis and medical transport – correctional and detention facilities and homeless and emergency shelters, Davis said. Masking is already required for people exposed to COVID-19 in the past 10 days, in healthcare settings and congregate care facilities and at any sites that require it, he said.L.A. County’s 7-day average of nearly 1,500 cases per day the past week marked a 13% rise from the previous week and a 52% spike since Nov. 1, Davis said. Hospitalizations are also going up; the county averaged 97 admissions per day the past week, a 26% week-over-week increase and a 54% jump since Nov. 1, Davis said.

Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, said on a media call Thursday the L.A. County decision reflects local conditions but didn’t rule out the state following suit if its COVID-19 trends continue to rise. “Making that move here, again, local decision, definitely makes sense,” Ghaly said. “I think as we see the next weeks evolve, that decision on a statewide basis may be appropriate, and we’ll see.”

No link between vaccine and shingles, UCSF study confirms
There is no association between COVID-19 vaccination and shingles, according to a study of more than 2 million individuals in the U.S. Researchers at UCSF found that the risk of herpes zoster in the month after receiving a dose of COVID-19 vaccine was no different when compared with a control period 60 to 90 days following an individuals' last dose. “There was no increase in risk of herpes zoster after COVID-19 vaccination when individuals were stratified by age, immunocompromised status, or type of vaccine administered," the team wrote in JAMA Network Open.

COVID-19 vaccination was associated with a slightly lower shingles risk than outcomes following influenza vaccination in a period before the pandemic, the research showed.

"Compared with previous work, our study had a larger sample, which enabled us to control for confounders that were not included in other studies, such as measures of healthcare use, history of zoster vaccination, and comorbidity-related risk factors for herpes zoster rather than weighted indices,” lead author Nisha Acharya said in a statement.

California COVID cases jump 36% ahead of anticipated surge
California’s COVID-19 trends have officially reversed ahead of an anticipated winter surge. The state is averaging about 9 new daily cases per 100,000 residents as of Thursday, marking a 36% increase compared to the 6.5 per 100,000 reported two weeks earlier, according to health department data. Before last week, the rate of new cases in California had been on a steady decline since a July peak. The state test-positive rate is also up for the second week in a row, growing to 6.3% compared to 4.5% just two weeks ago.

The pace of growth is similar to what the state saw ahead of previous waves, including the summer BA.5 spike. And it‘s likely that the reported numbers are a severe undercount with so many people taking rapid home tests.Hospitalizations are also rising sharply. There were 2,187 patients hospitalized in California with confirmed COVID-19 as of Thursday, a 19% increase from the prior week and the state’s highest daily total since mid-September.

The number of COVID-19 patients in intensive care units Thursday had risen 28% from last week to 287.San Francisco’s average test-positive rate has also jumped to 6.1%, after falling below 5% for the first time since April last month.The trends coincide with a higher circulation of newer omicron subvariants that are overtaking the BA.5 subvariant that fueled a summer coronavirus surge in the U.S., according to federal data.

While newer subvariants such as BQ.1 and BQ.1.1 are thought to be more immune-evasive, raising the possibility of reinfections, it’s unclear if they cause more severe illness than prior strains of the virus, health experts have said.About 72% of Californians have completed their primary vaccination series, with 13% of those eligible receiving the updated bivalent booster targeting the newer omicron strains of the virus, according to the state dashboard

Expanded airport surveillance program detects an influx of XBB
The U.S. Centers for Disease Control and Prevention on Thursday announced it has expanded its airport genomic surveillance program, which tests international travelers to detect new variants entering the country. The service — which is already up and running in SFO, JFK, Newark-New York and Atlanta — is now available at Washington Dulles International Airport.
More than 60,000 people have voluntarily participated in the program from November 2021 through September 2022, with an average of 1,100 participants per week, per the CDC. Based on the latest data, there is a growing proportion of the omicron XBB subvariant arriving in the U.S., making up about 13% of the samples collected in the most recent week. But the national health agency has not yet flagged it as a variant it is monitoring nationwide.

Global cases up for first time in 4 months, WHO says
Global coronavirus cases increased last week for the first time in four months, the World Health Organization reported on Wednesday. Since mid-July, the U.N. health agency reported that cases were either stable or on the decline. But the trend appears to be reversing now, as the number of infections worldwide rose to 2.3 million infections in the latest tally. The five countries reporting the most cases were Japan, South Korea, Germany, China, and the U.S., where cases increased by 10% over the past two weeks after falling steadily since August, according to data from the Centers for Disease Control and Prevention. Japan's daily COVID-19 cases topped 100,000 for the first time in two months as the country reopened to visitors from other nations, according to Kyodo News

CDC forecasts virus hospitalizations to rise for first time since July
For the first time since July, the U.S. Centers for Disease Control and Prevention’s national ensemble predicts that the number of new daily confirmed COVID-19 hospital admissions will likely increase, with 2,000 to 9,000 new confirmed COVID-19 hospital admissions likely reported on Dec. 9. The health agency’s ensemble forecast for virus-related hospitalizations in the U.S. for the past four months has shown numbers to either remain stable or steadily decline. Some of the biggest increases have been reported in HHS Region 9.

Virus fight in China leads to 250,000 quarantine beds, iPhone production delays
China’s southern metropolis of Guangzhou announced plans Thursday to build quarantine facilities for nearly 250,000 people to fight surging coronavirus outbreaks even as the national government tries to reduce the impact of anti-disease controls that have confined millions of people to their homes. Guangzhou, a city of 13 million people and the biggest of a series of hot spots across China with outbreaks since early October, reported 9,680 new cases in the past 24 hours, according to the Associated Press.

That was about 40% of the 23,276 cases reported nationwide. China’s infection numbers are low compared with the United States and other major countries, but the ruling Communist Party is trying to isolate every case. Repeated closures of neighborhoods, schools and businesses are fueling public frustration and clashes with health workers. A spike in infections has led officials in areas across China to confine families to cramped apartments or order people into quarantine if a single case is found in their workplace or neighborhood. The Communist Party promised last week to cut the cost of anti-virus controls by reducing the length of quarantines and changing other rules. However, party leaders said they will stick to the “zero COVID” strategy at a time when other countries are easing restrictions and trying to live with the virus. Access to a Zhengzhou industrial zone that is home to the world’s biggest iPhone factory was suspended this month following outbreaks. Apple Inc. said deliveries of its new iPhone 14 model would be delayed

Home births rose in pandemic’s second year
The number of people giving birth at home in the U.S. rose slightly in the second year of the pandemic, according to a CDC report released Thursday.

“The percentage of U.S. home births rose from 1.26% (45,646) in 2020 to 1.41% (51,642) in 2021, an increase of 12% and the highest level since at least 1990,” the report’s authors wrote.

Why the number of at-home births increased during the pandemic wasn’t immediately clear, but the increase corresponded with a time in which vaccines weren’t yet widely available, suggesting some people giving birth may have been reticent to go to the hospital.